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Globe rupture is an ophthalmologic emergency. A ruptured globe or an open-globe injury must be assessed in any patient who has suffered orbital trauma because open-globe injuries are a major cause of blindness.
In blunt trauma, ruptures are most common at the insertions of the intraocular muscles where the sclera is thinnest.
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If intraocular contents are visualized at clinical examination, a diagnosis of a ruptured globe can be obvious.
Globe rupture is traumatic in the vast majority of cases:
- penetrating trauma
- blunt trauma
- chemical e.g. strong acids, alkalis
Rarely atraumatic spontaneous rupture is seen, e.g. patients with coexisting severe glaucoma and scleromalacia perforans.
While obvious globe rupture is a contraindication to ocular ultrasonography, less obvious cases may be incidentally detected with ultrasonography after ocular trauma. Findings consistent with globe rupture include 5:
- decreased anterior chamber (AC) depth (and/or collapse)
- anterior chamber may also contain layering, homogenous echogenic debris consistent with hyphema
- decreased globe volume
- with loss of spherical contour
- posterior scleral buckling
- associated with vitreous hemorrhage
- intraocular or periocular air
- scattered echogenicities with "dirty" acoustic shadowing
Unenhanced, thin-section axial axial CT scans with multiplanar reformation is the CT mode of choice 2.
CT findings that can be present in a globe rupture include 1:
- collapsed globe ("flat tyre" or "mushroom" appearance)
- presence of intraocular gas or a foreign body
- thick posterior sclera
- hazy outline of the globe
- abnormal anterior chamber size (enlarged in posterior rupture, decreased in anterior rupture)
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