Globe rupture

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. 

Clinical presentation

If intraocular contents are visualized at clinical examination, a diagnosis of a ruptured globe can be obvious. 

Pathology

Etiology

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.

Radiographic features

Ultrasound

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

CT

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)