Open Globe Injury

What is globe rupture (open globe injury)?

Open globe injury (often referred to simply as “an open globe”) is the term for an eyeball injury where trauma has caused a full-thickness cut or defect in the wall of your eye. (This term comes from the fact that medical professionals often call the eyeball “the globe.”) Open globe injuries generally happen because of severe blunt or penetrating trauma to your eye.

Various forms of open globe injury exist:

• Globe rupture (from blunt trauma).
• Full-thickness globe laceration (from a cutting injury).
• Globe penetration (from penetrating trauma where the object remains in your eye).
• Globe perforation (from penetrating trauma where the object doesn’t remain in your eye).

In all of these cases, a section of the eye wall is no longer intact, potentially allowing eye contents to extrude outside of the eye.

The eye wall has two sections: the sclera and the cornea. The sclera is the white part of your eye. The cornea is the clear front portion. You have an open globe injury when a full-thickness cut goes through either the cornea or the sclera or through both of them.

An open globe injury is different from a corneal abrasion, which is a scratch on the surface of the cornea. Corneal abrasions are much more common and generally less severe than open globe injuries.

Who do open globe injuries affect?

An open globe can happen to anyone. However, studies indicate that it’s more common among people assigned male at birth (AMAB). Moreover, it occurs twice as often to people AMAB who are under age 40 than to those who are over 40.

You may be more at risk of an open globe injury if you’ve had previous eye surgery because the protective tissues of the eye may be weaker at certain points. This includes cataract surgeries, glaucoma surgeries and certain forms of corneal transplants.

In the United States, the number of open globe injuries is approximately 3 per 100,000 people.

What are the signs and symptoms of an open globe injury?

The signs and symptoms of open globe injury vary but may include:

• Eye pain.
• Vision loss.
• Fluid leaking from the eye.
• An injury that’s visibly pierced your eyelid.
• Extrusion of ocular tissue from the eyeball (eye tissue is pushed out).

What are the causes of open globe injuries?

Common causes of open globe injuries include:

• Falls, especially if you hit your head. This is particularly true for people over age 75.
• Scissors. This is true for small children, who often get hurt at places where they can get scissors easily.
• Fights, including a punch or kick to the head.
• Accidents with motor vehicles or industrial machinery. Flying bits of debris at work sites can cause globe rupture, as can the actual machinery itself.
• Shrapnel or other flying debris.
• Gunshots.
• Explosions, including fireworks.
• Knife wounds.
• Fishing hooks.

How is an open globe injury diagnosed?

If you think it’s possible that you have an open globe, it’s critical that you don’t rub or apply any pressure to the eye and that you go to an ophthalmologist or emergency department immediately. An eye care provider may suspect an open globe injury based on your eye’s appearance, your symptoms, certain imaging techniques — like ultrasound or magnetic resonance imaging (MRI) — or your facial injuries.

If it’s possible, a provider will ask you questions about the events and timing of your injury, as well as what happened afterwards. The first examination should put no pressure at all on the eye. A provider will likely do tests, including:

• A complete slit lamp eye exam.
• Snellen eye chart exam to test how well you see. This test is the one you might call the “big E” test. It can reveal low vision.
• A computed tomography (CT) scan of your face and jaws.

A provider is unlikely to order certain tests until after they determine whether you have an open globe injury. For instance, you shouldn’t have a scan if you have an open globe injury since you may have metal debris in your eye, which would make an MRI potentially dangerous.

How are open globe injuries treated?

Open globe injuries are medical emergencies. If the trauma has caused other life-threatening injuries, then the healthcare team will take care of those first. An ophthalmologist should see open globe injuries as soon as possible.

Most open globe injuries require surgery. While awaiting your surgery, or if your open globe doesn’t need surgery, you should:

• Try to keep as calm as possible.
• Don’t rub or touch your eye. There should be no pressure on the eye at any time.
• Keep your eye protected.
• Avoid anything that may cause you to strain. This means you shouldn’t lift anything heavy, bend over or strain on the toilet. It’s best not to cough or sneeze, but if you must, then let it out. Don’t hold a cough or a sneeze in.
• Take medicine prescribed for you to keep you from throwing up and from being in pain. (If you didn’t receive medication but feel severe pain or nausea, talk with your provider about whether you should have medication for these symptoms.)
• Stay in bed with your head elevated to about 30 degrees.
• Get a tetanus shot if you need one.

Open globe injuries most often require urgent surgical treatment, including sutures to close wounds in your cornea and sclera. If you need surgery, your surgeon may reinsert eye tissue that has come through the wound or remove these tissues if the provider can’t repair the damage. They’ll also try to return your eye to the correct pressure.

After any type of surgery, your provider will prescribe topical antibiotics and possibly oral antibiotics. These antibiotics are to prevent endophthalmitis and other infections.

It usually takes at least two weeks for your eye to heal, but you’ll have to continue protecting it for several weeks after that.

Importantly, the initial surgery for globe rupture is primarily just to close the eye so that it can begin the healing process. Many times, you might have additional injuries (such as retinal detachment, cataract, or iris tears). Providers may treat these injuries with later surgery once the eye has begun to heal from the trauma.

You’ll need several follow-up appointments to check on your progress. Coming to these appointments is critical to the health of your eye.

What complications are possible with open globe injuries?

Open globe injury is one of the most severe injuries an eye can have. The outcomes vary a lot from case to case depending on the nature and extent of the injury.

• Eye pain.
• Permanent loss of vision or blurry vision.
• Retinal detachment.
• Choroidal rupture, which can lead to significant bleeding and intraocular pressure changes.
• Phthisis bulbi, which is when an eye with poor vision and low pressure for a long time begins to “shut down.”
• Endophthalmitis, which is an infection in the eye. This can be very serious and lead to permanent vision loss or even loss of the eye itself.
• Loss of the eye itself. This is uncommon, but it’s necessary in some cases where the injury is so severe that repair isn’t possible.

How can I reduce my risk of having an open globe injury?

It’s impossible to prevent all accidents, but some preventative measures can help. Here are some tips that may help prevent open globe injuries:

• Keep sharp objects like scissors out of the reach of small children. Teach them to handle sharp things carefully.
• Wear protective eyewear when working or participating in contact sports or sports that use projectiles.
• Drive carefully.
• Follow safety precautions when using machinery at work. Don’t work with machinery while intoxicated.
• Avoid physical fights with other people.
• Be especially careful if you’ve had previous eye surgeries or already have severely limited vision in one eye.
• Keep your house free of things that can cause falls, like slippery throw rugs or clutter that can get in your way. Have adequate lighting.

What can I expect if I have an open globe injury?

If you have an open globe injury, it’s usually best to have surgery within 24 to 48 hours of the injury. Recovery will also depend on how severe the initial injury is.

When should I see my healthcare provider?

An injury to your eye is a medical emergency. You need to see a healthcare provider or go to an emergency room right away.

If you do have an open globe injury, you may want to ask your ophthalmologist:

• What kind of activities you should avoid.
• When you’re able to return to work or school.
• How you should lie down in bed.
• What kind of eye protection you should use.
• Which symptoms would require you to contact a healthcare provider or go to an emergency room.
• What types of eye specialists you should follow up with, such as a retina specialist if you have a retinal detachment or a glaucoma specialist if your eye pressure is too high after surgery.

A note from Cleveland Clinic

If you injure your eye in any kind of fight, fall or accident, go immediately to an emergency room. It may not be evident to you right away if you have an open globe injury, but if you do, you may need medical help right away to preserve vision or even save your eye. There’s help available for this condition. You can also help yourself by taking measures to prevent a globe rupture from happening by always wearing recommended eye protection and using safe driving practices.