Open globe injury

Open Globe Injury Ruck • Moxifloxacin 400 mg PO/IV if not given • Position supine with head elevated Truck • Detailed evaluation as possible per guidelines • Initiate teleconsult with photos • Ultrasound contraindicated for suspected open globe injury • Tetanus prophylaxis as available (Tdap 0.5ml IM) • Continue endophthalmitis prophylaxis • Additional dose of moxifloxacin 400 mg PO/IV at 12 hrs • Continue moxiflxacin 400 mg PO/IV q day x 5 days • Add clindamycin 300mg IV every 8 hours if available* • Maintain patient comfort and supine/head elevated positioning House Guidelines for Evaluation of Suspected Open Globe Injury • Continue above treatments • Rigid eye shield • No altitude restrictions for open globe Plane Critical Items History: • Blast injury • Metal on metal impact • Blunt trauma to ocular region Concurrent trauma • Lid lacerations • Penetrating periocular trauma Physical Exam: • Visual acuity • Afferent pupillary defect • Suspicious findings • Peaked pupil • Abnormal anterior chamber depth • Hemorrhagic chemosis • Eyelid edema • Traumatic cataract • Definitive findings: • Obvious laceration/rupture • Prolapsed ocular contents Peaked pupil Occult rupture Abnormal anterior chamber depth Hemorrhagic chemosis • Maintain high suspicion for open globe injury • Rigid eye shield to prevent further damage • Moxifloxacin 400mg PO/IV (endophthalmitis prophylaxis) • Ondansetron • 4-8mg PO • 4mg IV over 2-5 min • 4mg IM • Pain control (ketamine approved) • Activate evac (URGENT) • Goal is surgery within 24 hours Hypopyon Cloudy vitreous behind lens Red, inflamed eye Endophthalmit is Endophthalmitis • Infection inside the eye • Rsk is increased with delayed wound closure and in injuries in rural settings • Increasing pain, decreased vision • Red, angry eye, hypopyon, cloudy vitreous

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Transcript of Open globe injury

Open Globe Injury

Ruck

• Moxifloxacin 400 mg PO/IV if not given • Position supine with head elevated

Truck

• Detailed evaluation as possible per guidelines• Initiate teleconsult with photos • Ultrasound contraindicated for suspected open globe injury• Tetanus prophylaxis as available (Tdap 0.5ml IM)• Continue endophthalmitis prophylaxis

• Additional dose of moxifloxacin 400 mg PO/IV at 12 hrs• Continue moxiflxacin 400 mg PO/IV q day x 5 days• Add clindamycin 300mg IV every 8 hours if available*

• Maintain patient comfort and supine/head elevated positioning

House

Guidelines for Evaluation of Suspected Open Globe Injury

• Continue above treatments• Rigid eye shield• No altitude restrictions for open globe

Plane

Critical ItemsHistory:• Blast injury• Metal on metal impact• Blunt trauma to ocular regionConcurrent trauma• Lid lacerations• Penetrating periocular traumaPhysical Exam:• Visual acuity• Afferent pupillary defect• Suspicious findings

• Peaked pupil• Abnormal anterior chamber depth• Hemorrhagic chemosis• Eyelid edema• Traumatic cataract

• Definitive findings:• Obvious laceration/rupture• Prolapsed ocular contents

Peaked pupil Occult rupture

Abnormal anterior chamber depth

Hemorrhagic chemosis

• Maintain high suspicion for open globe injury• Rigid eye shield to prevent further damage• Moxifloxacin 400mg PO/IV (endophthalmitis prophylaxis)• Ondansetron

• 4-8mg PO• 4mg IV over 2-5 min• 4mg IM

• Pain control (ketamine approved)• Activate evac (URGENT) • Goal is surgery within 24 hours

Hypopyon

Cloudy vitreous behind lens

Red, inflamed eye

Endophthalmitis

Endophthalmitis• Infection inside the eye• Rsk is increased with delayed wound closure and

in injuries in rural settings• Increasing pain, decreased vision• Red, angry eye, hypopyon, cloudy vitreous