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
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