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Ruptured globe


Key points

  • Definition: Ruptured globe (RG) occurs when the integrity of the eye is breeched by blunt or penetrating trauma causing full-thickness corneal or scleral breech. This is an ophthalmologic emergency.

  • Synonym: Shattered globe.

  • Classic clue: A man in his 30s with eye pain after having been struck by a projectile while carrying out a home-improvement project is sent by the emergency department with a request to “rule out (R/O) foreign body (FB).” A familiar “flat tire” appearance of the globe or abnormal air collection may be seen, but also look for more subtle findings like increased anterior chamber depth.

Imaging

Computed tomography features

  • Computed tomography (CT) is the usual imaging procedure for orbital trauma.

  • Globe collapse may give a flat tire appearance (see Figure 7-2 , B ).

    FIGURE 7-2 ■, Recent trauma to OS showing soft tissue swelling with globe having hazy outline and “flat tire” appearance caused by partial collapse. Air bubbles in anterior orbit and soft tissues anterolaterally.

  • May see intraocular air or FB.

  • Thickened posterior sclera.

  • Hazy outline of the globe (see Figure 7-2 , B ).

  • Enlarged anterior chamber suggests posterior scleral rupture.

    • A discrepancy of at least 2 mm between anterior chamber depths raises the question of scleral rupture.

    • Traumatic posterior scleral rupture with vitreous decompression may allow lens retropulsion, thus deepening the anterior chamber.

    • Anterior chamber depth normally ranges from 2.5 to 3.5 mm, but varies according to age, sex, and measurement method.

  • Vitreous hemorrhage suggests retinal or choroidal tear, optic nerve avulsion, or FB.

  • Retinal tears, edema, detachments, and hemorrhage may be seen with RG.

Magnetic resonance imaging features

  • Magnetic resonance (MRI) can clearly depict the orbital anatomy and pathology in multiple planes.

  • All CT findings listed above also apply to MRI, but CT is usually the initial imaging modality.

  • MRI is contraindicated if a metallic orbital FB is suspected.

Ultrasound features

  • Ultrasound can demonstrate the anatomy but may be contraindicated in certain trauma situations, particularly when perforation is present or suspected.

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