A 16-year-old boy is brought to the emergency department due to an eye injury. The patient was helping his father to mow the lawn when a flying object struck his left eye. He has had foreign body sensation, pain, excessive tearing, and decreased vision in the eye. His father noticed the eye being red but did not visualize any foreign objects. The patient has no other medical conditions and takes no medications. In the emergency department, the patient appears in obvious discomfort and keeps the left eye closed. Which of the following findings is most suggestive of acute globe perforation in this patient?

Question

A 16-year-old boy is brought to the emergency department due to an eye injury.  The patient was helping his father to mow the lawn when a flying object struck his left eye.  He has had foreign body sensation, pain, excessive tearing, and decreased vision in the eye.  His father noticed the eye being red but did not visualize any foreign objects.  The patient has no other medical conditions and takes no medications.  In the emergency department, the patient appears in obvious discomfort and keeps the left eye closed.  Which of the following findings is most suggestive of acute globe perforation in this patient?

Quizplus · Accepted Answer

11ec25c8_d933_2fab_bc81_e780b5ac9323_MD0003_00 This patient had a high-velocity projectile injury to the eye; however, the object is not identified on inspection, raising the possibility of open globe laceration (OGL) with an intraocular foreign body. OGL is typically caused by small, high-velocity particles (eg, metal shards) sent airborne by power tools, explosions (including weapons), lawn mowers, or motor vehicle accidents. Penetration of the globe most commonly occurs at the cornea. Large OGL may present with globe deformity, extrusion of vitreous or iris, or a visible entry wound. In the absence of an obvious wound, OGL may be inferred by a peaked or teardrop pupil (iris stretching due to the laceration or foreign object), increased or decreased anterior chamber depth, or reduced intraocular pressure. Other potential manifestations include loss of visual acuity or absent afferent pupillary response. If OGL is suspected, further assessment should be performed with fluorescein drops; as aqueous drains through the puncture site, fluorescein may be seen streaming away from the site or clear fluid may be seen flowing through the fluorescein. teardrop pupil Management of OGL requires shielding of the eye and emergent ophthalmologic consultation for surgical repair. Chronic complications include infection (endophthalmitis), posttraumatic cataract, and vision impairment. (Choice A) Acute corneal opacification suggests angle closure glaucoma, which most commonly occurs in older individuals and is associated with headache, nausea, conjunctival redness, and a fixed, dilated pupil. (Choices C and D) Hypopyon is a layering of inflammatory cells in the dependent portion of the anterior chamber. Perilimbal injection (also called ciliary flush) is characterized by dilation of the vasculature at the junction of the sclera and cornea. These findings are seen in a variety of inflammatory (eg, anterior uveitis/iritis) and infectious (eg, endophthalmitis, keratitis) conditions. Although OGL can lead to endophthalmitis, these findings would not be present at the time of initial presentation. Hypopyon (Choice E) Periorbital ecchymosis (raccoon eyes) suggests orbital/skull fracture. Orbital fracture with globe rupture typically occurs with blunt trauma. Periorbital ecchymosis (raccoon eyes) Educational objective: Open globe laceration (OGL) is typically caused by small, high-velocity particles sent airborne by power tools, explosions, lawn mowers, or motor vehicle accidents. Large OGL may present with globe deformity, extrusion of vitreous or iris, or a visible entry wound. Other manifestations include a peaked or teardrop pupil, asymmetric anterior chamber depth, loss of visual acuity or afferent pupillary response, and reduced intraocular pressure.

A 16-Year-Old Boy Is Brought to the Emergency Department Due