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Pre-Operative Management of Open Globe Injury

  • Victoria S. North
  • Matthew F. Gardiner
Chapter

Abstract

In cases of ocular trauma, the clinician should proceed with a detailed yet expedited history and ophthalmologic exam only after assessing and treating life-threatening injuries. Clinical features of open globe injuries include markedly decreased visual acuity, peaked or eccentric pupil, relative afferent pupillary defect, low intraocular pressure, extrusion of intraocular structures, hemorrhagic chemosis, and corneal or scleral irregularities such as tenting. Pre-operative management is centered on diagnostics (inspection, slit lamp exam, and computed tomography (CT) scan of the orbits with thin axial and coronal cuts), minimizing further damage (strict bed rest, avoiding unnecessary manipulation of the eye, covering with a protective shield, and avoiding eye drops), aggressive symptom control, and infection prophylaxis with intravenous (IV) antibiotics and tetanus immunization when indicated. We routinely use IV vancomycin and a third generation cephalosporin such as ceftazidime but reserve tetanus immunization for cases with high-risk features or when immunization status is not up to date or is unknown.

Keywords

Detailed history and physical exam Orbital CT scan Intravenous antibiotics 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Victoria S. North
    • 1
  • Matthew F. Gardiner
    • 1
  1. 1.Department of OphthalmologyHarvard Medical School, Massachusetts Eye and EarBostonUSA

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