Open Globe Injury: Emergency Protocol to Save the Eye from Complete Atrophy

Rupture of the eye walls due to sharp objects or accidents. Dr. Mahmoud Hassan warns of the risks of delaying surgical wound repair and the importance of immediate emergency intervention to protect the retina.

Open Globe and Penetrating Injuries: An Emergency Response to Save Sight

Open globe injuries, also known as eye globe ruptures and penetrating injuries, are among the most serious medical conditions that directly threaten vision. These injuries, often resulting from a sharp object penetrating the eye wall or from severe trauma leading to globe rupture, require immediate and urgent medical intervention to save the eye from permanent damage and complete atrophy. Understanding the nature of these injuries and responding quickly is the cornerstone of the emergency protocol aimed at preserving as much visual function as possible.

What are Open Globe and Penetrating Injuries?

Open globe injuries (globe rupture) and penetrating injuries are defined as any breach of the rigid outer wall of the eye, which consists of the sclera and cornea. This breach can occur due to sharp instruments, flying shrapnel, or even strong blunt force. This penetration leads to the loss of internal eye contents, such as the vitreous humor and retina, exposing sensitive tissues to infection and damage.

It is important to note that delaying surgical repair of these injuries can lead to severe consequences, including:

• Severe intraocular infections (Endophthalmitis).
• Acute internal hemorrhage.
• Retinal detachment.
• Permanent damage to visual tissues.
• Complete atrophy of the eye and permanent vision loss.

Emergency Protocol: Speed of Response is Key

When an open globe injury or penetrating injury is suspected, a strict emergency protocol must be followed to ensure the best chance of saving the eye. Dr. Mahmoud Hassan, a retina and vitreous surgeon, emphasizes that every minute without intervention increases the risk. The emergency protocol includes the following steps:

1. Immediate First Aid: Protecting the Eye Before Reaching the Doctor

The first crucial steps are to protect the injured eye and prevent the injury from worsening. Responders or those present at the scene must follow these guidelines:

• Do Not Touch or Apply Pressure to the Eye: Avoid any attempt to remove a foreign object if it is still embedded in the eye.
• Cover the Eye: Use a protective shield (such as a clean paper cup secured with tape around the periphery of the eye, not directly over it) to protect the eye from further trauma or pressure. Only the injured eye should be covered, leaving the other eye exposed to allow for vision.
• Complete Rest: The injured person should avoid any physical exertion or sudden head movements.
• Lie Down: It is preferable for the injured person to lie on their side with their head slightly elevated.
• Immediate Transfer to Hospital: The injured person should be transported as quickly as possible to the nearest emergency department or specialized ophthalmology center.

2. Rapid Medical Assessment in the Emergency Department

Upon arrival, the medical team will rapidly assess the injury's extent. This includes:

• Detailed Medical History: Asking the patient or their companions about the nature of the accident, the type of object that caused the injury, and the time elapsed since the incident.
• Initial Ocular Examination: Assessing visual acuity, examining the eyelids, cornea, anterior segment of the eye, and measuring intraocular pressure.
• Diagnostic Imaging: Tests such as ultrasound B-scan may be used to assess the inside of the eye if direct examination is difficult due to bleeding or swelling.

3. Urgent Surgical Intervention: Wound Repair and Ocular Reconstruction

Surgical intervention is the most critical step to save the eye. The surgeon aims to achieve several key objectives:

• Wound Repair: Closing any lacerations in the sclera or cornea using very fine surgical sutures.
• Repositioning Eye Contents: If parts of the vitreous or retina have prolapsed, efforts are made to reposition them as much as possible.
• Cleaning the Eye: Removing any dirt or debris that could cause inflammation.
• Assessing Internal Damage: After securing the external wound, damage to internal structures such as the retina and vitreous is assessed.

These delicate surgeries often require specialized expertise in retina and vitreous surgery. Al Mashreq Eye Center in Cairo, where Dr. Mahmoud Hassan is a core member, is one of the leading centers in handling such complex cases.

What Happens After Surgery? Close Monitoring for Recovery

After the initial surgery, a period of close monitoring begins to ensure healing and prevent complications. This phase may include:

• Antibiotic Treatment: To prevent bacterial infection, whether as topical drops, injections, or oral antibiotics.
• Anti-inflammatories: To control swelling and inflammation within the eye.
• Regular Follow-ups: To monitor the condition of the retina, intraocular pressure, and ensure no complications such as retinal detachment or cataracts occur.
• Additional Surgeries: In some cases, the patient may require further surgeries later, such as vitrectomy to remove blood or fibrotic tissue, or to reattach a detached retina. These cases may require complex vitrectomy surgery / tractional / retinal detachment.

Prevention is Better Than Cure

Although many open globe injuries occur accidentally, there are some preventive measures that can reduce the risk, especially in high-risk environments:

• Wearing Eye Protection: When engaging in hazardous sports, working in environments with flying debris, or using power tools.
• Caution When Handling Sharp Objects: such as knives and scissors.
• Awareness of Firework Dangers: especially during celebrations.

Managing open globe and penetrating injuries requires a specialized medical team and a rapid response. Adhering to the emergency protocol, from first aid to surgery and close follow-up, is the only way to increase the chances of saving the eye and preserving vision.

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