Difference between revisions of "Repair of ruptured of lacerated globe"

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Provide a brief summary of this surgical procedure and its indications here.
Repair of a globe rupture, laceration, penetration, or perforation is an urgent surgery to repair the corneal or scleral layers of the eye cause by blunt, penetrating, or perforating trauma. This often includes, but is not limited to, replacement of extruded intraocular contents, closure of open defects, and removal of foreign bodies. Anterior injuries are more readily identified and closed. If a posterior injury is suspected, further surgical intervention may be necessary including extraocular muscle removal to fully inspect the scleral surface.<ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2014|isbn=798-1-4511-7660-5|location=Philadelphia, PA|pages=162-164}}</ref>
 
An ophthalmic examination is performed preoperatively, and imaging is occasionally used as an adjunct to aid in identification of the specifics of the defect.<ref name=":0">{{Cite web|title=Ruptured Globe - EyeWiki|url=https://eyewiki.org/Ruptured_Globe#cite_note-37|access-date=2026-03-17|website=eyewiki.org|language=en}}</ref>


== Preoperative management ==
== Preoperative management ==
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!System
!System
!Considerations
!Considerations
|-
|Airway
|Potential concomitant airway trauma
|-
|-
|Neurologic
|Neurologic
|
|AMS 2/2 trauma
|-
|-
|Cardiovascular
|Cardiovascular
|
|CHF, CAD, cardiovascular stability
|-
|-
|Respiratory
|Pulmonary
|
|Potential lung injuries, smoking hx, asthma hx
|-
|-
|Gastrointestinal
|Gastrointestinal
|
|NPO status, recent N/V
|-
|-
|Hematologic
|Hematologic
|
|Potential bleeding
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}
|}


=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
CBC, CMP
Maxillofacial CT per ophthalmology


=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
Avoid circumstances that can increase IOP
* Consider anxiolytics such as benzodiazepines anxiety, crying, struggling, straining
* Consider pain medication, but avoid opioids due to concern for increased nausea and vomiting
* Consider antiemetics (ondansetron, Phenergan, ect) to prevent nausea and vomiting
Patient will most likely not have appropriate NPO status and will be considered a full stomach
* Consider metoclopramide and antacids prior to surgery to prevent aspiration pneumonitis
*
In patients with a smoking history, or asthma, consider pre-treating with albuterol to control coughing and improve oxygenation and ventilation after intubation.


=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
 
Regional anesthesia such as retrobulbar blocks are contraindicated as this can potentially increase IOP, worsening globe injury and surgical outcomes.<ref>{{Citation|last=Blair|first=Kyle|title=Globe Rupture|date=2026|url=http://www.ncbi.nlm.nih.gov/books/NBK551637/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=31869101|access-date=2026-03-17|last2=Alhadi|first2=Sameir A.|last3=Czyz|first3=Craig N.}}</ref>
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===


== Intraoperative management ==
== Intraoperative management ==


=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
Standard monitoring
PIV x1


=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
A smooth induction and intubation are crucial to prevent increasing IOP. Rapid sequence is required both due to NPO status and inability to mask ventilate to prevent increased IOP.
General endotracheal anesthesia
Standard induction
* IV opioid (fentanyl, dilaudid)
* Lidocaine
* Propofol
** Avoid ketamine as this may potentially increase IOP
* Paralytic
** Avoid succinylcholine as it may potentially increase IOP


=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
Supine
Table turned 90-180 degrees depending on surgeon preference


=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
Volatile anesthesia and TIVA are appropriate for this case. Avoid nitrous oxide due to concern for trapped air expansion in globe.<ref name=":0" />
Maintain muscle relaxation until eye is surgically closed
Avoid hypercarbia as this can increase IOP


=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
Goal of smooth emergence and extubation to prevent increased IOP


== Postoperative management ==
== Postoperative management ==


=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
PACU, floor bed


=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
Tylenol and ibuprofen if not contraindicated by patient comorbidities
Can consider IV or PO opiates, but consider risk of nausea.


=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
* Permanent blindness
* Endophthalmitis
* Retinal detachment
* Hemorrhagic retinopathy
* Sympathetic ophthalmia


== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
Line 78: Line 123:
!
!
!Variant 1
!Variant 1
!Variant 2
|-
|-
|Unique considerations
|Unique considerations
|
|Avoid medications or procedure that would increase intraocular pressure
|
|-
|-
|Position
|Position
|
|Supine, table turned 90-180 degrees
|
|-
|-
|Surgical time
|Surgical time
|
|1-2 hours
|
|-
|-
|EBL
|EBL
|
|Minimal
|
|-
|-
|Postoperative disposition
|Postoperative disposition
|
|PACU
|
|-
|-
|Pain management
|Pain management
|
|Tylenol, ibuprofen, opiates
|
|-
|-
|Potential complications
|Potential complications
|
|Endophthalmitis, retinal detachment, corneal abrasion, permanent blindness
|
|}
|}


Latest revision as of 19:20, 16 March 2026

Repair of ruptured of lacerated globe
Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
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Repair of a globe rupture, laceration, penetration, or perforation is an urgent surgery to repair the corneal or scleral layers of the eye cause by blunt, penetrating, or perforating trauma. This often includes, but is not limited to, replacement of extruded intraocular contents, closure of open defects, and removal of foreign bodies. Anterior injuries are more readily identified and closed. If a posterior injury is suspected, further surgical intervention may be necessary including extraocular muscle removal to fully inspect the scleral surface.[1]

An ophthalmic examination is performed preoperatively, and imaging is occasionally used as an adjunct to aid in identification of the specifics of the defect.[2]

Preoperative management

Patient evaluation

System Considerations
Airway Potential concomitant airway trauma
Neurologic AMS 2/2 trauma
Cardiovascular CHF, CAD, cardiovascular stability
Pulmonary Potential lung injuries, smoking hx, asthma hx
Gastrointestinal NPO status, recent N/V
Hematologic Potential bleeding

Labs and studies

CBC, CMP

Maxillofacial CT per ophthalmology

Operating room setup

Avoid circumstances that can increase IOP

  • Consider anxiolytics such as benzodiazepines anxiety, crying, struggling, straining
  • Consider pain medication, but avoid opioids due to concern for increased nausea and vomiting
  • Consider antiemetics (ondansetron, Phenergan, ect) to prevent nausea and vomiting


Patient will most likely not have appropriate NPO status and will be considered a full stomach

  • Consider metoclopramide and antacids prior to surgery to prevent aspiration pneumonitis

In patients with a smoking history, or asthma, consider pre-treating with albuterol to control coughing and improve oxygenation and ventilation after intubation.

Patient preparation and premedication

Regional anesthesia such as retrobulbar blocks are contraindicated as this can potentially increase IOP, worsening globe injury and surgical outcomes.[3]

Intraoperative management

Monitoring and access

Standard monitoring

PIV x1

Induction and airway management

A smooth induction and intubation are crucial to prevent increasing IOP. Rapid sequence is required both due to NPO status and inability to mask ventilate to prevent increased IOP.

General endotracheal anesthesia

Standard induction

  • IV opioid (fentanyl, dilaudid)
  • Lidocaine
  • Propofol
    • Avoid ketamine as this may potentially increase IOP
  • Paralytic
    • Avoid succinylcholine as it may potentially increase IOP

Positioning

Supine

Table turned 90-180 degrees depending on surgeon preference

Maintenance and surgical considerations

Volatile anesthesia and TIVA are appropriate for this case. Avoid nitrous oxide due to concern for trapped air expansion in globe.[2]

Maintain muscle relaxation until eye is surgically closed

Avoid hypercarbia as this can increase IOP

Emergence

Goal of smooth emergence and extubation to prevent increased IOP

Postoperative management

Disposition

PACU, floor bed

Pain management

Tylenol and ibuprofen if not contraindicated by patient comorbidities

Can consider IV or PO opiates, but consider risk of nausea.

Potential complications

  • Permanent blindness
  • Endophthalmitis
  • Retinal detachment
  • Hemorrhagic retinopathy
  • Sympathetic ophthalmia

Procedure variants

Variant 1
Unique considerations Avoid medications or procedure that would increase intraocular pressure
Position Supine, table turned 90-180 degrees
Surgical time 1-2 hours
EBL Minimal
Postoperative disposition PACU
Pain management Tylenol, ibuprofen, opiates
Potential complications Endophthalmitis, retinal detachment, corneal abrasion, permanent blindness

References

  1. ↑ Jaffe, Richard (2014). Anesthesiologist's Manual of Surgical Procedures. Philadelphia, PA: Wolters Kluwer. pp. 162–164. ISBN 798-1-4511-7660-5 Check |isbn= value: invalid prefix (help).
  2. ↑ 2.0 2.1 "Ruptured Globe - EyeWiki". eyewiki.org. Retrieved 2026-03-17.
  3. ↑ Blair, Kyle; Alhadi, Sameir A.; Czyz, Craig N. (2026), "Globe Rupture", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 31869101, retrieved 2026-03-17

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