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Lacerated Eyeball

by Kathryn Colby, MD, PhD

Most cuts (lacerations) around the eyes affect the eyelids rather than the eyeball. Of those that affect the eyeball, many are superficial and minor. However, some cuts go through the white of the eye (sclera) or the transparent dome on the front surface of the eye (cornea), penetrating the eye’s interior. Such cuts are considered a rupture of the eyeball (globe). The globe also can be ruptured by a blunt force. Such lacerations can seriously damage the structures necessary for vision. They also predispose to infection within the eye (endophthalmitis).

Most people with a ruptured globe can barely see. The eye is often obviously distorted, and the pupil may be shaped like a teardrop. Sometimes fluid leaks out of the eye.

Diagnosis and Treatment

An immediate evaluation by an ophthalmologist (a medical doctor who specializes in eye disorders) is required. Surgical repair is often necessary, except for some injuries that affect only the thin mucous membrane that covers the cornea (conjunctiva). Even before surgery, antibiotics are given to reduce the chance of infection within the eye. Antibiotics are given by vein (intravenously). Ointments should be avoided. A protective shield (either a commercial product or the bottom part of a paper cup) is taped over the eye to avoid unintentional pressure that could force the contents of the eye through the laceration. If necessary, vomiting can be controlled with drugs that treat nausea. Drugs for pain are given by vein or, if surgical repair is not needed, by mouth.

Even after all possible medical and surgical treatment, a serious injury may result in partial or total loss of vision. Very rarely, after a severe eyeball laceration (or eye surgery), the uninjured eye becomes inflamed (sympathetic ophthalmia), which may result in partial loss of vision or even blindness if left untreated. Often, corticosteroid drops can effectively prevent this reaction. Doctors may remove an irreversibly damaged eye to prevent sympathetic ophthalmia.