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An open-globe injury is a full-thickness wound of the eyewall (cornea and/or sclera) due to trauma. It is a sight-threatening emergency requiring urgent recognition and management to preserve vision and prevent complications.

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Etiopathogenesis

Classified by the Birmingham Eye Trauma Terminology (BETT):

Rupture	Inside-out injury due to blunt trauma → globe bursts at weakest point (often limbus or near previous surgical scar).
Laceration	Outside-in injury due to sharp object:
• Penetrating: Single wound, object enters but does not exit.
• Perforating: Two wounds, entry and exit.
• Intraocular foreign body (IOFB): Retained object inside eye.

![Open Globe Classification. Cross sectional views are shown with various mechanisms of open globe injury. (A) In ruptured globes, the wound can occur elsewhere from the impact site. (B) A penetrating injury is an entry wound without an exit wound and may have a retained intraocular foreign body. (C) A perforating injury is a pair of entry and exit wounds caused by the same object. (D) Zone I injuries are limited to the cornea and limbus, while zone II injuries extend 5 mm posterior to the limbus and zone III injuries extend beyond 5 mm posterior to the limbus.

Zhou Y, DiSclafani M, Jeang L, Shah AA. Open Globe Injuries: Review of Evaluation, Management, and Surgical pearls. Clinical Ophthalmology. 2022;Volume 16:2545-2559. doi:10.2147/opth.s372011](attachment:61b98a4f-8230-44f0-87fa-d39ebe7f0ba8:image.png)

Open Globe Classification. Cross sectional views are shown with various mechanisms of open globe injury. (A) In ruptured globes, the wound can occur elsewhere from the impact site. (B) A penetrating injury is an entry wound without an exit wound and may have a retained intraocular foreign body. (C) A perforating injury is a pair of entry and exit wounds caused by the same object. (D) Zone I injuries are limited to the cornea and limbus, while zone II injuries extend 5 mm posterior to the limbus and zone III injuries extend beyond 5 mm posterior to the limbus.

Zhou Y, DiSclafani M, Jeang L, Shah AA. Open Globe Injuries: Review of Evaluation, Management, and Surgical pearls. Clinical Ophthalmology. 2022;Volume 16:2545-2559. doi:10.2147/opth.s372011

Clinical Features

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Red flag signs: Low intraocular pressure, 360° subconjunctival hemorrhage, peaked pupil, intraocular contents visible.

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History: Trauma (blunt, sharp, projectile, blast, chemical, iatrogenic).
Symptoms: Sudden vision loss, severe pain, tearing, photophobia.

Signs:

Decreased visual acuity.
Irregular/teardrop pupil pointing toward wound.
Shallow/deep anterior chamber asymmetry.
Hyphema, vitreous prolapse, uveal prolapse.
Positive Seidel’s test (aqueous leak with fluorescein, avoided if obvious).
Obvious scleral/corneal defect.

![Penlight Open Globe Injury Findings. Selected findings by penlight displayed here, although examination may also be done by slit lamp. (A) Obvious left eye penetrating open globe with a retained fishing hook. (B) Penetrating injury of the left eye with aqueous humor leaking in a pool of fluorescein stain indicating a positive Seidel sign. (C) Right eye penetrating open globe injury with prolapsed iris. (D) Left eye penetrating open globe injury with a bead of extruded vitreous. (E) Right eye penetrating open globe injury with displaced lens extruding from a corneal laceration. (F) Dense 360-degree subconjunctival hemorrhage in the setting of ground-level fall suggesting occult open globe injury. (G) Obvious left eye globe rupture with significant volume loss causing a deformed anterior chamber. (H) Obvious right eye ruptured globe with significant volume loss causing disruption of the scleral contour. (I) Right eye peaked pupil pointing to an occult open globe injury of the inferotemporal sclera. (J) Left eye globe rupture with displaced lens and missing temporal section of iris.

Penlight Open Globe Injury Findings. Selected findings by penlight displayed here, although examination may also be done by slit lamp. (A) Obvious left eye penetrating open globe with a retained fishing hook. (B) Penetrating injury of the left eye with aqueous humor leaking in a pool of fluorescein stain indicating a positive Seidel sign. (C) Right eye penetrating open globe injury with prolapsed iris. (D) Left eye penetrating open globe injury with a bead of extruded vitreous. (E) Right eye penetrating open globe injury with displaced lens extruding from a corneal laceration. (F) Dense 360-degree subconjunctival hemorrhage in the setting of ground-level fall suggesting occult open globe injury. (G) Obvious left eye globe rupture with significant volume loss causing a deformed anterior chamber. (H) Obvious right eye ruptured globe with significant volume loss causing disruption of the scleral contour. (I) Right eye peaked pupil pointing to an occult open globe injury of the inferotemporal sclera. (J) Left eye globe rupture with displaced lens and missing temporal section of iris.

Zhou Y, DiSclafani M, Jeang L, Shah AA. Open Globe Injuries: Review of Evaluation, Management, and Surgical pearls. Clinical Ophthalmology. 2022;Volume 16:2545-2559. doi:10.2147/opth.s372011

Etiopathogenesis

Clinical Features

Complications