Globe Rupture Diagnosed with Point-of-Care Ultrasound

Abstract

Patients presenting to the emergency department (ED) with eye complaints comprise approximately 1.5% of all cases seen in the ED, and of these, up to 34% are related to trauma.1 One of the most concerning diagnoses an emergency physician (EP) must consider in this patient population is globe rupture. It can occur secondary to blunt or penetrating eye trauma or facial trauma. Patients often present with pain, redness, tearing, or decreased vision.2 Findings on ocular examination include shallow anterior chamber, 360° subconjunctival hemorrhage, irregular pupil, iris prolapse, visualization of a protruding foreign body, and Seidel sign.3 However, ophthalmological assessment can be challenging, especially if there is significant periorbital edema and ecchymosis post-trauma. In this setting, the eye can be further evaluated with imaging, either ultrasound or computed tomography (CT) scanning. Diagnostic radiology ultrasound has limited experience with ocular assessment, and CT is not always immediately available and may require patient transport in rural or remote settings. Alternatively, point of care ultrasound (POCUS) is a tool that allows the EP to perform a scan at the bedside to answer a specific clinical question. In the setting of ocular trauma, it can effectively and rapidly diagnose retinal detachment, lens dislocation, retrobulbar hematoma, and globe rupture.4 This case demonstrates the rapid diagnosis of globe rupture with POCUS, expediting the patient's care.