Management der Bulbusruptur

Abstract

Globe rupture is one of the most severe open globe injuries, permanently impairing visual acuity or leading to blindness. The risk of globe rupture is increased after previous intraocular surgery (27-fold), in myopia, older age, females, and after sudden falls. The differentiation between an occult globe rupture and severe ocular contusion may be complicated by pronounced subconjunctival hemorrhage with conjunctival swelling. In case of doubt, a rupture of the eyeball should be ruled out after a severe blunt ocular trauma. Limbal and scleral exploration after 360 degrees peritomy leads to the correct diagnosis. Immediate and watertight wound closure is essential to avoid expulsive choroidal hemorrhage, persisting ocular hypotony or epithelial ingrowth. Delayed wound closure raises the risk of posttraumatic endophthalmitis. Early vitrectomy may prevent tractional retinal detachment in case of retinal injury with vitreal bleeding. Silicone oil instillation stabilizes the central retina after open globe injury; scleral buckling is controversial.