Version May 2024
| History |
| May accompany multiple trauma or serious head injury |
| Open globe laceration is considered a tetanus-prone wound |
| Open globe rupture may be occult |
| Clinical features |
| Inspection (with penlight or, preferably, a slit lamp): |
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| Decreased visual acuity by Snellen or handheld chart; assess counting fingers, hand motion, or light perception if unable to see chart |
| Relative afferent pupillary defect by swinging penlight technique |
| Diagnostic evaluation |
| Immediate ophthalmology consultation for comprehensive eye examination if suspicion of an open globe |
| CT scan: non-contrast with 1- to 2-mm cuts axial and coronal through the orbits |
| Other studies based on presence and degree of traumatic injury to other anatomical regions (eg, head, thorax, abdomen) |
| Initial treatment |
| Ensure nothing by mouth (NPO) |
| Assess and treat life-threatening injuries |
| Avoid ketamine if RSI is required |
| If RSI is necessary, rocuronium is preferred to succinylcholine for muscle relaxation, although succinylcholine may be used with dexmedetomidine premedication |
| Do not remove any protruding foreign bodies |
| Avoid eye manipulation that will increase intraocular pressure (eg, lid retraction, intraocular pressure measurement, ocular ultrasound) |
| If open globe is present on gross eye inspection, do not give any eye drops (eg, fluorescein, tetracaine, cycloplegics) |
| Place eye shield without applying pressure on the eye after initial eye examination |
| Put patient on bed rest with head of bed elevated to 30 degrees if hemodynamic condition allows |
| Treat nausea and prevent vomiting (eg, in adults, IV ondansetron 4 to 8 mg; in children, IV ondansetron 0.15 mg/kg per dose, up to 4 mg per dose)* |
| Provide sedation as needed (eg, lorazepam 0.05 mg/kg, maximum single dose: 2 mg) |
| Provide analgesia (eg, IV fentanyl or morphine); for adult and pediatric dosing, refer to Lexicomp drug monographs |
| Begin IV antibiotics: |
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| Ensure definitive management by an ophthalmologist |
| Urgent surgical repair, ideally within 24 hours of injury |
RSI: rapid sequence intubation; CT: computed tomography; IV: intravenous; SQ: subcutaneously; ECG: electrocardiogram.
* Ondansetron should be avoided in patients with congenital long QT syndrome. ECG monitoring should be performed for patients receiving ondansetron who also have the following conditions: electrolyte abnormalities (eg, hypokalemia, hypomagnesemia), congestive heart failure, or bradyarrhythmias; or are taking medications that prolong the QT interval.
¶ In adults, adjust subsequent vancomycin doses based on therapeutic monitoring. For children, the maximum single dose for vancomycin is 1 g.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
