[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Ocular emergencies and trauma](https://durgical.com/en/ophthalmology/areas/emergencies/) › Suspected open globe: the first steps # Suspected open globe: the first steps - Emergency If an injury may have opened the eye, the exam stops: a rigid shield goes on, nothing presses on the eye, and the patient goes for CT and surgery. Updated Nov 5, 2026 **See it in 3D:** [Cornea](https://durgical.com/en/anatomy/cornea/) · [Sclera](https://durgical.com/en/anatomy/sclera/) ## Key points - Suspect it: shield, do not press, stop examining. - Peaked pupil towards the wound = open globe. - CT, not MRI, if a metal foreign body is possible. - Nothing by mouth, antiemetic, tetanus, antibiotics. ## What it is An open globe is a full-thickness wound of the cornea or sclera, from a cut, a projectile or a blunt rupture. It threatens sight and the eye can become infected (endophthalmitis). The general doctor's job is to suspect it, protect the eye from further damage, prevent vomiting and straining, and send the patient for imaging and surgical repair. ## How to recognise it - High-speed mechanism: hammering metal on metal, grinding, explosions, gunshot. - Peaked or teardrop pupil pointing towards the wound. - Dark tissue (uvea) or jelly (vitreous) at the wound; a very deep or very shallow anterior chamber. - Bullous subconjunctival haemorrhage around the whole cornea, or hyphema. - Markedly reduced vision; a positive Seidel test (aqueous leaking through fluorescein). ## What to do at once - Stop the examination as soon as an open globe is suspected; do not measure the pressure or force the lids open. - Cover the eye with a rigid shield that rests on the bones of the orbit, not a pressure patch. - Leave any protruding object in place. - Keep the patient fasting, give analgesia and an antiemetic, and avoid anything that raises eye pressure (vomiting, coughing, straining). - Give tetanus prophylaxis and systemic antibiotics according to the local protocol. - Request a thin-slice CT of the orbits for a foreign body; avoid MRI if a metal fragment is possible. - Arrange emergency ophthalmology for surgical repair. ## Mistakes that cost sight - A small high-speed metal fragment can enter the eye through a tiny, self-sealing wound with few symptoms; ask about hammering or grinding. - Blunt rupture usually happens where the sclera is thinnest: at the limbus, behind the muscle insertions or at old surgical wounds. - Eye drops and ointments are avoided before surgery because they may enter the eye. ## Next step / Initial management - Every suspected open globe: emergency ophthalmology the same day; repair is usually done as soon as possible, ideally within 24 hours. - Orbit CT without contrast to find a foreign body and associated fractures. - Systemic antibiotics and tetanus prophylaxis to lower the risk of endophthalmitis. - Plan for eye protection (polycarbonate glasses) in the patient's work and sport to prevent the next injury. ## Test yourself Think of the answer, then tap the question to see it. ## What should cover an eye with a suspected open globe? A rigid shield resting on the bony orbit, never a pressure patch. ## Why is MRI avoided when an open globe from hammering is suspected? Because a metal foreign body may be present, and the magnet can move it and damage the eye. ## What does a teardrop-shaped pupil after trauma suggest? An open globe, with the iris drawn towards the wound. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/suspected-open-globe-the-first-steps/) ## Connections ## See it in 3D 2 The structures of Durgical's 3D anatomy where it is found. - [Cornea](https://durgical.com/en/anatomy/cornea/) - [Sclera](https://durgical.com/en/anatomy/sclera/) ## Related 4 - [Eye emergencies: minutes, hours or days](https://durgical.com/en/ophthalmology/eye-emergencies-minutes-hours-or-days/) - [Fluorescein staining and the Seidel test](https://durgical.com/en/ophthalmology/fluorescein-staining-and-the-seidel-test/) - [Eyelid lacerations: which to refer](https://durgical.com/en/ophthalmology/eyelid-lacerations-which-to-refer/) - [Ocular ultrasound and point-of-care scanning](https://durgical.com/en/ophthalmology/ocular-ultrasound-and-point-of-care-scanning/) ## Related conditions 3 - [Ocular trauma: hyphema and open globe injury](https://durgical.com/en/conditions/ocular-trauma-hyphema-and-open-globe-injury/) - [Endophthalmitis](https://durgical.com/en/conditions/endophthalmitis/) - [Orbital floor (blowout) fracture](https://durgical.com/en/conditions/orbital-floor-fracture/) ## In Pharmacology 1 - [Fluorescein](https://durgical.com/en/pharmacology/fluorescein/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Globe Rupture](https://www.ncbi.nlm.nih.gov/books/NBK551637/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Tetanus Prophylaxis](https://www.ncbi.nlm.nih.gov/books/NBK559008/) (StatPearls Publishing (NCBI Bookshelf), 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/suspected-open-globe-the-first-steps/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/suspected-open-globe-the-first-steps/