Open-globe injuries generally have a guarded prognosis regarding visual acuity outcomes (see the section Prognostication of Globe Injuries later in this chapter). The development of a retinal detachment is common; the detachment is usually caused by the primary injury or by traction resulting from proliferative vitreoretinopathy (PVR). In all cases of open-globe injuries, the presence of an intraocular foreign body should be ruled out.
Severe blunt injuries can rupture the globe. Rupture injuries can be very severe; there is often expulsion of intraocular content (to varying degrees). The 2 most common locations for rupture are the limbus, particularly through previous surgical wounds, or through areas of physiological scleral thinning parallel to and under the insertions of the rectus muscles. Important diagnostic signs of rupture include a marked decrease in ocular ductions, very boggy conjunctival chemosis with hemorrhage (ecchymosis), deepened anterior chamber, and severe vitreous hemorrhage. The IOP is usually very low but may be normal or even elevated.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.