Indirect traumatic rupture of the globe

Abstract

Indirect rupture of the globe was found to be a rare injury, more common in males (P less than .01), and having a tendency to involve the left eye. Severe chemosis, a hyphema, and hypotony were usually present, but the intraocular pressure was elevated in three eyes. Of the 50 ruptures in this study, 41 were at the equator or anterior to it (P less than .01), and 37 were parallel to the equator. Thirty-three of the 41 anterior ruptures were located in the superior half of the eye. The nasal-superior quadrant between the limbus and spiral of Tillaux, the temporosuperior quadrant between the spiral of Tillaux and 5 mm posterior to the equator, and the temporosuperior quadrant between the limbus and spiral of Tillaux were the three most common areas involved, in decreasing order of frequency. A theory has been described to explain this distribution. The absence of a hyphema (P less than .001), the presence of a rupture of 9 mm or less (P less than .01), and the use of cryotherapy or diathermy at the wound edge at the time of closure of the rupture (P less than .01) were all good prognostic signs. The visual outcome was light perception or worse in 45 of the 50 ruptures, but every effort must be made to preserve the eye rather than to remove it.