Case 1 - Anterior Segment Ocular Injury

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Indication: Status post exercise band injuring the left eye. Concern for ruptured globe. Pain.

Technique: Axial CT scan images were performed from the foramen magnum to the vertex without administration of intravenous contrast. Axial scans of the orbits with multiplanar reconstructions were also performed.

Findings: These images demonstrate

Brain: There is no evidence of intracranial hemorrhage. No mass effect is seen. There is prominence to the intrahemispheric fissure anteriorly and to some of the frontal sulci without mass effect. The calvarium is unremarkable.

Orbits: There is hemorrhage in the left globe with what appears to be multiple loculated spaces including the vitreous and the choroid. There is a density in the posterior aspect of the vitreous which may represent either hemorrhage or a piece of the lens of the eye. There is blood products along the ciliary bodies bilaterally as well.

There is soft tissue swelling overlying the left globe.

The orbital floor on the left side is depressed, seen best on the coronal reconstructed images as well as series 602 image 27. There is retrobulbar bulbar hemorrhage. There is thickening of the inferior rectus muscle. The lateral rectus muscle also has an abnormal shape to it on the left side.

IMPRESSION:

Ruptured left globe with vitreous hemorrhage, likely choroidal detachment, and possible disruption of the left lens floating in the residual vitreous with adjacent soft tissue swelling and retrobulbar hemorrhage.

Inferiorly displaced left orbital floor fracture with edema of the inferior rectus muscle but without entrapment.

Ophthalmology Note:
a 63 y.o. male with PMH OSA and no POH who presented with trauma to the left eye and concern for open globe.
On exam, VA J10 ph J2 OD HM w/o direction OS, unreactive pupil OS with RAPD by reverse, pupil OD round and reactive with no RAPD. IOP 13 OD 8 OS. CVF full OD and global defect OS, 2/4 gross colors OS. External exam normal OD. Dilated exam OD reveals pigmented nevus nasally, otherwise unremarkable. External/bedside exam OS reveals laceration inferior to L brow, edematous and ecchymotic LUL, 360 hemorrhagic chemosis, scattered corneal PEE, scattered hyphema but no layering, lens displacement with heme posteriorly. Poor view to posterior pole OS.

Operative Note:

Title of Operation:

1.   Repair of zone 3 open globe injury with resection of uveal tissue, left eye

2.   Injection of intracameral vancomycin and ceftazidime, left eye.

3.   Non-marginal lid laceration repair (2.7 cm), left upper lid

 Indications for Surgery:

A 63 y.o. male with presumed left eye open globe injury 2/2 metal spring to the eye as well as left upper eyelid laceration.

Preoperative Diagnosis:

Presumed zone 2/3 globe rupture, left eye

Intraocular hemorrhage, left eye

Non-margin involving eyelid laceration, left upper lid

Postoperative Diagnosis:

Presumed zone 2/3 globe rupture with uveal and vitreous prolapse, left eye

Intraocular hemorrhage, left eye

Non-margin involving eyelid laceration, left upper lid

 Surgeons Narrative:

The eye was inspected and found to have 360 degree hemorrhagic chemosis without a clear indication of location of rupture prior to incision, as such exploration was indicated with complete peritomy.

It was noted that the wound was located temporally beneath the lateral rectus muscle at 3 o'clock, which was found to be partially dehisced from the globe at its insertion. There was ongoing choroidal bleeding, which was controlled with pressure and absorbent cotton tipped swabs and wek cell sponges, no need for cautery.  The wound was found to be a large gaping scleral defect 8 mm posterior to the limbus temporally extending at least to as far posteriorly as could  be visualized at the microscope.There was also uveal prolapse as well as copious vitreous prolapse through the wound.