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Publication Exclusive: Girl initially presents with open globe injury
The ophthalmology service was consulted for an otherwise healthy 6-year-old girl who was hit in the right eye by her brother with a pen 3 days before presenting to the emergency room. The patient’s mother thought her daughter seemed fine immediately after the event. However, over the next few days, the child complained of increasing irritation in her right eye. The mother took a closer look and was alarmed when she saw a “brown bubble” on the right eye.
Examination
On exam, the patient’s visual acuity was 20/70 in the right eye and 20/25 in the left eye. In the right eye, the pupil was peaked at 7 o’clock with iris prolapsing from a full thickness scleral laceration near the limbus. The anterior segment of the left eye was unremarkable. Fundus exam was deferred until surgery due to the patient squeezing, given the open globe injury. A CT scan of the orbits showed no intraocular metallic foreign body. She was then taken to the operating room that night for urgent repair of the open globe.
Intraoperatively, the scleral laceration was found to be approximately 1 mm posterior and parallel to the limbus and measured 2.5 mm. The prolapsed portion of iris tissue appeared necrotic and was amputated. The scleral wound was then sutured closed, followed by closure of the conjunctiva. The intraoperative fundus exam was unremarkable in both eyes.
The child did well over the next 2 weeks. The vision in the right eye improved to 20/30. IOP was normal, and the anterior chamber remained deep and quiet. There was no evidence of infection. However, at postoperative week 3, she complained of new intermittent right eye pain.
At postoperative week 3, the patient’s visual acuity had worsened to 20/70 in the right eye and 20/30 in the left eye. On anterior segment exam, there was an area of conjunctival injection in the right eye localized to an exposed limbal suture. The cornea and lens were otherwise clear in both eyes. There was 4+ cell and 3+ flare in the anterior chamber of both eyes. In addition, 1+ anterior vitreous cell was seen in both eyes. Fundus exam revealed no chorioretinal lesions as well as normal optic nerves and vessels.
Click here to read the full publication exclusive, Grand Rounds at the New England Eye Center, published in Ocular Surgery News U.S. Edition, July 25, 2015.