Question

A 75-year-old female is brought to the ED after a ground-level fall when she was going down the stairs. You note a subconjunctival hemorrhage of the right eye with deformity of the globe. The patient's vision in that eye is count fingers at three feet. You order a non-contrast CT scan with 1-2 mm cuts axial and coronal through the orbits. The radiologist notes that the integrity of the globe is compromised. Assuming the radiologist is correct in the assessment, where is the most common site for rupture?

A. Posterior to rectus muscle insertion
B. Through the central cornea
C. 2 mm inferior and 8 mm temporal to the optic nerve
D. Emanating from the optic nerve

Answer 1

The most common site for a rupture of the globe is posterior to the rectus muscle insertion, where the sclera is thinnest and there is less structural support. The fibrous tunic, especially the sclera, is susceptible to damage in trauma cases, requiring careful emergency management and surgical repair.

Step-by-step explanation:

The most common site for a rupture of the globe following trauma is posterior to the rectus muscle insertion. The globe of the eye is relatively more susceptible to injury in this region, where the sclera is the thinnest and where the intrinsic pressure of the eye is directed outward against a weakened area. The rectus muscles, which are involved in eye movement, attach to this area of the globe, providing less support compared to other, more reinforced regions. In a traumatic event such as a fall, the force applied to the globe can cause a rupture in these weak spots.

A globe rupture poses a significant risk to vision and ocular health. The fibrous tunic is the outer layer of the eye and consists of the sclera and cornea, which can become damaged in cases of trauma. Emergency management focusing on preventing infection and further injury of the eye, with delicate surgical repair when necessary, is essential. Due to the potential complexity of the injury and the importance of the eye’s structures, an ophthalmologist should address the manage globe ruptures.