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Blunt or penetrating trauma to the eye may result in a ruptured globe. The diagnosis is obvious when orbital contents spill from the globe itself. Occult presentations manifest as a tiny rent in the sclera. Ruptures at the limbus, the margin between the cornea and sclera, may cause a small amount of iris to herniate, resulting in an irregularly shaped “teardrop” or “peaked” pupil. Choroidal rupture may also occur. A coloboma of the iris may appear similar to a teardrop pupil.
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Management and Disposition
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Obtain urgent specialty consultation. Protect the eye with a rigid eye shield, and defer all further examination and manipulation of the eye. Administer antibiotics and adequate sedation (parenteral analgesics are appropriate). Address tetanus status. Since vomiting may result in further prolapse of intraocular contents, treat with antiemetics proactively. Consider CT scanning if the presence of a FB is suspected.
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Suspect a rupture with severe conjunctival hemorrhage following trauma.
Rupture usually occurs where the sclera is thinnest, at the attachment of extraocular muscles and the limbus.
A teardrop pupil may easily be overlooked in the triage process or in the setting of multiple traumatic injuries.
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