Moran CORE

Open source ophthalmology education for students, residents, fellows, healthcare workers, and clinicians. Produced by the Moran Eye Center in partnership with the Eccles Library

Search Moran CORE

How to Assess Whether a Globe is Ruptured

Home / Basic Ophthalmology Review / Trauma

Title: How to Assess Whether a Globe is Ruptured
Author: Johnny Lippincott, 4th Year Medical Student, University of Mississippi Medical Center

Location: Medical Student Education Outline > II. Anatomical Approach to Eye Disease > Trauma > 2. How to assess whether a globe is ruptured


Introduction: An open globe or ruptured globe is an eyeball with a full-thickness defect in part of the eye’s wall, and is a true ophthalmic emergency. “Full-thickness” means all layers of the eye are disrupted. An open globe therefore allows communication between the eye’s interior and the environment. The danger of this communication is two-way: the eye’s internal contents can extrude, and environmental factors (e.g., pathogens) may enter.

If there is any concern that a patient may have an open globe, the top priority is avoiding further damage to the eye. This means special precautions must be taken immediately to assess whether this is the case. Until the integrity of the globe is confidently established, do not place external pressure of any sort on the eye of concern. Doing so can squeeze ocular contents through the defect and possibly cause permanent loss of vision or loss of the eye itself. Do not: patch the eye, measure intraocular pressure (e.g., with a Tonopen®), or allow the patient to rub the eye.


Patients may present with an open globe after various forms of trauma, from work- and sports-related injuries to falls and motor vehicle accidents. Particularly important history includes:

Signs of an Open Globe

A simple penlight is useful in grossly assessing the integrity of the globe.


Figure 1: Prolapsed iris through a corneal laceration with a very irregular pupil visible retina through the pupil.  The conjunctiva is boggy and the entire globe appears deflated or slightly collapsed or simply “not round.”

Image 2: Fundus photo of an inferior choroidal rupture versus scleral rupture with a vitreous tracking to the wound.

Pathognomonic signs:

Three necessary tools for this test are 1) anesthetic eye drops (e.g., proparacaine HCl 0.5%), 2) fluorescein strip, and 3) cobalt blue light source with slit lamp/magnification. After numbing the eye with drops, gently paint dye across the wound. Looking under magnified cobalt blue light, either gross leakage from the defect or paling of the fluorescein dye wound indicate an active leak (indicating dilution of dye with intraocular fluid).

Suggestive signs:

Treatment & Plan

Salient orders in the event of a suspicious or confirmed open globe include:


  1. Castellarin, A. A., & Pieramici, D. J. (2006). Open globe management. Comprehensive ophthalmology update8(3), 111-124.
  2. Ehlers, J. P., & Shah, C. P. (Eds.). (2008). The Wills eye manual: office and emergency room diagnosis and treatment of eye disease. Lippincott Williams & Wilkins.
  3. Harlan Jr, J. B., & Pieramici, D. J. (2002). Evaluation of patients with ocular trauma. Ophthalmology Clinics of North America15(2), 153-161.
  4. Seidel Test. Retrieved August 21, 2017, from