Open Globe injury is a common ophthalmic emergency. It is a leading cause of blindness. We should examine the patient thoroughly and treat the patient as early as possible. Preoperative care must include antibiotics, analgesics and no manipulation to globe.[1] In cases of open globe injuries when there is iris prolapse, making a paracentesis opposite to the area of the prolapse is advised; this is followed by injection of a minimal amount of a viscoelastic and gentle repositioning of the iris using an iris sweep. Injecting excessive viscoelastic can result in increased pressure and additional iris prolapse. An important point in such cases is to avoid inadvertent incarceration of the iris into the suture as well as to avoid cutting the iris, except in cases in which it is frankly necrotic or epithelialized because the iris tissue can be used for future reconstruction.[2]

A 32-year-old male presented to emergency department with history of trauma to left eye by sharp object, ocular pain and dimunition of vision. On examination, visual acuity in right eye was 6/6 and left eye 6/24. There was circumciliary congestion, limbal laceration extending from 9o clock position to 10o clock position with iris prolapsed (Figure 1). Posterior segment could not be examined.

Repair was done under local anaesthesia. A protective eye shield was placed and the

patient was sent for X-ray; no intraocular foreign body was detected. The patient then was given tetanus immunization, antiemetics, analgesics and intravenous broad-spectrum antibiotics and prepared for globe repair under local anaesthesia. Laboratory tests included complete blood count, liver function tests, kidney function tests and all were within normal limits.

Figure 1: Patient with traumatic prolapsed of left iris.

Repair of the right globe rupture was done under LA, which included sterilization of conjunctiva by povidone-iodine eye drops. No scleral extension of the wound was found. The reparative steps in this case followed those mentioned previously: creation of a paracentesis opposite the area of prolapse, injection of minimal viscoelastic, and iris sweep. Before any corneal sutures are placed, the iris may prolapse again after the sweep and so placing a few sutures before sweeping may be necessary. The prolapsed iris was viable and was reposited by iris spatula. Limbal sutures were placed using 10/0 Nylon sutures.

In the first postoperative visit, the eye was slightly congested with periorbital ecchymosis and conjunctival chemosis. Anterior chamber was formed and no signs of wound leakage or infection were found (Figure 2). Best corrected visual acuity after 4 weeks was 6/9.

Figure 2: Patient on first post-operative visit.

Ocular trauma is a common ophthalmic emergency.[3] Rapid and accurate diagnosis of ruptured globe is mandatory to savevisual acuity and prevent further damage of the eye although diagnosis of occult globe rupture may be challenging.[3] Alarming signs that raise the suspicion of globe rupture include: hyphema, sub-conjunctival hemorrhage, abnormally deep or abnormally shallow anterior chamber, distorted pupil or irido-dialysis, low intraocular pressure, uveal tissue exposure and limitation of ocular motility.[4] If globe injury is suspected, emergency ophthalmic consultation mustbe taken after stabilization of the general condition of the patient. Ocular manipulation must be avoided.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Regional Hospital, Himachal Pradesh

1. Hassan, N. H. F. "Case Report: Repair of Open Globe Injury." Advances in Ophthalmology & Visual System, vol. 3, no. 1, 2015, pp. 00076. https://medcraveonline.com/AOVS/AOVS-03-00076.pdf.

2. Charters, Lynda. "Managing the Iris after Trauma." Ophthalmology Times Europe, 2021, https://europe.ophthalmologytimes.com/view/managing-the-iris-after-trauma.

3. Bord, S. P., and J. Linden. "Trauma to the Globe and Orbit." Emergency Medicine Clinics of North America, vol. 26, no. 1, 2008, pp. 97-123. DOI: 10.1016/j.emc.2007.11.006.

4. Pokhrel, Prabhat K., and Sanaz A. Loftus. "Ocular Emergencies." American Family Physician, vol. 76, no. 6, 2007, pp. 829-836. https://www.aafp.org/pubs/afp/issues/2007/0915/p829.pdf.