Day 2 Post-Operative Care for Globe Rupture of an Eye
For day 2 post-operative care of globe rupture, the patient should receive topical antibiotics, topical corticosteroids, and close monitoring for complications including hypotony, wound leakage, and signs of infection.
Medication Management
Topical Antibiotics
- Continue broad-spectrum topical antibiotic prophylaxis to prevent infection
- A quinolone preparation such as moxifloxacin or levofloxacin is recommended due to its wide range of activity against Gram-positive and Gram-negative organisms 1
- Apply four times daily
Topical Corticosteroids
- Prednisolone acetate 1% ophthalmic suspension 4 times daily to control post-operative inflammation 2
- Alternatively, loteprednol etabonate 0.5% may be used, particularly in patients at risk for steroid-induced IOP elevation 2
- Do not abruptly discontinue steroids as this may cause rebound inflammation
Other Medications
- Preservative-free artificial tears for ocular surface lubrication, especially if epithelial defects are present 2
- Consider cycloplegic agents if significant anterior chamber inflammation is present
Clinical Assessment
Critical Examination Elements
- Visual acuity assessment (if patient's condition allows)
- Intraocular pressure measurement (crucial to detect hypotony)
- Slit-lamp examination to evaluate:
- Wound integrity - check for leakage or gaping
- Anterior chamber depth and inflammation
- Corneal epithelial defects
- Conjunctival closure and coverage of any exposed sutures
Specific Complications to Monitor
Hypotony - Most common complication after globe rupture repair 1
- Check for wound leakage, which should be dried and thoroughly examined
- If mild hypotony without other serious signs, pressure patching may be sufficient
- Persistent hypotony with choroidal detachments or anterior chamber flattening requires immediate surgical revision 1
Conjunctival Erosion/Dehiscence 1
- Particularly over suture sites
- If detected, initiate topical antibiotics until surgical closure can be performed
Infection Risk 1
- Monitor for increasing pain, redness, or discharge
- Differentiate between normal post-operative inflammation and signs of endophthalmitis
- Be alert for symptoms of retinal detachment (new floaters, flashes, visual field defects)
- Consider dilated fundus examination if posterior segment issues are suspected
Activity Restrictions
- Strict eye protection with a shield, especially during sleep
- Avoid bending, heavy lifting, or straining that could increase intraocular pressure
- No eye rubbing or pressure on the operative eye
- Limited physical activity to prevent accidental trauma to the eye
Follow-up Planning
- Schedule next follow-up within 24-48 hours (day 3 post-op) 1
- Provide clear instructions about warning signs requiring immediate attention:
- Sudden decrease in vision
- Severe pain
- Discharge from the eye
- Wound leakage
Special Considerations
- Globe rupture patients have a high risk of retinal detachment (up to 27% within 3 months) 4
- Visual prognosis is often guarded, with studies showing only about 27% of patients achieving visual acuity of 20/200 or better after traumatic globe rupture 4
- If the patient had a previous corneal transplant, be particularly vigilant about wound integrity, as the graft-host junction remains a weak point even years after transplantation 4
Common Pitfalls to Avoid
- Do not assume small amounts of wound oozing will resolve spontaneously - thoroughly check and address any leakage 1
- Do not miss signs of endophthalmitis, which requires immediate intervention
- Do not neglect IOP monitoring, as both high and low pressure can compromise outcomes
- Do not discontinue topical steroids abruptly, as this may cause rebound inflammation 2
- Do not delay return to the operating room if persistent hypotony, wound leakage, or other serious complications are present 1