Open Globe Injury (Answer: B)
This patient has sustained an open globe injury, defined as a full-thickness defect of the eyewall (cornea or sclera), which is an ocular emergency requiring immediate ophthalmologic consultation and surgical intervention. 1, 2
Why This is an Open Globe Injury
The clinical presentation clearly indicates open globe injury based on:
- Scleral involvement with penetrating trauma - The wood stick injury specifically involved the sclera, indicating full-thickness breach of the eyewall 1, 2
- Active bleeding from the eye - Hemorrhage from the globe is a hard sign of penetrating ocular injury 3, 4
- Inability to move the eye - This suggests either direct extraocular muscle damage, severe globe disruption, or associated orbital injury 4, 5
- Severe pain - Consistent with full-thickness ocular trauma 2
Why Not the Other Options
Corneal laceration alone (Option A) would not explain scleral involvement. While corneal lacerations are a subset of open globe injuries, the question specifically states scleral involvement, making this answer incomplete 1, 2.
Orbital injury alone (Option C) would not typically present with bleeding from the eye itself or direct scleral involvement. Orbital injuries primarily affect the bony orbit and surrounding structures, though they can coexist with open globe injuries 4, 5.
Critical Management Principles
Immediate actions required:
- Protect the eye - Apply a rigid eye shield (hard plastic shield, paper cup, or plastic cup) without applying any pressure to prevent extrusion of intraocular contents 3, 6
- Avoid any manipulation - Do not attempt to examine the eye further, evert lids, or apply pressure 6
- Prevent Valsalva maneuvers - Instruct patient not to cough, strain, or bend over as this increases intraocular pressure and can extrude globe contents 2
- Immediate ophthalmology consultation - This is an ocular emergency requiring urgent surgical exploration and primary closure 3, 1, 2
- Broad-spectrum systemic antibiotics - Start immediately to prevent endophthalmitis, which has relatively high risk in open globe injuries 1, 2
- Update tetanus status - Essential for penetrating trauma 2
Imaging Considerations
CT orbit without contrast with thin cuts and multiplanar reconstructions is the imaging study of choice if the patient is stable enough for imaging, with 94.9% sensitivity for intraorbital foreign bodies (particularly important with wood stick injuries) 4, 6. However, do not delay surgical consultation for imaging if the diagnosis is clinically obvious 3, 2.
Prognostic Factors
Poor visual outcomes are associated with: lacerations ≥5mm, intraocular foreign bodies, vitreous hemorrhage, ciliary body detachment, and endophthalmitis 4. Blunt mechanisms, presence of relative afferent pupillary defect, absence of red reflex, and initial visual acuity worse than 6/60 are associated with higher rates of eventual enucleation 7.