A patient sustained a wood‑stick injury to the sclera causing ocular bleeding, severe pain and loss of eye movement—what is the injury type: corneal laceration, open globe injury, or orbital injury?

Open Globe Injury

This patient has sustained an open globe injury. Active bleeding from the eye, inability to move the eye, and severe pain following penetrating trauma to the sclera are hard signs of full-thickness disruption of the eyewall. 1

Why This Is an Open Globe Injury

Open globe injury is defined as a full-thickness defect of the eyewall (cornea, sclera, or both) and represents an ocular emergency requiring immediate surgical intervention. 2, 3

The clinical presentation clearly indicates open globe injury rather than the other options:

• Active bleeding from the eye is a hard sign of penetrating ocular injury that mandates immediate ophthalmologic consultation and surgical exploration. 1
• Scleral involvement with a penetrating wood stick creates a full-thickness defect in the eyewall, which by definition is an open globe injury. 2, 3
• Inability to move the eye combined with severe pain suggests extensive globe disruption, possible extraocular muscle damage, or associated orbital injury—all consistent with severe open globe trauma. 1, 4

Why Not the Other Diagnoses

Corneal Laceration Alone

• While corneal laceration is a subtype of open globe injury, this patient's injury explicitly involves the sclera, not just the cornea. 2
• The description of active bleeding and complete loss of eye movement suggests more extensive posterior involvement beyond an isolated anterior corneal injury. 5

Orbital Injury Alone

• Orbital injury (fractures, soft tissue trauma) can coexist with open globe injury in 25.7% of cases, but the active bleeding from the eye itself indicates globe wall disruption, not merely periorbital trauma. 4
• Isolated orbital injuries typically present with periorbital swelling, ecchymosis, and diplopia from muscle entrapment—not active ocular bleeding. 6, 7
• The mechanism (penetrating wood stick to the sclera) and hard signs (bleeding from the eye) point directly to globe perforation. 1, 2

Classification of This Open Globe Injury

This injury is most consistent with globe laceration (penetrating injury from sharp trauma):

• Wood stick injuries create sharp penetrating trauma that lacerates the sclera. 2, 3
• The sclera is a common site for open globe injury, particularly in penetrating trauma. 1
• Penetrating injuries account for the majority of open globe cases and carry high risk for intraocular foreign body retention. 2, 4

Immediate Management Priorities

Protect the eye immediately with a rigid shield without applying any pressure to prevent extrusion of intraocular contents. 1

• Avoid any manipulation of the eye, including forced duction testing, which is contraindicated when open globe is suspected. 1, 7
• Prevent Valsalva maneuvers (straining, coughing, vomiting) that could extrude ocular contents. 2
• Request immediate ophthalmology consultation for urgent surgical exploration and primary closure. 1, 2
• Administer broad-spectrum systemic antibiotics immediately to prevent endophthalmitis, which carries high risk in open globe injuries. 2, 3
• Update tetanus vaccination status. 2

Imaging Considerations

Order non-contrast orbital CT with thin cuts and multiplanar reconstructions if the patient is stable enough for imaging. 1, 8

• CT has 94.9% sensitivity for detecting intraorbital foreign bodies, particularly metallic objects. 1, 8
• Do not delay surgical consultation for imaging if the diagnosis is clinically obvious, as in this case. 1
• MRI is absolutely contraindicated if metallic foreign body is suspected. 1, 8
• Wood foreign bodies may appear hypoattenuating on CT and can be mistaken for air—a critical pitfall to recognize. 8

Prognostic Factors

This patient has multiple poor prognostic indicators:

• Scleral (posterior) involvement is associated with worse visual outcomes than anterior injuries. 5
• Inability to move the eye suggests possible extraocular muscle damage or extensive posterior injury. 4, 5
• Severe pain may indicate significant intraocular damage. 6
• Factors predicting poor visual prognosis include lacerations ≥5mm, lens damage, vitreous hemorrhage, and coexisting injuries. 1, 5

Critical Pitfalls to Avoid

• Do not apply pressure to the eye or attempt to examine the globe aggressively—this can extrude intraocular contents. 1, 2
• Do not perform forced duction testing when open globe is possible. 7
• Do not use point-of-care ultrasound on a suspected open globe, as probe pressure may extrude globe contents (though this remains controversial). 2
• Do not delay ophthalmology consultation for imaging if the clinical diagnosis is clear. 1
• Do not forget systemic antibiotics—endophthalmitis risk is high and requires immediate empiric coverage. 2, 3