Open Globe Injury
This patient has an open globe injury. The combination of scleral involvement, intraocular hemorrhage (bleeding inside the eye), severe pain, and complete loss of ocular movement following penetrating trauma with a wood stick definitively indicates a full-thickness breach of the eyewall 1, 2.
Why This Is an Open Globe Injury
Scleral involvement with bleeding confirms full-thickness eyewall disruption, which is the defining feature of open globe injury—not merely a corneal laceration or isolated orbital trauma 2, 3.
Intraocular hemorrhage indicates penetration into the globe's interior, distinguishing this from superficial corneal injury 1.
Complete loss of ocular movement suggests either direct extraocular muscle damage, severe globe disruption, or associated orbital injury, all of which occur with penetrating open globe trauma 4, 1.
Wood stick injuries commonly cause penetrating open globe lacerations because the sharp or irregular surface creates full-thickness defects through the sclera 5, 1.
Why Not the Other Options
Not Simply a Corneal Laceration
A corneal laceration alone would not explain scleral involvement or the severity of intraocular hemorrhage described 2, 3.
While corneal lacerations are a subtype of open globe injury, the explicit mention of scleral involvement makes this a scleral laceration or corneoscleral laceration, which falls under the broader category of open globe injury 6.
Not Isolated Orbital Injury
Pure orbital injury (fracture or soft tissue trauma without globe penetration) would not produce active intraocular bleeding or scleral disruption 4, 7.
Loss of ocular movement in isolated orbital injury typically results from muscle entrapment in fractures or periorbital swelling, not from direct globe penetration 4, 7.
This patient's presentation includes hard signs of globe penetration (active bleeding from the eye, scleral involvement), which supersedes orbital injury as the primary diagnosis 1.
Immediate Management Priorities
Protect the eye immediately with a rigid shield without applying any pressure to prevent extrusion of intraocular contents 1, 3.
Request emergency ophthalmology consultation for urgent surgical exploration and primary closure—open globe injuries require operative repair as soon as possible to prevent irreversible vision loss and endophthalmitis 1, 2, 3.
Administer broad-spectrum systemic antibiotics immediately because intraocular infection risk is high in penetrating injuries 2, 3.
Avoid any manipulation of the eye, including forced duction testing, lid eversion, or pressure application, as these maneuvers can worsen globe content extrusion 1, 8.
Update tetanus vaccination status and prevent Valsalva maneuvers (straining, coughing, vomiting) that could extrude ocular contents 3.
Imaging Considerations
Obtain non-contrast orbital CT with thin cuts and multiplanar reconstructions if the patient is stable enough for imaging, to assess the full extent of globe damage, detect intraocular foreign bodies (wood fragments), and evaluate for concurrent orbital fractures 5, 1.
CT has 94.9% sensitivity for detecting intraorbital foreign bodies, especially metallic ones, though wooden foreign bodies may appear hypoattenuating and be mistaken for air 5, 1.
Do not delay surgical consultation for imaging if the diagnosis is clinically obvious—active bleeding from the eye with scleral involvement is a hard sign of open globe injury requiring immediate operative intervention 1.
MRI is absolutely contraindicated if any metallic foreign body is suspected, though less relevant in this wood stick injury 5, 1.
Critical Pitfalls to Avoid
Do not assume this is merely an orbital injury or corneal abrasion based on the mechanism—wood stick injuries frequently cause full-thickness globe penetration 5, 1.
Do not apply eye patches, topical medications, or pressure before ophthalmology evaluation, as these can worsen globe content extrusion 1, 3.
Do not perform detailed eye manipulation or forced duction testing when open globe is suspected, as this exacerbates injury 1, 8.
Do not delay antibiotic administration—endophthalmitis risk is substantial in penetrating injuries and requires immediate empiric coverage 2, 3.