globe disease

Globe Diseases: A Comprehensive Overview

The term "globe" refers to the eyeball, and diseases affecting it can have a significant impact on an individual's quality of life. Globe diseases encompass a broad range of pathologies that may lead to progressive vision loss or acute presentations.

• Degenerative Disorders: Degenerative disorders of the globe, such as degenerative myopia, chalcosis, siderosis, and other conditions, can cause irreversible damage to the eye (4). These conditions often result from prolonged exposure to certain factors, leading to gradual deterioration of the eye's structure.
• Trauma-Related Injuries: Traumatic injuries, including globe rupture (3) and luxation (6), can occur due to blunt or penetrating trauma. Globe rupture is a medical emergency that requires immediate attention to prevent further complications (5).
• Systemic Abnormalities: Local and systemic abnormalities within the globes can manifest in various ways, with only a few requiring specific treatment (8). These conditions may be caused by underlying health issues or other factors.
• Luxation and Retraction: Globe luxation is a rare condition where the eyeball protrudes or "pops" out of its socket (9), while globe retraction occurs when the globe is displaced deeper within the orbit from its normal position (7).

Global Burden of Disease

The Global Burden of Disease (GBD) study provides a comprehensive picture of mortality and disability across countries, time, age, and sex. It quantifies health loss from hundreds of diseases, injuries, and risk factors, enabling health systems to be improved and disparities eliminated (12). The burden of disease is a related but different indicator that accounts for both mortality and morbidity, often measured by estimating the number of years of life "lost

Signs and Symptoms of Globe Disease

Globe disease, also known as open globe injury or ruptured globe, can manifest in various ways depending on the severity and location of the injury. Here are some common signs and symptoms:

• Eye pain: A sharp, stabbing, or dull ache in the eye is a common symptom of globe disease [1].
• Vision loss: Decreased vision or blindness can occur due to damage to the retina, optic nerve, or other structures within the eye [2][3].
• Fluid leaking from the eye: Clear or bloody fluid may leak from the eye if the injury has caused a rupture or laceration [4].
• An injury that’s visibly pierced your eyelid: A visible wound or puncture in the eyelid can indicate an open globe injury [5].
• Extrusion of ocular tissue from the eyeball: In severe cases, tissue may be pushed out of the eye, indicating a ruptured globe [6].
• Markedly decreased visual acuity: Significant vision loss can occur due to damage to the retina or other structures within the eye [14].
• Relative afferent pupillary defect: A pupil that reacts abnormally to light can indicate damage to the optic nerve or retina [14].
• Teardrop pupil: A pupil that is shaped like a teardrop can be a sign of globe disease, particularly if it's accompanied by other symptoms such as eye pain and vision loss [14].
• Change in anterior chamber depth compared to the unaffected eye: A change in the depth of the anterior chamber, which is the space between the cornea and the iris, can indicate damage to the eye [14].

It's essential to seek medical attention immediately if you suspect a globe disease. Delaying treatment can lead to further complications and potentially permanent vision loss.

References:

[1] Context result 1 [2] Context result 3 [3] Context result 5 [4] Context result 6 [5] Context result 7 [6] Context result 8 [14] Context result 14

Diagnostic Tests for Globe Disease

Globe disease, also known as open-globe injury (OGI), can be diagnosed using various tests and examinations. Here are some of the diagnostic tests used to diagnose globe disease:

• Physical Examination: A physical examination is usually the first step in diagnosing globe disease. This includes a thorough examination of the eye, including the cornea, sclera, iris, and retina.
  • Most open-globe injuries can be diagnosed with simple pen light or flashlight examination [6].
  • Smaller wounds may require slit-lamp examination for confirmation [6].
• Seidel Test: The Seidel test is a diagnostic test used to detect the leak of aqueous fluid following globe penetration. It should not be performed if globe rupture or penetration has already been confirmed.
  • The Seidel test assesses for the presence of aqueous humor leakage from the anterior chamber [8].
• Computed Tomography (CT) Scan: A CT scan is a diagnostic imaging test that uses X-rays to produce detailed images of the eye and surrounding tissues. It can help diagnose globe disease, especially in cases where physical examination is not diagnostic.
  • Computed tomography (CT) scans have a reported sensitivity between 56% and 68% in diagnosing patients with an open globe [4].
• Magnetic Resonance Imaging (MRI): MRI is another diagnostic imaging test that uses magnetic fields and radio waves to produce detailed images of the eye and surrounding tissues.
  • Eye globe abnormalities can be readily detected on dedicated and non-dedicated CT and MR studies [5].

Other Diagnostic Tests

In addition to these tests, other diagnostic tests may also be used to diagnose globe disease. These include:

• Slit-Lamp Examination: A slit-lamp examination is a detailed examination of the eye using a special microscope.
  • The first examination should put no pressure at all on the eye [2].
• Snellen Eye Chart Exam: A Snellen eye chart exam is used to test visual acuity and detect low vision.
  • This test can reveal low vision [2].

References

[1] Context 1 [4] Context 4 [5] Context 5 [6] Context 6 [8] Context 8

Treatment Options for Globe Disease

Globe disease, also known as ruptured globe or traumatic eye injury, requires prompt medical attention to prevent further complications. The primary goal of treatment is to preserve vision and prevent infection.

• Medications: Administering prophylactic systemic antibiotics is recommended to cover organisms commonly associated with posttraumatic endophthalmitis [1]. Antiemetics such as ondansetron may be given to prevent Valsalva maneuvers, which can exacerbate the injury [2].
• Pain Management: Take medicine prescribed for pain and discomfort. If severe pain persists, consider administering analgesics such as morphine [3].
• Sedation and Analgesia: Administer sedation and analgesics as needed to manage patient comfort [4].

Additional Treatment Options

In some cases, additional treatment options may be considered:

• Steroid Injections: Steroid injections may be used to reduce inflammation and swelling [7].
• Eye Drops: Eye drops can help reduce irritation and dryness [7].
• Sunglasses: Wearing sunglasses can help protect the eye from further injury [7].

Important Considerations

It is essential to note that if clinical suspicion of a ruptured globe is high, any medication such as tetracaine or diagnostic eye drops should be avoided until further evaluation [4]. Additionally, administration of antifibrinolytics may be considered, and miotic or mydriatic medications are viable options. Intraocular pressure should be monitored with a tonometer [8].

References:

[1] Mar 21, 2024 — Prophylactic systemic antibiotics should be given to cover organisms commonly associated with posttraumatic endophthalmitis. [2] Mar 21, 2024 — Administer antiemetics (eg, ondansetron) to prevent Valsalva maneuvers. [3] Dec 11, 2022 — Take medicine prescribed for you to keep you from throwing up and from being in pain. [4] Sep 20, 2024 — If clinical suspicion of a ruptured globe is high, any medication such as tetracaine or diagnostic eye drops should be avoided until further evaluation. [7] Mar 22, 2024 — General treatment options · steroid injections to reduce inflammation · eye drops to reduce irritation and dryness · wearing sunglasses to help protect the eye. [8] Administration of antifibrinolytics may be considered, and miotic or mydriatic medications are viable options. Intraocular pressure should be monitored with a tonometer.

The differential diagnosis of globe disease encompasses a wide range of conditions that affect the eye, including traumatic, neoplastic, iatrogenic, and other types of diseases.

Traumatic Globe Diseases

• Open Globe Injuries: These include lacerations, perforations, and ruptures of the eyewall, which can be caused by blunt trauma or penetrating injuries [9][14].
• Closed Globe Injuries: These include contusions and lamellar lacerations, which are types of traumatic injuries that do not involve a break in the eyewall [13].

Neoplastic Globe Diseases

• Scirrhous Breast Carcinoma: This is a type of cancer that can metastasize to the eye and cause globe disease [4].
• Other Neoplasms: Various other types of cancers, such as melanomas and lymphomas, can also affect the globe and be part of its differential diagnosis.

Iatrogenic Globe Diseases

• Intraocular Foreign Bodies (IOFBs): These are objects that enter the eye through a penetrating injury or perforation [13].
• Other Iatrogenic Causes: Various medical procedures, such as cataract surgery, can also cause globe disease.

Other Globe Diseases

• Vitreous Hemorrhage: This is a condition where blood leaks into the vitreous humor of the eye, causing vision loss and other symptoms [2].
• Retinal Detachment: This is a condition where the retina separates from the back of the eye, which can cause vision loss and other symptoms [2].

References

[1] Blunt eye trauma can result in various intrinsic eye injuries. [2] Mar 21, 2024 — Differential Diagnoses · Corneal Laceration · Retinal Detachment · Vitreous Hemorrhage in Emergency Medicine. [3] As such, common disease entities in this region are of interest to the general radiologist and the diagnosis of globe disease need not be the remit of experienced observers in specialist centres. [4] Apr 28, 2021 — Silent sinus syndrome. Duane syndrome. Convergence retraction nystagmus. Orbital fracture. Scirrhous breast carcinoma. Differential Diagnoses. [5] by JTPD Hallinan · 2016 · Cited by 41 — The differential diagnosis can be made easier and refined by categorising the abnormalities according to the layers and the compartments of the globe. [6] Sep 20, 2024 — Differential Diagnosis. Traumatic hyphema; Orbital fracture; Globe rupture; etc. [7] A more realistic organizational ap- proach to differential diagnosis is one based on clinical presentation. [8] Lesions of the globe may present with abnormali- ties of size, shape, or abnormal vision. [9] Globe rupture is seen most commonly at the anterior chamber. [10] Infection, inflammation, and systemic diseases affecting the globe encompass a broad range of pathologies which may ultimately lead to progressive vision loss. [11] Clinical symptomatology varies from the inexorably silent progressive visual loss to an acute presentation of ocular pain and/or red eye. [12] Blunt eye trauma can result in various intrinsic eye injuries.[1] [13] Open globe injuries can be laceration and globe rupture.[2] [14] Globe rupture, globe laceration, globe perforation, or open globe injuries are forms of ocular trauma that require urgent diagnosis and treatment.