Cornea

Open Globe Injury / Intraocular Foreign Body

Also known as: open globe, penetrating eye injury, perforating eye injury, intraocular foreign body, IOFB, ruptured globe, globe rupture, hammering eye injury

Filed as: Emergency

Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed

Clinical decision support only

OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.

Overview

A full-thickness wound of the cornea or sclera, with or without a retained intraocular foreign body (IOFB). The mechanism carries suspicion: any high-velocity event — hammering metal on metal, grinding, drilling, power tools — supports managing the eye as an open globe until ophthalmic assessment and appropriate imaging have excluded occult penetration, because a small self-sealing entry wound can leave a comfortable, white, 6/6 eye. The immediate priorities are to protect the globe from any pressure, withhold drops and ointment, keep the patient fasted, control vomiting, and arrange same-day transfer to an ophthalmic surgical unit. CT orbit, at the receiving hospital, is the imaging of choice for suspected IOFB — requested with the referral, never a reason to delay transfer. MRI is never used when a metallic IOFB is possible.

Recognition

Symptoms: what patients report

A high-velocity mechanism — hammering, grinding, drilling, power tools — with or without a felt impact.
Pain ranging from severe to minimal: a sealed-entry IOFB can be near-painless.
Reduced vision in the affected eye, from mild blur to severe loss.
Sudden onset at the moment of injury; a foreign-body sensation may or may not be present.
Fluid leaking from the eye (tears that will not stop) after trauma.

Signs: what the examination shows

Peaked, teardrop or irregular pupil — the iris points to the wound.
Shallow or flat anterior chamber compared with the fellow eye.
Positive Seidel test — aqueous streaming through fluorescein at the wound.
360-degree or bullous subconjunctival haemorrhage after blunt trauma (may hide a scleral rupture).
Uveal tissue (dark knuckle) presenting at or through the cornea or sclera.
Marked hypotony — but a sealed wound can retain normal pressure.
Visible entry wound, lid laceration in line with the globe, or a track through the cornea.
Vitreous haemorrhage or a poor view after a projectile mechanism.
New lens opacity or capsular disruption after trauma.

What OptoGuide™ covers for open globe injury / intraocular foreign body

Pattern reasoning: what this combination of findings points to, and its differentiators
Don't-miss risks and escalation triggers
Management tiers with linked Australian therapeutics
Referral urgency, specialty, and letter drafting

Open the full clinical record: free 14-day trial All conditions covered

Sources

Full bibliography