In the management of an open globe injury (globe rupture/laceration), which action is CONTRAINDICATED before surgical repair?
- A Applying topical anaesthetic eye drops with a cotton-tipped applicator pressed against the globe for examination ✓
- B Covering the eye with a rigid shield without applying any pressure
- C Administering systemic antibiotics (IV ciprofloxacin or cefazolin)
- D Keeping the patient nil by mouth for emergency surgical repair
Correct answer: A. Applying topical anaesthetic eye drops with a cotton-tipped applicator pressed against the globe for examination
Explanation
In an open globe injury, ANY direct pressure on the eye is absolutely contraindicated as it can cause extrusion of intraocular contents (iris, lens, vitreous) through the wound, worsening prognosis. Application of a topical anesthetic with a cotton-tipped swab pressed against the eye applies pressure and must be avoided. The eye should be covered with a rigid (fox) shield — not a pad. Systemic antibiotics are appropriate to prevent endophthalmitis. The patient should be kept NPO for emergency surgical exploration.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.