After an assault, a 35-year-old man has marked periorbital ecchymosis, a 360 degree subconjunctival haemorrhage, a markedly shallow anterior chamber, a peaked irregular pupil, and soft globe tension on palpation. The next step in management is:
- A B-scan ultrasonography to assess the posterior segment
- B Urgent CT orbit followed by surgical exploration for occult globe rupture ✓
- C Topical antibiotics with review in one week
- D Immediate lateral canthotomy and cantholysis
Correct answer: B. Urgent CT orbit followed by surgical exploration for occult globe rupture
Explanation
A 360 degree subconjunctival haemorrhage, shallow anterior chamber, peaked pupil pointing towards the breach, and hypotony are classic signs of occult posterior globe rupture hidden beneath the haemorrhage. The eye must be protected with a shield and explored surgically after imaging. B-scan pressure risks extruding intraocular contents and is avoided until rupture is excluded. Lateral canthotomy treats raised pressure from retrobulbar haemorrhage, the opposite situation.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.