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S Klein, N Bhagat; Elevated Intraocular Pressure in a Ruptured Globe With Retrobulbar Hemorrhage . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4494.
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Purpose: To describe an unusual presentation of a case of ruptured globe with high intraocular pressure. Methods:Retrospective Case review Results: A 15 year old male, with history of congenital rubella and mental retardation sustained a traumatic injury and presented with hemorrhagic chemosis and proptosis of the right eye. The vision could not be assessed due to disability. Extraocular muscle movement was extremely restricted. The pupil of right eye was difficult to assess secondary to corneal opacity but was found to have an afferent pupillary defect. Pupil of the left eye constricted briskly from 2 mm to 1 mm. The intraocular pressure (IOP) was 60 mm Hg by applanation. Anterior segment examination was positive for 360 degrees of hemorrhagic chemosis. The cornea was clouded but not lacerated. CT scan revealed extensive peribulbar and retrobulbar hemorrhage, along with vitreous hemorrhage. Intraoperative exploration of the globe revealed a 15mm scleral laceration originating 2mm from the limbus at 10 o'clock running circumferentially superiorly and posteriorly to behind the superior rectus muscle. There was extensive uveal and vitreal prolapse from the wound. Conclusion:While typically the IOP of a ruptured globe is low, the presence of extensive subtenon peribulbar hemorrhage can tamponade the rupture site. The intraocular pressure can be very high in cases with concomitant ruptured globe and retrobulbar hemorrhage.
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