A ruptured globe is a full-thickness tear of the wall of the eye after a strong blunt blow. The eye has a tough outer coat made of the clear cornea in the front and the white sclera around the rest of the eye. When a hard hit squeezes the eye suddenly, the pressure inside the eye spikes and forces the wall to split at its weakest point. The tear may be in the white part, at the junction between the white and the clear part, or even behind the visible portion of the eye. Because the tear goes through the whole thickness of the eye wall, the inside of the eye is now open to the outside world. This makes infection, bleeding, and permanent vision loss much more likely unless the eye is protected and repaired quickly. Doctors call this an “open-globe injury,” and a “rupture” is the open-globe subtype caused by blunt force (as opposed to a “laceration,” which is caused by a sharp object). A ruptured globe is an absolute emergency and needs urgent eye shielding, no pressure on the eye, fast imaging, antibiotic coverage, tetanus protection, and prompt surgery by an eye surgeon.

A ruptured globe means the wall of the eye (the cornea in front and/or the sclera around) has torn open because of an injury. This can happen after a blunt hit, a sharp cut, a high-speed fragment, or an explosion. When the eye wall is open, the inside of the eye is no longer sealed. This is an emergency because germs can get inside and cause a severe infection, the eye can lose fluids and structure, and delicate tissues like the lens, iris, or retina can be damaged. A ruptured globe needs urgent protection and surgery. Most people do better when the eye is gently shielded, the person is kept calm and still, intravenous (IV) antibiotics are started, and a skilled eye surgeon repairs the eye quickly—ideally within 24 hours. Early repair lowers the chance of vision-threatening infection called endophthalmitis. PMCAAO JournalAAO

---

How doctors think about it

A blunt hit compresses the eye from front to back and stretches it at the sides. The pressure rises in a fraction of a second. The eye wall can split at old surgical wounds, at natural weak spots, or where the tissues are thinnest. Once a full-thickness tear occurs, fluid from inside the eye (aqueous or vitreous) can leak out, tissues like the iris or choroid can bulge or prolapse, and germs can enter. Bleeding inside the eye can block the view. The retina can detach. The lens can become cloudy or dislocated. Infection inside the eye (endophthalmitis) can develop quickly and can destroy sight. Fast protection and closure of the wound reduce these risks and help save vision.

---

Types of ruptured globe

By mechanism

• Rupture from blunt trauma: The classic type. A fist, ball, dashboard, or other blunt object hits the eye. The wall bursts at its weakest point. The external cut may be small or hard to see, especially if it is hidden under the eyelids or behind the visible part of the eye.

By location of the tear

• Corneal rupture: The tear is in the clear front window. It can cause marked fluid leak and a “flat” or very soft eye.

• Limbal rupture: The tear is at the edge where the clear cornea meets the white sclera. This location bleeds easily and can involve the iris.

• Scleral rupture (anterior or posterior): The tear is in the white part. Anterior tears lie near the front; posterior tears lie farther back and can be difficult to see without imaging. Posterior tears are especially dangerous because they may be large and are hidden.

• Corneoscleral rupture: The tear crosses the limbus and involves both clear and white portions.

By extent and associated features

• With tissue prolapse: Iris, uveal tissue, or vitreous bulges out through the wound. This raises the infection risk and often needs careful surgical cleaning and repair.

• With lens injury: The lens may be torn, dislocated, or become cloudy (traumatic cataract). This can blur vision a lot and may require staged surgery.

• With retinal or choroidal damage: There may be retinal detachment, retinal breaks, or bleeding in the layers under the retina. These injuries affect long-term vision and often need vitreoretinal surgery.

• With intraocular foreign material: Although rupture is caused by blunt force, dirt or small fragments can still be driven into the eye through the torn wall. This increases the infection risk and changes the surgical plan.

• By “zones” (surgeon’s map): Zone I (cornea and limbus), Zone II (front sclera up to 5 mm behind the limbus), Zone III (sclera more than 5 mm behind the limbus). Farther back (Zone III) injuries have higher risk to vision because of retina involvement.

---

Causes

1. Punch or fist to the eye
   A direct blow from a fist compresses the eye very fast and can burst the eye wall at a weak spot, often behind the visible area.

2. Sports ball impact (cricket, baseball, soccer, squash)
   Fast-moving balls carry a lot of energy. When they strike the eye, the sudden squeeze can tear the wall, especially if protective eyewear is not used.

3. Elbow, head, or shoulder during contact sports
   Accidental hits in crowded play can compress the eye and cause a rupture, even without a sharp object.

4. Road traffic crashes (dashboard, airbag, steering wheel)
   High-energy blunt trauma to the face during a crash can split the eye wall. Airbags can save lives but still cause strong blunt force to the eyes.

5. Falls (especially in older adults)
   A fall onto a hard surface can generate enough force to rupture an eye, particularly in people with fragile tissues or prior eye surgery.

6. Assault with blunt objects (stick, bat, stone)
   A blow with a non-sharp object exerts crushing pressure and may open the globe at weak sites.

7. Industrial accidents (tools, machinery recoil, high-pressure hoses)
   Recoil from bungee cords, straps, or high-pressure lines can whip the eye, causing severe blunt trauma and rupture.

8. Explosions and blasts (firecrackers, fireworks, pressure cookers)
   The blast wave or flying blunt debris can compress the eye or strike it hard, leading to a tear of the wall.

9. Rubber band or elastic exercise band snap-back
   Sudden recoil of a stretched band can hit the eye with surprising force and rupture it.

10. Animal-related blunt injury (horns, hooves, beaks)
    A horn or hoof can press and crush the eye, causing a rupture even without a sharp puncture.

11. Door edge or furniture corner impact
    Everyday blunt hits during household accidents can be enough to tear an eye with prior weakness.

12. Bicycle or motorcycle handlebar impact
    The handlebar is a hard, focused surface that can apply strong blunt force to the orbit and eye.

13. Workplace shield or goggle failure
    A failed or displaced shield can allow a heavy blunt strike to the unprotected eye.

14. Childhood play accidents (hard toys thrown at the face)
    A hard, rapidly thrown object can compress a child’s eye and cause rupture, especially if hit directly.

15. Airbag deployment without seatbelt
    When the body moves forward, the airbag can strike the face and eye with more relative force, raising rupture risk.

16. Prior eye surgery with weak wound (e.g., recent cataract incision) + minor blunt hit
    Old surgical wounds can be weak points. Even a modest blow months or years later can cause wound dehiscence and rupture at that site.

17. Severe corneal thinning from infection (ulcer) leading to open-globe after trivial bump
    An infected cornea can melt and thin. A small tap or even eye rubbing may then open the globe. While this is technically a perforation, the end result is an open-globe emergency and is often discussed alongside ruptures.

18. Autoimmune corneal melts (e.g., rheumatoid arthritis, vasculitis)
    Inflammatory disease can thin the cornea or sclera. A very mild hit can then produce a full-thickness opening.

19. Scleromalacia (very thin sclera) from long-standing inflammation
    Paper-thin sclera can split with minimal blunt pressure, causing a posterior rupture that is hard to see.

20. Chemical or thermal injuries causing tissue death and thinning, followed by minor blunt stress
    After severe burns, the eye wall may be fragile. Even small blunt force can then create a full-thickness tear.

---

Symptoms

1. Sudden, severe eye pain
   The pain comes quickly after the hit. The eye feels sore, deep, and very tender. Pain can worsen with any attempt to open or move the eye.

2. Sudden drop in vision
   Vision may become blurred, dim, or completely lost. Some people can only see hand movements or light.

3. A feeling that the eye is “soft,” “leaking,” or “not round”
   The eye can feel different, as if its shape has changed. Some people sense wetness or fluid, which might be a real leak.

4. Blood in the eye or visible bleeding
   There may be a blood level in the front chamber (hyphema) or blood that clouds the vision. Blood on the white of the eye can be extensive.

5. Misshaped or teardrop-shaped pupil
   The black center of the eye may look pulled toward a wound, making the pupil look pointy or uneven.

6. Something “brown” or “dark” on the surface of the eye
   Brownish tissue (iris or uveal tissue) may be seen bulging through the wound. This is a medical emergency sign.

7. Excessive tearing and light sensitivity
   The eye waters a lot and bright light is very uncomfortable because the surface and inside of the eye are exposed and irritated.

8. Lid swelling and bruising
   The eyelids can swell and bruise after a blunt hit, which can hide the wound and make the eye hard to examine.

9. Foreign body sensation or gritty feeling
   The person may feel like something is stuck in the eye, even if nothing is obvious from the outside.

10. Double vision or trouble moving the eye
    The eye muscles or nerves can be stunned, injured, or trapped by fractures. This causes double vision or a heavy, stiff feeling.

11. Flashes or floaters
    Bright flashes or dark specks can appear if the retina is irritated or bleeding occurs inside the eye.

12. Headache, nausea, or vomiting
    Severe eye pain and sudden vision loss can trigger nausea and vomiting. This is common after major eye trauma.

13. Loss of the normal “red reflex” in photos
    The eye may look black on flash photography instead of showing a red reflex because blood or other material blocks the light.

14. General dizziness or unsteadiness
    The shock and pain can make standing or walking feel unsafe, and the person may feel faint.

15. A sense of pressure or fullness behind the eye
    Swelling and bleeding within the orbit can give a deep pressure feeling and sometimes threaten the optic nerve.

---

Diagnostic Tests

A. Physical Exam

1. No-pressure visual inspection with rigid eye shield in place
   The first “test” is careful looking without touching. The doctor gently lifts the upper lid only if safe and often avoids this if the shield is on and the wound is obvious. They look for a tear, a peaked pupil, brown tissue on the surface, blood in the front, or a very soft eye. A rigid shield is placed early to prevent accidental pressure. Safety is the priority during this step.

2. Basic visual acuity check without pressure
   The doctor checks how well each eye sees letters or counts fingers, hand motion, or light perception. This is done while avoiding any pressure on the injured eye. The result becomes the baseline for later comparison and helps judge urgency, prognosis, and the need for specific surgical plans.

3. Pupil and light reflex check for optic nerve function
   A penlight is used to see if the pupil reacts to light and to check for a relative afferent pupillary defect (RAPD), which suggests serious optic nerve or retinal injury. The doctor keeps the exam brief and gentle, because the goal is information without causing more damage.

4. External exam of eyelids, lashes, and surrounding tissues
   The doctor notes lid cuts, bruises, or fractures around the eye socket. Lid wounds can hide a globe rupture. There may also be a gush of blood under the conjunctiva (subconjunctival hemorrhage) that is 360 degrees around the cornea, which strongly hints at an open globe.

5. Assessment for orbital compartment syndrome (no palpation)
   The doctor looks for very tight lids, bulging eye, severe pain, and poor vision that suggest dangerously high pressure in the orbit from bleeding. They do not press on the globe. If compartment syndrome threatens the optic nerve, urgent decompression of the orbit may be needed by specialists.

B. Manual Tests

6. Color vision check (very brief, if possible)
   Quick color plate testing (like Ishihara) can show whether the optic nerve is functioning. A sudden drop in color vision can be a sign of serious internal damage. The test is done only if the person can cooperate and if it does not stress the eye.

7. Confrontation visual fields (simple bedside field test)
   The doctor checks how much side vision the person can see by comparing it to their own. Big blind areas can mean retinal or optic nerve injury. It is quick, requires no equipment, and avoids pressure on the eye.

8. Light projection and localization
   If vision is very poor, the doctor asks whether the person can tell where a bright light comes from in different directions. Being able to locate light suggests that some retinal function remains. This helps guide urgency and prognosis.

9. Near-target reading test or recognition of shapes
   If safe and vision allows, the person may try to read large print or identify simple shapes. This gives another simple measure of central vision without touching the eye.

10. Seidel test (fluorescein leak test) — used only with great caution
    A tiny drop of fluorescent dye is placed on the surface, and a blue light is used to look for a green “waterfall” pattern that shows fluid leaking from a wound. This test is avoided if the rupture is obvious because touching can worsen the tear. If used, it is done very gently by experienced clinicians.

C. Lab and Pathological Tests

11. Tetanus immunization review and update
    The doctor confirms when the last tetanus shot was given. A booster is given if needed, because open injuries are at risk of infection by tetanus bacteria.

12. Complete blood count (CBC)
    This blood test checks red cells, white cells, and platelets. It helps evaluate bleeding risk, infection risk, and readiness for anesthesia and surgery.

13. Basic metabolic panel and kidney function
    These tests look at electrolytes and kidney function before anesthesia and for safe antibiotic dosing. They also help spot medical problems that may complicate surgery.

14. Wound or foreign-material cultures (selected cases)
    If the wound is contaminated with soil, water, or organic matter, the surgeon may take cultures during surgery. This helps target antibiotics if infection develops. Cultures are not taken in all cases and are usually done in the operating room.

D. Electrodiagnostic Tests

15. Visual evoked potential (VEP) — selected, later use
    This test measures signals traveling from the eye to the brain when a pattern or light is shown. It can help predict vision potential when the media are opaque or the exam is limited. It is not an acute emergency test and is done only when safe.

16. Electroretinography (ERG) — selected, later use
    ERG measures the electrical response of retinal cells to light. If the view is blocked by blood or scars, ERG can show whether the retina still functions. Like VEP, this is a specialized test used later for prognosis, not in the first emergency hour.

E. Imaging Tests

17. Non-contrast CT scan of the orbits (thin slices)
    CT is the key imaging test in suspected rupture. It can show the site of the wall break, air inside the eye, a very soft eye, lens problems, intraocular foreign bodies, and fractures. It is fast, widely available, and does not push on the globe. CT is usually done without contrast to avoid obscuring small foreign bodies.

18. Plain X-ray of the orbits (if CT unavailable or to screen for metal)
    X-rays can show metal near or in the orbit if CT is not immediately available. It is less detailed than CT but can help avoid unsafe MRI when a metallic fragment may be present.

19. Ocular ultrasound (B-scan) — only if the surgeon approves and contact is safe
    Ultrasound can show retinal detachment, vitreous hemorrhage, or choroidal detachments. However, it can apply pressure to the eye and can make a rupture worse if used inappropriately. It is usually deferred until after the globe is closed, or performed with extreme caution by experienced hands when CT is inconclusive.

20. Optical coherence tomography (OCT) / Anterior segment OCT — later, when the eye is stable
    OCT uses light to create cross-section pictures of the cornea, angle, and retina. It helps assess corneal wounds, macular damage, and subtle retinal problems after the globe is closed and the surface is safe to image.

Non-pharmacological treatments

These steps do not replace surgery. They are the safe, supportive things that help protect the eye and the patient until and around the time of surgery.

1. Rigid eye shield, not a pad
   Place a hard, protective shield (like a Fox shield) over the injured eye without pressure. Do not patch the eye. A shield prevents accidental rubbing and further leakage of eye contents. AAO

2. Absolute “no pressure” rule
   Do not press on the eyelids, do not measure eye pressure, do not roll the lids to look underneath, and do not perform ultrasound on the open eye. Pressure can squeeze fluid or tissue out of the eye and worsen the tear. publishing.emanresearch.org

3. Keep NPO (nothing by mouth)
   No food or drink in case urgent anesthesia is needed. This keeps the airway safer during surgery.

4. Head elevation and rest
   Keep the head of the bed up ~30 degrees. This can reduce swelling and lower the chance of more fluid leaking.

5. Limit movement and strain
   Avoid bending, lifting, or straining. Ask the patient not to cough, vomit, or bear down because it spikes pressure in the head and eye. Use gentle anti-nausea measures (see drug section) to prevent vomiting.

6. Protective transport and positioning
   If transport is needed, stabilize the neck when appropriate (trauma rules) and keep the shield in place. Avoid bright light if painful.

7. Careful, minimal exam
   Check basic vision and pupil shape without touching the eye. Look for signs like misshapen pupil, deep cut, or tissue prolapse—but do not press. The goal is quick recognition and protection until the ophthalmologist takes over. EyeWiki

8. CT orbit (no contrast) if imaging is required
   A non-contrast CT scan of the orbits helps detect fractures and foreign bodies. Avoid MRI if a metal fragment is possible because the magnet can move metal. Imaging supports the surgical plan but should never delay shielding or transfer. NCBI

9. Avoid contact lens removal if difficult
   If a contact lens is stuck and removal would push on the eye, leave it for the surgeon.

10. Eye surface care only if clearly safe
    Do not irrigate or “wash out” a suspected open globe unless a corrosive chemical is involved and you are trained to irrigate without applying pressure. Otherwise, defer to the surgical team.

11. Protect the uninjured eye
    In bright light or severe pain, a dark lens or cover on the other eye can reduce reflex movements in the injured eye (eyes move together).

12. Calm environment and reassurance
    Quiet, dim room; explain steps in simple terms; reduce anxiety to limit squeezing of the eyelids and sudden head movements.

13. Avoid aspirin and NSAIDs (non-drug step here = “do not give”)
    These medicines increase bleeding risk. Use non-NSAID pain strategies (see drug section).

14. Clean but do not probe
    Gently clean facial blood or debris without touching the globe. Do not remove protruding objects; stabilize them and let the surgeon remove them.

15. Eye protection education for family at bedside
    Explain that nobody should touch or adjust the shield or “peek” at the eye until the surgeon is present.

16. Early ophthalmology involvement
    Rapid transfer to a surgical eye center. Earlier repair is associated with lower endophthalmitis risk and better outcomes. PMCAAO Journal

17. Tetanus risk triage
    Open injuries carry tetanus risk. Record vaccine history so the clinical team can update shots (see drug section for vaccine). CDC

18. Eye trauma documentation and Ocular Trauma Score
    Record mechanism, environment (farm, soil, metal), and initial vision. These details help predict risk and guide counseling. (Ocular Trauma Score is often used by specialists for prognosis.) EyeWiki

19. Protective measures for the other eye in surgery
    When the injured eye is repaired, the team protects the fellow eye from accidental injury, light, or pressure.

20. Early counseling about staged care
    Explain that vision recovery is a journey. There may be staged surgeries (for lens, retina, or cornea) after the primary closure. This lowers fear and sets realistic expectations.

---

Drug treatments

Doses are typical adult starting ranges; adjust for age, kidney/liver function, allergies, pregnancy, and hospital protocol. Pediatric dosing differs. The ophthalmology/anesthesia teams individualize all therapy.

1. Vancomycin (IV) — Glycopeptide antibiotic
   Dose: 15–20 mg/kg IV every 8–12 h (use actual body weight; adjust to trough/AUC goals and renal function).
   When: Start as soon as open globe is suspected/confirmed; usually continue ~48 h or per protocol.
   Purpose: Prevent/treat Gram-positive infections including MRSA while the globe is open or freshly repaired.
   Mechanism: Inhibits bacterial cell wall synthesis by binding D-Ala-D-Ala.
   Key side effects: Kidney injury, “red man” infusion reaction, ototoxicity (rare). PMC+1

2. Ceftazidime (IV) — Third-generation cephalosporin
   Dose: 2 g IV every 8 h (or 50 mg/kg IV q8h; max 2 g/dose).
   When: With vancomycin as empiric combo for broad coverage ~48 h or per protocol.
   Purpose: Gram-negative coverage including Pseudomonas.
   Mechanism: Beta-lactam cell-wall inhibitor.
   Key side effects: Allergy/hypersensitivity, diarrhea; adjust in renal dysfunction. PMC

3. Fluoroquinolone alternative (e.g., Moxifloxacin 400 mg IV/PO daily or Levofloxacin 750 mg IV/PO daily) — Fluoroquinolone antibiotic
   When: For severe beta-lactam allergy or as step-down therapy per culture risk and local practice.
   Purpose: Broad Gram-negative/positive coverage as an alternative.
   Mechanism: Inhibits DNA gyrase/topoisomerase.
   Key side effects: QT prolongation, tendinopathy, CNS effects; interacts with some antiarrhythmics. PMC

4. Intravitreal antibiotics (given in the operating room when indicated) — Local, high-dose ocular therapy
   Typical doses: Vancomycin 1 mg/0.1 mL + Ceftazidime 2.25 mg/0.1 mL injected into the vitreous when there is suspected/confirmed contamination or endophthalmitis risk.
   Purpose: Directly bathe the inside of the eye in antibiotics to kill bacteria fast.
   Mechanism: Same as above but at therapeutic intraocular levels.
   Key side effects: Retinal toxicity if mis-dosed, rare retinal artery occlusion. NatureU.S. Pharmacist

5. Voriconazole (IV/PO) (selected high-risk cases) — Azole antifungal
   Dose: 6 mg/kg IV q12 h for 2 doses, then 4 mg/kg IV q12 h (or 200 mg PO q12 h), individualized.
   When: If injury involved soil/vegetative matter or high fungal risk by history or region.
   Purpose: Prevent/treat fungal endophthalmitis.
   Mechanism: Inhibits ergosterol synthesis.
   Key side effects: Visual disturbances, liver enzyme elevation; many drug interactions. PMC

6. Tetanus vaccination ± Tetanus Immune Globulin (TIG) — Active and passive immunization
   Dose: Tdap or Td 0.5 mL IM (booster per status); TIG 250–500 IU IM if vaccination is incomplete or unknown and wound is major/dirty.
   When: As soon as possible after injury; follow CDC wound management guidance.
   Purpose: Prevent tetanus, which can follow open wounds.
   Mechanism: Vaccine induces antibodies; TIG provides immediate antibodies.
   Key side effects: Soreness at injection site, rare allergy. CDCMinnesota Department of Health

7. Ondansetron (IV/PO) — Antiemetic
   Dose: 4–8 mg IV/PO every 8 h as needed.
   When: Immediately if nausea/retching is present or likely.
   Purpose: Prevent vomiting and Valsalva that could force eye contents outward.
   Mechanism: 5-HT3 receptor blockade.
   Key side effects: Headache, constipation, rare QT prolongation.

8. Opioid analgesic (e.g., Morphine IV) — Analgesic
   Dose: 2–4 mg IV, titrate slowly to comfort; or hydromorphone 0.2–0.5 mg IV.
   When: Early, to control severe pain without raising bleeding risk.
   Purpose: Reduce pain, squeezing, and movement.
   Mechanism: Mu-opioid receptor agonism.
   Key side effects: Sedation, respiratory depression, constipation; monitor closely.

9. Acetaminophen (Paracetamol) — Analgesic/antipyretic
   Dose: 1 g PO/IV every 6–8 h (max 3–4 g/day depending on liver status).
   When: First-line non-NSAID pain reliever.
   Purpose: Pain relief without bleeding risk associated with NSAIDs.
   Mechanism: Central prostaglandin modulation.
   Key side effects: Hepatotoxicity with overdose or chronic high dose.

10. Atropine 1% ophthalmic (after primary closure, if indicated) — Cycloplegic
    Dose: 1 drop to the operated eye once or twice daily as prescribed.
    When: After the surgeon closes the globe, to rest the iris/ciliary body in some cases.
    Purpose: Relieve ciliary spasm pain, stabilize the anterior segment.
    Mechanism: Muscarinic blockade causing dilation and cycloplegia.
    Key side effects: Light sensitivity, blurred near vision; systemic anticholinergic effects if overused.

Notes: Avoid aspirin and traditional NSAIDs early because of bleeding risk. Antibiotic choices and durations vary across centers; some use 48 h of IV therapy, then oral step-down based on risk and findings. Early repair within 24 h plus appropriate intraocular/IV antibiotics lowers endophthalmitis risk. PMCeye.hms.harvard.eduAAO Journal

---

Dietary “molecular” supplements

Use these only with the treating team’s approval, especially if you’re on blood thinners or have liver/kidney disease. Typical adult amounts are listed; adjust to diet, labs, and comorbidities.

1. Protein (with arginine)
   Dose: Total daily protein 1.2–1.5 g/kg/day; arginine 6–9 g/day from nutrition formulas if advised.
   Function: Tissue repair building blocks; arginine may support collagen and immune function.
   Mechanism: Provides amino acids for collagen and cell growth.

2. Vitamin C
   Dose: 500–1,000 mg/day.
   Function: Collagen cross-linking and antioxidant support.
   Mechanism: Cofactor for prolyl/lysyl hydroxylase in collagen synthesis.

3. Vitamin A
   Dose: 5,000–10,000 IU/day (avoid high doses in pregnancy; check levels).
   Function: Supports epithelial healing of the ocular surface.
   Mechanism: Regulates epithelial gene expression and mucin production.

4. Zinc (with copper balance)
   Dose: 20–40 mg elemental zinc/day; add copper 2 mg/day if >2–3 weeks of zinc.
   Function: Collagen formation, immune enzyme function.
   Mechanism: Cofactor in DNA/RNA polymerases.

5. Omega-3 fatty acids (EPA+DHA)
   Dose: 1–2 g/day EPA+DHA combined.
   Function: May help resolve inflammation and support tear film.
   Mechanism: Pro-resolving lipid mediators (resolvins/protectins).

6. Vitamin D3
   Dose: 1,000–2,000 IU/day (or as per level).
   Function: Immune modulation and musculoskeletal support during recovery.
   Mechanism: Nuclear receptor signaling in immune cells.

7. Selenium
   Dose: 100–200 µg/day.
   Function: Antioxidant (glutathione peroxidase) activity.
   Mechanism: Selenoproteins reduce oxidative stress.

8. B-complex (esp. B2, B6, B12)
   Dose: Per standard B-complex label.
   Function: Energy metabolism for healing tissues; nerve support.
   Mechanism: Coenzymes in cellular metabolism and myelin support.

9. Collagen peptides
   Dose: 5–10 g/day.
   Function: Source of glycine/proline for collagen rebuilding.
   Mechanism: Provides substrate peptides.

10. Probiotics
    Dose: 1–10 billion CFU/day (Lactobacillus/Bifidobacterium blends).
    Function: Gut support during antibiotics; may reduce antibiotic-related GI upset.
    Mechanism: Competes with pathogens and supports mucosal immunity.

---

Regenerative / stem-cell-type” therapies

There are no approved stem-cell drugs that restore vision after a ruptured globe in routine care. The items below are specialist-directed adjuncts used for ocular surface healing or in clinical trials—they are not first-line for open-globe trauma and should only be used by experts with informed consent.

1. Autologous serum eye drops (ASEDs)
   Dose: Commonly 20%–50% serum in sterile saline, 4–8×/day, short courses under supervision.
   Function: Supply natural growth factors (EGF, fibronectin) to support surface healing after the globe is closed.
   Mechanism: Delivers patient’s own tear-like growth factors.

2. Platelet-rich plasma (PRP) eye drops
   Dose: Center-specific (often 20%–100%), several times daily.
   Function: Delivers PDGF, TGF-β, VEGF, EGF for epithelial healing when appropriate.
   Mechanism: Platelet-derived growth factor signaling.

3. Cenegermin (recombinant human nerve growth factor) 20 µg/mL
   Dose: 1 drop 6×/day for 8 weeks in indicated cases (approved for neurotrophic keratitis).
   Function: Helps corneal nerve and epithelial recovery in neurotrophic damage; sometimes considered after severe surface injury (specialist decision).
   Mechanism: TrkA receptor activation; nerve trophic support.

4. Topical cyclosporine (0.05%–0.1%)
   Dose: 1 drop BID to the healed ocular surface if inflammation and tear instability complicate recovery.
   Function: Immunomodulation to stabilize tear film and reduce surface inflammation.
   Mechanism: Calcineurin inhibition in T-cells.

5. Amniotic membrane graft (biologic surgical adjunct)
   Dose: Applied in the OR or clinic as a graft/sutureless device (one-time placement).
   Function: Provides a biologic scaffold rich in anti-inflammatory mediators to support epithelialization after closure.
   Mechanism: Down-regulates inflammation; promotes epithelial migration.

6. Clinical trials (mesenchymal stem cell–derived factors, gene or cell therapies)
   Dose: Experimental only within IRB-approved protocols.
   Function: Investigational approaches to modulate inflammation or repair tissue.
   Mechanism: Paracrine effects, exosomes, or cell replacement—not standard care; risks and unknowns remain.

---

Surgeries

1. Primary globe repair (corneal/scleral wound closure)
   Procedure: In the operating room under general anesthesia, the surgeon gently cleans the wound, re-positions any viable tissue, removes non-viable tissue, and sutures the laceration to seal the eye wall. A careful exam of the inside of the eye is performed as feasible, sometimes with microscope and intraoperative adjuncts.
   Why it’s done: To seal the eye, restore anatomy, reduce infection risk, and create a stable platform for future vision-saving steps. Earlier repair—ideally within 24 hours—has been associated with a lower endophthalmitis risk. AAO JournalAAO

2. Removal of intraocular foreign body (IOFB)
   Procedure: If a fragment entered the eye, the surgeon removes it during primary repair or in a planned second operation, using magnetic instruments or forceps, often via pars plana vitrectomy if posterior.
   Why it’s done: Metallic or organic fragments increase infection, toxicity, and scarring risks; removal improves safety and outcomes.

3. Pars plana vitrectomy (PPV)
   Procedure: Small ports are placed in the sclera; micro-instruments remove vitreous hemorrhage and contaminants, relieve traction on the retina, repair retinal tears, and allow intravitreal antibiotic placement.
   Why it’s done: Clears the visual axis, reduces infection risk, treats retinal damage, and helps reattach the retina when needed.

4. Lensectomy / cataract extraction (traumatic lens injury)
   Procedure: If the lens is ruptured or displaced, the broken lens is removed. An artificial lens (IOL) may be placed later when the eye is quieter and measurements are safe.
   Why it’s done: A torn lens leaks proteins that inflame the eye and cloud vision; removal stabilizes the anterior segment and clears the visual axis.

5. Enucleation or evisceration (last resort)
   Procedure: Removal of the eye (enucleation) or its inner contents (evisceration) when the globe is unsalvageable and painful.
   Why it’s done: To relieve intractable pain, manage severe infection, or when reconstruction isn’t possible. Modern evidence does not support removing a repairable eye solely to prevent sympathetic ophthalmia; primary repair is preferred whenever feasible. Nature

---

Practical preventions

1. Wear certified eye protection in jobs with flying debris, grinding, welding, or chemicals.

2. Use sports eye guards for racquet sports, hockey, baseball, and paintball.

3. Follow fireworks safety or avoid home fireworks altogether.

4. Install machine guards and follow lock-out/tag-out rules at work.

5. Use shields and curtains in welding and cutting areas.

6. Practice tool safety (chisels, nails, trimmers); never strike metal on metal without goggles.

7. Keep chemicals capped; store acids/alkalis separately; use splash shields.

8. Eye-safe home improvement: safety glasses for mowing, trimming, drilling, sanding.

9. Seatbelts and airbags: blunt head impacts can rupture the globe; safe driving matters.

10. Educate children: toys, darts, and projectiles can blind; set rules and provide protection.

---

When to see a doctor

• Any eye cut, puncture, or object stuck in or near the eye.

• Severe pain, sudden blurry or lost vision, or a misshapen/oval pupil.

• Fluid or tissue leaking from the eye, or the eye looks “soft” or smaller.

• A high-speed fragment exposure (metal on metal, lawn mower, trimmer).

• Nausea/vomiting after an eye hit (can signal dangerous pressure spikes).

• Chemical splash with persistent irritation.

• After any head/face trauma if the eye is red, swollen, or sight is worse.
  Do not press on the eye. Place a rigid shield and go to an emergency department with ophthalmology coverage. EyeWiki

---

What to eat and what to avoid

What to eat (support healing):

1. Protein-rich foods (fish, eggs, beans, yogurt, tofu) at each meal.

2. Citrus and berries for vitamin C (oranges, guava, kiwi, strawberries).

3. Leafy greens and orange vegetables for vitamin A and carotenoids (spinach, kale, carrots, pumpkin).

4. Nuts and seeds (almonds, walnuts, flax, chia) for healthy fats and micronutrients.

5. Whole grains and legumes for steady energy and B-vitamins.

What to limit/avoid (early recovery):

1. Alcohol (slows healing, interacts with pain meds).
2. Smoking or vaping (impairs oxygen delivery and tissue repair).
3. High-salt ultra-processed foods (worsen swelling, poor nutrition density).
4. Excessive caffeine if it worsens anxiety or sleep (rest is key).
5. NSAIDs without doctor advice (bleeding risk; ask the team first).

---

FAQs

1) Is a ruptured globe the same as a scratched eye?
No. A scratch (abrasion) is a surface injury with the eye wall still sealed. A ruptured globe is a full-thickness opening—an emergency that needs surgery.

2) Why can’t anyone press on my eye or take my eye pressure?
Any pressure can push fluid or tissue out and worsen the tear. That’s why we use a rigid shield and avoid tonometry and lid manipulation until repair. publishing.emanresearch.org

3) Why do doctors rush me to surgery, often within a day?
Earlier closure (often within 24 h) lowers the risk of severe infection (endophthalmitis) and may improve outcomes. AAO Journal

4) Will I need antibiotics?
Yes. Most centers give IV antibiotics to cover common germs, sometimes followed by eye injections in the OR if risk is high. Regimens vary by hospital and allergy profile. PMC

5) Do I always need a CT scan?
Not always, but CT without contrast is the usual first test when imaging is needed to look for fractures or foreign bodies. MRI is avoided if a metal fragment is possible. NCBI

6) What about tetanus shots?
Open, dirty wounds can carry tetanus risk. The team reviews your vaccine record and gives a booster (and sometimes TIG) by CDC guidance. CDC

7) Can I use eye drops at home before surgery?
No. Do not put in drops unless your doctor explicitly tells you—opening bottles or touching lids can push on the eye or seed infection.

8) Why are nausea medicines so important?
Retching and vomiting spike pressure inside the head and eye and can force fluid out of the globe. Antiemetics help prevent this.

9) Why can’t I eat or drink before surgery?
To keep you safe under anesthesia; a full stomach increases aspiration risk.

10) Will I see again?
Vision depends on the wound’s location, infection, retinal damage, and other complications. Some people recover useful sight; others need staged surgeries. Your surgeon will explain your specific outlook.

11) Could I lose the eye?
If the globe is unsalvageable or infected beyond control, enucleation/evisceration may be required. If the eye can be repaired, modern guidance favors repair over removal just to avoid sympathetic ophthalmia. Nature

12) How long is recovery?
Weeks to months, sometimes longer if lens or retina need later procedures. Protecting the eye and keeping follow-ups is critical.

13) What activities are safe after surgery?
Your team will set limits. In general: avoid heavy lifting, bending, straining, dusty environments, and contact sports until cleared.

14) Do supplements replace medicines?
No. Supplements support healing but do not replace antibiotics, surgery, or medical care.

15) What can I do to prevent this in the future?
Use proper eye protection at work and during hobbies. Teach children eye safety. Follow sports and fireworks rules.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 24, 2025.