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A 40-year-old metal worker comes into the office complaining of pain in his right eye. He works on the factory floor and states that he is constantly exposed to metal shards. He has had a corneal abrasion in the past and the pain feels similar. He denies any medical history. On examination his pupils are reactive to light bilaterally and there is no afferent pupillary defect. There is no pain with constriction or dilation of the pupil. Extraocular muscles are intact with mild pain. The sclerae are moderately injected. Vision is 20/30 in the left eye and 20/40 in the right eye. Fluorescein examination reveals an area of clearing in the upper outer aspect of the right eye.
Which of the following is the most likely diagnosis?
A.Conjunctivitis
B.Corneal abrasion
C.Iritis
D.Ruptured globe
E.Scleritis
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The correct answer is D. 26% chose this.
This patient has the classic presentation of a ruptured globe. His history is significant for a previous corneal abrasion, which can occur when one hammers "metal on metal" as this patient does daily as an occupation. A history of ocular trauma or surgery may predispose him to globe rupture. He has a positive Seidel's test (clearing of the fluorescein), indicating a leakage of aqueous humor. Once a ruptured globe is suspected, care should be taken to protect the eye and not aggravate the injury. Intraocular pressure should not be measured, and the eye should be protected with a metal shield until the patient can be evaluated by an ophthalmologist.
A is not correct. 5% chose this.
Conjunctivitis is usually a viral or bacterial process that involves the eye. There is injection of the blood vessels with erythema but sparing of the limbus. Treatment usually consists of antibiotic drops and symptom control.
B is not correct. 41% chose this.
Corneal abrasions are a common eye injury. Most corneal abrasions are small (
