1 

Disclai

SEE A

DESpatien

This Cinjury

Red F

Trguco

Incpr

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Cliregcar

Peri aManaInjury

imer

ALSO: HypInjTr

CRIPTIOnts with pe

CPG is desy and ruptu

Flags:

rauma patiuidelines somplication

creased risresentation

RU fellow tjury, or if itedico-lega

nical handgistrars andre.

and Poagemeny (PEI)

 Peri‐ 

phaema, Ejury and Rrauma

ON – optioenetrating e

signed for red globe

ents can hhould be c

ns.

sk of endon of repair,

to be alertet is unclearal or workca

over of pad AO on pu

ost Opent of Peand R

and post‐op

Endophthaluptured Gl

ns for peri eye injury (

use AFTECPG

have a varieconsidered

phthalmitislarge wou

ed if: PEI isr as to wheare issues

tients betwublic holida

erative enetratupture

perative care

lmitis, Aculobe, Proc

and post-(PEI) or ru

R the Acut

ed and comon a case

s with retaind, contam

s behind mether poste

ween surgiays and we

ting Eyed Glob

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te Manageedure for M

operative mptured glo

te Manage

mplicated e by case b

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muscle inseerior segme

cal team, weekends is

ye be

uptured glob

ement of PManageme

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ement of pe

clinical coubasis. Mon

ocular foreigury

ertion, signent involve

ward teams critical for

be CPG  v2 1

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ts who having consul

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(list avgement, Gen-call consholidays.

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surgical eending bey

mited peritere extent

0 degree pwhere globecialty clinic

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nd ED/ Acu

uma admint within 24

team whn the ward

o ED consic from theAOS clinicfacilitate cory, the AO

s with clinic noted abo

ve had reptant while ged to see

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vailable theneric Repsultants ar

or concer

ic involvembe CPG

PAIR: CON

exploratioyond the lim

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peritomy: gbe rupture sc involvem

and post‐op

admitted uonday-Fridatrar, Senioute Ophtha

issions (su4 hours of o will req. These pa

sultant roste ward to c. They muonsultant rS consulta

cal concernove, to revi

pair of PEIan inpatie

e and follow

eekends, pconcerns whrough swports, selee encoura

ns must be

ment : see

NSIDERAT

on requiredmbus.

nd extendiis easily de

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ment re: VR

perative care

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urgical andf admissionuest that atients sho

tered, thenbe seen b

ust be accreview andant will be a

ns, either tiew the pa

or ruptureent. Eye rew up the pa

patient willwill be escwitchboardect ‘on calaged to se

e discusse

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ing beyondelineated

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bedcard of rd team cogistrar (botervice (AO

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ould not be

n ambulatoby consultcompaniedd manage ask to revie

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be seen calated to td or on l’, then ‘froe new adm

ed with a se

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uptured glob

a subspeconsisting ofth designa

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ory patientsant at the

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ew the pat

AOS consu

may also bnvolved in ng admissi

by either tthe Gener

intranet om’ and ‘tmissions o

enior eye r

of penetra

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terior segme injury no

be CPG  v2 1

cialty clinicf Ward Eye

ated by ‘wtant as nee

uld be seeill be identonsultant sED for con

s may be te beginningmber of thhe patient tient on the

ultant shou

be followed patient’s ion.

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ment involvoted. (See

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e ward.

uld be

d by the surgery

post-op nsultant Doctors General nds and

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vement

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ery attemptexcision if

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all breach:

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nificant ca

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nsider IOL metry avai

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ce: options

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8/0 Nylon

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eign body

mber (AC): hours, Gebe used in

ment: VRU

t should bef the prolapd attempts

agement

ma: do prim

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: no lens m

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or signs of i

psule brea

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phakic with

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small simpeneral Eye these cas

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e made to psed maters to reposit

mary closu

ding to trau

material in A

ens alone

inflammati

ach: lens m

e time of s

h plan to pl

at the time mal damag

perative care

ple AC IOF Consultan

ses (see an

ge (see ab

reposit uverial has bet the tissue

ure. LEAVE

umatic hyp

AC:

on indicati

material in A

urgery

ace a seco

of primaryge to corne

 of PEI and r

FB to be mnt on-call antibiotic us

ove, subsp

eal tissue. en expose

e leads to f

E hyphaem

phaema gu

ng need fo

AC:

ondary IOL

y repair if thea, and no

uptured glob

anaged byafter hours)e, see belo

pecialty clin

Consider ed for longeurther dam

ma in major

uidelines

or lens surg

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he other eyon-organic

be CPG  v2 1

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nic involve

uveal tissuer than 48

mage

rity of case

gery

stage

ye is aphainjury.

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Intr

o

o

Intr

o

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racameral

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Amsus

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NOTE: if Discussioinjection fellow mahours co

PC6.3 Intraency Depa

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see Acut

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Children

Cipup tDepthe ther250tabl

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ications a

EIs involvhalmitis

olin 1mg/0

njection (if

r in cases elayed preuption.

ncomycin 1

photericin pected fun

xamethaso

suspect eon with Vis outside

ay be askentact AO o

avitreal Injeartment

Procedure

tival

ve to intrac

olin 100mg100mg/1.0m

tibiotics

e Manage

halmitis pro

ult

al ciprofloxa

rofloxacin to a maximpartment (Dtablets wit

re is no co0mg, 500mlets are sco

and post‐op

nd dosage

ing the

0.1ml

f indicated

with high esentation

1mg/0.1 m

B 5microgngal infectio

one 0.4mg/

endophthalVRU shoul the area

ed to attenor senior re

ection Proc

for the Tr

cameral Ce

g/1.0 mL mL)

ment of PE

ophylaxis:

acin 500-7

(risk of advmum 500mgDrug Informth a strongmmercial o

mg and 750ored) and

perative care

es

anterior

d)

risk of en(>24hrs),

ml, Ceftazid

g/0.1mL or on, (withho

/0.1mL (wi

mitis at preld be conof expertisd theatre.

egistrar on

cedure for

reatment o

ephazolin.

(Dilute 1g

EI and Rup

750 mg BD

verse jointg bd for 7-mation Ceng flavouredoral mixtur

0mg strengthen quart

 of PEI and r

segment,

ndophthalmsoil /orga

dime 2mg/

Voriconazold until VR

thhold unti

esentationnsidered inse of the o If the VRcall.

the Treatm

of Endoph

in 10mL

ptured Glo

for 7-10 d

t effect is lo-10days. Nntre) recom

d agent sucre availablegths and thtered if nee

uptured glob

AC IOF

mitis: suspenic materi

/0.1 ml

zole 100micRU consult

il VRU con

, VRU shon cases woperating cU fellow is

ment of En

thalmitis in

of normal

be CPG

days.

ow) dose: 1Note: The Rmmend cruch as chocoe. The tablese can beeded.

be CPG  v2 1

FB, no s

ected or ral contam

crog/0.1mted)

nsulted)

ould be conwhere intrclinician th

s unavailab

ndophthalm

n the Eme

l saline to

10mg/kg sRCH Phar

ushing andolate toppilets come ie halved (a

9092017 

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retained mination,

L in

nsulted. ravitreal he VRU ble after

mitis –

ergency

give a

stat oral rmacy d mixing ing as in as the

5 

Top

o

POST

Routin

Hist

Exa

o

o

o

o

Complfellow a

Infto

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Hy

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o

o

ElPrCoco

 

pical antib

as per ind

OPERATI

ne post-op

tory: asses

amination

General:

Visual Ac

Slit lamp

Wo(locwou

Cor

Con

Ant

Pup

Len

Fundus egently ov

lications: and/or con

flammationpical stero

ndophthalmRU for opin

yphaema:

Wound leakrough leak

For mild/no contra

Brisk leawound.

evated intrrostaglandonsider oraonsider Gla

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biotics

dividual ca

VE MANA

perative as

ss for chan

periocular

cuity (VA) w

exam:

und: assescation/burieund leak on

rnea: clarity

njunctiva: c

erior cham

pil: shape,

ns: capsule

exam or B ver closed

monitor fonsultant

n: trauma rids once in

mitis: signsnion and fo

see CPG h

: Seidel pok (slow or b

slow leak caindication

ak: re-sutu

raocular prin analogual Diamox aucoma co

and post‐op

ase

AGEMENT

ssessmen

nge in visio

r swelling/e

with/withou

ss repaireded/unburiedn ALL repa

y, oedema

chemosis,

mber (AC):

sphincter t

e breach (a

scan if pooeyelid.

r the follow

related, lennfection ru

s - increaseor tap/injec

hyphaema

ositive, AC brisk), wou

consider: Ds, bandage

uring likely

ressure: roues may incif no contra

onsult.

perative care

nt

on, pain, na

ecchymosi

ut pinhole,

d lacerationd), bandagairs even i

a, Desceme

haemorrha

depth and

tear, iridod

anterior/pos

or fundus v

wing and d

ns related oled out.

ed pain, dect if indicate

a

may be deund integrit

Diamox 25e contact l

y, consider

outine topiccrease inflaindication

 of PEI and r

ausea/vom

s, repair of

IOP, pupil

n/rupture inge contact f IOP norm

et’s folds

age, suture

cells, hyp

dialysis, mi

sterior), ca

view. Note

iscuss with

or infection

ecrease vised

eep with noy/sutures,

50 mg po tdens.

r corneal

cal glaucomammation

n. If medica

uptured glob

miting.

f skin/lid la

ls (RAPD)

ntegrity, sulens. Seid

mal and AC

es

haema, fib

ssing iris s

ataractous,

e: if B scan

h senior ey

n. Increase

sion, hypop

ormal IOP.AC depth.

ds if not su

referral if

ma medica. Avoid Piloal manage

be CPG  v2 1

aceration, m

utures el test: che

C deep

brin, hypop

segment

, aphakic

n needed, p

ye registra

e frequency

pyon. Cont

. Assess fl.

ulphur aller

complex

ations. ocarpine.

ement inad

9092017 

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pyon

perform

r,

y of

tact

ow

rgic and

corneal

equate

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CaDeimyesu

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For pat

S

S

S

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GP

ataract: aselay surge

mminent coears old) wubsequent

osterior traonsultation

RN TO TH

tients need

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See PatientEEOP.

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HARGE PL

scharge ponsultant o

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Options f

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AOS

Priv

ear writtenppointment

contact th

Work cover

onsider the

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sess statury if possibnsider refe

will need provisual reha

auma/retain

EATRE

ding surge

r Trauma T

t transport

Acute manaate theatres coordina

LANNING

lanning anr specialty

discharge m

for follow u

bspecialty c

S clinic if fcondary len

S clinic for

vate specia

n instructiots, limitatio

he hospital

or medical

e need for

ge summar

and post‐op

s of capsuble to allowerral to SOompt surgeabilitation.

ned IOFB:

ry with Sur

Theatre allo

procedure

agement ofe allocationator after ho

nd follow-upy clinic cons

medication

up:

clinic (on a

urther surgns implant)

r acute ma

alist

ns provideon to physic

or present

l certificate

counsellin

ry/update t

perative care

ule, lens opw inflammaOS. Note: c

ery for visu

gentle B s

rgical Opht

ocation list

e for patien

f penetratin (Elective ours)

p to be arrsultant/fell

ns (system

approval by

gery anticip)

nagement

ed to patiencal activityt to the em

e to be com

g if require

to be comp

 of PEI and r

pacity, andation to setthildren at r

ually signifi

scan over c

thalmology

t in ED and

nts needing

ng eye injusurgery A

ranged in cow.

ic and topi

y fellow or

pated (i.e.

nt regardiny and/or womergency d

mpleted be

ed.

pleted.

uptured glob

associatetle. If catarrisk of ambicant catar

closed lids.

y Service (

d on intrane

g to be tran

ury for procccess man

consultation

cal)

consultant

cataract ex

ng medicatork and indepartment

fore discha

be CPG  v2 1

ed inflammaract surgerblyopia (agracts and

. VRU

(SOS):

et

nsported to

cedure for nager in ho

n with ED/

t)

xtraction,

ions, followdications fot.

arge.

9092017 

ation. ry ge < 8

o

contact ours,

/AOS

w up or them

7 

OUT-P

History

Cha

Pai

Com

Doc

Examin

VA:

RAP

IOP

Gon

Slit cell

Dila

Manag

Ant

o

Topnatu

To

o

Sut

o

o

o

o

PATIENT F

y:

ange in vis

n

mpliance w

cument cu

nation:

: pinhole, r

PD, colour

P

nioscopy if

lamp exams/flare/RBC

ated fundus

gement:

tibiotics

Systemic

pical antibiure of the

pical stero

Taper as

ture remov

Corneal s

Conjunct

Loose su

Topical aChloramp

 Peri‐ 

FOLLOW U

sion

with medica

rrent medi

refraction w

r plates if O

f angle rec

mination: dC, hyphae

s exam

c antibiotics

iotics can injury.

oids

s inflammat

val

sutures ma

tival suture

utures shou

antibiotic cophenicol td

and post‐op

UP

ation and r

cations

when stabl

ON dysfunc

ession like

document wma (height

s can usua

usually be

tion settles

ay need to

es can usua

uld be rem

overage fods for 3/7

perative care

recommen

e

ction

ely

wound, scat in mm)

ally be stop

e stopped

s

remain in

ally be rem

oved

ollowing co

 of PEI and r

dations

ar, sutures

pped after

after 1-2

place for 3

moved afte

rneal sutur

uptured glob

s, oedema,

7-10 days

2 weeks d

3 months

r 7-10 day

re removal

be CPG  v2 1

AC depth

depending

ys

l, eg,

9092017 

,

on the

8 

Com

o

o

o

o

o

o

Fur

o

o

o

o

o

mplications

Hyphaem

Prolonge

Con

Con

Con

Elevated

Rouana

Oradrop

Gla

Corneal a

Pen

May

RefOpt

Cataract

Ref

Not

If unexpla

Ref

Mac

Opt

rther follow

AOS for a

SOS for c

Subspec

Australiacorrectio

Private o

 Peri‐ 

s

ma: see CP

ed inflamm

nsider incre

nsider risk

nsider risk

IOP

utine topicaalogues ma

al acetazolaps when p

ucoma op

astigmatism

ntacam

y require s

fer to Contatometry

ferral to SO

te urgency

ained or un

fractive cau

cular patho

tic nerve dy

w up

acute issu

cataract or

ialty clinic

n College n, long term

ophthalmolo

and post‐op

PG, Hypha

ation

easing top

of infection

of missed

al glaucomay increase

amide as nossible

inion if IOP

m

pectacles,

act lens cli

OS or priva

of catarac

nexpected

use/astigm

ology: OCT

ysfunction

es

r other gen

with appro

of Optomm monitori

ogist

perative care

aema mana

ical steroid

n

foreign bo

ma medicate inflamma

needed if n

P uncontro

, hard cont

inic, private

ate ophthal

ct surgery i

visual loss

matism

T

: colour pla

neral ocula

oval from fe

metry (ACOing for glau

 of PEI and r

agement

d dose, add

ody, gonios

tions (avoidation)

no contrain

olled with a

tact lens

e optometr

lmologist if

n children

s consider

ates, HVF,

ar surgery

ellow or co

O) or privatucoma in p

uptured glob

d Hycor oi

scopy to ex

d pilocarpin

ndication. G

bove meas

rist, Austra

f visually s

at risk of a

:

nerve fibe

onsultant

te optomepatients at

be CPG  v2 1

ntment at

xamine ang

ne; prostag

Gradually w

sures

alian Colleg

ignificant

amblyopia

er layer ana

etrist for rerisk

9092017 

night

gle

glandin

wean

ge of

alysis

efractive

 

9 

AUDIT

There is aand Oculaudit crite

Betts cla

Classifica

Kuhn F, MterminologAmerica. 2

an ongoingar Traumaeria (clinica

assificatio

ation of Inj

Morris R, Wgy and clas2002;15(2)

 Peri‐ and 

g audit of ta Score (OTal audit too

on

jury (Birm

Witherspoonssification o):139-43.

post‐operat

rauma patTS) on day

ol) by ward

mingham E

n CD. Birmof mechan

tive care of P

tients. Wary one of ad

d HMO.

Eye Traum

mingham Eynical eye in

PEI and ruptu

rd team to dmission. D

ma Termino

ye Traumanjuries. Oph

ured globe C

determine Data to be

ology – BE

a Terminolohthalmolog

CPG  v2 1909

Betts Clascollected

ETT) Pleas

ogy (BETTgy Clinics o

2017 

ssification as per

se circle:

T): of North

 

100 

Ocular traParamete

Rupture of

Afferent pudefect

Endophtha

Retinal de

Perforating

Initial visio

Total scorDo not counable to any categ

OTS categ

<45

45 to 65

66 to 80

81 to 91

92 to 100

Conversiovisual acu

Sum of raw points

0-44

45-65

66-80

81-91

92-100

auma scorers

f the globe

upillary

almitis

etachment

g injury

on

re omplete if

assess gory

gory

Total

on of raw poity in five c

s OTS

1

2

3

4

5

 Peri‐ and 

re (OTS) Findin

e absen

prese

absen

prese

absen

prese

absen

prese

absen

prese

Better

20/50

19/20

Light hand

No lig

score

oints into acategories

No perc

7

2

post‐operat

ngs

nt

nt

nt

nt

nt

nt

nt

nt

nt

nt

r than 20/4

to 20/200

0 to 1/100

perceptionmotion

ht percept

an OTS ca

light ception

Lph

74%

27%

2%

1%

0%

tive care of P

40

n or

tion

ategory and

Light perceptionhand motio

15%

26%

11%

2%

1%

PEI and ruptu

Points

0

-23

0

-10

0

-17

0

-11

0

-14

100

90

80

70

60

OT

d calculatin

/ on

1/200 19/200

7%

18%

15%

3%

1%

ured globe C

U

3

0

7

4

0

TS catego

1

2

3

4

5

ng the likel

– 0

20/20/

%

%

%

%

%

CPG  v2 1909

Unable to a

ory

ihood of th

/200 – /50

3%

15%

31%

22%

5%

2017 

assess

he final

≥20/40

1%

15%

41%

73%

94%

 

111 

REFERE

Birminghaeye injurie

The Ocula

Post-traum

Controvers(2013) 33:

1. Open

2. Post-

3. ProphrandoOphth

AUTHOR

Anton vanGroup

REVIEW

19/09/202

NCES:

m Eye Traes, Ophtha

ar Trauma

matic Infect

sies in ocu:435-445

n Globe Ma

-traumatic

hylaxis of aomized clinhalmology.

RS:

Heerden,

DATE:

2

 Peri‐ and 

auma Termlmol Clin N

Score (OT

tious Endo

ular trauma

anagemen

Endophtha

acute postnical trial of. 2007 Apr

Kristen W

post‐operat

minology (BN Am 15 (2

TS), Ophtha

ophthalmiti

a classifica

t, Compr O

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