Globe Injury Iris Prolapse Management

A sudden eye injury can be a frightening experience, especially when it involves trauma to the structure of the eye itself. These types of ocular injuries, known as globe injuries, can range from mild surface damage to severe internal disruption that threatens vision.

One rare but serious complication of globe trauma is iris prolapse, where part of the iris protrudes through a wound in the eye wall. Understanding more about both globe injuries, and this specific complication, can help patients respond quickly, reduce risk, and protect their long-term vision.

Globe injuries refer to trauma that affects the eyeball itself, particularly the outer wall of the eye, which includes the cornea and sclera. These injuries are typically classified as either open-globe or closed-globe injuries.

Open-globe injuries: Involve a full-thickness wound to the outer eye wall, such as a puncture or rupture.

Closed-globe injuries: Do not break the surface but may still cause internal damage.

Open-globe injuries are generally considered more serious because they expose the interior structures of the eye, but patients should take both types of injuries seriously and seek medical attention.

Globe injuries can vary widely depending on the force, object, and location of impact. A globe rupture is a common and severe type of open-globe injury where the outer shell of the eye gives way under blunt force. This force can cause a sudden increase in intraocular pressure (IOP), resulting in a rupture of the eyewall.

Lacerations and cuts, such as corneal lacerations, are another common type of open-globe injury. These injuries are the result of a tear or cut often caused by sharp objects like glass, metal, or fingernails.

Globe lacerations can be “penetrating injuries” which involve an entry wound into the globe without an exit. They may also be “perforating injuries” that have both an entrance and an exit wound through the eyewall.

Symptoms of globe injuries can vary depending on the severity and type of trauma. However, they often share common warning signs:

• Sudden changes in vision, including blurred or double vision.

• Eye pain which can range from mild discomfort to throbbing pain.

• Fluid leaking from the eye

• Visibly pierced eyelid

• Protruding eye tissue

In cases of more severe trauma, patients may also develop internal bleeding such as a vitreous hemorrhage, which can cause sudden vision loss, floaters, or dark shadows in the visual field.

Globe injuries can result from blunt force, sharp objects, projectiles, or high-speed accidents. They often involve other complications like bleeding, infection, or tissue damage inside the eye.

Because the eye is such a delicate structure, even relatively small injuries can lead to significant vision problems if patients don’t treat them promptly. Recognizing the signs of a globe injury and seeking immediate care is essential to preserving sight and preventing long-term damage.

Diagnosing a globe injury begins with a thorough medical history and physical examination. Eye care providers may ask how the injury occurred, what object or force was involved, and what symptoms the patient has experienced.

A careful external inspection of the eye is followed by diagnostic testing. The type of tests performed will depend on the severity and type of injury.

Visual acuity test: Performed first to assess baseline vision.

Slit lamp exam: To identify lacerations, foreign bodies, or signs of iris prolapse.

Seidel test: May be performed if there is concern about fluid leakage from the eye.

In more complex or severe injuries, Computer topography (CT) and diagnostic imaging may be ordered. Providers may also use an Ocular Trauma Score (OTS) to predict the likelihood of visual recovery.

Treatment depends on the type and severity of the trauma. Open-globe injuries typically require urgent surgery to close the wound, remove any intraocular foreign bodies, and address complications like iris prolapse or lens damage. Patients are often given antibiotics to prevent infection and medications to reduce inflammation and eye pressure.

Closed-globe injuries may be managed with medications and close monitoring, but serious cases can also require surgery. After treatment, patients are advised to protect the eye, avoid strenuous activity, and attend follow-up visits to monitor healing and vision.

Some patients may require additional surgeries to manage complications such as glaucoma, cataract formation, or retinal detachment.

Iris prolapse is a condition that occurs when part of the iris tissue (colored ring in the eye) pushes through a wound in the outer wall of the eye. This typically happens after a penetrating globe injury, where the structure of the eye is disrupted and intraocular pressure forces the iris outward through the opening. The area where the iris connects to the eye, known as the iris root, is particularly vulnerable in traumatic injuries.

Iris prolapse is considered a medical emergency. Beyond the visible tissue displacement, it often signals deeper structural damage and increases the risk of infection, inflammation, and permanent vision loss.

The most common cause of iris prolapse is a penetrating injury to the eye, where a sharp object punctures the outer surface and creates an opening in the cornea or sclera. When this occurs, the pressure inside the eye may push the iris through the wound.

Iris prolapse can also occur as a complication of eye surgery, particularly after procedures like cataract surgery or corneal transplant. In some cases, surgical wounds may not heal properly or may reopen with minimal force.

Early diagnosis is vital to preserve vision and prevent infection or other complications. Similar to other globe injuries, the eye doctor will typically begin the diagnosis by asking patient’s questions about their history.

From there they will conduct an eye exam to look for visible signs of trauma. Like other globe injuries additional test may run depending on the severity of the injury:

• Slit-Lamp Examination: To assess the extent of the wound and prolapsed tissue

• Seidel Test - To detect aqueous humor leakage from the eye

• CT imagining - Used when intraocular foreign bodies or orbital fractures are suspected

Management of iris prolapse depends on the extent of the injury and the overall condition of the eye. In nearly all cases, urgent surgical repair is required.

Treatment may involve:

• Surgical repositioning of the iris
  

• Partial excision (iridectomy) if the iris is damaged or necrotic
  

• Wound closure using sutures to restore globe integrity
  

• Removal of any foreign bodies or contaminated tissue
  

Patients may also receive medications to reduce inflammation and prevent infection. If vision changes persist after healing, further procedures may be considered.

Recovery from surgery typically involves:

• Using prescribed antibiotic and anti-inflammatory eye drops
  

• Wearing an eye shield or patch to protect the area
  

• Avoiding strenuous activities, eye rubbing, or exposure to irritants
  

• Regular follow-up appointments to monitor healing and pressure levels

In some cases, patients may experience residual issues such as irregular pupils, visual disturbances, or glaucoma. With a timely intervention, most patients will retain vision in the injured eye.

Preventing ocular trauma is the most effective way for patients to reduce the risk of globe injuries and complications such as iris prolapse. Wearing protective eyewear is essential during activities like sports, construction work, or any task involving sharp tools or flying debris.

Patients should also handle objects such as knives, scissors, and machinery with care, and follow proper safety protocols to minimize the chance of injury.

Creating a safe environment at work and home can also help prevent accidents. Additionally, patients should address existing eye conditions promptly and following advice given by their eye doctor.