Primary repair of an open globe

Why are we operating?

The ruptured eye is closed watertight as the first, not the final, operation: anatomy tonight, vision's verdict later.

Indication: Full-thickness injury of cornea or sclera; protected with a shield, no pressure on the eye, repair without delay.

The operation in 4 steps

1. 01Protection and assessment

   From suspicion onward: rigid shield, nothing that presses the globe, antiemetics, nil by mouth, imaging for a foreign body without MRI if metal is possible.

2. 02Examination and exploration under anaesthesia

   Under general anaesthesia the wound's full extent is defined, following scleral wounds posteriorly as far as safe exposure allows.

3. 03Watertight closure

   The cornea is closed with fine interrupted sutures restoring its landmarks first, the sclera closed working back, prolapsed uvea repositioned or minimally excised.

4. 04Antibiosis and the next operations

   Antibiotic cover against endophthalmitis, tetanus addressed, and the staged plan made: vitreoretinal surgery, lens surgery, later reconstruction as needed.

Anatomy you need

The globe's coats in order, sclera outermost: a repair closes them the way the anatomy stacks them.

What can go wrong

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.