OR / Prep · Ophthalmic Surgery · open
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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
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.
Why: Everything before theatre exists to prevent squeezing the eye's contents out through the wound: no pressure, no vomiting against a closed lid, no examination heroics. The exam happens properly under anaesthesia.
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.
Why: Wounds run further than they look, and the posterior extent decides the repair. The exploration is gentle for the same reason as everything else: the globe's contents are held in by nothing but the plan.
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.
Why: Watertight is the standard because the eye is a pressure vessel: it needs its volume and tone back to survive. Landmarks first (the limbus especially) rebuilds the geometry the optics depend on.
04Antibiosis and the next operations
Antibiotic cover against endophthalmitis, tetanus addressed, and the staged plan made: vitreoretinal surgery, lens surgery, later reconstruction as needed.
Why: Primary repair restores the container, rarely the vision; the retina and lens get their own operations once the eye is closed and quiet. Sympathetic ophthalmia, the injured eye's threat to its healthy partner, joins the counselling.
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
Watch it done
Open globe repair from a retina surgeon
A Mayo lecture on ocular trauma and the primary repair.
Source: Mayo Clinic · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.