Background: Blunt injuries are frequent causes of ocular trauma. Rupture of the globe without conjunctival injury following ocular contusions may be as dangerous as ruptures with opened conjunctiva, but is much more difficult to diagnose.
Patients and methods: Retrospective analysis of 13 inpatients of the University Ophthalmological Hospital in 1991-1995 with rupture of the globe but without conjunctival injury following ocular contusion. These were 5 % of all the patients with through-through injuries of the eye wall.
Results: The characteristic finding in all 13 patients has been hyposphagma, hyphema, vitreal haemorrhage and loss of visual acuity to "finger counting" or less. At the time of the first examination, in 6 of the 13 patients intraocular pressure was between 3 mm Hg and 16 mm Hg. One patient had had an initial pressure of 3 mm Hg, but at the time of surgery, the eye had a stable normalized pressure. Postoperatively three of the 13 patients attained final visual acuities between 80/200 and 140/200 after at least 6 months, the remaining patients achieved not more than 5/200.
Conclusion: In patients after blunt eye trauma rupture of the globe may occur in patients without damaging the conjunctiva and with normalised intraocular pressure. In such cases with intraocular bleeding and loss of vision it may be essential to open the conjunctiva and explore the sclera in order to be sure that there has not been a rupture of the sclera and to have the opportunity to perform pars-plana vitrectomy in time.