Park D, Park JS, Kang HY, Lew H. Spontaneous eyeball rupture in a 94-year-old patient.

J Korean Ophthalmol
Soc 2011;52:734-7

Occurrence of rupture of the eye without prior trauma is very rare. It is rare and has

been reported several times in foreign countries. Chronic glaucoma and

inflammatory necrosis of choroidal vessels leading to suprachoroidal discharge.

There is an example of bleeding and perforation. 1-4 Upper choroidal hemorrhage

caused by rupture of choroidal or posterior ciliary vessels. Whether the cause of the

cleft palate is due to superior choroidal hemorrhage, glaucoma or The antecedent

relationship to whether it is due to inflammatory necrosis of the cornea is unclear.

What these cases have in common is advanced age and chronic glaucoma.

Acute pain with severe pain in patients with a history of

It was caused by an excessive amount of bleeding. this

Risk factors for such spontaneous suprachoroidal hemorrhage include old age and

arteriosclerosis.

such as psoriasis, vascular disease, glaucoma, corneal ulcer or corneal

staphylococcus

Preceding factors that thin the outer wall of the eyeball and the like are known.

2 now

Until now, there has been no domestic report of spontaneous ocular rupture, and the

authors

A case of ocular rupture without trauma in an elderly female patient

Since I experienced a case, I would like to report it together with a literature review.

A 94-year-old female patient visited our hospital complaining of sudden left eye pain

and accompanying ocular hemorrhage (Fig. 1). patient 20 years ago

treatment

Cataract eye drops (Clid®), Samcheondang Pharmaceutical, Seoul, Korea) and

artificial tears(Himeran®, Samcheondang Pharmaceutical) was prescribed and

instilled three times a day. The intraocular pressure was unknown at the private

ophthalmologist 15 days before the most recent visit, but left Ocular overmature

cataract findings and shallow anterior chamber, enlarged and light-sensitive . Left

eye occlusion with unresponsive pupils and severe corneal edema Each was

diagnosed with glaucoma. The patient is in severe pain and cannot cooperate. It was

said that the measurement of intraocular pressure was not possible, and the clinical

picture was overdone.A Study on Secondary Acute Angle-Close Glaucoma Induced by Cataract She was

transferred to our hospital for further examination and treatment.

At the time of admission to our hospital, the patient had a special systemic disease

despite his advanced age. There was no specific finding, and only the usual

gastrointestinal medicine was used intermittently said to take it. A blood test with a

high glucose level of 214. There were no abnormal findings except for the serum test

for autoimmune disease. life was not enforced. The patient's right eye visual acuity is

a safe index and left My eyesight was wide-angle. Subconjunctival hemorrhage seen

under slit lamp microscopy. Severe conjunctival edema accompanied by thrombosis

in the anterior chamber was observed. Extraocular prolapse of the iris to the inferior

border of the cornea and hypermature cataract exit was seen. On orbital computed

tomography, the eyeball is posteriorly. The system was well maintained, but the

shape of the anterior segment was irregular. The inside was full of hemorrhage (Fig.

2). Severe pain and eye

contents and upper ocular

intraocularly under local anesthesia (postoral anesthesia) as an emergency

considering the axis

Ablation was performed. According to surgery, from 3 to 9 o'clock

The 180° corneal border was thinned, prolapse of ocular contents and

uveal thrombosis was observed (Fig. 3). remove eye contents A high bacterial

culture test was performed, and the inner wall of the sclera was treated with 90%

alcohol. After wiping thoroughly with wool, perfusion with warm physiological saline

After hemostasis, a 360° incision is made in the posterior equator of the sclera.

hydroxyapatite 18 mm (IOI, Sandiego, CA, USA) ocular

A filler was inserted.

Choroidal hemorrhage in the ocular contents excised as a result of histological

examination

The blood clot and cornea caused by purulent inflammation were observed.

There were no findings of malignant tumor such as melanoma. bacterial culture

As a result of the test, Gram-negative bacilli belong to the family Enterobacteriaceae.

discussion

Eye ruptures are most often caused by trauma and treatment is

Depending on the severity, simple corneal or scleral suturing may be performed or

Sieve resection and enucleation if the shape of the eye cannot be maintained

Alternatively, ocular contents removal may be performed.

Reports so far include Haugen and Kjeka5

rupture of the eyeball in the sclera of the attachment of the superior rectus muscle,

which became extremely thin,

There have been reports of ocular rupture during intraocular triamcinolone injection.

It can also occur during retinal detachment surgery.

7 of these surgeries

Ocular rupture occurs in patients with collagen disease or outside

A history of abnormalities, high blood pressure, and high myopia are known risk

factors.

there is.

8-11 In particular, local scleromalacia is associated with rheumatoid arthritis and

It is observed in the same rheumatic disease, and these findings are observed

When surgery requires special attention.

12 With endogenous endophthalmitis

necrotic perforation of the cornea or sclera due to

Cases caused by Klebsiella and reported by Serratia marcescens. It was

expensive.13-15 Terrien suffered a ruptured eye due to trauma in Korea.

Scleral rupture in patients with limbic degeneration and retinopathy of prematurity.

Eye rupture rarely occurs in the absence of an antecedent trauma.

It was reported several times abroad in the late 1890s or early 1900s.

it has been hard Rutherford1

right eye in a broken glass bottle 5 years ago

Chronic Glaucoma

Stomach due to vomiting after spontaneous rupture of the eyeball with passage

The expansion of the eye causes an increase in intraocular pressure, which prevents

prolapse of the ocular contents.

I have experienced the case brought. Ophir et al4

is chronic glaucoma

A 90-year-old male patient treated with corneal perforation

A significant amount of suprachoroidal hemorrhage was reported. This spontaneous

suprachoroidal

Bleeding has been reported rarely before, but Winslow et al2

silver

Risk factors include age over 60, arteriosclerosis, vascular disease, rust

Thinning of the outer wall of the eye, such as viscera, corneal ulcers, or corneal

vines

suggested antecedent factors.

As far as the authors know, there is no such spontaneous eye rupture in Korea.

Nothing has been reported yet. In this case, the history of trauma

There was no case at all, and a physical examination performed by a private

ophthalmologist 2 weeks before the visit

The fact that the examination did not find any findings suggestive of trauma

and cataract eye drops without regular observation for several years at the age of 94

It is noteworthy that the eye drops were continuously instilled three times a day.

summer solstice

It is not known whether the patient suffered from chronic glaucoma. that
In the preoperative examination, serological tests for autoimmune diseases were

other comorbid autoimmune diseases or collagen diseases

It was not confirmed whether The patient in this case was 2 months after surgery

Although follow-up was observed without any abnormalities until the patient's

personal

No follow-up was done after normal

In this case, gram-negative bacilli were found in bacterial culture.

Morganella morganii was detected, which is a β-lactamase

Rarely causes keratitis and surgery as a bacterium sensitive only to inhibitors

It has been reported to cause posterior endophthalmitis.

18,19 Also the cornea

As a result of histological examination, purulent inflammatory findings were

observed.

Corneal thinning due to morganella morganii infection

Due to diseased glaucoma, intraocular pressure is continuously elevated, resulting in

corneal perforation and

Accompanied by suprachoroidal hemorrhage, resulting in extensive ocular paresis

I think the fever has progressed. In addition, eye drops that have been used for

years

The preservative (Ethyl parahydroxybenzoa) contained in corneal epithelium,

Causes cytotoxicity to endothelial and conjunctival tissues and

May have caused ocular rupture with thinning of the cornea and sclera

You will have to consider your abilities.

20-22
In this case, bacterial corneal keratitis and

Secondary glaucoma can cause superior choroidal hemorrhage due to eyeball

rupture.

knew that it could be In addition, long-term use of eye drops with preservatives

Use can also act as a cause of thinning of the cornea, so this

Ophthalmologically regular follow-up to prevent these complications

I think you need to observe. In addition, patients undergoing cataract surgery

Acute closed-angle glaucoma due to overmature cataract

Considering the loss in addition to these aforementioned risk factors,

Appropriate to prevent the direct cause of the eye rupture.

I think it is important to consider cataract surgery at the same time.

do.