Visual Prognosis and Treatment of Ruptured Eyes after Blunt Globe Rupture

Abstract

Despite advanced technology, ruptured globes are still associated with limited visual prognosis. The aim of this retrospective case series is to analyse the surgical approach to globe ruptures and identify factors influencing visual outcomes. The surgical records of the Department of Ophthalmology from 2000 to 2021 were electronically evaluated using the keyword “globe rupture”. This led to 390 results, which were manually reviewed. Ultimately, 172 globe ruptures resulting from blunt globe trauma were identified. Several factors influencing visual prognosis were identified. Improved visual outcomes were associated with younger age and better initial visual acuity. Work accidents were linked to worse visual outcomes. The Ocular Trauma Score (OTS) was positively associated with visual prognosis. Other variables such as gender and delayed primary or secondary care did not show statistically significant correlations with visual outcomes but might still be relevant due to the limited case numbers. The results of this retrospective study confirm the validity of the OTS score for estimating visual prognosis and identify younger age at the time of trauma and the work setting as statistically significant negative factors. While some factors, such as early primary or secondary care and less extensive injury, were correlated with better visual outcomes, they did not achieve statistical significance, which may be due to the limited scope of the study. A multicentric analysis is therefore recommended to provide a larger sample size and more robust data.

Zusammenfassung

Trotz fortschrittlicher Operationstechniken ist die Visusprognose bei Bulbusberstungen weiterhin limitiert. Ziel dieser retrospektiven Fallserie ist es, das chirurgische Vorgehen bei Bulbusberstungen zu analysieren und Einflussfaktoren auf das Visusergebnis zu identifizieren. Die Operationsprotokolle der Augenklinik von 2000 bis 2021 wurden elektronisch mit dem Stichwort „Bulbusberstung“ ausgewertet. Dies führte zu 390 Ergebnissen, die manuell überprüft wurden. Es wurden 172 Bulbusberstungen nach stumpfem Bulbustrauma identifiziert. Es konnten mehrere Faktoren mit Einfluss auf die Visusprognose identifiziert werden. Bessere Visusergebnisse waren mit jüngerem Alter und besserer initialer Sehschärfe assoziiert. Arbeitsunfälle waren mit schlechteren visuellen Ergebnissen verbunden. Der Ocular Trauma Score (OTS) war positiv mit der Visusprognose assoziiert. Andere Variablen wie Geschlecht und verzögerte Primär- oder Sekundärversorgung zeigten keine statistisch signifikanten Korrelationen mit den visuellen Ergebnissen, könnten aber aufgrund der begrenzten Fallzahlen dennoch relevant sein. Die Ergebnisse dieser retrospektiven Studie bestätigen die Validität des OTS-Scores zur Einschätzung der Visusprognose und identifizieren höheres Alter zum Zeitpunkt des Traumas sowie Arbeitsunfälle als statistisch signifikante negative Faktoren. Während einige Faktoren, wie eine frühzeitige Primär- oder Sekundärversorgung und ein geringeres Verletzungsausmaß, mit besseren visuellen Ergebnissen korrelierten, erreichten sie keine statistische Signifikanz, was auf die begrenzte Fallzahl zurückzuführen sein könnte. Eine multizentrische Analyse wird daher empfohlen, um eine größere Stichprobengröße und robustere Daten zu liefern.

Conclusion Box

Already known:

• Open globe injuries, particularly blunt ruptures, have a poor visual prognosis.

• The Ocular Trauma Score (OTS) is a widely used and validated tool for predicting visual outcomes after open globe injuries.

• Factors like initial visual acuity and the extent of posterior segment damage are known to influence the final prognosis.

Newly described:

• This large, single-center series confirms the prognostic value of the OTS specifically for blunt globe ruptures in a modern cohort, noting that actual outcomes may be better than originally predicted by the OTS.

• Work-related accidents were identified as an independent statistically significant negative prognostic factor for visual outcome in blunt globe ruptures.

• In this cohort, a delay in primary or secondary surgical intervention did not have a statistically significant negative impact on the final outcome, suggesting that surgical planning and team readiness may take precedence over immediate intervention in some cases.

Keywords

trauma - open globe injury - primary and secondary surgery

Schlüsselwörter

Trauma - Bulbusberstung - Primär- und Sekundärversorgung

Publication History

Received: 09 October 2025

Accepted: 24 November 2025

Article published online:
26 February 2026

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