A traumatic incident that can cause blindness, desiccation of the cornea, and corneal ulceration, proptosis requires immediate attention,6 including initiation of pain medications (eg, carprofen [2.2 mg/kg PO q12h4], tramadol [2-4 mg/kg PO q8h]).
Globes should be salvaged when possible. If more than 2 extraocular muscles are avulsed, the globe should usually be removed, as proper innervation and vascular supply have been compromised. Often, patients with scleral ruptures are candidates for enucleation when the globe develops hyphema, prognosis for return to vision is grave, or the eye remains painful.6,8 Furthermore, in the author’s experience, small scleral tears may result in hyphema, requiring globe replacement; these patients will require acute pain medication for an extended period (eg, 4-6 weeks), and although the globe may become phthisical, owners often are pleased with the cosmetic result.9
Diagnostic testing (eg, menace response, dazzle reflex, pupillary light reflexes [direct and consensual], Schirmer tear testing, tonometry, fluorescein staining) is important in deciding whether the globe can be salvaged or should be removed. Patients have a grave prognosis for return of vision if they lack dazzle and consensual pupillary light reflexes and have intraocular pressures (IOPs) >25 mm Hg (ie, glaucoma).