Decision-making when your patient has an open globe injury

It is not a pretty picture. Today we have the finest tools for diagnostics and a full armamentarium of therapeutics including intraocular drugs, temporary keratoprosetheses (TKP), vitrectomy equipment and instruments; yet more and more patients find out that what determines their fate is indeed fate. Does the facility where s/he is taken keep its operationroom doors open afterhours? Even if yes, is the available staff well trained and all necessary tools accessible? In this publication I summarize my personal opinion regarding the decisions to be made for patients presenting with an open globe injury (OGI) – assuming that the facility is a 24/7 one with all the required logistics/infrastructure being optimal. This also means that the physician to make the decisions and perform the surgery is not an untrained, young resident (as unfortunately so often the case is) but a surgeon experienced in both ‘segments’ of the eye: i.e. a vitreoretinal specialist. If these criteria are not fulfilled, it may be preferable to transport/refer the patient to a different facility where conditions allow optimal treatment. Roughly half of eyes with an OGI require surgery on the posterior segment; if these pathologies cannot be addressed by the surgeon closing the wound, the delay may lead to irreversible damage.