JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2011.52.6.734 jkos-52-734 Original Article Spontaneous Eyeball Rupture in a 94-Year-Old Patient ParkDae Il MD 1 ParkJong Seo MD 1 KangHae Youn MD 2 LewHelen MD 1 Department of Ophthalmology, Bundang CHA Hospital, CHA University, Seongnam, Korea Department of Pathology, Bundang CHA Hospital, CHA University, Seongnam, Korea Address reprint requests to Helen Lew, MD, Department of Ophthalmology, Bundang CHA Hospital #351 Yatap-dong, Bundang-gu, Seongnam 463-712, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333, E-mail: eye@cha.ac.kr 08 2011 31 08 2011 52 6 734 737 22072010 27012011 12042011 Copyright © 2011 Korean Ophthalmological Society 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To report a case of spontaneous eye ball rupture without trauma in a 94-year-old patient.

 Case summary

A 94-year-old female patient diagnosed with cataract in both eyes 20 years was referred to this ophthalmologic department for treatment consultation of a painful left eye with spontaneous bleeding. She has used anti-cataract eye drops and artificial tears three times a day for several years without consulting a doctor. Fifteen days prior to presentation, the patient suffered severe left eyeball pain and headache and was diagnosed with acute angle-closure glaucoma secondary to hypermature cataract. She underwnet eviceration after ocular examination and systemic evaluation. Surgical findings included a thin cornea at the inferior limbus and protruding intraocular tissues. Additionally, the eyeball was filled with a blood clot from a choroidal hemorrhage. Morganella morganii were grown in a bacterial swap culture, and a corneal biopsy revealed suppurative inflammation.

 Conclusions

In old age, a thin corneal limbus due to infection and complicated acute angle-closure glaucoma can cause massive suprachoroidal hemorrhage with spontaneous eyeball rupture.

 Glaucoma Morganella morganii Preservative eyedrops Spontaneous eyeball rupture Suprachoroidal hemorrhage References Rutherford WJ Spontaneous rupture of the glaucomatous eye: an illustrative case Br J Ophthalmol 192042824 Winslow RL Stevenson W 3rd Yanoff M Spontaneous expulsive choroidal hemorrhage Arch Ophthalmol 197492336 Goldsmith C Rene C Massive spontaneous expulsive suprachoroidal haemorrhage in a blind glaucomatous eye treated with chronic topical steroid Eye (Lond) 20031743940 Ophir A Pikkel J Groisman G Spontaneous expulsive suprachoroidal hemorrhage Cornea 2001208936 Haugen OH Kjeka O Localized, extreme scleral thinning causing globe rupture during strabismus surgery J AAPOS 200595956 Ung T Williams CP Canning CR Globe rupture as a complication of intravitreal injection of triamcinolone Eye (Lond) 2007214234 Tabandeh H Flaxel C Sullivan PM Scleral rupture during retinal detachment surgery: risk factors, management options, and outcomes Ophthalmology 200010784852 Awad AH Mullaney PB Al-Hazmi A Recognized globe perforation during strabismus surgery: incidence, risk factors, and sequelae J AAPOS 200041503 Dang Y Racu C Isenberg SJ Scleral penetrations and perforations in strabismus surgery and associated risk factors J AAPOS 2004832531 Warwick R Eugene Wolff's Anatomy of the Eye and Orbit 7th ed. London HK Lewis & Co 19764851 Fleming A Dodman S Crown JM Corbett M Extra-articular features in early rheumatoid disease Br Med J 1976112413 Sipperley JO Shore JW Septic retinal cyst in endogenous Klebsiella endophthalmitis Am J Ophthalmol 1982941245 Tae KS Kim TH Moon YS Chin HS A case of klebsiella endogenous endophthalmitis accompanied by necrotizing scleral perforation J Korean Ophthalmol Soc 20031126806 Equi RA Green WR Endogenous Serratia marcescens endophthalmitis with dark hypopyon: case report and review Surv Ophthalmol 20014625968 Taherian K Sharma P Prakash P Azad R Scleral perforations in strabismus surgery: incidence and role of prophylactic cryotherapy–a clinical and experimental study Strabismus 2004121725 Yu YS Chang BL Scleral perforation after scleral buckling surgery for retinopathy of prematurity Korean J Ophthalmol 1999 134951 Kwon JD Kim SW Park DH Lee CH A case of a traumatic eye-ball rupture in terrien's marginal degeneration and it's surgical repair J Korean Ophthalmol Soc 200647116670 Cunningham ET Jr Whitcher JP Kim RY Morganella morganii postoperative endophthalmitis Br J Ophthalmol 1997811701 Tsanaktsidis G Agarwal SA Maloof AJ Postoperative Morganella morganii endophthalmitis associated with subclinical urinary tract infection J Cataract Refract Surg 20032910113 Burstein NL Preservative cytotoxic threshold for benzalkonium chloride and chlorhexidine digluconate in cat and rabbit corneas Invest Ophthalmol Vis Sci 19801930813 Tripathi BJ Tripathi RC Cytotoxic effects of benzalkonium chloride and chlorobutanol on human corneal epithelial cells in vitro Lens Eye Toxic Res 19896395403 Figures

(A) Ruptured left eye ball with protruded intraocular tissues and conjunctival hemorrhage are noted in the 94-year-old female patient. (B) Axial image of orbital CT shows irregular anterior margin of the left eye ball filled with hemorrhage.

Intraoperative findings. (A) Protruding intraocular tissues are noted. (B) The cornea is very thin and perforated along the inferior corneoscleral junction. (C) After removal of intra ocular tissues, the posterior part is intact.

(A) Choroidal vessels (arrow) with blood clots, inflammatory cells (arrowhead) surrounding vessel wall are noted (H&E stain, ×200). (B) Corneal biopsy specimen presents diffuse supprative inflammation in the stroma. Stromal infiltrations of many lymphocytes are noted (arrowhead) (H&E stain, ×200).