Open Globe Injury — Surgical Repair

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Sequence of Primary Repair
Suture Material Selection
Antibiotic Prophylaxis
High-Yield Pearls
Related Topics

Sequence of Primary Repair

Primary open globe repair follows a consistent anterior-to-posterior order. For a combined corneal-scleral injury, the corneal laceration is closed first, followed by the limbus, and then the sclera. Working anterior-to-posterior reestablishes a stable anterior chamber and clear anatomic landmarks early in the case, which the surgeon then uses to guide extension of the closure posteriorly. This ordering matters practically as well as anatomically: the sclera becomes progressively harder to visualize and access the farther posterior the wound extends, so establishing a secure, watertight anterior closure first gives the surgeon a stable reference point and restored chamber depth to work from as the repair moves back toward more difficult territory.

Suture Material Selection

For primary closure of a full-thickness corneal laceration, 10-0 nylon suture is the preferred material. Three properties make it the standard choice: it is nonabsorbable, so it holds the wound securely for as long as needed rather than dissolving prematurely; it provokes minimal inflammatory reaction, limiting scarring and inflammation-driven astigmatism at the visual axis; and its very fine caliber allows precise, watertight apposition of the wound edges with reduced induced astigmatism compared to a thicker suture. This is a meaningfully different choice from sutures used elsewhere on the eye or ocular surface (such as coarser absorbable material used for conjunctival closure) — the cornea's optical role is exactly why such a fine, minimally reactive suture is worth the added technical difficulty of placing it.

Antibiotic Prophylaxis

Because any open globe injury creates a direct route for organisms to enter the eye, patients are started on intravenous broad-spectrum antibiotics as soon as the diagnosis is made — before surgical repair, not after. This is initiated promptly, alongside globe protection, specifically to reduce the risk of post-traumatic endophthalmitis while the patient awaits repair; soil or organic contamination of the wound (a common feature of trauma from rural settings, gardening, or farming injuries) raises particular concern for Bacillus species, which broad-spectrum coverage is chosen to address.

High-Yield

Repair order: cornea → limbus → sclera, always anterior to posterior.
10-0 nylon is the standard corneal suture — nonabsorbable, low-reactivity, fine enough for a watertight, low-astigmatism closure.
IV (not topical) broad-spectrum antibiotics start as soon as open globe is diagnosed, not just postoperatively — this is prophylaxis against post-traumatic endophthalmitis, and soil-contaminated wounds raise particular concern for Bacillus coverage.

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