Primary Globe Preservation In Paediatric Firecracker-Related Open Globe Injury With No Light Perception: A Surgical Decision-Making Approach

To highlight the intraoperative surgical decision-making involved in primary globe preservation versus immediate enucleation in a paediatric patient presenting with firecracker-related open globe injury, extensive corneoscleral laceration, uveal prolapse and no light perception.

Ophthalmology Clinic, Clinical Hospital Centre Zagreb, Croatia

A 14-year-old female sustained left ocular trauma following accidental firecracker activation and was referred to our tertiary centre with no light perception. Examination revealed full-thickness superior and inferior eyelid lacerations, marked periorbital oedema and periocular burns. Slit-lamp assessment demonstrated a large full-thickness corneoscleral laceration with uveal prolapse and anterior segment collapse.

Orbital CT confirmed globe rupture with partial extrusion and multifragmented medial and inferior orbital wall fractures, while the optic nerve appeared structurally intact.

Intraoperatively, extensive tissue disruption with anterior segment disorganisation raised the question of immediate enucleation due to the risk of expulsive haemorrhage and subsequent sympathetic ophthalmia. However, preserved optic nerve integrity on preoperative imaging supported an attempt at primary globe preservation.

A stepwise tectonic approach was undertaken, including cautious repositioning of prolapsed uveal tissue, controlled anterior chamber reformation and sequential corneoscleral wound closure to restore structural integrity and minimise further intraocular content loss. Conjunctivoplasty was performed to achieve surface coverage and wound stabilisation. Simultaneous reconstruction of the anterior and posterior eyelid lamellae was undertaken to optimise early ocular surface protection.

Systemic and topical broad-spectrum antibiotic therapy was initiated postoperatively.

In paediatric blast-related open globe injuries presenting with no light perception, preserved optic nerve integrity may support an attempt at primary globe preservation over immediate enucleation. Even in the absence of early functional recovery, tectonic reconstruction enables structural stabilisation, reduces the risk of early inflammatory complications and maintains the potential for staged anterior segment rehabilitation. This approach underscores the role of intraoperative surgical judgement in determining globe salvageability in severe anterior segment trauma.