Can an eye explode? Woman blinded at the Ryder Cup

What happened to that woman’s exploded eye at the Ryder Cup?

You may have heard about the recent tragedy involving a woman being blinded in one eye after it was directly struck by a golf ball hit by Brooks Koepka at the Ryder Cup in Paris last week. At some point the word “exploded” was used in describing what happened to the eye, and now every major news outlet is using this description. Given that it sounds like the woman also suffered an orbital fracture from the impact, it must have been quite a severe injury.

The more correct medical term would be “rupture”. And yes, an eye can rupture. In the field we call this injury a “ruptured globe”, and it is a surgical emergency that needs to be fixed by an ophthalmologist right away. Without getting in to too much detail, an eye exposed to the outside world is at a high risk for infection and further loss of the intraocular contents. Surgical repair is aimed at closing the wound and re-establishing the integrity of the eyeball. Subsequent surgeries are often required.

How can an eye rupture?

Ruptured globes are caused by trauma, either blunt or penetrating. The woman at the Ryder Cup would fall into the category of blunt trauma as it wasn’t a sharp, piercing injury that caused the injury. In contrast, penetrating trauma usually involves a sharp object, like a small projectile (think metal grinding accident) or something like a pencil (I’ve seen it). When an eye ruptures from blunt trauma it typically does so at the limbus and/or behind where the eye muscles attach to the white part of the eye, the sclera.

This is perhaps a good time to mention that the loss of an eye from an injury is almost always a freak accident. No mechanism of injury surprises me anymore. I’ve seen ruptured globes from sticks, pencils, and nails. I’ve seen eyes ruptured from cell phones (yes, a cell phone) and the corner of a nightstand (more than once). Just this year I’ve repaired ruptured eyes injured by a nailgun and also a firework. The takeaway is that you should always wear safety glasses or sunglasses when performing at-risk activities. Earlier today I drove by a road worker pulverizing asphalt without safety glasses… With that said, it’s impossible to prevent all injuries, especially such freaky ones.

What should I do if I think my eye is injured?

The most common symptoms of a ruptured globe (exploded eye) are a sudden loss of vision and onset of pain. It is rare for a patient to note any fluid coming out or onto their cheek, the amount of fluid in the front of the eye is very small. One of the more telling signs of a ruptured eye is a severely misshapen pupil. An irregular pupil is caused by a rupture injury whereby the iris (colored part of the eye) follows the flow of fluid and ends up plugging the wound. The least gory picture I could find is below, courtesy of the Cornea Academy via Twitter. If you ever suffer an injury and think you may have ruptured your eye it is important to see an eye doctor right away.

Will that French woman ever be able to see again?

I don’t know any more about her particular case than you, but based on the media reports it doesn’t sound like it. I say this because of the reports that she “lost her eye” and is now blind. This would suggest that the eye was removed, or enucleated. If the eye was incredibly damaged with minimal discernible anatomy at the initial surgery, thus suggesting no hope of ever having vision again, then the surgeon may have made the decision to remove the eye. This would be in part to prevent sympathetic ophthalmia (Google it). Going forward, one of the most important things for this woman to do is adhere to “monocular precautions”, which essentially means wearing glasses with a polycarbonate lens all the time, even if she doesn’t need them optically. This is basically like having a pair of safety glasses on all the time to prevent what would be another devastating freak accident. Also, using common sense and not engaging in high-risk activities should go without saying.