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Open Globe Injury: The Road to Recovery

Donald Masciadrelli was cleaning his yard when a tree branch ruptured the globe of his eye. After multiple surgeries and ongoing care from the Mass Eye and Ear Emergency Department, he will regain his vision.

Donald Masciadrelli

Donald Masciadrelli had taken the morning off from work to clear his property. He and his wife were building a new house and Donald, an electrician by trade, was no stranger to hard work around the home. Using a tractor, he was moving logs into the woods and accidently grabbed an apple branch with the forks; when he dropped the logs, the branch swung back and hit him right across his left eye.

“I mean, it hurt like hell,” Donald recalled to Focus. “I didn’t know what happened, but I knew it wasn’t good.”

Donald rushed to his local eye doctor in Western Massachusetts, who luckily could bring him in right away for an exam. Donald remembered the doctor sat him down and looked in his eye for no longer than three seconds, quickly stood up and asked, “How fast can you get to Boston?”

Emergency Open Globe Injury

After an hour-and-a-half ride into the city, Donald and his wife walked into Mass Eye and Ear’s Emergency Department. The staff was ready at the door with a stretcher and immediately started giving him antibiotics. He then met Margot Weinert, MD, Director of Ocular Trauma Service at Mass Eye and Ear, who walked him through the severity of his injury and the next steps.

Donald had what’s called an open globe injury, where the wall of the eye is cut or ruptures as a result of trauma. Open globe injuries can be immensely painful and require immediate treatment to ensure no major vision loss. Donald had a laceration, or cut, in the cornea, the clear dome-shaped structure at the front of the eye.

Donald was rushed into surgery within a few hours of his arrival. The first step of open globe surgery is to stitch close the laceration or rupture where the injury occurred. This will determine if the eye can be saved, which is the first goal of treatment, according to Dr. Weinert.

Dr. Weinert was able to save the eye, but this was only the beginning of Donald’s care journey. He remained in the hospital for three more days, getting IV antibiotics flushed into his system. A tree branch is not generally clean and there could be an abundance of bacteria on it, so the antibiotics were necessary to prevent infection.

“We don’t really talk about vision recovery until after we know that there isn’t an infection in the eye,” said Dr. Weinert. “Because once you’ve exposed the inside of the eye to the outside world, an infection can take hold and that can be really devastating to the vision.”

Preserving His Vision

Donald was extremely lucky and did not develop an infection. Now, it was time to focus on doing every medical intervention possible to help save his vision.

“At this point, I could only see light,” said Donald. “Everything else was a blur.”

A few days after his discharge, Donald had to return to Mass Eye and Ear and undergo another surgery with the retina team. The injury had gone deep enough into his eye to damage the lens – the structure behind the pupil that focuses light – and caused vitreous – a jelly-like substance in the back of the eye – to come through his cornea. The surgeons removed his lens and did a procedure called a vitrectomy to remove the vitreous, and further assessed any needs in the back of his eye. Everything went well; his retina was attached, but he was left without a lens.

“We didn’t put a new lens in his eye yet because we wanted to get rid of all the stitches before we tried to correct the vision, because stitches cause astigmatism,” explained Dr. Weinert. “He’ll then have an option of trying a contact lens and see how that works with his vision before he considers additional surgery. By separating the procedures we give Donald the best chance at regaining the most vision.”

With the success of the surgery, doctors were hopeful his vision could eventually come back. Down the road, if he chooses, Donald could have another surgery to put a new lens in his eye, similar to what takes place after cataract surgery.

Returning to Daily Life

After Donald’s surgeries, he said he could only see a “ghostly” image with his left eye and has zero depth perception. He can see in front of him but cannot decipher any details, rather all images look blurred, making it very challenging to complete the tasks he used to do daily pre-injury.

In addition to his work as an electrician, Donald’s favorite hobby is to weld. He spends his time both on and off the clock doing incredibly detailed, hands-on work. After his open globe injury, he couldn’t successfully screw in a nut and bolt without it being a challenge; a simple task he did for years in his work. He also tried to use his welder, and without any depth perception, he couldn’t easily line up the welder to the metal.

“I’m stubborn and I didn’t stop working after this accident. But the loss of vision and depth perception makes it a lot harder to do my job, and completing some tasks are virtually impossible,” said Donald. “I can’t wait to get my vision back.”

Continuing the Care Journey

When a patient comes into the Mass Eye and Ear Emergency Department, Dr. Weinert tells them that “it’s the start of a journey together.” She creates a personal relationship with each patient and her care does not end after they are discharged from the hospital. In fact, Dr. Weinert typically follows a patient for months after the initial emergency.

“She came and saw me while I was in the hospital every day and she called me at home regularly to check in,” said Donald. “She wanted to make sure that I was feeling alright and that I was taking my eye drops.”

Dr. Weinert added that there’s a whole team of dedicated nurses, residents, and a psychologist who work with trauma patients during their time in the emergency department and after as well.

Donald shared that the nursing staff was particularly amazing, and he felt he could never repay the medical team for their dedication and empathy.

“I told all the doctors and nurses, ‘You know what? I wish I didn’t have to meet you all, but I’m very glad that I did,’” said Donald.

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