When the Nail Gun Goes Wrong: A Case of Penetrating Globe Injury

Globe rupture is a rare but sight-threatening ocular emergency that requires prompt recognition and management by emergency medicine providers. We report the case of a 27-year-old male who presented to the emergency department following accidental ocular trauma from a nail gun, resulting in classic physical exam findings consistent with globe rupture. Examination revealed a positive Seidel sign, confirming the presence of an open-globe injury. The patient underwent management in the emergency department, including measures to prevent elevated intraocular pressure, administration of tetanus prophylaxis, initiation of broad-spectrum antibiotics with vitreal penetration, and urgent ophthalmology consultation. Globe rupture is a time-sensitive diagnosis requiring a high index of suspicion and rapid intervention to preserve visual function. Emergency medicine practitioners must be adept at recognizing key clinical findings, implementing critical initial management steps, and coordinating immediate ophthalmologic evaluation to optimize patient outcomes.