Mechanical eye damage
Damage to the appendages of the eye can be the result of injuries or concussion. In the first case, lesions of the eyelids are possible with a through or blind violation of the integrity of the tissues of the eyelids, ruptures of the mucous membrane, lesions of the lacrimal gland or tear ducts. In such cases, the patient needs to lay an antibacterial ointment and with an aseptic bandage urgently sent to the eye department, where he will be surgically treated with a wound.
1. With blunt injuries of the eyelids, hemorrhages in the thickness of the eyelids or subcutaneous emphysema are possible, which indicates a violation of the integrity of the bones of the orbit bordering the air sinuses. Blunt injuries arise from a blow to the eye with a stick, fist, workpiece, horn of an animal, etc. As a result, there are various symptoms and their combinations( depending on the severity of the lesions):
• hemorrhages in the eyelids, under the conjunctiva, in the anterior chamber, vitreous, retina;
• ruptures of the iris, choroid, retina, optic nerve;
• Lens trauma - its displacement in the anterior chamber, under conjunctiva, in the vitreous or traumatic cataract.
Often a blunt trauma is accompanied by secondary glaucoma. It is possible to crush the eye.
Treatment. Patients are urgently sent to the ophthalmologist with a binocular bandage in a supine position. In the hospital, depending on the indications, an operation is performed( removal of the dislocated or cloudy lens, suturing of the sclera, removal of the smashed eye, etc.).
2. In case of injury and contusion, damage to orbital bones, displacement of their fragments, which may result in a decrease or increase in the volume of the orbit, and in connection with this - protrusion or overshadowing of the eyeball. In these injuries, as a result of a rupture of the optic nerve, trauma to the eyeball with extensive hemorrhages, ruptures of the inner membranes and even a crushing of the eye, sudden, often irreversible blindness may occur. Orbital injuries are always very serious, as they can be complicated by infection: phlegmon orbit, cavernous sinus thrombosis, meningitis, which threatens the vision and life of the patient. Traumas of the orbit due to injury can be complicated by the introduction of foreign bodies( fragments of metal, wood, bullets, etc.).Wounds of the conjunctiva and lacrimal organs are surgically treated, the main purpose of which is restoration of function.
The damage to the eyeball is divided into impenetrable, perforated, blunt, or contusions, and burns.
Non-punched superficial injuries are applied by small foreign bodies( grains of emery, stone, metal, wood, etc.) that are stuck in the groove of the upper eyelid or penetrate into the superficial layers of the cornea. In this case, there is a sharp pain in the eye, photophobia, lacrimation. Sorpies that fall on the conjunctiva should be removed with a piece of damp cotton wool, turning out the upper eyelid.
Foreign corneal body is removed with special sterile instruments( chisel or spear) after anesthesia with dicain or lidocaine. For the extraction of a foreign body, a needle of a disposable syringe is also used. For this, the patient's eyelids are extended with the index finger and the thumb of the left hand, and with their right hand they bring the instrument under the foreign body so that it is removed together with the rust remnant, after that ointment is placed from the antibiotics. In some cases, with obvious signs of irritation of the iris, the pupil( preferably scopolamine) needs to be enlarged and maintained in such a state until the inflammatory phenomena decrease( 2-4 days).At this time and before the narrowing of the patient's pupil, one must be freed from work, as with an enlarged pupil the visual acuity decreases, there is no binocular vision, which creates the danger of damage to the healthy eye. In cases of deep foreign body insertion, as well as complications( ulcer of the cornea, iritis) that have arisen after removal of the foreign body, the patient should put an aseptic bandage around his eye and prepare an operative intervention.
Surface injuries without the introduction of foreign bodies can be applied by a branch, straw, snowball, finger;they are usually accompanied by a defect in the epithelium of the cornea - erosion, which can be detected reliably after instilling a fluorescent. Treatment is carried out similarly, as after the removal of foreign bodies, and in addition, the restoration of the integrity of the corneal epithelium is promoted by the use of blood with antibiotics. To do this, 5 ml of blood is taken from the vein of the patient with a syringe and the eye is irrigated with a few drops;the remaining blood is poured into a bottle with the same amount of a solution of antibiotics and it is recommended to instill 4-5 times a day a mixture of separated serum together with antibiotics into the eye. It should be remembered that the patient should be examined by express method for lues( syphilis).
Penetrating wounds are applied by cutting and stabbing objects, firearms, beak of birds, during explosions, introduction of metal and other foreign bodies into the eye, etc. The severity of the damage depends on the size and shape of the wounding instrument, the foreign body, its location in the eye( cornea, sclera or limbus), the presence of infection, etc. One of the main symptoms of a penetrating injury is a decrease in intraocular pressure( hypotension) caused by the expiration of chamber moisture orvitreous body, gaping of the wound, infringement in its edges of the fallen shells. Frequent hemorrhages under the conjunctiva, in the anterior chamber( hyphema) or vitreous( hemophthalmus), lens damage. Penetrating wounds lead to a decrease in visual acuity of varying degrees. Particularly serious are injuries involving the introduction of foreign bodies into the eye. Patients with penetrating eye traumas, irrespective of anamnesis, must necessarily perform an x-ray of the orbit and skull for diagnosis and determination of the location of foreign bodies. Suspicion of the presence of a foreign body occurs if an iris rupture with an opening in it is detected. In some cases, the foreign body can be seen in the anterior chamber, the vitreous body or the bottom of the eye. Intraocular foreign body in connection with mechanical damage to the shells of the eye and the chemical action of metal( metalloz) is a direct indication for its immediate removal in an eye hospital. With the prolonged stay of an iron or copper fragment in the eye in its tissues, metal deposition occurs. At the same time, the iris becomes rusty, and on the anterior capsule of the lens, rust stains are deposited or cataracts occur. Injuries can be complicated by an infection, the signs of which are edema of eyelids and conjunctiva of the eyeball, pus in the anterior chamber or panophthalmitis.
The most serious complication of penetrating trauma is the inflammation of the second, intact eye in the form of sluggish serous or fibrinous iridocyclitis or optic neuritis called sympathetic inflammation. It can occur even after the operation with the opening of the eyeball, and sometimes after diseases accompanied by violation of the integrity of the eye( for example, perforation of the corneal ulcer).Sympathetic inflammation develops, as a rule, in those cases when the penetrating wound is complicated by the sluggish, iridescent iridocyclitis.
Sympathetic inflammation begins 10 to 14 days after injury, but may occur months and years after. The cause of the disease is still unknown, the significance of a viral infection, a specific allergy is assumed. There are no exact signs that help to establish the possibility of its occurrence in each individual case; it is only known that if the wounded blind eye does not calm for a long time because of stubborn flaccid iridocyclitis, it is painful, then the risk of sympathetic inflammation on the other eye increases. Therefore, such a blind eye should be removed for the prevention of sympathetic inflammation. If damaged eye partially retained vision, you should continue its treatment and, depending on the success and especially on the condition of a healthy eye, decide whether to remove the damaged one. Signs of sympathetic inflammation: a sudden decrease in visual acuity of the healthy eye, lacrimation, photophobia, deep injection of the conjunctiva of the eye, pronounced iridocyclitis with its consequences. The process can begin with neuritis of the optic nerve, occasionally and without inflammation of the vascular tract. The disease is extremely severe and about half of the patients end in blindness, despite treatment. In the best case, if the eye recovers and retains its vision, a relapse of inflammation is inevitable, the outcome of which is always serious.
Patient with penetrating eye injury should be dripped antibiotic solution, apply a binocular aseptic bandage, inject tetanus antiserum and immediately prepare for surgery. Great importance for the outcome of penetrating wounds is the primary treatment of wounds and the correct positioning of the wound edges with the help of silk or biological sutures;filling or excising of the fallen shells, removal of the cloudy lens, etc. In the case of the presence in the eye of the magnetic intraocular foreign body after an accurate determination of the localization, it is extracted by a hand permanent magnet or a large electromagnet. Much more difficult and less successful extraction of magnetic foreign bodies from the eye.
Treatment. Atropine or pilocarpine is used as indicated, locally prescribed disinfectants or antibiotics, and 7-10 days after wound treatment - instillations or subconjunctival injections of corticosteroids. Conduct courses of intramuscular injection or taking antibiotics inside, the introduction of tissue preparations, blood transfusion, X-ray and ultrasound therapy, etc. The same treatment is performed with sympathetic inflammation, at the same time in each case the problem of removing the damaged eye is individually solved. The outcome of the penetrating injury depends on the nature, magnitude and location of the wound, the presence of infection, timeliness and quality of first aid and subsequent treatment.