Injuries to the eye - Causes, symptoms and treatment. MF.

Injury to the eye is a condition in which the integrity and function of the organ of vision is impaired. The appearance may be industrial, agricultural, transport, sports, household, criminal, etc.

Causes of eye trauma

Any aggressive external exposure to the eye, whether it is a solid object, a corrosive chemical substance, radiation can lead to eye trauma.

Kinds of eye injuries

By severity of injury can be light( do not lead to a decrease in the functions of the organ of vision), medium severity( decreased function is temporary), severe( persistent decrease in eye function), especially severe( loss of the eye is not excluded).

In the depth of the lesion, non-penetrating( extraocular foreign bodies, erosion, burns, concussion) and penetrating( the integrity of the fibrous envelope of the eye to its entire thickness is broken).

Injuries to the orbit of have various manifestations: pain, almost immediately there is diplopia. With fractures, it is possible to exophthalmos or enophthalmos, subcutaneous emphysema, edema and hematomas of the eyelids, restriction of eye movements, ptosis( ovulation of the eyelid).Wounds of soft tissues, closed and open fractures are possible. Often combined with injuries of the eyeball.

Slits of the eye - blunt injuries, in which the integrity of the tissues is not compromised. Complaints about pain, limitation of mobility, formation of bruises, redness. Visual acuity decreases, becausedamage to the eyeball occurs.

With soft tissue injury of the , the orbit can damage the nearby organs - the lacrimal gland, the external muscles of the eye.

Eyeball injuries have different mechanisms of appearance and a different clinical picture. There may be stupid( concussion), non-penetrating and penetrating injuries.

eyelid wounds are not through and through;without damage and with damage to the free edge of the eyelid;Torn, chipped or cut. In the case of perforations, the entire eyelid is damaged( skin, muscles and cartilage).

The contusions of are direct( with direct exposure to the eyeball) and indirect( due to a concussion of the head or trunk).Depending on the impact strength, elasticity of the eye tissues and the presence of concomitant pathology, the membranes can tear or tear. The patient is troubled by pain, nausea, dizziness, redness of the eye, decreased vision, fog before the eyes, floating opacities. An objective examination can be corneal edema, hemorrhage into the anterior chamber( hyphema), partial or complete detachment of the iris, paralysis of the sphincter of the pupil( the irregular shape of the pupil, the lack of response to light), the ring Fossiusa the front lens capsule( imprint pigment rim of the iris), paresisor paralysis of the ciliary muscle( accommodation broken), traumatic cataract, subluxation and dislocation of the pupil, choroid hemorrhage, retinal - berlinovskoe turbidity and / or hemorrhage, it tears, detachment( may occur with long-termoki).

Non-penetrating wounds happen with the presence or absence of foreign bodies. At the same time, the integrity of the outer shell( cornea, sclera) is not broken at all thickness. The most common injuries are foreign corneal bodies. Occur due to non-compliance with safety regulations and work without protective eyewear. Often there are foreign bodies after working with a Bulgarian and in windy weather. There is a sense of foreign body, lacrimation, photophobia, the inability to open the eye. At an objective inspection foreign bodies of eyelids, a cornea or a conjunctiva, a superficial and deep injection of an eyeball are visible.

penetrating wound

eyes Symptoms penetrating wounds : sequentially wound in the cornea or sclera, the opening in the iris, the anterior chamber filtration moisture loss of internal eye membranes or vitreous humor, intraocular presence of a foreign body. Also indirect signs are shallow or deep anterior chamber, the irregular shape of the pupil, the gap of the iris, ocular hypotonia, hemophthalmus etc.

penetrating wounds with loss of the iris and ciliary

body most severe complication penetrating wounds -. endophthalmitis - inflammation purulent vitreous60-80 percent of cases lead to blindness. There is general malaise, fever, eye hypotonic, eyelids and conjunctiva are edematic and hyperemic, behind the lens is the abscess of the vitreous body of yellow-gray color.

Endophthalmitis

Panophthalmite in all cases leads to blindness and is dangerous for the patient's life. It is an inflammation of all the membranes of the eye, quickly passes into orbit and the inflammatory process can spread to the brain. Infection penetrates at the time of injury or even after it. The most common pathogen is staphylococcus aureus. First there is a purulent iridocyclitis, then an abscess of the vitreous body is formed, then the retina, vascular and fibrous envelope of the eye are involved in the process. In the anterior chamber there is pus, nothing is visible behind it, the cornea and eyelids are swollen, exophthalmos appears.

Sympathetic ophthalmia is a sluggish inflammation of an inflammatory nature on the unaffected eye with a penetrating wound of the second eye. It often develops 1-2 months after the injury. It flows in the form of iridocyclitis or neuroretinitis. The first signs are a slight injection of conjunctival vessels, a slight soreness, photophobia. Then there are symptoms of iridocyclitis, hypertension is replaced by hypotension, and then by subatrophy of the eye.

Eye burns are thermal( high or low temperature action), chemical( alkali and acid), thermochemical, radiation.

The depth of the lesion is divided into 4 stages:

1. Hyperemia of the skin and conjunctiva, the presence of superficial erosion of the cornea.
2. Bubbles on the skin of the eyelids, conjunctival films, translucent opacity of the corneal stroma.
3. Necrosis of the skin, conjunctiva, the cornea has the appearance of "frosted glass."
4. Necrosis of the skin, conjunctiva, cornea in the form of a "porcelain plate".

Patients are concerned about severe pain, lacrimation, photophobia, inability to open eyes, reduce visual acuity.

Eye burns

Examination of a patient with an eye injury

The examination is carried out very carefully to correctly diagnose and prescribe treatment. With any trauma of the eye, you should immediately consult an ophthalmologist in order not to miss a serious pathology and prevent the development of complications.

- external inspection - damage in the form of wounds, bleeding, foreign bodies is often noticeable. Possible edema, eyelid hematomas, exophthalmos or enophthalmos
- visual acuity determination - many injuries are reduced due to lack of full transparency of the optical media of the eye
- perimetry
- sensitivity of the cornea( many injuries and burns reduced)
- determination of intraocular pressure -is possible both hypertension and hypotension
- examination in transmitted light - foreign bodies or injuries associated with trauma are visible( opacities of the lens and / or vitreous body, etc.)
-the bioprospecting of the cornea with fluorescein
- gonioscopy is performed to examine the angle of the anterior chamber and to diagnose damage to the ciliary body and iris
-ophthalmoscopy direct and indirect, and also with the help of the Goldman lens helps to define such pathology as retinal contusion, intraocular foreign bodies, retinal detachment
- X-raythe orogram of the orbit and skull in two projections
- radiography using the Baltina-Comberg prosthesis for locating the intraocular foreign body. To do this, on the anesthetized eye, the prosthesis is placed exactly at the points 3, 6, 9, 12 hours. Take a picture and then apply it to special tables
- computer tomography of the orbit and eyes to determine the presence of X-ray negative foreign bodies
- The ultrasound of the eye helps to determine the condition of the inner membranes and eye environments, as well as the location and the number of foreign bodies.
- fluorescent angiography is indicated for detectionsites that need to be delimited by laser retinal coagulation.
- general clinical blood tests, urine, sugar, blood for RW, HIV infection, HBs-antigen
- consultations of a traumatologist, a neurosurgeon, a therapist, if necessary.

Treatment for eye trauma

Treatment should be started as soon as possible after trauma.

A slight concussion of the orbit ( for example, when punching the eye) in most cases requires outpatient treatment, but the examination of the ophthalmologist is mandatory. Immediately after the injury, it is necessary to apply cold on the area of ​​injury, to drip disinfectant drops( you can use normal albucid), with severe pain, take pain medication and contact the nearest trauma center. The doctor can already prescribe hemostatic drugs inside or intramuscularly( etamzilate or dicinone), as well as calcium, iodine and trophic( emoxipin injection intramuscularly or parabulbar - under the eye).

In more severe cases, strict bed rest is required. For any damage to the integrity of the tissues, it is necessary to administer tetanus antitetanus and / or toxoid.

The eyelid wounds are subject to surgical treatment with the application of seams and if the tear duct is damaged, a Polac probe is inserted into it.

Foreign bodies of the cornea , if superficially located, are to be removed under the conditions of admission, with the subsequent administration of antibacterial drops and ointments. In this case, after local anesthesia, remove the foreign body and scale around it with the help of an injection needle.

With eye contusion , treatment can be conservative and operative. Obligatory is bed rest and cold on the area of ​​injury. Assign the following groups of drugs: hemostatic( stopping bleeding), antibacterial( antibiotics for local and general validity), diuretics( reduce tissue swelling), anti-inflammatory( steroidal and hormonal), physical therapy( UHF, magnetic).Surgical treatment is subject to ruptures of sclera and retina, secondary glaucoma, traumatic cataracts).

When penetrating wounds exemplary treatment plan: instilled drop with antibiotics( Floksal, Tobrex et al.), Impose sterile binocular bandage, transportation is performed in a reclining position, if desired anesthetized( local or general) is administered tetanus toxoid or serum, intramuscularlyor intravenously - antibiotics of a wide spectrum of action( penicillins, cephalosporins, macrolides, etc.).In the hospital, depending on the type and extent of injury, surgical treatment is performed. This can be revision of the wound and primary surgical treatment, removal of intraocular foreign bodies, prevention of rupture of the retina in case of their threat( scleroplegmage, laser coagulation), removal of foreign bodies, implantation of the intraocular lens in traumatic cataract. In severe cases, solve the issue of enucleation of the eyeball within 1-2 weeks after injury.

Prevention of sympathetic ophthalmia provides for the removal of a blind eye injury in the first 2 weeks after injury. Treatment should be carried out under the obligatory supervision of an immunologist. Locally applied instillations of corticosteroids, as well as their subconjunctival administration, mydriatica in the form of drops and injections. Systemically, hormonal drugs are used, and if they are ineffective, immunosuppressive therapy( mnotrexate, azathioprine).Effective methods of extracorporeal detoxification - plazamapheresis, ultraviolet irradiation of blood.

Treatment of endophthalmitis involves the administration of high doses of antibiotics parenterally and topically, as well as vitrectomy with the administration of antibacterial drugs to the vitreous. If the treatment is ineffective or the development of atrophy of the eyeball produces enucleation. With panophthalmitis - evisceration.

For all burns of 2-4 degree , tetanus prophylaxis is mandatory. Stage 1 is subject to outpatient treatment. Assign antibacterial drops and ointments( Tobrex, Floxal, Oftakwix).The rest of the burns are treated in the hospital. Prescribe conservative treatment;with stage 3 also surgical. It is possible to use medical contact lenses.

Medication:

- midiatichistestno - instill 1 drop 3 times a day( Mesatone, Midratsil, Tropicamide) or subconjunctival
- antibiotics topically in the form of drops and parabulbar injections( first every hour, then reduce the frequency of instillation up to 3 times a day - Tobrex, Floxal, Oftakvix, parabulbarno gentamycin, cefazolin) or ointments( Floxal, erythromycin, tetracycline), and also for systemic use
- anti-inflammatory drugs topically and systemically non-steroid( drops Indocollir, Naklof, Diclof 3-4 times a day) or hormoneAspen-dexamethasone, parabulbararnodexon
- inhibitors of proteolytic enzymes - countercracker, gordox
- detoxification therapy( intravenous drip solutions - Hemodez, reopolyglucin 200.0-400.0 ml)
- diuretics( diacarb, lasix)
-desidensitizing drugs( dimedrol, suprastin)
- vasodilators( no-sppa, papaverine, cavinton, nicotinic acid)
- vitamin therapy( especially group B)

Surgical treatment: layered or through keratoplasty, with conjunctival burns -transplantation of the mucosa from the oral cavity, with burns of the 4th stage, perform a transplantation of the oral mucosa on the entire front surface of the eye and blepharoraphy( eyelid cross-linking).

Complications of eye injuries

In case of untimely wound treatment and inadequate conservative therapy, complications such as endophthalmitis, panophthalmitis, sympathetic inflammation, persistent decrease in visual acuity, loss of the eye, brain abscess, sepsis, etc. are possible. Many conditions threaten the patient's life, therefore eventhe slightest trauma requires an examination of the ophthalmologist in a hospital.

Doctor ophthalmologist Letyuk T.Z.