Penetrating injury of the eye is one of the types of injuries of the eyeball, in which its body is subjected to direct contact with a foreign body, which as a result leads to deformation. Almost every case of such an injury in ophthalmology is severe.
Main differences in injuries
Doctors classify two types of eye injury: penetrating and non-penetrating. With non-penetrating damage, the sclera or cornea is deformed, but the foreign body does not penetrate into the very thickness of the elements of the eye. It should be noted that damage of this type does not cause any special complications, and the work of the visual organ is not disturbed. In 8 out of 10 cases, a non-penetrating injury occurs after an eye injury.
A penetrating wound of the cornea of the eye is different in that a foreign body penetrates through several layers of the eye at once, which leads to their deformation and disruption of integrity. In this case, a foreign object may remain in the body of the eyeball, which as a result will require mandatory removal by surgery. According to the ICD, a penetrating eye injury has the code SO5.
Types of injuries
All penetrating woundscan be divided into:
- major penetrating eye injury (injury in which foreign material pierces the wall of the eyeball);
- deformation of the eyeball, in which it is no longer possible to restore the functions of the visual organ;
- penetrating wound - it leads to double damage to each shell of the visual organ.
Despite the fact that all the described conditions are classified as severe, in some cases the patient still manages to almost completely restore his vision while maintaining the basic functions of the eye.
Sometimes the opposite happens - a slight injury leads to dangerous consequences and complication of a penetrating injury to the eye, for example, complete loss of vision without the possibility of recovery.
Symptoms of injury
Signs of a penetrating eye injury are obvious and fairly easy to identify. It is possible to judge the presence of such an indisposition both by absolute (reliable) and relative signs.
The absolute signs of organ damage include:
- presence of an obvious penetrating wound and entry hole;
- a foreign body is visible in the eye;
- the inner membranes of the eyeball fall out.
Relative features
Relative signs of illness are as follows:
- hypotension (decrease in intraocular pressure);
- reduction in the size of the anterior chamber of the eye or its complete absence;
- changing the shape of the pupil itself (does not always happen);
- the anterior chamber deepens as a result of damage to the integrity of the sclera;
- the iris and lens are displaced (begin to adhere to the back of the eye).
And although the described signs are obvious, sometimes it is quite difficult to determine a penetrating wound. Most often this happens when the object that caused the injury is small or very sharp. This leads to adaptation of the edges of the wound and to their gluing, the anterior chamber has time to recover in just a few days.
What are the causes of injury?
The main cause of penetrating wounds is the impact of sharp, piercing or cutting objects on the body of the eyeball.
It is important to remember that depending on which side of the eye is damaged, the wound can be corneal (corneal deformity), scleral (excision of the sclera itself) and limbal (damage to the border of the eye chamber).
What is prohibited?
With a penetrating wound, it is important for the patient to provide professional medical assistance, but at the time of waiting for the ambulance team or when delivering the victim directly to the hospital, something is forbidden to do. Contraindicated manipulations for penetrating eye injuries:
- Apply cotton wool to apply a bandage on the sore eye. In this case, small fibers of cotton can accidentally penetrate into the wound itself, which will cause a negative reaction.
- Press on the sore eye, rub it even gently.
- Rinse the eye with any liquid (an exception isa situation where, together with a penetrating wound, there is a risk of a chemical burn).
- Try to remove the foreign body that remains in the eye body on your own.
Help the victim
In case of a penetrating wound of the eye, it is necessary to drop weak antibiotic drops into the eyes and gently rinse the sore eye with a solution of "Furacioin" or "Rivanol", but avoid any rubbing.
Antibacterial agents can be the following drops: Vigamox, Gentamicin, Albucid or Levomycetin.
If the wound is not too large, then you can additionally drip a solution of "Novocaine" or "Lidocaine" into the eye for pain relief. Although some experts recommend not disturbing the deformed organ, but giving an intramuscular injection of analgin or another drug with a similar effect. After that, clean gauze is applied to the sore eye.
After arrival at the clinic, the patient is given an x-ray of the orbit to detect a foreign body. Emergency care for a penetrating injury to the eye is to conduct an immediate operation. During the procedure, the damaged tissue is excised. The main goal of the doctor in this case is to save as much viable tissue as possible.
After identifying the location of the foreign body, it is removed. If it is a metal body, then a magnet is used to eliminate it. Otherwise, the operation proceeds withusing surgical instruments.
Wound dressing
First aid for a penetrating eye injury consists in the mandatory application of a bandage to the injured eye, no matter the right or left - the order of application is the same. In this case, the dressing must be sterile, soft, elastic and hygroscopic (absorb moisture). Clean gauze is best for this.
If possible, it is recommended to additionally iron the material from the outside and back with a hot iron. Gauze should be folded in half, evenly distribute cotton between the layers. You can only touch the material with alcohol-treated hands. The finished dressing is fixed with a simple plaster (to the skin of the forehead). You can also bandage your head with a simple sterile bandage.
What complications are possible?
In addition to the fact that a penetrating injury to the eye can completely deprive a person of the ability to see normally due to severe deformation of the eyeball, there are a number of other complications that can occur even with a small injury.
This happens when iron foreign bodies remain in the eye - the iris can change its color to reddish over time. Most often, such changes spread in the anterior part of the lens. This is a clear sign of the development of toxic retinopathy, which can subsequently provoke the onset of pathological processes affecting the optic nerve. This in turn can lead to total blindness.
If the foreign body is copper or includesimpurities of such a metal, then a person may begin chalcosis (changes in eye tissues due to the negative effects of copper). With a similar disease, opacities of a yellowish-green hue form inside the lens of the eye. The second common name for this disease is copper cataract. Complications of this type can develop over several weeks, but in some cases it will take years to develop.
Specialized eye care
Specialized care of ophthalmologists is provided immediately to the patient at any time of the day or night in the eye trauma center, which is in any city. The list of services of specialized ophthalmological care includes additional diagnostics and X-ray localization, removal of intraocular foreign bodies, and primary surgical treatment of the wound.
After the diagnosis is officially confirmed, the doctor performs a survey x-ray of the eye sockets in several projections - lateral and anteroposterior.
For this, it is important to properly position the patient. With an anteroposterior x-ray of the orbit, the patient lies face down in such a way as to touch the table with the end of the nose and lips. With this laying of the head, the shadow of the pyramidal bone is displayed from the projection of the orbit. In a side view, the patient turns their head so that they have access to the diseased eye.
If the shadow of a foreign body is visible on the survey radiographs in the region of the orbit of the diseased eye, then it is important to conduct radiolocalization of the foreign body in order to identify its location. It is on this factor that the further actions of the doctor in assisting the patient will depend.
If the foreign body is located in the fiber of the orbit and it is not large, then it is not required to eliminate it. Chemical removal is carried out only for large bodies, which lead to the appearance of pain in the orbit.
Intraocular foreign bodies are removed immediately. If the foreign body stays inside the eyeball for too long, then as a result it can lead to some difficulties in its removal due to the fouling with connective tissue. In the tissues of the eye, the foreign body is rapidly oxidized, and the oxidation products adversely affect the delicate structures of the organ. Along with this, the presence of a foreign object can lead to the spread of a purulent infection, which will require additional treatment.
Vitreous haemorrhage of the eye
Injury to the vitreous body of the eye leads to the onset of bleeding. Blood in the retrolental space of the vitreous body increases its size, and blood secretions in the orbicular space lead to the formation of a specific rim (strip) that surrounds the periphery of the lens on the reverse side.
Retrolental hemorrhage resolves much longer than orbicular hemorrhage. In some cases, small hemorrhages can only be diagnosed when they move into the lower anterior chamber. Hemophthalmos is a massive hemorrhage into the vitreous body, as a result of which the latter is filled with a large volume of blood.
On the third day afterthe onset of hemorrhage in the vitreous body, hemolysis begins with the loss of hemoglobin by erythrocytes, as a result of which they become colorless, and in the future they completely disappear. Hemoglobin, in turn, takes the form of grains, which are then absorbed by phagocytes.
Hemosiderin is formed, which poisons the retina. In some cases, the blood does not completely resolve and the formation of a blood clot begins with its replacement with connective tissue sutures.
Deformation of the vitreous body
With hemophthalmia, cases of loss of visual acuity from light perception to complete blindness are common. Focal illumination and biomicroscopy help determine the presence behind the lens of a dark brown granular, sometimes with reddish clots, mass of blood that impregnates the vitreous.
Ophthalmoscopy helps to determine the absence of a reflex from the fundus. Further, during the resorption of the blood clot, one can see the deformation of the vitreous body, followed by liquefaction. Hemophthalmos is important to distinguish from partial hemorrhage into the vitreous body, which quickly and completely resolves.
If you do not start treating diseases in time, the degenerative process of the vitreous body will soon begin.
Features of treatment
First aid for a penetrating eye injury is very important. With a hemorrhage in the vitreous body, the doctor prescribes to the patient bed rest and a bandage with cold on the sore eye. They use drugs with calcium (tablets, eye drops, intramuscular injections), hemostatics ("Vikasol").
To speed up the process of resorption of blood clots, apply "Heparin" (1-2 days), "Potassium iodide" and enzymatic medicines. During sleep, the patient's head should be in an elevated position. He is also given a binocular bandage for 2-3 days.
Once a day, the patient drinks "Calcium Chloride", "Pilocarpine" 1%, glucose with ascorbic acid, a solution of "Dicinone" is injected subconjunctively. After 2-3 days, they begin a course of absorbable drugs: Dionina, Lidaza and Potassium Iodide. Additionally, corticosteroids and fibrinolysin may be prescribed. At a late stage of treatment, physiotherapy and ultrasound can be good.
