A penetrating eye wound is one of the varieties of eyeball injuries in which his body is in direct contact with a foreign body, which, as a result, leads to deformation. Almost every case of such an injury in ophthalmology is serious.
The main differences of 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 the very thickness of the eye elements. It should be noted that damage of this type does not cause particular complications, and the work of the visual organ is not disturbed. In 8 cases out of 10 after an eye injury, a non-penetrating injury occurs.
A penetrating wound of the cornea of the eye is distinguished by the fact that a foreign body penetrates several shells of the eye at once, which leads to their deformation and violation 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 wound to the eye has the code SO5.
Types of injuries
All penetrating wounds can be divided into:
- main penetrating wound of the eye (trauma in which foreign material pierces the wall of the eyeball);
- deformation of the eyeball, in which it is not possible to restore the functions of the visual organ;
- through 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 it happens the other way around - a slight wound leads to dangerous consequences and complicates the penetrating wound of the eye, for example, complete loss of vision without the ability to recover.
Symptoms of Injury
Signs of penetrating eye injuries are obvious, and identifying them is quite simple. One can judge the presence of such ailment by both absolute (reliable) and relative signs.
The absolute signs of organ damage include:
- the presence of an obvious through wound and inlet;
- a foreign body is visible in the eye;
- prolapse of the inner membranes of the eyeball occurs.
Relative signs
The relative signs of malaise are as follows:
- hypotension (decreased intraocular pressure);
- a decrease in the size of the anterior chamber of the eye or its complete absence;
- the shape of the pupil itself changes (it does not always happen);
- the front chamber deepens as a result of damage to the integrity of the sclera;
- the iris and lens move (begin to lie on the back of the eye).
And although the described symptoms are obvious, sometimes it is quite difficult to determine a penetrating wound. Most often this happens when the injured item is small or very sharp. This leads to the adaptation of the edges of the wound and to their gluing, the front camera manages to recover in just a few days.
What causes of injury exist?
The main reason for the appearance of penetrating wounds is the impact of sharp, stabbing 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 (deformation of the cornea), scleral (excision of the sclera itself) and limbal (damage to the border of the eye chamber).
What is forbidden to do?
In case of penetrating wound, it is important for the patient to provide professional medical assistance, but at the moment of waiting for the ambulance crew or when delivering the victim directly to the hospital, something is prohibited. Contraindicated manipulations for penetrating eye injuries:
- Use cotton wool to apply bandages to the sore eye. In this case, small fibers of cotton wool can accidentally penetrate 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 is the situation when, together with a penetrating wound, there is a risk of a chemical burn).
- Try to independently eliminate the foreign body that remains in the ocular body.
Help to the injured
In case of penetrating eye injury, it is necessary to instill weak antibiotic drops into the eyes and carefully rinse the diseased eye with a solution of "Furatsioin" or "Rivanol", but at the same time avoid any rubbing.
The following drops can be antibacterial agents: Vigamox, Gentamicin, Albutsid or Levomycetin.
If the wound is not too large, then in the eye you can additionally drip a solution of "Novocaine" or "Lidocaine" for pain relief. Although some experts recommend not to disturb the deformed organ, but to make an intramuscular injection of analgin or another drug with a similar effect. After that, clean gauze is applied to the sore eye.
Upon arrival at the clinic, the patient is given an X-ray of the orbit to detect a foreign body. Emergency care for penetrating eye injuries is to conduct immediate surgery. During the procedure, excised damaged tissues are excised. The main goal of the doctor in this case is to preserve as many viable tissues 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 is performed using surgical instruments.
Wound dressing
First aid for penetrating wounds of the eye consists in the mandatory application of a bandage to the injured eye, whether it is right or left - the application procedure is the same. In this case, the dressing should be sterile, soft, elastic and hygroscopic (absorb moisture). Pure gauze is best for this.
If possible, it is recommended that the material is additionally ironed on the outside and back with a hot iron. Gauze should be folded in half, evenly distribute the cotton between the layers. You can touch the material only with alcohol-treated hands. The finished dressing is fixed with a simple patch (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 wound 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 color over time to reddish. Most often, such changes spread in the front 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 complete blindness.
If the foreign body is copper or includes impurities of a similar metal, then a person may begin chalcosis (a change in the eye tissues due to the negative effects of copper). With a similar disease, a yellowish-green opacity forms in 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 care for ophthalmologists
Specialized assistance of ophthalmologists is immediately provided to the patient at any time of the day or night in the eye trauma center, which is in any city. The list of specialized ophthalmic care services 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 conducts a survey radiography of the eye sockets in several projections - lateral and anteroposterior.
For this, it is important to properly lay the patient. With anteroposterior radiography of the orbit, the patient lies face down in such a way as to touch the table with the tip of the nose and lips. With such a laying of the head, the shadow of the pyramidal bone is derived from the projection of the orbit. In a side view, the patient turns his head so that he has access to the sore eye.
If the shadow of a foreign body is visible on the survey radiographs in the area of the orbit of the sick eye, then it is important to carry out X-ray radarization of the foreign body to determine its location. It is from 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 necessary to eliminate it. Chemical removal is carried out only on large bodies, which lead to the appearance of pain in the orbit.
Intraocular foreign bodies are eliminated immediately. If the foreign body is too long inside the eyeball, as a result, this can lead to some difficulties in removing it due to fouling with connective tissue. In the tissues of the eye, a foreign body is rapidly oxidized, and oxidation products adversely affect the delicate structures of the organ. However, the presence of a foreign object can lead to the onset of purulent infection, which will require additional treatment.
Vitreous hemorrhage of the eye
An injury to the vitreous body of the eye leads to the onset of bleeding. Blood in the retrolental space of the vitreous increases its size, and blood discharge in the orbicular space leads to the formation of a specific rim (strip) that surrounds the periphery of the lens on the back side.
The retrolental hemorrhage resolves much longer, than orbicular. In some cases, minor hemorrhages can be diagnosed only when they move to the lower part of the anterior chamber. Hemophthalmus - massive vitreous hemorrhage, as a result of which the latter is filled with a large volume of blood.
On the third day after the onset of hemorrhage in the vitreous body, hemolysis begins with the loss of hemoglobin by red blood cells, as a result of which they become colorless, and in the future completely disappear. Hemoglobin, in turn, takes the form of grains, which are then absorbed by phagocytes.
The formation of hemosiderin, which poison the retina. In some cases, the blood does not completely dissolve and the formation of a blood clot begins with the replacement of its connective tissue moorings.
Vitreous deformity
With hemophthalmus, cases of loss of visual acuity from light perception to complete blindness are common. Focal illumination and biomicroscopy helps to determine the presence behind the lens of a dark brown granular, sometimes with reddish clots of blood mass that impregnates the vitreous body.
Ophthalmoscopy helps to determine the absence of a reflex from the fundus. Further, during the resorption of the blood clot, deformation of the vitreous body can be seen, followed by liquefaction. Hemophthalmus is important to distinguish from partial vitreous hemorrhage, which quickly and completely resolves.
If you do not start treating diseases in time, then the degenerative process of the vitreous body will begin.
Treatment features
First aid for penetrating eye injuries is very important. In case of hemorrhage in the vitreous body, the doctor prescribes the patient bed rest and a bandage with cold in the sore eye. Use drugs with calcium (tablets, eye drops, intramuscular injections), hemostatics ("Vikasol").
To speed up the process of resorption of blood clots, "Heparin" (1-2 days), "Potassium iodide" and enzymatic medicines are used. During sleep, the patient's head should be in an elevated position. A binocular dressing is also applied to him for 2-3 days.
Once a day, the patient drinks "Calcium Chloride", "Pilocarpine" 1%, glucose with ascorbic acid, a solution of "Dicinone" is administered subconjunctively. After 2-3 days, a course of absorbable drugs begins: "Dionina", "Lidase" and "Potassium Iodide". Additionally, corticosteroids and fibrinolysin can be prescribed. At the late stage of treatment, a good effect can be achieved from physiotherapy and ultrasound.