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Bruises and injured eyes: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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The consequences of blunt trauma of the eye vary from the violation of the integrity of the eyelids to the damage to the orbit.
[1]
Bruises of the eyelids ("black eyes")
Bruises of the eyelids ("black eyes") have more cosmetic than clinical significance; although in some cases, with bruises of the eyelids, corneal lesions are possible, which are often missed. Uncomplicated bruises in the first 24-48 hours are treated by applying ice to reduce edema, then hot compresses are used to resolve the hematoma.
Small ruptures of the eyelids that do not affect their edge or arch can be sewn with a thin nylon thread (or catgut in children) 6-0 or 7-0. It is preferable that the restoration of the edge of the eyelid is performed by an ophthalmologist who can more accurately compare the edges of the wound and maintain the contour of the eye. Surgical treatment of large wounds of the eyelids with the spread to the middle part of the lower eyelid (possibly involving a lacrimal canal), through, penetrating into the peri-ocular tissue or arch of the eyelid, should be performed only by an ophthalmologist.
[2],
Injury of the eyeball
Trauma can cause hemorrhage under the conjunctiva, in the anterior chamber, in the vitreous, in the retina or retinal detachment; injury to the iris, cataract; lens dislocation; glaucoma and rupture of the eyeball. Inspection may be difficult due to pronounced edema of the eyelids or their injury. Nevertheless, due to the fact that some conditions may require immediate surgical treatment, the eyelids are gently diluted, avoiding pressing inward, and the eye is examined as closely as possible. A minimum list of studies includes assessment of visual acuity, pupillary response, eye movement volume, anterior chamber depth or degree of hemorrhage, and the presence of a red reflex. Analgesics and anxiolytics can greatly facilitate the examination. The gentle and careful use of retractors of the eyelids and the eye mirror will dilute the eyelids. Emergency care that can be provided prior to the arrival of an ophthalmologist consists of dilating the pupil with 1 drop of 1% cyclopentonal solution or 1 drop of 2.5% phenylephrine solution, applying a protective screen and applying infection control measures by local and systemic methods (as after removal of foreign bodies). When the eyeball is injured, local antibiotics are administered only in the form of drops, since penetration of the ointment into the eye is undesirable. In connection with the danger of fungal contamination of an open wound, the appointment of glucocorticoids is contraindicated prior to surgical closure of the wound. Very rarely, after damage to the eyeball, the undamaged eye of the opposite side also becomes inflamed (sympathetic ophthalmia), and without vision loss of vision is possible up to blindness. The pathogenetic mechanism is an autoimmune reaction; Glucocorticoids in drops can prevent this reaction.
Depressed fractures
Depressed fractures arise as a result of the forceful impact of a blunt trauma directed through the most fragile part of the orbit, usually its bottom. Fractures of the medial wall and the roof of the orbit are also possible. Symptoms include double vision, enophthalmos, an eyeball shift down, numbness of the cheek and upper lip (due to damage to the infraorbital nerve), or subcutaneous emphysema. Possible nasal bleeding, edema of the eyelids and ecchymosis. The diagnosis is most accurately established on CT. If diplopia and cosmetically unacceptable enophthalmus persists for 2 weeks, surgical intervention is indicated.
Post-traumatic iridocyclitis
Post-traumatic iridocyclitis (traumatic anterior uveitis, traumatic inflammation of the iris)
Post-traumatic iridocyclitis is an inflammatory reaction of the vascular and iris of the eye, typically developing on the third day after blunt trauma to the eye.
Symptoms of post-traumatic iridocyclitis include acute pulsating pain and redness of the eye, photophobia and blurred vision. The diagnosis is made on the basis of anamnesis, symptoms, examination results with a slit lamp, which is characterized by the identification of opalescence (due to an increase in protein content in the tissue fluid as a result of the accumulation of inflammatory exudates) and white blood cells in the anterior chamber of the eye. Treatment consists in the appointment of cycloplegic drugs (for example, 1 drop of 0.25% solution of scopolami-on, 1% solution of cyclopentolate or 5% solution of gomatropine methyl bromide, all drugs are prescribed 3 times a day). To reduce the symptomatic period, use topical glucocorticoids (for example, 1% solution of prednisolone from 4 to 8 times a day).
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