Contusions of the eye

By severity, eye contusion is second only to perforating wounds. Contusions of the organ of vision in its clinical picture are very diverse - from minor hemorrhages under the conjunctiva of the eyelids to crushing the eyeball and surrounding tissues. They can arise as a result of the blunt effect of the damaging factor directly on the eye and its appendages (direct concussion) or indirectly (when exposed to more or less distant parts of the body). The source of injury in the first case is bruising with a fist or some object, falling on stones, on various protruding objects, an air wave, a stream of liquid, etc. Indirect concussions are the result of blows to the head, compression of the body,

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Symptoms of eye contusion

Clinical manifestations of contusion injury do not always correspond to its real severity. In addition, even relatively light bruises can lead to severe changes in the eyeball. Contusional damage to the visual organ in a number of cases is accompanied by a closed trauma of the brain. Traumatic damage to the eye tissues during contusion depends on two main factors: the force and direction of the stroke, as well as the features of the anatomical structure of the eye. So, depending on the strength and direction of the impact, tissue damage can be minor, and can be so strong that the scleral capsule ruptures. One can not ignore the age of the patient and the state of the eye before concussion.

Classification of eye contusion

There are three degrees of severity of contusions.

• I degree - contusions, in which a decrease in vision during recovery is not noted. At this degree, there are temporary reversible changes - edema and erosion of the cornea. Retinal opacities, the ring of Fossmus, spasm of accommodation, etc.
• II degree - contusions, which have persistent vision, deep erosions of the cornea, local contusion cataracts, ruptured sphincter ruptures, hemorrhages, etc.
• III degree - contusions, in which severe changes are observed, in which there is a possibility of a volume increase in the eye due to subconjunctival rupture of the sclera, as well as a state of sharp hydrodynamic shifts. At this degree, subconjunctival scleral ruptures are possible; persistent hypertension of the eye; deep, persistent hypotension of the eye.

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Symptoms of eye contusion

Symptomokompleks in the post-contusion period is very diverse and includes not only symptoms of damage to the eyeball and its auxiliary organs, but also changes in the general condition of the patient's body. There are pains in the cranio-facial area on the side of the lesion, headaches at first after trauma, dizziness, mild nausea, some change in convergence in reading (if visual functions are preserved). These common symptoms are observed in patients only in the first days. One of the signs of eye contusion in almost all patients is the infection of the eyeball, which is observed during the first day and keeps at the same level for 3-4 days, and then gradually decreases.

Contusions of the epididymis

In cases of light contusions, a different amount of hemorrhage under the eyelid skin and conjunctiva can be observed. The hemorrhage, which appeared immediately after the trauma, arises from the damaged vessels of the century. Hemorrhage, which appeared after a few hours or even days, indicates damage to the deep parts of the orbit or skull. For the fracture of the base of the skull, hemorrhage under the skin of the eyelids like the "glasses" is typical, appearing a day or later. Fresh contusion hemorrhages under the skin of the eyelids and in the conjunctiva have the appearance of sharply limited red spots of varying size and shape. Such hemorrhages in special treatment do not need, as they gradually dissolve without a trace. However, such an approach is possible only after a reliable exclusion of eye contusion and orbit.

Sometimes, with bruises of the eyelids, one can detect subcutaneous emphysema on palpation but characteristic crunch under the fingers (crepitation), indicating damage to the bone walls of the orbit and penetration of air from the airway cavities of the nose.

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Retrobulbular hematoma

Retrobulbular hematoma is a condition that is a manifestation of contusion of the orbit. Typical symptoms are: exophthalmos, limitation of mobility of the eyeball, intraocular pressure may increase. The decrease in visual functions is associated with compression of the orbital part of the optic nerve. In connection with a sharp increase in pressure in the orbit, reflex nausea, vomiting, and slowing of the pulse are possible. Hemorrhages are located under the skin of the eyelids and under the conjunctiva, the tactile sensitivity of the facial skin is reduced below the orbital margin.

Treatment:

• Diacarb 250 mg - 2 tablets per reception, once;
• 0.5% solution of timolol 2 times a day in the conjunctival sac;
• osmotherapy - 20% mannitol solution 1-2 g / kg body weight intravenously for 45-60 minutes.

Treatment of eye contusion

If there is a hemorrhage in the first day to narrow the blood vessels and reduce the hematoma, you can recommend cold, and then heat to accelerate resorption. They do not require any other special treatment and can independently resolve themselves.

In case of contusions, it is necessary to observe the patient's condition for several days, since trauma associated with damage to the trellis can later lead to the penetration of infection from the sinuses into the cranial fossa. Serious causes can cause ptosis, which sometimes appears simultaneously with subcutaneous hemorrhage. In this case, one can think of the concomitant damage to the oculomotor nerve or the rupture (stretching) of the eyelid levator. Special care is not required for contusion ptosis, but the neuropathologist should observe the patient, since the upper globule can be affected.

Severe concussion can be accompanied by tearing of the eyelids, ruptures of the conjunctiva and even a complete separation of the eyelid, with tear ducts often affected. Such lesions require surgical treatment, it is carried out according to the same rules as the wound of the eyelids.