Contusion of the eye

In terms of severity, eye contusions are second only to penetrating wounds. Contusions of the visual organ are quite diverse in their clinical picture - from minor hemorrhages under the conjunctiva of the eyelids to crushing of the eyeball and surrounding tissues. They can occur as a result of blunt impact of a damaging factor directly on the eye and its appendages (direct contusions) or indirectly (when impacting more or less distant parts of the body). The source of injury in the first case is bruises with a fist or some other object, falls on stones, on various protruding objects, air waves, streams of liquid, etc. Indirect contusions are the result of blows to the head, compression of the body, etc.

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Symptoms of eye contusion

The clinical manifestations of contusion trauma do not always correspond to its actual severity. In addition, even relatively mild bruises can lead to severe changes in the eyeball. Contusion injuries to the visual organ are sometimes accompanied by closed brain injury. Traumatic damage to eye tissues during contusion depends on two main factors: the force and direction of the blow, as well as the features of the anatomical structure of the eye. Thus, depending on the force and direction of the blow, tissue damage can be insignificant, or it can be so severe that the scleral capsule ruptures. The patient's age and the condition of the eye before the contusion cannot be ignored.

Classification of eye contusion

There are three degrees of severity of contusion.

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

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Symptoms of eye contusion

The symptom complex in the post-concussion period is very diverse and includes not only symptoms of damage to the eyeball and its accessory organs, but also changes in the general condition of the patient's body. There are pains in the craniofacial region on the side of the injury, headaches in the first period after the injury, dizziness, mild nausea, some change in convergence when reading (if visual functions are preserved). These general symptoms are observed in patients only in the first days. One of the signs of eye contusion in almost all patients is infection of the eyeball, which is observed during the first day and remains at the same level for 3-4 days, and then gradually decreases.

Contusions of the eye appendages

In cases of mild contusions, various sizes of hemorrhages can be observed under the skin of the eyelids and conjunctiva. Hemorrhages that appear immediately after the injury arise from damaged vessels of the eyelid. Hemorrhages that appear several hours or even days later indicate damage to the deep parts of the orbit or skull. A fracture of the base of the skull is characterized by hemorrhages under the skin of the eyelids of the "glasses" type, which appear a day or later. Fresh contusion hemorrhages under the skin of the eyelids and in the conjunctiva look like sharply limited red spots of various sizes and shapes. Such hemorrhages do not require special treatment, as they gradually resolve without a trace. However, this approach is possible only after reliably excluding contusion of the eyeball and orbit.

Sometimes, with eyelid contusions, subcutaneous emphysema can be detected by palpation, with a characteristic crunch under the fingers (crepitus), indicating damage to the bony walls of the orbit and the penetration of air from the air cavities of the nose.

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Retrobulbar hematoma

Retrobulbar hematoma is a condition that is a manifestation of orbital contusion. Characteristic symptoms are: exophthalmos, limited mobility of the eyeball, intraocular pressure may increase. Decreased visual functions are associated with compression of the orbital part of the optic nerve. Due to a sharp increase in pressure in the orbit, reflex nausea, vomiting, and a slow pulse are possible. Hemorrhages are located under the skin of the eyelids and under the conjunctiva, tactile sensitivity of the skin of the face below the orbital edge decreases.

Treatment:

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

Treatment of eye contusion

If hemorrhage occurs on the first day, cold can be recommended to constrict the vessels and reduce the hematoma, and then heat to speed up resorption. They do not require any other special treatment and can resolve on their own.

In case of contusions, it is necessary to observe the patient's condition for several days, since trauma associated with damage to the ethmoid sinuses may subsequently lead to infection from the ethmoid sinuses penetrating the cranial fossa. Serious causes may cause ptosis, which sometimes appears simultaneously with subcutaneous hemorrhage. In this case, one may think about concomitant damage to the oculomotor nerve or a rupture (stretching) of the levator of the eyelid. Special assistance is not required for contusion ptosis, but a neurologist should observe the patient, since the superior orbital fissure may be affected.

Severe contusions may be accompanied by lacerations of the eyelids, ruptures of the conjunctiva, and even complete detachment of the eyelid, with the tear ducts often being affected. Such injuries require surgical treatment, which is carried out according to the same rules as eyelid injuries.