Contusions to the eyeball

Blunt trauma or contusion is accompanied by damage to various parts of the eyeball. In mild cases, damage to the epithelium can be observed - corneal erosion or damage to the epithelium and Bowman's capsule.

Contusions affect the eye from the front or from below, since it is protected from the sides by the thickened edges of the orbit. As a result of a contusion, the eye is sharply compressed, and the intraocular pressure increases sharply. Depending on the force of the blow, either the more delicate inner membranes and parts of the eye may be damaged, or, if the force of the blow is great, the outer capsule of the eye is damaged.

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Symptoms of eyeball contusions

One of the most common phenomena in contusion of the eye is considered to be hemorrhage in the anterior chamber and in the vitreous body, which indicates damage to the iris, ciliary body or choroid. In this case, one can often see a tear in the iris at the root (iridodialysis); at the site of the tear, after the hemorrhage has resolved, a black hole is noticeable, which appears bright red when examined with an ophthalmoscope; the edge of the lens and fibers of the zonule can sometimes be seen in the hole. The pupil takes on an irregular shape. In other cases, tears or radial ruptures are observed in it. Contusion of the ciliary body is indicated by a sharp and persistent ciliary infection, photophobia and pain, which are especially noticeable when touching the eye. In the vascular membrane, ruptures with hemorrhages often form during contusions; the ruptures become visible with an ophthalmoscope only after the hemorrhage has resolved.

In the retina, hemorrhages, edemas and ruptures can also be noted. Contusion is often the cause of retinal detachment. The most delicate and most important part of the retina for vision is especially often affected - the area of the macula lutea, where ruptures and hemorrhages can form during contusion.

Contusion changes in the lens are manifested either by its clouding due to a rupture of the capsule, or due to a tear of the Zinn ligament, by subluxation or dislocation of the lens into the vitreous body or into the anterior chamber, and in the case of a rupture of the sclera - under the conjunctiva. Often, contusions of the eye lead to secondary glaucoma.

Contusions with rupture of the outer capsule of the eyeball are always serious and very severe. In severe cases, a rupture of the sclera may occur, which is most often found in the upper part of the eyeball and has the appearance of a crescent wound. A rupture of the sclera may be with or without a rupture of the conjunctiva, i.e. subconjunctival. Most often, a rupture of the sclera has an arcuate outline, concentric with the limbus, usually retreating from it by 1-2 mm, in a place corresponding to the position of Schlemm's canal, where the sclera is especially thin. But ruptures of the sclera are also possible in other places, often extensive and irregular in outline, where internal parts of the eyeball may fall out. If the undamaged conjunctiva remains above the rupture of the sclera and there is significant hemorrhage under it, the site of the rupture of the sclera is difficult to recognize until the blood is absorbed. However, a rupture, in addition to other signs, is indicated by a sharp decrease in intraocular pressure, the presence of vitreous body in the wound opening and its staining with pigment.

Contusive corneal edema is accompanied by a sudden deterioration in vision due to its diffuse clouding. Most often, edema appears as a result of damage to the epithelium and Bowman's membrane, but it can also be a consequence of reactive hypertension of the eye.

Damage to the optic nerve most often occurs due to its integrity being compromised or being compressed by bone fragments, foreign bodies, or a hematoma formed between the membranes of the optic nerve. Symptoms of damage to the optic nerve include visual impairment and changes in the visual field. With significant compression, visual acuity drops to zero, with the pupil dilating; in the presence of a sympathetic reaction, there is no direct reaction to light.

Complications in the post-contusion period are varied, among them are hypertension of the eye, hypotension, changes in the anterior part of the uveal tract. There are two phases of hypertension - the first occurs immediately after the contusion and is the result of vascular-nervous changes of reflex genesis, as well as due to an increase in the secretory capacity of the eye. The outflow of intraocular fluid is usually observed for 1-2 days, then it is replaced by hypotension. The second stage of hypertensive shifts is noted for the first time in weeks and months. Sometimes post-contusion glaucoma occurs 10-15 years after the injury and depends on changes in the iridocorneal angle.

Hypotension after blunt eye trauma is observed somewhat less frequently than hypertension. It most often occurs in patients with damage to the anterior segment of the eyeball - pathology of the iridocorneal angle and detachment of the ciliary body.

With persistent deep hypotension, swelling of the optic disc is observed, as well as the development of myopia, which is usually associated with a decrease in the secretion of the ciliary body.

The following factors influence the course of the post-contusion period and the outcomes of blunt eye trauma: damage to the vascular system of the eye as a whole; changes in ophthalmotonus; traumatic tissue changes; hemorrhages in the cavity of the eye tissue; inflammatory changes in the form of iritis and iridocyclitis.

Treatment of eyeball contusions

When treating patients with eye contusion, the main therapy in the first 1-2 weeks should include the use of sedatives (valerian, bromides, luminal, etc.); dehydration (2% or 3% calcium chloride solution at the site of installation, 40% glucose intravenously, diuretics orally - diacarb); vasoconstrictors, thrombolytics, anti-inflammatory drugs; drugs that regulate ophthalmotonus. Further treatment tactics depend on the damage to the eye tissue. Thus, in case of corneal erosions, disinfectants and drugs that promote epithelialization and regeneration are prescribed, in case of lens opacities - taufon, vitamin preparations; in case of retinal opacities - intravenous 10% sodium chloride solution, dicynone and ascorutin orally; in case of ciliary body contusion - painkillers, in case of hypertension - 0.5% thymol solution, 0.1% dexamethasone solution in drops 4 times a day; in case of contusion rupture of the sclera - instillation of 11.25% chloramphenicol solution and 20% sodium sulfacyl solution; in case of retrobulbar hematoma - diacarb 250 mg - 2 tablets once, 0.5% timolol solution 3 times a day in the conjunctival sac, osmotherapy - 20% mannitol solution intravenously; in case of iris damage: in case of mydriasis - 1% pilocarpine solution, in case of miosis - 1% cyclopentolate solution; in case of contusion of the choroid rim - askorutin and dicynone orally, osmotherapy - 10 ml of 10% sodium chloride solution or 40% glucose solution 20 ml intravenously; in case of lens displacement - instill disinfectant drops (0.25% solution of chloramphenicol), in case of increased intraocular pressure - 0.5% timolol solution, diacarb tablets orally (0.25).

Immediate surgical treatment of eye contusions is indicated only in cases of subconjunctival ruptures of the sclera and cornea, contusions of the eyelids and conjunctiva, as well as dislocations of the lens into the anterior chamber.