Foreign bodies in the eye

Foreign body when ingested into the eye causes:

1. destruction, the degree of which depends on the mass of the fragment, shape, flight trajectory;
2. infection of the eye;
3. loss of shells;
4. hemorrhage.

The splinter causes inflammation leading to mooring and metallurgy.

You need to delete all the fragments, but to remove them was less traumatic than leaving, and those that can be deleted.

Classification of fragments

The smallest - up to 0.5 mm; small - up to 1.5 mm; average - up to 3 mm; large - up to 6 mm; giant - more than 6 mm; Long - rarely the same size and especially long. Interaction of fragments with shells:

1. fragments, free-moving in the vitreous body;
2. fragments relatively mobile in the vitreous body;
3. oshl ochechnye fragments - motionless;
4. in the lens - motionless.

On interaction with shells: partially penetrated, with the inhibition zone, by a rhylet (possible free-moving and secondary interaction with shells). 99% of the fragments are not detected.

Small foreign bodies such as steel particles, coal or sand often settle on the surface of the cornea or conjunctiva. Subsequently, such foreign bodies can:

• To be washed away by a tear into the system of lacrimal passages.
• Slip off the palpebral conjunctiva of the upper eyelid in the sub-tarsal sulcus and injure the cornea with each blink. Subtarzal foreign body can be overlooked, if the examination does not turn out the upper eyelid.
• Migrate and stay in the upper conjunctival vault, and then provoke chronic conjunctivitis. Such foreign bodies are also easy to miss, if you do not turn your eyelids and do not examine the vault.
• Infiltrate the bulbar conjunctiva.
• Insert into the epithelium or stroma of the cornea to a depth proportional to the speed of the foreign body.
• High-speed foreign bodies can penetrate the cornea, sclera and intraocular.

[1], [2], [3], [4], [5], [6]

Corneal foreign bodies

Clinical features. Corneal foreign bodies are extremely common and cause considerable irritation. Around any foreign body after some time, leukocyte infiltration is formed. If the foreign body is not removed, the risk of secondary infection and ulceration of the cornea is high. Moderately expressed so-called secondary uveitis is characterized by miosis, irrigation and photophobia. Around the iron foreign body in a few days begins the deposition of rust in the bed of its occurrence.

Treatment

• a thorough investigation on the slit lamp is necessary to determine the exact location of the foreign body and the depth of its occurrence;
• the foreign body is removed under the control of the slit lamp using an insulin needle. A magnet is convenient to use for a deeply embedded metallic foreign body. The residual "rusty ring" (scales) can easily be removed with a sterile "boron";
• antibiotics in the form of ointments are used together with cycloplegic drugs and / or ketolorac for comfort.

In the presence of detachable, infiltration or expressed uveitis, a secondary bacterial infection should be suspected; follow-up should be done, as with the ulcer of the cornea. Metal foreign bodies are usually sterile due to a significant increase in temperature at the time of passage through the air; Organic and stone foreign bodies are more often carriers of infection.

[7], [8], [9], [10], [11], [12], [13]

Intraocular foreign bodies

Intraocular foreign bodies can injure the eye mechanically, infect or have a toxic effect on intraocular structures. Once in the eye, the foreign body can be localized in any of its structures, in which to penetrate; thus, it can be located anywhere from the anterior chamber to the retina and the choroid. Visible mechanical effects include the development of secondary cataracts with damage to the lens capsule, vitreous liquefaction, ruptures and retinal hemorrhage. Stones and organic foreign bodies are especially dangerous for infection. Many substances, including glass, various plastics, gold and silver, are inert. However, iron and copper can be dissociated and lead to the development of siderosis and chalcosis, respectively.

Sideroz Eye

Fragments of iron - one of the most common foreign bodies. Intraocular iron foreign bodies are dissociated, resulting in the deposition of iron fragments in the intraocular epithelial structures, especially on the epithelium of the lens and retina, with a toxic effect on the enzyme system of cells and leading to their death. Signs of siderosis: anterocapsular cataracts, consisting of radial deposits of iron on the anterior capsule of the lens, reddish-brown iris coloration, secondary glaucoma due to injured trabeculae and pigmentary retinopathy. The latter, basically, determines the prognosis for vision, Electroretinography after some time after trauma shows progressive weakening of the b-wave.

Chalk eye

The reaction of the eye to the intraocular foreign body with a high copper content is similar to endophthalmitis. Often with a progressive course until the death of the eye. On the other hand, an alloy of the type of brass or bronze with a relatively low content of copper leads to chalcosis. The electrolytically dissociated strand is deposited within the eye, forming a picture similar to that of Wilson's disease. Thus, the Kayser-Fleischer ring develops, the anterior capsule cataract in the form of a "flower of a sunflower". Defeat of the retina is expressed in the form of golden lamellar deposits, visible ophthalmoscopically. Since copper is less toxic to the retina than iron, degenerative retinopathy does not develop, and visual functions can persist.

[14], [15], [16], [17]

Diagnosis of foreign bodies of the eye

1. Anamnesis is required to determine the origin of the foreign body; it would be prudent for the patient to bring objects from which a fragment, such as a chisel, bounced off.
2. Ophthalmic examination is performed, paying special attention to any possible places of entry or exit of a foreign body. A fluorescein probe can help in identifying the inlet. Evaluation of the location of the wound, its projection on the eye logically suggests the localization of the foreign body. It is necessary to perform gonioscopy and ophthalmoscopy. Concomitant symptoms, such as rupture of the eyelids and damage to the structures of the anterior segment, should be carefully noted.
3. CT in axial and frontal projections is necessary for the diagnosis and localization of metallic intraocular foreign bodies. Perform cross-sections, which, but diagnostic value, exceed simple x-ray and echography.

NMR is contraindicated in the presence of metallic intraocular foreign bodies.

[18], [19], [20]

Method for removal of foreign bodies from the eye

Removal of foreign bodies by a magnet includes:

• Sclerotomy in the place of adherence of the foreign body;
• low-intensity diathermy on the choroid to prevent bleeding;
• removal of a foreign body by a magnet;
• cryopexy for fixing the retipal ruptures and the adjacent retina;
• Injection of the sclera to reduce the risk of retinal detachment, but this is not necessary.

Removal by tweezers is used for non-magnetic foreign bodies and magnetic bodies, which can not be safely removed by a magnet.

• perform a total vitrectomy through the flat part of the ciliary body;
• a small foreign body can be removed through the flat part of the ciliary body;
• a large foreign body on the aphakic eye in the pupil area can be removed by keratom through the limbal incision.

Prevention of endophthalmitis by intravitreal administration of antibiotics is indicated at a high risk of infection, for example when introducing foreign bodies of plant origin or contaminated with soil.

Enucleation of the eye

Primary enucleation of the eye should be performed only with very serious injuries, with no prospect of restoring vision and the inability to restore the sclera. Secondary enucleation of the eye is performed after the initial treatment, if the eye damage is serious and its functions are not recoverable, as well as for cosmetic reasons or in case of discomfort. According to some researchers, it is recommended to perform enucleation within 10 days after the initial injury in order to prevent the least possible possibility of sympathetic ophthalmia. However, there is no objective evidence of this fact. Temporary postponement also allows patients to adapt psychologically and emotionally to loss of the eye.

[21], [22], [23], [24], [25], [26]