Corneal-scleral perforation wounds

In case of corneoscleral injury, the limbus zone may remain intact. Such penetrating wounds have separate entrance and exit holes in the wall of the eyeball and are called through and through (they are rarely scleroscyphoid). Surgical treatment of the entrance wound in such a very severe injury presents certain difficulties, because it is necessary to work on the eye, which is still white and softer than usual. Whether to suture the entrance hole at the time of primary treatment is decided only under the following favorable factors: the injury is not accompanied by cataract of the lens, there is no massive hemorrhage into the vitreous body, the exit wound in the area of the posterior pole is presumably less than 10 mm and does not affect the area of the macula or the optic disc, the intraocular pressure is not very low, there are no signs of endophthalmos or purulent infiltration of the wound. Such intervention is justified if the fate of the eyeball depends on suturing the extensive exit wound.

Wounds of the corneoscleral region are treated as follows. First, the corneal section of the wound is sutured as it is more accessible. The first form-forming suture is applied to the limbus, since its precise alignment is of great functional and cosmetic importance. After finishing the treatment of the corneal part of the wound, they move along its scleral section, gradually exposing the edges of the wound from the integumentary tissues and sealing the passed sections with knotted silk sutures 08. If the course of the wound has a sharp bend or branches, then a thicker synthetic thread (04-05) is applied to their corners.

When exiting the second opening, a wide incision is made in the conjunctiva and Tenon's capsule, 1-2 muscles are temporarily separated from the sclera, a frenulum suture is applied to the stump of these muscles or to the episclera - in the intermediate meridians, the tissues of the orbit and the walls of the turned eyeball are pressed with wide blades and spatulas. Flat, slightly curved, short (5-7 mm) and relatively strong needles are usually used when applying sutures. Both lips of the wound are sutured sequentially.

If the wound is parallel to the equator, then a regular needle can only be used to apply a cross-mattress (X-shaped) suture, which poorly adapts the edges of the wound. In these cases, Ohm needles (from a set for retinal detachment surgery) are used, which are specially designed for suturing tissues deep in the wound with a "towards you" movement. With such a needle, both lips of the wound are suturing at once - the back, and then the front, holding their edge firmly enough.

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Destruction of the eyeball

When the fibrinous capsule is damaged very extensively and the vitreous body is so lost that the eyeball cannot be saved, primary enucleation is used. All flaps of the membranes must be found and removed, since leaving even a small area of uveal tract tissue can negate the effect of the procedure. Usually, they try to restore at least the general structure of the eyeball with strong sutures, filling its cavity with a tampon made of gauze turunda or balls. After the eyeball takes on a rounded shape and a known density, it is removed.

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Penetrating injury of the eyeball with the introduction of a foreign body

Intraorbial foreign bodies, as a rule, are not subject to urgent extraction, since the trauma of the search often increases the risk of leaving them in the tissues. Intraocular foreign bodies, on the contrary, almost always must be removed due to the risk of metallosis, secondary mechanical trauma.

A corneal or scleral injury that requires surgical treatment, with a shadow of a metal fragment on survey radiographs of the orbit in two projections. It is known that penetrating wounds of the eye are relatively rare (especially in industrial rather than military injuries). Therefore, most likely, this fragment did not go beyond the eyeball. Most often, such fragments are magnetic and in 1/5 of cases they easily move in the eye cavity. At the final stages of surgical treatment of the wound, the tip of a permanent eye magnet Dzhalialshvili is brought to its edges. If the fragment comes out on the magnet - good; if it does not come out - it means that it is either fixed in the shell or in the lens (80% of cases), or is non-magnetic by nature. The relatively low power of this magnet and its gradual approach to the wound create conditions for a completely atraumatic movement of the unfixed fragment in the cavity of the vitreous body and in the chambers of the eye.

Therefore, the risk of complications after this manipulation does not exceed that which may arise after a repeat operation with opening of the eyeball.

A corneal or scleral wound requiring surgical treatment, with a non-magnetic foreign body in the visible area. Non-magnetic foreign bodies are removed through the wound with regular or special tweezers, depending on its size. For pellets and other similarly shaped foreign bodies, use "spoon" instruments; for polymorphic fragments, use a Gorban instrument with a trident collet grip; eyelashes are most reliably grasped with tweezers with flat, non-knurled branches; glass and coal - with tweezers with thin-walled plastic tubes on the ends; strong anatomical tweezers are suitable for wood. If the visible fragment is small, it is better to remove it immediately, since it may slip inside the eyeball when suturing. When such a danger is not felt, it is worth first applying form-forming sutures to ensure the possibility of quickly sealing the eye immediately after the removal of a large foreign body, since it is this manipulation that can open the cavity of the vitreous body and contribute to its falling out into the wound.

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