Wounds of the eyeball

Non-penetrating superficial corneal damage - erosion (corneal epithelial defect, scratch) - accompanied by significant pain, lacrimation, photophobia, sensation of foreign body. Around the cornea appears a pericorneal injection. Since all these phenomena interfere with eye examination, preliminary epibulbar anesthesia is necessary. To diagnose the erosion of the cornea, determine the size of the eroded area in the conjunctival cavity, instill a 1% solution of sodium fluorescent, and then drops containing isotonic sodium chloride solution. The dye stains the corneal tissues, not covered with epithelium, in a greenish color. From the epithelium the same fluorescent is easily washed off. On the site of erosion, keratitis, an inflammation of the cornea, may develop, so patients are prescribed treatment. Within 3-4 days the patient instilled 4 drops a day 2 drops of a 30% solution of albucid or 0.15% solution of levomecitin, the lower eyelid is laid 2 times and the chain ointment containing an antibiotic. If erosion does not become infected, the defect of the cornea is quickly replaced by a complete new epithelium.

A non-poor wound of the cornea is the basis for urgent surgical manipulation in two cases:

1. scalp wounding of the cornea, when a more or less thick layer of surface tissue has not completely separated from it. If the flap is small, tends to wrap up, i.e., does not lie in the wound bed, then after the epubulbar anesthesia it is sufficient to turn it off on the base, after which the surfaces are washed with a disinfectant solution. On top of the flap, put in place, put a soft giorogel contact lens. If the flap is large, then keep it in place without seams, especially if by the time of treatment there has already been a considerable swelling, it is rarely possible. Depending on the nature of the wound, a continuous seam is applied from the synthetic monofilament with the immersion of its ends into the thickness of the intact cornea or knotty stitches of silk;
2. foreign body in the superficial layers of the cornea. Foreign bodies lying on the surface of the cornea can be removed easily with a cotton swab moistened with a disinfectant solution after a preliminary epibulbar anesthesia. Deeply located bodies are removed by ophthalmologists in the hospital due to the danger of pushing them into the anterior chamber. From the thickness of the cornea, a metallic magnetic foreign body is extracted with a magnet. Along with a foreign body, an infection can enter the cornea and cause an inflammatory process in it, sometimes purulent. Therefore, after the removal of foreign bodies from the cornea, the same treatment is prescribed, as with the erosion of the cornea. Surface or embedded in the corneal tissue of foreign bodies are often found in people whose work is associated with metal processing. Particularly dangerous are the injuries of the cornea by the sting of the bee, which has on its side a notch pointed towards the tip. Because of this, any actions, even the blinking movements of the eyelids, move the stinger into the depths of the tissue, so it is impossible to remove the stinger from the cornea with tweezers, just as a pin or non-magnetic wire is extracted.

Remove the sting as follows. At first, the end of the razor blade is very carefully and necessarily in the optical section of the slit lamp, the channel is widened in the plane of the tip and then its protruding end is grasped with tweezers with pointed jaws. The same tactic is used to extract the spikelet.

Dense foreign bodies are removed after epibulbar anesthesia with a spear, grooved chisel or Schotter's instrument, also under the control of a slit lamp. The iron-containing fragment can be extracted with the tip of a portable permanent magnet or a magnet knife.

After removing any foreign body from the cornea, you need to put a Seidel color sample and drip disinfectant drops.

If around the foreign body in the cornea has already formed a rim of pink color ("scale"), then it is scraped after removing the foreign body with a needle or chisel, otherwise the healing of the tissue defect will be delayed.

In the presence of yellowish (purulent) infiltration after removal of the foreign body every 2-3 hours, the conjunctival bag is washed with a disinfectant solution and the surface is covered with an antibiotic. Inside also prescribe antibiotics and sulfonamides.

Penetrating wounds of the eyeball are heavy, they are applied with spiky objects, with firearms. The perforating wounds of the eyeball are those injuries in which the wounding body dissects the entire thickness of its wall. This damage in most cases is dangerous, since it can lead to a decrease in the visual function of the eye until complete blindness, and can also sometimes lead to the death of the second, intact eye.

Classification of injuries of the eyeball (Polyak).

1. Penetrating (foreign body once perforated capsule, has an inlet).
2. Through (a perforated hole has an inlet and an outlet).
3. The destruction of the eyeball (the shape is broken, the internal tissues of the eye are lost, which leads to enucleation of the eye).

On the localization of wounds of the outer shell of the eyeball distinguish corneal, limbal and scleral wounds.

Wound injuries are often accompanied by loss of shells and contents of the eyeball, hemorrhages, opacification of optical media, the introduction of foreign bodies, the penetration of infection.

The main task in providing emergency care to such wounded is the early sealing of the wound. Surgical treatment can be performed only after a detailed examination of the patient, and to clarify the question of the presence and localization of the intraocular foreign body.

Examination of the wounded with suspicion of perforating injury of the eyeball is best performed after epubulbar anesthesia.

The perforated injury of the eyeball is evidenced by both direct signs (a through wound in the cornea or sclera, a hole in the iris, the loss of the iris, the ciliary body or the vitreous body, the detection of the intraocular foreign body), and indirect signs (small or, conversely, deep anterior chamber , tearing of the pupil edge of the iris, clouding of the lens, hypotension of the eye).

A patient with suspected perforated injury of the eye should be necessarily placed in the hospital. When transporting, you must take precautions: on stretchers or gurney, slow movement, no shaking, observing the correct position of the head, etc.

During sanitation in the reception room, no physical stresses should be tolerated; when cutting hair on the head, prevent the hair from getting into the damaged eye; washing the patient to produce in the bath in the sitting position, with the personnel; The toilet of the head should be made with great care, flipped back so that water and soap could not get into the eyes; with extensive gaping wounds, the head can not be washed.

Penetrating wounds are often caused by ingress into the eye of a foreign body, therefore, for all perforated wounds of the eyeball, an X-ray examination is performed to establish the presence of a foreign body in the eye. Most often, magnetic and amagnetic metal fragments fall into the eye.