Wounds to the eyeball

Non-penetrating superficial damage to the cornea - erosion (defect of the corneal epithelium, scratch) - is accompanied by significant pain, lacrimation, photophobia, sensation of a foreign body. Pericorneal injection appears around the cornea. Since all these phenomena interfere with the examination of the eye, preliminary epibulbar anesthesia is necessary. To diagnose corneal erosion, determine the size of the eroded area, a 1% solution of sodium fluorescent is instilled into the conjunctival cavity, and then drops containing an isotonic solution of sodium chloride. The dye colors the corneal tissues not covered by the epithelium in a greenish color. Fluorescent is easily washed off from the epithelium. Keratitis - inflammation of the cornea - can develop at the site of erosion, so such patients are prescribed treatment. For 3-4 days, the patient instills 2 drops of a 30% solution of albucid or 0.15% solution of levomycetin 4 times a day, and an ointment containing an antibiotic is placed behind the lower eyelid 2 times a day. If the erosion does not become infected, the corneal defect is quickly replenished with fully formed newly formed epithelium.

A non-perforating corneal injury is a basis for urgent surgical manipulation in two cases:

1. a scalp wound of the cornea, when a more or less thick layer of superficial tissue has not completely separated from it. If the flap is small and tends to roll up, i.e. does not lie in the wound bed, then it is sufficient to turn it back at the base after epibulbar anesthesia, after which the surfaces are washed with a disinfectant solution. A soft hyrogel contact lens is placed over the flap laid in place. If the flap is large, it is rarely possible to hold it in place without sutures, especially if considerable swelling has already passed by the time of treatment. Depending on the nature of the wound, a continuous suture of synthetic monofilament is applied with its ends immersed in the thickness of the intact cornea or knotted silk sutures;
2. a foreign body in the superficial layers of the cornea. Foreign bodies lying on the surface of the cornea are easily removed with a cotton swab soaked in some disinfectant solution after preliminary epibulbar anesthesia. Deeply located bodies are removed by ophthalmologists in a hospital due to the danger of pushing them into the anterior chamber. A metallic magnetic foreign body is removed from the thickness of the cornea using a magnet. An infection can penetrate the cornea along with the foreign body and cause an inflammatory process in it, sometimes purulent. Therefore, after removing foreign bodies from the cornea, the same treatment is prescribed as for corneal erosion. Superficial foreign bodies or those penetrating into the corneal tissue are often found in people whose work is related to metal processing. Corneal injuries caused by a bee sting are especially dangerous, as it has serrations on its lateral surface that point toward the tip. Because of this, any action, even blinking movements of the eyelids, moves the sting deeper into the tissue, so it is impossible to extract a bee sting from the cornea with tweezers in the same way as a splinter or non-magnetic wire.

The sting is removed in the following way. First, the channel in the plane of the sting is widened very carefully with the end of a razor blade and necessarily in the optical section of a slit lamp, and then its protruding end is grasped with tweezers with pointed jaws. The same tactics are used to extract the spikelet.

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

After removing any foreign body from the cornea, it is necessary to perform a Seidel color test and instill disinfectant drops.

If a pink rim (“scale”) has already formed around the foreign body in the cornea, it is scraped out after the foreign body is removed 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, the conjunctival sac is washed with a disinfectant solution every 2-3 hours and the surface is sprinkled with an antibiotic. Antibiotics and sulfonamides are also prescribed internally.

Penetrating wounds of the eyeball are considered severe and are caused by sharp objects and firearms. Penetrating wounds of the eyeball are injuries in which the wounding body cuts through the entire thickness of its wall. This injury is dangerous in most cases, as it can lead to a decrease in the visual function of the eye up to complete blindness, and can also sometimes cause the death of the second, undamaged eye.

Classification of injuries of the eyeball (Pole).

1. Penetrating (the foreign body pierces the capsule once and has an entrance hole).
2. Through (a through hole has an input and an output hole).
3. Destruction of the eyeball (shape is disrupted, internal tissues of the eye are lost, which leads to enucleation of the eye).

Depending on the location of the wounds of the outer shell of the eyeball, corneal, limbal and scleral wounds are distinguished.

Penetrating wounds are often accompanied by loss of membranes and contents of the eyeball, hemorrhages, clouding of the optical media, introduction of foreign bodies, and penetration of infection.

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

Examination of a wounded person with suspected penetrating injury of the eyeball is best performed after epibulbar anesthesia.

A penetrating wound of the eyeball is indicated by both direct signs (a through wound in the cornea or sclera; a hole in the iris; prolapse of the iris, ciliary body or vitreous body; detection of an intraocular foreign body) and indirect signs (a shallow or, conversely, deep anterior chamber, a tear in the pupillary edge of the iris, clouding of the lens, hypotonia of the eye).

A patient with a suspected penetrating eye injury must be hospitalized. During transportation, precautions must be taken: on a stretcher or gurney, slow movement, no shaking, correct head position, etc.

During sanitization in the admissions department, no physical exertion should be allowed; when cutting hair on the head, eliminate the possibility of hair getting into the injured eye; wash the patient in a bath in a sitting position, by the staff; wash the head with great care, throwing it back so that water and soap cannot get into the eyes; in case of large gaping wounds, the head should not be washed.

Penetrating wounds are often caused by a foreign body entering the eye, so all penetrating wounds of the eyeball require an X-ray examination to determine the presence of a foreign body in the eye. Magnetic and amagnetic metal fragments are most often found in the eye.