Injuries to eyelids and conjunctiva

The injuries of eyelids and conjunctiva look different depending on the nature of the damaging factor and the place of its application. In some cases, this may be a small hemorrhage under the skin, but in others - extensive breaks and ruptures of the eyelids. Damage to the eyelids is often combined with damage to the surrounding parts of the face, the bones of the eye socket and the eyeball, which are not always immediately evident.

The size and appearance of the wound of the eyelid and conjunctiva may not correspond to the severity of the concomitant damage of the underlying parts. Therefore, anyone seeking help for any damage to the eyelids should be carefully examined to identify such hidden disorders. In these cases, it is necessary to study visual acuity, transparent media and the fundus.

Damage to the eyelids and conjunctiva is often accompanied by swelling and flushing of the skin and subcutaneous hemorrhage. Sometimes there are abrasions or wounds. It is necessary to check the presence of subcutaneous emphysema, which indicates a concomitant violation of the integrity and bones of the nose and its adnexal sinuses.

The wounds of the eyelids can be superficial (blind), involving only the skin or skin along with the muscle layer, or deep (through) layers of the eyelid extending through the weight, including the conjunctiva, with or without damage to the free edge. The end-to-end wound of the eyelid usually yawns, its edges diverge as a result of the contraction of the circular muscle of the eye. The most severe lesion is a complete separation of the eyelid at the outer or inner corner of the eye. Separation at the inner corner is accompanied by tearing of the tear duct. In this case, the outflow of tears is violated, lachrymation occurs. Damage to the eyelids can be accompanied by tissue defects. After the injuries of the eyelids, their scar deformation can develop. Wounds and contusions of the eyelids are accompanied by extensive subcutaneous and subconjunctival hemorrhages. Neither is associated with vascularization of the eyelids. The spread of blood to the method is eliminated by a light-stretchy eyelid skin and loose fiber. When hemorrhaging them under the skin of the eyelids, special treatment is not required, one can confine oneself to the appointment of cold in the first day (locally).

Treatment of wounds of the eyelids. Patients with injury of the eyelids should be administered tetanus antiallergic serum. Treatment of wounds of the eyelids should be carried out at the microsurgical level.

Features of surgical processing:

1. perfect matching of the line of the eyelashes;
2. correct matching of the front and back edges;
3. the imposition of deep seams on the cartilage layer by layer, then on the fascia line, then on the skin;
4. on the lower eyelid, traction seams are also needed;
5. at a defect of a century it is possible to make an external kontotomiyu, a plastic, to put seams on a skin.

If there is a separation of the eyelid - due to good vascularity, eyelids can not be cut off, even if they hang "in the balance". In the treatment, each millimeter of tissue should be preserved to avoid shortening and deformation of the eyelids. In case of blind wound of eyelids, seams of fine silk or hair are applied to the skin. In the case of a through wound of the eyelid, especially if the wound goes in an oblique direction to the free edge of the eyelid or perpendicular to it, the seams are placed "on two floors": on the conjunctival cartilaginous part and on the musculocutaneous. First, sew the cartilage and conjunctiva, for which it is necessary to twist the eyelid. If the free edge of the eyelid is damaged, then the seam is first placed close to the free edge, or through the inter-marginal space. The superposed seam is tightened, but not fastened for the convenience of overlapping other seams. Only after superimposing and tying the rest of the seams the first seam is tied. The threads are cut short, the eyelid is straightened. Apply seams to the skin. For the eyelids lay 30% albutsidovuyu ointment. Apply a bandage to the eye. The operation is performed under local infiltration anesthesia. Dressings are done daily. Sutures are removed on the sixth day.

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

The wound of the century with damage to the tear duct

When injuring the upper eyelid, the upper-inner edge may injure the lacrimal gland. If it falls into the wound, the tear sack, the lower lacrimal canal is also destroyed. When the tear duct is affected, the main difficulty (in surgical treatment) is the "mouth" of the proximal end of the tubule. This is done with a special spiral probe with a hole at the rounded end. One of the ends of the probe is carried through the lacrimal point of the surviving tubule into the lacrimal sac, and then - retrograde - into the proximal part of the ruptured tubule. Then, into the hole, the mandrene is pulled into the tear ducts by rotating the probe. Further, the probe is injected into another lacrimal point and the second end of the mandrel is drawn into the distal portion of the broken tubule. On the edges of the canal, 2-3 immersion sutures are applied and the wound of the eyelid is sutured. The ends of mandrin with overlap are pasted with adhesive tape to the skin of cheeks and forehead. To reduce the elasticity of the mandril in the middle, it is cut beforehand with a razor by 2/3 thickness. Post retraction of this zone in the lacrimal sac, the mandril easily folds in half and lies without deforming the tubules. After 2-3 weeks, the mandran is removed.

Conjunctival injuries

The wounding of the conjunctiva of the eyeball is isolated rarely, it often accompanies the wound of the eyeball. The wound of the conjunctiva does not gap even at a considerable length. Therefore, she does not need to be sutured. Ziyanie wounds of the mucosa testifies to concomitant damage and elastic tenon capsule. First of all, the wound is inspected to find out whether the sclera is damaged. On the surface of the conjunctiva, small foreign bodies are often retained, they are visible during an external examination.

Quite often the foreign body lingers on the conjunctiva under the upper eyelid. The foreign body located here gives a lot of unpleasant sensations (pain, aggravated by blinking, marked photophobia). Such a foreign body injures the cornea. Foreign bodies must be removed immediately. On the wound of the conjunctiva more than 5 mm in length it is necessary to impose seams of fine silk, anesthetizing the conjunctiva by instillation of a 1% solution of dicaine. In the conjunctival cavity lay the albucid or other disinfectant ointment. Sutures are removed on the 4-5th day. The wound of the conjunctiva, which is less than 5 mm in length, does not require suturing. In these cases, a 20% solution of the albucid in the form of drops or ointment is prescribed to the patients.

[6], [7], [8]

Injury of the external muscle of the eye

Sometimes the wound of the conjunctiva and the tenon capsule also grabs the outer muscle of the eyeball. Stitching of the muscle is necessary only when it is completely separated from the sclera. It is necessary to find the proximal part of the muscle and sew it to the tendon cult with two stitches catgut. But this is not easy to do because of the tendency of the muscle to retract. Then the blunt path (due to the separation of the ends of the scissors) opens the connective tissue vagina of the muscle, preferably from the Tenon space, so as not to enter the orbital fiber and not damage the eye suspension apparatus to the walls of the orbit. If the wound is stale and the retraction is significant, then one should focus on the layers of tissues, the most mobile when trying to actively turn the eye in the right direction. In extreme cases, they cut out a tape about 1 cm wide that contains soldered muscle. It is sewn to the muscular stump on the eyeball.