Perforated corneal scleral wounds

With a corneal scleral wound, the limb zone may remain intact. Such perforating wounds have a separate entrance and exit holes in the wall of the eyeball and are called through (they are rarely scleroskiphal). Surgical treatment of the input wound with such a very serious injury presents certain difficulties, because it is necessary to work on an even soft white than usual eye. Whether to cover the inlet at the time of primary treatment is decided only with the following favorable factors: the wound is not accompanied by clouding of the lens, there is no massive vitreous hemorrhage, the exit wound in the region of the posterior pole is supposedly less than 10 mm and does not affect the area of the macula or optic disc, intraocular pressure is not very much lowered, there are no signs of endophthalmia or purulent infiltration of the wound. Such interference is justified, if the fate of the eyeball depends on suturing the extensive wound wound.

The injuries of the cornea-scleral region are treated like this. First, the corneal cut of the wound is sutured as more accessible. The first shaping suture is superimposed on the limb, as an exact comparison of it has a large and functional, and cosmetic significance. After the treatment of the corneal part is completed, the wounds move along its scleral site, gradually exposing the edges of the wound from the coverslips and sealing the traversed areas with knotty silk sutures 08. If the course of the wound has a sharp bend or branching, a thicker synthetic thread (04- 05).

When you exit the second hole, make a wide incision of the conjunctiva and tenon capsule, temporarily separate 1-2 muscles from the sclera, a stitch is placed on the stump of these muscles or on the episcler - in the intermediate meridians, the orbital tissues and the walls of the turned eyeball are squashed with wide blades and spatulas. Usually used for suturing flat, slightly curved, short (5-7 mm) and relatively strong needles. Both wounds are stitched sequentially.

If the wound is located parallel to the equator, then the usual needle can be applied only cross-mattress (X-shaped) seam, which poorly adapts the edges of the wound. In these cases, use Oma needles (from the set for surgery of retinal detachment), which are specially designed for sewing tissues deep wounds by moving "on yourself." With this needle, both the lips of the wound are stitched simultaneously - the back, and then the front, keeping their edge firmly enough.

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

Destruction of the eyeball

When the wound of the fibrinous capsule is very extensive and the loss of the vitreous is so great that it is impossible to keep the eyeball, it is resorted to primary enucleation. All the flaps of the shells must be spotted and removed, since leaving even a small portion of the uveal tract tissue can reduce the effect of the procedure to none. Usually, they try to restore at least the overall structure of the eyeball with firm seams, filling it with a swab from the gauze turunda or balls. After the eyeball takes a round shape and a known density, it is removed.

[5], [6], [7], [8], [9], [10]

A perforated wound of the eyeball with the introduction of a foreign body

Intraoral orbital bodies, as a rule, are not subject to urgent extraction, since traumatic searching often increases the risk of leaving them in tissues. Intraocular foreign bodies, on the contrary, almost always should be removed because of the danger of metallurgy, secondary mechanical trauma.

The wound of the cornea or sclera, subject to surgical treatment, in the presence of panoramic X-ray photographs of the orbit in two projections of the shade of the metal fragment. It is known that the through wounds of the eye are relatively rare (especially with industrial, not military trauma). Therefore, most likely, this fragment outside the eyeball did not come out. More often such fragments happen magnetic and in 1/5 cases easily move in cavities of an eye. At the final stages of surgical treatment of the wound, the tip of the permanent eye magnet, Jalialishvili, is brought to its edges. The splinter comes off to the magnet - well; does not go out - then it is either fixed in the shell, or in the lens (80% of cases), or is non-magnetic in nature. The comparatively low power of this magnet and its gradual approach to the wound create conditions for completely atraumatic movement of the unfixed fragment in the vitreous cavity and in the chambers of the eye.

Therefore, the risk of getting complications after this manipulation does not exceed what can arise after a repeated operation with an opening of the eyeball.

The wound of the cornea or sclera, subject to surgical treatment, in the presence of a non-magnetic foreign body in the zone of visibility. Non-magnetic foreign bodies are extracted through the wound with an ordinary or special tweezers, depending on its size. For "pellets" and other similarly shaped foreign bodies "spoon" tools are used; for polymorphous fragments - Gorban's instrument with a three-finger collet grip; eyelashes are most reliably grasped by tweezers with flat jaws without knurled; glass, coal - with tweezers, on the ends of which thin-walled plastic tubes are put on; Strong anatomical tweezers are suitable for wood. If the visible fragment is small, it is better to remove it immediately, because when applying seams, it can slip into the eyeball. When this danger is not felt, it is necessary first to apply the shaping seams to ensure the possibility of rapid sealing of the eye immediately after the removal of a large foreign body, since it is this manipulation that can open the cavity of the vitreous and help it fall into the wound.

[11], [12], [13], [14], [15]