Contusions of the eyeball

Blunt trauma or concussion is accompanied by damage to various parts of the eyeball. In mild cases, damage to the epithelium can be observed - corneal erosion or damage to the epithelium and the Bowman capsule.

Contusions act on the eye from the front or from below, since it is protected from the sides by the thickened edges of the orbit. As a result of eye contusion, the eye sharply contracts, and the intraocular pressure rises sharply. Depending on the strength of the blow, the tender inner shells and parts of the eye may suffer, or, if the impact force is great, the outer capsule of the eye is damaged.

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Symptoms of eye contusion

One of the most common phenomena in eye contusion is hemorrhage in the anterior chamber and the vitreous, which indicates damage to the iris, ciliary body or choroid. In the rainbow rim, it is often necessary to see its separation from the roots (iridodialysis); on the site of detachment after resorption of the hemorrhage, a noticeably black opening, which when viewed with an ophthalmoscope appears bright red; Sometimes the edge of the lens and the fibers of the zinn ligament can be seen in the hole. The pupil at the same time takes an irregular shape. In other cases, tears or radial gaps in it are observed. The concussion of the ciliary body is indicated by a sharp and persistent ciliary infection, photophobia and pain, which are particularly noticeable when you touch the eye. In the choroid shell with contusions, ruptures with hemorrhages are often formed, the gaps become visible with the help of an ophthalmoscope only after resorption of the hemorrhage.

In the retina, hemorrhages, edema and ruptures can also be noted. Often, contusion causes retinal detachment. Especially often the most delicate and most important part of the retina is affected - the area of the yellow spot where ruptures and hemorrhages may develop during contusion.

Contusional changes in the lens are affected either by its turbidity due to rupture of the capsule, or due to tearing of the zinn ligament by subluxation or dislocation of the lens into the vitreous or in the anterior chamber, and when the sclera ruptures, under the conjunctiva. Often eye contusions entail secondary glaucoma.

Contusions with a rupture of the outer capsule of the eyeball are always serious and very severe. In severe cases, a scleral rupture may occur, which is more common in the upper part of the eyeball and has the appearance of a semilunar wound. The rupture of the sclera can be with a rupture of the conjunctiva and without breaking it, that is, it is subconjunctival. Most often the rupture of the sclera has an arcuate shape, a concentric limbus, usually departing from it by 1-2 mm, in a place corresponding to the position of the helmet canal, where the sclera is especially thin. But sclera ruptures are also possible in other places, often extensive and irregular in outline, where the inner parts of the eyeball may fall out. If the intact conjunctiva remains above the rupture of the sclera and there is a significant hemorrhage beneath it, the place of rupture of the sclera before blood resorption is difficult to recognize. However, the break, among other signs, is marked by a sharp decrease in intraocular pressure, the presence of a vitreous body in the opening of the wound and staining it with a pigment.

The concussive edema of the cornea is accompanied by a sudden deterioration of vision on the soil of diffuse clouding. Most often, edema appears as a result of damage to the epithelium and the Bowman shell, but it can also be a consequence of reactive hypertension of the eye.

Damage to the optic nerve is more often due to a violation of its integrity or compression of bone fragments, foreign bodies formed hematoma between the membranes of the optic nerve. Symptoms of damage to the optic nerve are a disorder of the visual function, a change in the field of vision. With significant compression, visual acuity drops to zero, while the pupil expands, in the presence of a sympathetic response, there is no direct reaction to light.

Complications in the post-contusion period are diverse, among them, hypertension of the eye, hypotension, changes in the anterior section of the uveal tract. There are two phases of hypertension - the first comes immediately after a concussion and is the result of neurovascular changes in the reflex genesis, and also due to an increase in the secretory ability of the eye. The outflow of the intraocular fluid is usually observed within 1-2 days, then it is replaced by hypotension. The second stage of hypertensive changes is observed for the first time weeks and months. Sometimes postcontractive glaucoma occurs 10-15 years after the injury and depends on changes in the iris-corneal angle.

Hypotension after blunt trauma of the eye is noted somewhat less often than hypertension. Most often, it happens in patients with damage to the anterior segment of the eyeball - the pathology of the iris-corneal angle and the detachment of the ciliary body.

With persistent deep hypotension, the edema of the optic disc is noted, as well as the appearance of myopia, which is usually associated with a decrease in the secretion of the ciliary body.

The following factors influence the course of the post-concussion period and the outcome of blunt trauma of the eye: damage to the vascular system of the eye as a whole; change ophthalmotonus; traumatic changes in tissues; hemorrhages in the cavity of the eye tissue; inflammatory changes in the form of irites and iridocyclites.

Treatment of eye contusion

In the treatment of patients with eye contusion in the first 1-2 weeks, the main therapy should include the use of sedatives (valerian, bromides, luminal, etc.); dehydration (the place of installation of 2% or 3% solution of calcium chloride, 40% glucose intravenously, inside diuretics - diacarb); vasoconstrictive, thrombolytic, anti-inflammatory agents; drugs regulating the ophthalmotonus. The further tactics of treatment depend on damage to the tissues of the eye. Thus, with the erosion of the cornea, disinfectants and preparations that promote epithelialization and regeneration are prescribed, with opacities of the lens - taufon, vitamin preparations; with opacity of the retina - intravenously 10% solution of sodium chloride, dicinone and ascorutin inside; with concussion of the ciliary body - analgesics, with hypertension - 0.5% solution of thymol, 0.1% solution of dexamethasone in drops 4 times a day; at a contusion rupture of the sclera - instillation of 11.25% solution of levomycetin and 20% solution of sulfacyl-sodium; with retrobulbar hematoma - diacarb 250 mg - 2 tablets once, 0.5% solution of timolol once a day in a conjunctival sack, osmotherapy - 20% mannitol solution with a vagina; with damage to the iris: with mydriasis - 1% solution of pilocarpine, with miosis - 1% solution of cyclopentolate; with contusion of the vascular ridge - ascorutin and dicinone inside, osmotherapy - 10 ml of 10% sodium chloride solution or 40% glucose solution 20 ml intravenously; when the lens is shifted - to drip disinfectant drops (0.25% solution of levomycetin), with increasing intraocular pressure - a solution of timolol 0.5%, inside the diacarb pill (0.25).

Immediate surgical treatment of eye contusions is indicated only with subconjunctival ruptures of the sclera and cornea, bruises of the eyelids and conjunctiva, and also with dislocations of the lens to the anterior chamber.