LECTURE No. 23. Injuries of the eye

1. Perforated wounds of the eyes

Due to the nature of the injuring objects (such as, for example, wooden sticks, glass fragments, metal particles), injuries are more often infected and are always severe.

Corneal perforation wounds are characterized by the presence of a wound that passes through all layers of the cornea. The anterior chamber is small, but with good adaptation of the wound edges, especially with stab wounds, it can recover by the time of examination by an ophthalmologist. Ophthalmotonus is reduced. In connection with damage to the intraocular vessels, hyphema can be observed. If there is damage to the anterior capsule of the lens, then a cataract appears.

Scleral perforated wounds are often not visible and are indirectly manifested by a deep anterior chamber and hypotension of the eye. The lens is damaged less frequently than with corneal injuries. Simultaneously with the injury of the sclera, the choroid and retina are injured. In the fundus, retinal ruptures and hemorrhages can be determined, respectively, at the site of injury to the sclera.

Corneoscleral wounds can combine in their clinical picture signs of corneal and scleral wounds. With penetrating wounds of the eyeball, along with the inlet in the cornea or sclera, there may also be an outlet. It is diagnosed more often with ophthalmoscopy by the presence of retinal rupture and hemorrhages in the direction opposite to the inlet.

In addition, in some cases, there is hemorrhage in the retrobulbar space, manifested by exophthalmos, soreness, and limited mobility of the eyeball.

According to the scheme proposed by E. I. Kovalevsky in 1969, according to severity, it is advisable to divide perforated wounds into simple, complex and complicated.

For simple perforated wounds of various localization, adapted edges are characteristic without loss of the internal contents of the eye; for complex (more common in children) prolapse and infringement of the membrane. Complications of penetrating wounds are manifested in the form of metallosis (siderosis, chalcosis, etc.), purulent and non-purulent inflammation, as well as sympathetic ophthalmia.

Treatment. For cut or puncture wounds with adapted edges no longer than 2 mm, surgical treatment is not performed. Antibiotics are prescribed intramuscularly or orally, instillation of a 30% solution of sulfacyl into the conjunctival sac. When the wound is localized in the center of the cornea, mydriatics are indicated, while myotics are indicated in the periphery or in the limbus region. A sterile bandage is applied to the eye. Bed rest is observed for four to five days. The administration of tetanus toxoid is mandatory.

For more extensive and especially complicated wounds, surgery is performed under anesthesia. Before the operation, a culture of the conjunctiva is taken to determine the flora and its sensitivity to antibiotics. In the postoperative period, conservative treatment is carried out using antibiotics, corticosteroids, vitamin absorption therapy according to indications (oxygen under the conjunctiva, ultrasound).

Once their location has been established, intraocular magnetic foreign bodies are removed using an electromagnet. If the foreign body is located in the anterior chamber or iris, it is removed through the corneal wound, in other cases diascleral, along the shortest path, followed by suturing the scleral wound and diathermocoagulation around it. Unremoved metallic magnetic and amagnetic foreign bodies cause metallosis, which is accompanied by inflammatory and degenerative changes in the vascular tract, retina, as well as clouding of the optical media of the eye with a gradual decline in vision up to blindness. Operated patients should be on strict bed rest for five to twelve days, depending on the location of the wound, and receive conservative therapy.

With sluggish, non-treatable iridocyclitis, which is more common with corneoscleral injuries with damage to the ciliary body, there is a risk of sympathetic inflammation in a healthy eye.

Sympathetic inflammation (ophthalmia) can occur within a period of two weeks to several years from the moment the other eye is injured. The disease occurs as serous or plastic sluggish uveitis, as well as in the form of neuroretinitis or a mixed form of the disease. The process is manifested by moderate pericorneal injection of the eyeball, dust-like precipitates on the posterior surface of the cornea, posterior synechiae, and occurs with multiple relapses, most often in the form of plastic uveitis with fusion and fusion of the pupil. The outcome of the disease is a sharp decrease in vision, and often blindness. Almost the only preventive measure is timely (up to ten days) removal of the damaged eye to preserve vision in the undamaged eye. When sympathetic ophthalmia begins, it is necessary to urgently inject 23 ml of a 0,50,1% hydrocortisone solution under the conjunctiva daily or 1 times a week, prescribe prednisolone (dexamethasone) orally according to the age-specific dosage regimen and broad-spectrum antibiotics in combination with B vitamins .

2. Contusion of the eye

Based on clinical, morphological and functional data, blunt injuries are divided into four degrees of severity (according to V. V. Mishustin).

Blunt injuries of the first degree are characterized by reversible damage to the appendages and the anterior part of the eye, visual acuity and field of vision are completely restored.

With blunt injuries of the second degree, damage to the appendages, anterior and posterior parts of the eyeball is observed, mild residual effects are possible, visual acuity is restored to at least 0,5, the boundaries of the visual field can be narrowed by 10-20°.

With blunt injuries of the third degree, more pronounced residual effects are possible, a persistent drop in visual acuity within 0,40,05, narrowing of the visual field boundaries by more than 20 °.

Blunt injuries of the fourth degree are characterized by irreversible violations of the integrity of the membranes of the eye, hemophthalmos, damage to the optic nerve. Visual functions are almost completely lost.

Treatment. For intraocular hemorrhages, oral administration of rutin (vitamin P), ascorbic acid, and calcium chloride is indicated; in case of retinal concussion, dehydrating agents are prescribed (25% solution of magnesium sulfate intramuscularly, 40% solution of glucose intravenously, etc.), vitamin therapy (orally and parenterally, especially B vitamins). After a few days, oxygen injections under the conjunctiva of the eyeball, ionogalvanization with dionine or potassium iodide, and ultrasound are prescribed to resolve the hemorrhages.

With dislocation and subluxation of the lens, accompanied by constant irritation of the eye or hypertension, its prompt removal is indicated, with retinal detachment, diathermo, cryo or photocoagulation with shortening (filling, depression, corrugation) of the sclera. With subconjunctival ruptures of the sclera, the wound is sutured, followed by conservative therapy with antibiotics and corticosteroids.

A metallic magnetic foreign body is removed from the cornea with a magnet. If the foreign body in the cornea is amagnetic, then under local anesthesia with a 1% solution of dicaine (lidocaine), they are removed using a spear-shaped needle, and disinfectants are prescribed (30% sulfacyl solution, 1% synthomycin emulsion).

Multiple small foreign bodies in the conjunctiva of the eyeball must be removed only if the eye is irritated. Large foreign bodies are removed with a lance-shaped needle in the same way as corneal foreign bodies, after instillation of a 1% dicaine solution.

Orbital injuries can be the result of blunt trauma and wounds. In some cases, they are accompanied by subcutaneous emphysema, which most often occurs when the lower inner wall is damaged and is characterized by crepitus, bone defects detected on the radiograph, impaired skin sensitivity along the first and second branches of the trigeminal nerve, superior orbital fissure syndrome (ptosis, external and internal ophthalmoplegia, violation of the sensitivity of the cornea), exophthalmos due to retrobulbar hematoma or displacement of fragments into the orbital cavity or enophthalmos with divergence of fragments and an increase in the cavity of the orbit, rupture and separation of the optic nerve, ruptures of the choroid and retina.

Fractures of the outer wall of the orbit may be accompanied by ruptures of the outer parts of the eyelids, hemosinus of the maxillary sinus, lockjaw. With fractures of the inner wall, various changes are observed in the lacrimal ducts, tears of the inner corner of the eyelids and severe damage to the eyeball. Injuries to the lower wall are complicated by hemosinus and fractures of the zygomatic bone. With fractures of the upper wall, cerebral phenomena are possible.

Orbital injury is usually treated surgically. Foreign bodies present in the orbit are removed if they cause an inflammatory process or compression of soft tissues, the optic nerve or blood vessels. Bone fragments are also removed. Assign conservative treatment.

3. Eye burns

The most common thermal burns in children are burns caused by lime, potassium permanganate crystals, and office glue. Due to an oversight by medical personnel during the prevention of gonoblennorrhea according to Matveev Kreda, newborns sometimes suffer burns from a concentrated (1030%) solution of silver nitrate.

In children, burns are more severe than in adults. Particularly severe damage (colliquation necrosis) occurs with chemical burns, mainly with alkalis. Acid burns, especially sulfuric acid, are also very severe, but the acid does not penetrate deep into the tissue (coagulative necrosis).

According to severity, burns are divided into four degrees, taking into account their localization, size and condition (hyperemia, bladder, necrosis) of burned tissues. First-degree burns are characterized by edema and hyperemia of tissues, second-degree burns are blisters, erosions, and superficial, easily removable necrotic films. The burn of the third degree is characterized by necrosis, which captures the thickness of tissues with the formation of a grayish folded scab, and the fourth degree by necrotic changes in almost all membranes of the eye.

Third- and fourth-degree burns can be complicated by aseptic uveitis and endophthalmitis and result in eye atrophy. Another serious complication of these burns is perforation of the necrotic capsule of the eye with loss of membranes and subsequent death of the entire eye.

The consequences of damage to the skin and conjunctiva are cicatricial eversion and inversion of the eyelids, their shortening, leading to non-closure of the palpebral fissure and the formation of adhesions between the conjunctiva of the eyelids and the eyeball, symblepharon, which, unlike trachomatous, is anterior.

A burn can be caused by a chemical substance and hot foreign bodies that have entered the eye, as well as exposure to radiant energy, electric welding without goggles, and prolonged exposure to snow. Bright sunlight causes ultraviolet burns of the cornea and conjunctiva. There is a sharp photophobia, lacrimation, blepharospasm, edema and hyperemia of the mucous membrane. Biomicroscopy shows vesicles and erosions in the corneal epithelium. Watching a solar eclipse or molten glass or metal without protective goggles can cause infrared burns. The patient complains of the appearance of a dark spot before the eye. Ophthalmoscopy shows retinal edema in the macular region. After a few days, pigment mottling (dystrophy) may appear. The preservation of central vision depends on the degree of damage to the retina.

Treatment. First aid for chemical burns of the eyes consists of abundant and prolonged rinsing of the burn surface of the conjunctival cavity with water, removing particles of the substance that have entered the eye. Further treatment is aimed at fighting the infection (local disinfectants are prescribed), improving the trophism of the cornea (subconjunctival injections of autologous blood with penicillin, vitamin drops and ointments, oxygen injections, intravenous 40% glucose solution, injections under the conjunctiva of riboflavin, fibrin film are indicated), reduction of corneal edema (instillation of glycerin and oral fonurite are recommended). Due to insufficient oxygenation of the cornea, unithiol and cysteine ​​are indicated. In order to prevent adhesions in severe burns, a daily massage of the conjunctival fornix with a glass rod is performed after dicaine anesthesia. For third and fourth degree burns, urgent hospitalization in an eye hospital is indicated, and plastic surgery is often recommended.

In cases of aniline burns, frequent rinsing with a 3% tannin solution should be prescribed; for lime burns, instillation of a 4% solution of disodium salt of ethylenediaminetetraacetic acid (EDTA) is indicated; for burns with potassium permanganate, a 5% solution of ascorbic acid is indicated.

4. Frostbite of the eyes

Frostbite of the eyeball is extremely rare, since the protective apparatus protects the eye from exposure to low temperatures. However, under unfavorable conditions (workers of Arctic expeditions, pilots, athletes, etc.), as a result of the absence of cold receptors in the cornea, cases of frostbite of the cornea are possible.

Subjective sensations during frostbite are manifested in the feeling of a foreign body under the eyelids. Since in such cases, medical workers do not detect foreign bodies, anesthesin (dicaine, lidocaine) is instilled as first aid. This, in turn, aggravates the conditions of frostbite, since the eye loses all sensitivity, and the protective reflex of closing the eyelids and moistening the cornea stops.

Objectively, during frostbite, tender subepithelial vesicles appear in the cornea, on the site of which erosions subsequently form: eye irritation is absent at first and occurs only 68 hours after frostbite (like ultraviolet burns). According to the severity of frostbite are divided in the same way as burns.

Treatment. Instillation of miotics, vitamin drops, application of 1% synthomycin emulsion or sulfacyl ointment.

5. Combat damage to the organ of vision

Combat injuries of the organ of vision have a number of significant features compared to peacetime injuries. Unlike household injuries, all combat injuries are gunshot wounds. More often, eye injuries are caused by shrapnel, bullet wounds are rare. Wounds, as a rule, are multiple and are combined with powder gas burns.

A characteristic feature of combat injuries is a high percentage of perforated wounds and severe concussions of the eye, damage to the orbit, combined wounds, combined with wounds of the skull and brain.

The main principle of treatment is the phasing with the evacuation of the patient as directed. First aid (the application of a bandage from an individual package) is provided to the wounded on the battlefield by a comrade or medical personnel. The first medical (eye) aid (dressing and drug treatment) is provided on the day of injury in the SME or on the PHC. On the same day, the wounded is sent to the PPG, GLR or evacuation hospital, where he is assisted by an ophthalmologist.

The first ophthalmic care unit is the Army Ophthalmic Reinforcement Group, part of the ORMU. These groups, together with groups in other specialties, are transferred to the KhPPG, where wounds are treated for the wounded. Slightly wounded soldiers finish treatment in these hospitals and return to the front. Seriously wounded soldiers are sent to the evacuation hospital of the first and second echelons of the GBF. They provide full-scale ophthalmosurgical care.

The wounded, who need long-term treatment, are evacuated from the GBF to the evacuation hospitals of the inner region.

Children often experience damage to the eye, similar to combat: when launching rockets, explosions of capsules, cartridges, which are produced without adult control.

Author: Shilnikov L.V.

<< Back: Diagnosis, clinical picture and treatment of optic nerve pathologies (General diagnostic issues. Optic neuritis (neuritus nervi optici). Congestive papilla (disc) of the optic nerve (papillitis oedematosa s. oedema papillae n. optici). Optic nerve atrophy (atrophia nervi optici). Optic nerve glioma (glioma nervi optici) )

>> Forward: Myopia and astigmatism (Myopia. Astigmatism)

We recommend interesting articles Section Lecture notes, cheat sheets:

▪ Geography. Crib

▪ Pedagogy. Lecture notes

▪ Experimental psychology. Lecture notes

See other articles Section Lecture notes, cheat sheets.

Read and write useful comments on this article.

<< Back

Latest news of science and technology, new electronics:

The existence of an entropy rule for quantum entanglement has been proven 09.05.2024

Quantum mechanics continues to amaze us with its mysterious phenomena and unexpected discoveries. Recently, Bartosz Regula from the RIKEN Center for Quantum Computing and Ludovico Lamy from the University of Amsterdam presented a new discovery that concerns quantum entanglement and its relation to entropy. Quantum entanglement plays an important role in modern quantum information science and technology. However, the complexity of its structure makes understanding and managing it challenging. Regulus and Lamy's discovery shows that quantum entanglement follows an entropy rule similar to that for classical systems. This discovery opens new perspectives in the field of quantum information science and technology, deepening our understanding of quantum entanglement and its connection to thermodynamics. The results of the study indicate the possibility of reversibility of entanglement transformations, which could greatly simplify their use in various quantum technologies. Opening a new rule ... >>

Mini air conditioner Sony Reon Pocket 5 09.05.2024

Summer is a time for relaxation and travel, but often the heat can turn this time into an unbearable torment. Meet a new product from Sony - the Reon Pocket 5 mini-air conditioner, which promises to make summer more comfortable for its users. Sony has introduced a unique device - the Reon Pocket 5 mini-conditioner, which provides body cooling on hot days. With it, users can enjoy coolness anytime, anywhere by simply wearing it around their neck. This mini air conditioner is equipped with automatic adjustment of operating modes, as well as temperature and humidity sensors. Thanks to innovative technologies, Reon Pocket 5 adjusts its operation depending on the user's activity and environmental conditions. Users can easily adjust the temperature using a dedicated mobile app connected via Bluetooth. Additionally, specially designed T-shirts and shorts are available for convenience, to which a mini air conditioner can be attached. The device can oh ... >>

Energy from space for Starship 08.05.2024

Producing solar energy in space is becoming more feasible with the advent of new technologies and the development of space programs. The head of the startup Virtus Solis shared his vision of using SpaceX's Starship to create orbital power plants capable of powering the Earth. Startup Virtus Solis has unveiled an ambitious project to create orbital power plants using SpaceX's Starship. This idea could significantly change the field of solar energy production, making it more accessible and cheaper. The core of the startup's plan is to reduce the cost of launching satellites into space using Starship. This technological breakthrough is expected to make solar energy production in space more competitive with traditional energy sources. Virtual Solis plans to build large photovoltaic panels in orbit, using Starship to deliver the necessary equipment. However, one of the key challenges ... >>

Random news from the Archive Smart grenade launcher XM25 19.08.2013 A Pentagon official said that the XM25 grenade launcher will soon drop the letter "X", which means that the product is experimental. In other words, the XM25 will go into production, though at first in small batches - the first series will have 1100 grenade launchers and their ammunition. The US Army is currently working on implementing some improvements regarding the fire control system, battery life, grenade weight and size. After the completion of this work, the US Army will receive weapons ready for widespread combat use. The XM25 grenade launcher is a 5,5 kg semi-automatic four-shot grenade launcher equipped with a smart sight with built-in thermal imager, ballistic computer and range finder. The sight allows you to detect the enemy at any time of the day and in any weather, determine the range to the target and program a 25-mm grenade to detonate in a certain place near the enemy, for example, above a trench, a tank hatch, in a window opening, etc. This allows you to reliably hit the target behind shelters that protect against conventional small arms fire. Based on several hundred episodes of the use of the XM25 in Afghanistan, the military concluded that the new weapon is much more effective than most wearable support weapons. A shot from the XM25 usually stops the Taliban attack, and the grenade launcher provides high accuracy at a distance of up to 500 m, that is, further than the Kalashnikov assault rifle. Guidance occurs as follows: the soldier first finds the target with the help of a perfect 4-fold thermal imaging sighting system integrated into the weapon, then the laser rangefinder is turned on and information about the range to the target appears in the eyepiece of the sight. The soldier needs to select a point near the position of the enemy: on the side, above, behind and press the trigger - the grenade will explode behind, above, under or to the side of the shelter. When exploding, a grenade strikes manpower within a radius of 6 meters. In one of the episodes of the use of the XM25, a member of the foot patrol, Sergeant Carlos Smith, discovered an ambush using the XM25 sight. Usually the Taliban hide behind rocks, hills, ruins and other shelters that protect from bullets. But in this case, the fighter had an XM25, and a 25-mm grenade exploded right above the enemy machine gunner. As a result, the ambush was thwarted - the enemy fled, taking the wounded with him. In general, the use of a "smart" grenade launcher reduced the battle from the usual 15-20 minutes to 5-7. Thanks to the XM25, the soldiers did not have to approach the enemy from the flanks - the XM25 grenades simply smoked the enemy out of cover, showering him with a hail of shrapnel. For its high combat qualities, the XM25 was nicknamed Punisher ("Punisher").

Other interesting news:

▪ NXP is preparing an ultra-compact Wi-Fi chip

▪ Island powerhouse with artificial intelligence

▪ DC/DC converters TEQ 20/40WIR

▪ LG with its smartphones was caught lying

▪ How long will a rose last

News feed of science and technology, new electronics

Interesting materials of the Free Technical Library:

▪ section of the site Consumer Electronics. Selection of articles

▪ article The problem of desertification. Fundamentals of safe life

▪ article What grades in mathematics did Einstein get in school? Detailed answer

▪ article Transportation, storage and operation of cylinders with compressed and liquefied gas. Standard instruction on labor protection

▪ article Autonomous 32-channel programmable light-dynamic device with a serial interface. Encyclopedia of radio electronics and electrical engineering

▪ article Norms of acceptance tests. Fuses, fuse-disconnectors with voltage above 1 kV. Encyclopedia of radio electronics and electrical engineering

Leave your comment on this article:

All languages ​​of this page

Arabic	Hebrew	Polish
Bengali	Hindi	Portuguese
Chinese	Italian	Spanish
English	Japanese	Turkish
French	Korean	Ukrainian
German	Malay	Vietnamese

Home page | Library | Articles | Website map | Site Reviews

www.diagram.com.ua
2000-2024