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37. Perforated wounds of the eyes
Due to the nature of the injuring objects, wounds 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. In addition, in some cases, there is hemorrhage into the retrobulbar space, manifested by exophthalmos, soreness, and limited mobility of the eyeball.
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 area. A sterile bandage is applied to the eye. 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).
Intraocular magnetic foreign bodies, after establishing their localization, are removed using an electromagnet. If the foreign body is in the anterior chamber or iris, it is removed through the corneal wound, in other cases diasclerally, along the shortest path, followed by suturing the scleral wound and diathermocoagulation around it. Unremoved metal magnetic and amagnetic foreign bodies cause metallosis.
Author: Shilnikov L.V.
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