Wounds of the cornea are divided into penetrating and non-penetrating. With a penetrating injury, the integrity and relative position of the anatomical structures of the eye are disrupted and moisture is released. With non-penetrating injury, the injury is limited to the surface of the cornea.

Clinical picture

• Sharp pain in the eyeball.
• Sharp decline vision up to complete blindness.
• Drainage of moisture and blood from the eye.

Diagnostics

• When examining the eye, a violation of the anatomical integrity is noted eyeball.
• With non-penetrating wounds, defects or the foreign body itself are visible on the surface of the cornea.
• With penetrating wounds, ophthalmotonus is sharply reduced.
• Visus reduced.
• Ultrasound or x-ray diagnostics can detect a foreign body deep in the eyeball.
• The anterior chamber is shallow.

Treatment of corneal wounds

• Patients with corneal injuries should immediately receive first aid in the form of instillation of antibiotics, administration of anti-tetanus serum and application of a binocular patch. Next, the patient should be referred to a specialized eye hospital. It is necessary to pay attention to the fact that it is strictly forbidden to remove blood clots.
• If there is a minor penetrating wound to the cornea, when the wound channel has a straight shape with smooth and neat edges, PSO of the wound should be performed followed by application contact lens. In this case, healing will take place with the formation of a neat scar, but this is only possible if the wound is small.
• In case of severe injury to the cornea experienced surgeon applies suture material. Usually the suture is not applied to the entire depth of the cornea, but sometimes it is necessary to resort to through application of suture material.
• Despite the severity of the injury to the cornea, the use of antibiotics and anti-inflammatory drugs is mandatory, both in the form of drops and injections into the eye area, and at the systemic level. Instillation of drops is carried out 4 times a day, more often if necessary. We must pay attention to the fact that early application ointments are unacceptable, as they slow down healing, impair the outflow of pus, and contribute to the development bacterial infection. To speed up the healing process at the systemic level, antibiotics and NSAIDs are used for 1-2 weeks. First in the form of injections, then you can switch to tablet forms of drugs.

One of the important aspects of treatment is the use of drugs that dilate the pupil; their use is justified high risk formation of adhesions. Drugs that improve the regeneration of eye tissue include Korneregel and others.

Essential drugs

There are contraindications. Specialist consultation is required.

• (stimulator of regenerative processes in the cornea, has an anti-inflammatory effect). Dosage regimen: standard dosage - 1 drop into the affected eye 3 to 5 times a day. The frequency of instillations depends on the severity of the patient's condition. Do not touch the tip of the pipette to any surfaces, eyes or skin. Immediately after use, carefully close the bottle.
• Moxifloxacin () is a fluoroquinolone antibiotic for local application in ophthalmology. Dosage regimen: adults and children over 1 year of age, instill 1 drop into the affected eye 3 times a day. Typically, improvement occurs within 5 days and treatment should be continued for the next 2-3 days. If the condition does not improve after 5 days, the question of the correctness of the diagnosis and/or prescribed treatment should be raised. The duration of treatment depends on the severity of the condition and the clinical and bacteriological course of the disease.
• eye drops (NSAIDs for topical use in ophthalmology). Dosage regimen: instill 1 drop into the conjunctival sac of the affected eye 4 times a day.

Damaging factors. Penetrating eye injuries can be caused by fragments of metal, glass, stone and other sharp cutting and piercing objects.

As soon as the diagnosis of a penetrating eye injury is confirmed, a survey radiography of the orbits is performed in two projections - anteroposterior and lateral. In this case, the patient must be positioned correctly. During anteroposterior x-ray of the orbit, the victim lies face down so that he touches the table with the tip of his nose and lips. With this positioning of the head, the shadow of the pyramidal bone is removed from the projection of the orbit. For a lateral photograph, the patient turns his head with the wounded eye down.

If survey radiographs reveal a shadow of a foreign body in the orbital area of ​​the wounded eye, then after this it is necessary to do x-ray localization of the foreign body in order to determine its location, on which the doctor’s further tactics when providing treatment will depend. specialized assistance to the victim.

If a foreign body is in the tissue of the orbit and it is not large sizes, there is no need to delete it. Only large foreign bodies that cause pain in the orbit, limit the movements of the eyeball, support the inflammatory process in it and delay wound healing should be removed.

Intraocular foreign bodies are removed urgently. Prolonged residence of a foreign body in the eye creates difficulties for its removal due to fouling connective tissue. In the tissues of the eye, the foreign body is oxidized and the oxidation products have a detrimental effect on the delicate structures of the tissues of the eyeball. Along with this, a foreign body can be a source of purulent infection in the eye.

Due to the superficial and open location of the eyes, this organ is very vulnerable to injury and various types of mechanical, chemical, and thermal damage. Eye injury is dangerous due to surprise. It can happen anywhere; neither adults nor children are immune from it.

Eye injury means damage to the natural structure and, as a result, disruption normal functioning organ of vision, which can lead to disability of the victim. Injury occurs as a result of contact with the eye foreign bodies, chemicals, exposure to temperatures or due to physical pressure to the organ

This must be taken seriously; if you experience an eye injury, it is important to consult a doctor immediately. After providing assistance to a traumatologist, a mandatory consultation with an ophthalmologist is required. Despite the severity of the injury, complications can arise over time. To avoid them, it is important to carry out treatment under the close supervision of a specialist.

An eye injury in a child is a particularly dangerous injury. Having arisen at a young age, in the future it can become a reason for disruption and decrease in the functions of the injured organ. Most often, the cause of injury can be:

• damage to the eye by a foreign object;
• blows, bruises;
• – thermal or chemical.

Species

Eye injuries are distinguished depending on the causes of origin, severity and location.

According to the mechanism of damage, it happens:

• blunt eye injury (bruises);
• wound (non-penetrating, penetrating and through);
• uninfected or affected by infection;
• with or without penetration of foreign objects;
• with or without prolapse of the eye shell.

Classification by location of damage:

• protective parts of the eye (eyelid, orbit, muscles, etc.);
• eyeball injury;
• appendages of the eye;
• internal elements of the structure.

The severity of eye injury is determined based on the type of damaging object, the force and speed of its interaction with the organ. There are 3 degrees of severity:

• 1st (mild) is diagnosed when foreign particles penetrate the conjunctiva or the plane of the cornea, a 1-2 degree burn, a permanent wound, a hematoma of the eyelids, and short-term inflammation of the eye;
• 2nd (medium) is characterized by acute conjunctivitis and clouding of the cornea, rupture or tearing of the eyelid, 2-3 degree burns of the eyes, non-penetrating injury to the eyeball;
• 3rd (severe) is accompanied by penetrating injury to the eyelids, eyeball, significant deformation of the skin tissue, bruise of the eyeball, damage to it by more than 50%, rupture of the internal membranes, damage to the lens, retinal detachment, hemorrhage into the orbital cavity, fracture of closely spaced bones, 3-4 degree burn.

Depending on the conditions and circumstances of the injury, there are:

• industrial injuries;
• domestic;
• military;
• children's

Reasons

Mild, superficial injuries occur when the eyelids, conjunctiva, or cornea are damaged by a sharp object (nail, tree branch, etc.).

More serious injuries occur when there is a direct blow to the face or eye area with a hand or a blunt, voluminous object. If the eye is injured during a fall from a height. These injuries are often accompanied by hemorrhage, fractures, and bruises. Damage to the eye can occur due to traumatic brain injury.

When a penetrating wound occurs in the eye area, it is injured by a sharp object. With fragmentation, internal penetration of foreign large or small objects or particles occurs.

Symptoms

The sensations experienced by the victim do not always correspond to the actual clinical picture of the injury. There is no need to self-medicate, remember that the eyes are an important organ, a failure in their functioning leads to the patient’s disability and disrupts the usual course of his life. For this injury, consultation with an ophthalmologist is required. This will help on early stages avoid complications and serious problems with vision.

Depending on the nature of the damage, their symptoms are also distinguished. Mechanical injury to the eye by a foreign body is characterized by hemorrhages in various parts of the eye, the formation of hematomas, damage to the lens, its dislocation or subluxation, retinal rupture, etc.

Bright severe symptoms The patient has a lack of reaction of the pupil to light, an increase in its diameter. The patient experiences decreased clarity of vision, pain in the eyes upon contact with a light source, and excessive tearing.

A commonly encountered injury is damage to the cornea of ​​the eye. The cause of mechanical injuries is the unprotectedness of this part of the eye and the lack of safety elements, its openness to foreign objects and particles. These injuries, according to statistics of visits to a doctor, occupy a leading place among existing eye injuries. The difference between superficial and deep injuries depends on how deeply the body penetrates.

In some cases, corneal erosions develop; their appearance is associated with a violation of the integrity of the membrane under the influence of foreign bodies, chemicals or temperatures. A corneal burn in most cases leads to loss of visual acuity and disability of the patient. If the cornea is injured, the patient feels a decrease in the clarity of the “picture”, pain in the eyes upon contact with a light source, profuse lacrimation, discomfort, a feeling of “sand” in the eyes, acute pain, redness and swelling of the eyelids.

Consequences

Eye injuries have serious consequences. At difficult cases damage may result in loss of vision without its subsequent restoration. This occurs with penetrating wounds or chemical thermal burns. A consequence of eye injuries and a complication during their treatment is deterioration of the outflow intraocular fluid– secondary glaucoma. After an injury, hard scars appear on the cornea, pupil displacement occurs, the vitreous becomes clouded, swelling of the cornea is noticeable, and intraocular pressure increases.

In some cases of eye damage, traumatic cataracts occur (Fig. below). Its signs are clouding of the lens and loss of visual acuity. It may be necessary to remove it.

When providing competent and emergency assistance, can be avoided serious consequences eye injuries.

First aid

In case of eye injury, the first steps to take are:

Regardless of their nature and type, any eye injuries require competent and timely assistance and consultation with a doctor. If your eye is damaged, you must treat it very carefully. Timely treatment is a guarantee of minimal complications and minimization negative consequences eye injury.

Treatment

Treatment of eye injuries cannot begin without an accurate diagnosis. The patient requires a mandatory visit to the ophthalmologist, as well as an appointment additional examinations, such as:

• detailed study of eye structures (biomicroscopy);
• radiography;
• visual acuity test;
• study of the anterior chamber of the eyeball (gonioscopy);
• examination of the fundus (ophthalmoscopy), etc.

Treatment and related procedures begin immediately. For minor injuries, the patient uses the procedure of eye instillation with drugs containing anti-inflammatory, analgesic and hemostatic elements.

In case of a burn or mechanical damage, it is necessary to eliminate and remove the source of irritation. Treatment in a hospital setting is indicated for moderate to severe injuries.

A penetrating wound requires surgical intervention. This unscheduled and urgent procedure is performed by an ophthalmologist.

Prevention

Measures to prevent eye injury include the following:

• compliance with safety regulations;
• careful use of household chemicals;
• careful handling of dangerous sharp objects;

Important for schoolchildren competent behavior in the chemistry classroom, as well as in the workshop, at the machines. Before the start of a lesson in school laboratories, the teacher must remember the statistics of childhood eye injuries, so communication should begin by repeating the norms and requirements of safety and caution, which everyone should know about.

Before starting machine work, it is necessary to check the serviceability of the unit and use eye protection.

All household chemicals, used at home, should be kept out of reach of children. When buying children's toys, it is important to consider their suitability for the child's age (lack of sharp corners and traumatic parts).

Compliance with the above rules will help avoid eye injuries of any severity, both in adults and children.

Includes wounds and blunt trauma to the eyeball, its adnexa and bone bed. Mechanical damage may be accompanied by hemorrhages in soft fabrics and structure of the eye, subcutaneous emphysema, loss of intraocular membranes, inflammation, decreased vision, crushed eyes. Diagnostics mechanical damage eye is based on data from an examination of the victim by an ophthalmic surgeon, neurosurgeon, otolaryngologist, maxillofacial surgeon; radiography of the orbit, biomicroscopy, ophthalmoscopy, ultrasound echography and biometry, fluorescein tests, etc. The method of treating mechanical eye injuries depends on the nature and extent of the injury, as well as the complications that have developed.

General information

Due to their superficial location on the face, the eyes are extremely vulnerable to various types of damage - mechanical injuries, burns, penetration of foreign bodies, etc. Mechanical damage to the eyes quite often leads to complications of a disabling nature: weakened vision or blindness, functional death of the eyeball.

Severe eye injuries occur more often in men (90%) than in women (10%). About 60% of visual injuries occur in adults under the age of 40; 22% of injured people are children under 16 years of age. According to statistics, foreign bodies of the eye occupy the first place among injuries to the organ of vision; second - bruises, eye contusions and blunt injuries; third - eye burns.

Classification

Penetrating eye injuries are caused by mechanical damage to the eyelids or eyeball with sharp objects (stationery and cutlery, wooden, metal or glass fragments, wire, etc.). With shrapnel wounds, the penetration of a foreign body into the eye is often noted.

Symptoms

Blunt eye injuries

Subjective sensations in case of mechanical eye injuries do not always correspond to the actual severity of the injury, therefore, for any eye injuries, consultation with an ophthalmologist is necessary. Blunt trauma the eyes are accompanied by various types of hemorrhages: eyelid hematomas, retrobulbar hematomas, subconjunctival hemorrhages, hyphema, hemorrhages in the iris, hemophthalmos, preretinal, retinal, subretinal and subchoroidal hemorrhages.

With contusion of the iris, traumatic mydriasis may develop due to sphincter paresis. In this case, the reaction of the pupil to light is lost, and an increase in the diameter of the pupil to 7-10 mm is noted. Subjectively, photophobia and decreased visual acuity are felt. With paresis of the ciliary muscle, accommodation disorder develops. Strong mechanical shocks can lead to partial or complete detachment of the iris (iridodialysis), damage to the vessels of the iris and the development of hyphema - an accumulation of blood in the anterior chamber of the eye.

Mechanical damage to the eye with a traumatic effect on the lens is usually accompanied by opacities of varying degrees of severity. When the lens capsule is preserved, subcapsular cataracts develop. In case of injury ligamentous apparatus holding the lens, subluxation (subluxation) of the lens may occur, which leads to accommodation disorder and the development of lenticular astigmatism. In case of severe injuries to the lens, it luxates (dislocates) into the anterior chamber, vitreous, under the conjunctiva. If the displaced lens obstructs the outflow of aqueous humor from the anterior chamber of the eye, secondary phacotopic glaucoma may develop.

With hemorrhages into the vitreous body (hemophthalmos), traction retinal detachment and optic nerve atrophy may subsequently occur. Retinal tears are often the result of blunt mechanical damage to the eye. Quite often, contusion injuries of the eye lead to subconjunctival ruptures of the sclera, which are characterized by hemophthalmos, hypotonia of the eyeball, swelling of the eyelids and conjunctiva, ptosis, and exophthalmos. In the post-concussion period, iritis and iridocyclitis often occur.

Injuries to the eyeball

With non-penetrating wounds of the eyeball, the integrity of the cornea and scleral membranes of the eye is not compromised. In this case, most often there is superficial damage to the corneal epithelium, which creates conditions for infection - the development of traumatic keratitis, corneal erosion. Subjectively, non-penetrating mechanical damage is accompanied by severe pain in the eye, lacrimation, and photophobia. Deep penetration of foreign bodies into the corneal layers can lead to scarring and the formation of a cataract.

Signs of a penetrating injury to the cornea and sclera include: a gaping wound into which the iris, ciliary or vitreous body falls out; the presence of a hole in the iris, the presence of an intraocular foreign body, hypotension, hyphema, hemophthalmos, changes in the shape of the pupil, clouding of the lens, decreased visual acuity of varying degrees.

Penetrating mechanical injuries to the eyes are dangerous not only in themselves, but also due to their complications: the development of iridocyclitis, neuroretinitis, uveitis, endophthalmitis, panophthalmitis, intracranial complications, etc. Often with penetrating wounds, sympathetic ophthalmia develops, characterized by sluggish serous iridocyclitis or optic neuritis of the intact eye . Symptomatic ophthalmia can develop in the immediate period after injury or months and years after it. The pathology is manifested by a sudden decrease in visual acuity of the healthy eye, photophobia and lacrimation, and deep conjunctival injection. Symptomatic ophthalmia occurs with relapses of inflammation and, despite treatment, in half of the cases ends in blindness.

Orbital damage

Orbital injuries may be accompanied by damage to the superior oblique tendon, leading to strabismus and diplopia. In case of fractures of the walls of the orbit with displacement of fragments, the capacity of the orbit may increase or decrease, and therefore retraction (endophthalmos) or protrusion (exophthalmos) of the eyeball develops. Orbital injuries are accompanied by subcutaneous emphysema and crepitus, blurred vision, pain, and limited mobility of the eyeball. Severe combined (orbitocranial, orbitosinual) injuries are common.

Mechanical damage to the orbit and eye often results in sudden and irreversible blindness due to extensive hemorrhages in the eyeball, rupture optic nerve, ruptures of the internal membranes and crushing of the eye.

Damage to the orbit is dangerous due to the development of secondary infection (orbital phlegmon), meningitis, cavernous sinus thrombosis, and the introduction of foreign bodies into the paranasal sinuses.

Diagnostics

Recognition of the nature and severity of mechanical eye injuries is made taking into account the history, clinical picture of the injury and additional research. For any eye injuries, it is necessary to conduct a survey X-ray of the orbit in 2 projections to exclude the presence of bone damage and the introduction of a foreign body.

A mandatory diagnostic step for mechanical damage is examination of the structures of the eye using various methods (ophthalmoscopy, biomicroscopy, gonioscopy, diaphanoscopy), measurement intraocular pressure. When the eyeball protrudes, exophthalmometry is performed. At various violations(oculomotor, refractive) the state of convergence and refraction is examined, the reserve and volume of accommodation are determined. A fluorescein instillation test is used to detect corneal damage.

To clarify the nature of post-traumatic changes in the fundus, fluorescein angiography of the retina is performed. Electrophysiological studies (electrooculography, electroretinography, visual evoked potentials) in comparison with the clinic and angiography data allow us to judge the condition of the retina and optic nerve.

In order to identify retinal detachment in case of mechanical damage to the eyes, assess its location, size and prevalence, an ultrasound of the eye is performed in A and B modes. Using ultrasound eye biometry, changes in the size of the eyeball are assessed and, accordingly, post-concussion hypertension or hypotonic syndrome.

Patients with mechanical eye injuries should be consulted by an ophthalmologist, neurologist, neurosurgeon, otolaryngologist, or maxillofacial surgeon. Additionally, an X-ray or CT scan of the skull and paranasal sinuses may be required.

Treatment

The variety of factors causing mechanical damage to the eye, as well as varying degrees The severity of the injury determines differentiated tactics in each specific case.

For eyelid injuries with loss of integrity skin Primary surgical treatment of the wound is performed, if necessary, excision of crushed tissue along the edges of the wound and suturing.

Superficial mechanical damage to the eyes, as a rule, is treated conservatively with the help of instillations of antiseptic and antibacterial drops and ointments. When fragments are introduced, a jet wash of the conjunctival cavity is performed, mechanical removal of foreign bodies from the conjunctiva or cornea.

For blunt mechanical injuries to the eyes, rest, the application of a protective binocular bandage, and instillation of atropine or pilocarpine under the control of intraocular pressure are recommended. In order to quickly resolve hemorrhages, autohemotherapy, electrophoresis with potassium iodide, subconjunctival injections of dionin. For prevention infectious complications sulfonamides and antibiotics are prescribed.

According to indications it is carried out surgical treatment(extraction of a dislocated lens followed by implantation of an IOL in an aphakic eye, suturing of the sclera, vitrectomy for hemophthalmos, enucleation of an atrophied eyeball, etc.). If necessary, reconstructive operations are performed in the delayed period: dissection of synechiae, laser, electrical and magnetic stimulation). For phacogenic glaucoma, antiglaucomatous surgery is required.

Surgical treatment of orbital injuries is carried out jointly with otolaryngologists, neurosurgeons, and dental surgeons.

Prognosis and prevention

Unfavorable outcomes of mechanical eye damage can include the formation of a cataract, traumatic cataract, the development of phacogenic glaucoma or hypotony, retinal detachment, wrinkling of the eyeball, decreased vision and blindness. The prognosis of mechanical eye injuries depends on the nature, location and severity of the injury, infectious complications, timeliness of first aid and the quality of subsequent treatment.

Prevention of mechanical damage to the eye requires compliance with safety precautions at work and caution at home when handling traumatic objects.

Non-penetrating wounds of the eyeball are damage to the cornea or sclera, which involves part of their thickness. Such damage usually does not cause severe complications and less likely to affect eye function. They account for about 70% of all eye injuries.
Superficial damage or microtrauma occurs when the eye is hit by a tree branch, pricked with a sharp object, or scratched. In these cases, superficial erosion of the epithelium is formed, and traumatic keratitis can develop. More often, superficial damage occurs when small foreign bodies (pieces of coal or stone, scale, small metal bodies, particles of animal and plant origin) enter, which, without piercing the eye capsule, remain in the conjunctiva, sclera or cornea. As a rule, their sizes are small, so to identify such bodies, side lighting and a binocular magnifying glass are used, and best of all, biomicroscopy. It is important to find out the depth of the foreign body. If it is localized in surface layers photophobia, lacrimation, and pericorneal injection are noted, which is explained by irritation of the large number of nerve receptors of the trigeminal nerve located here.

Treatment of non-penetrating wounds of the eyeball

All foreign bodies must be removed, since their prolonged presence in the eye, especially on the cornea, can lead to complications such as traumatic keratitis or purulent corneal ulcer. Superficial bodies are removed on an outpatient basis. They can often be removed with a damp cotton swab after instilling a 0.5% alcaine solution into the eye. However, most often bodies that have entered the superficial or middle layers of the cornea are removed with a special spear, a grooved chisel or the end of an injection needle. At a deeper location, due to the danger of opening the anterior chamber, it is advisable to remove the foreign body surgically, under an operating microscope. The metal body can be removed from the cornea using a magnet; if necessary, the surface layers above it are first cut. After removing the foreign body, disinfectant drops, ointments with antibiotics or sulfonamides, methylene blue with quinine, Korneregel (to improve epithelization of the cornea), and an aseptic bandage are prescribed for 1 day.
Foreign bodies from the deep layers of the cornea, especially on only eye, should only be removed by an ophthalmologist.

Penetrating eye injuries

Penetrating eye injuries are heterogeneous in structure and include three groups of injuries that differ significantly from each other.
In 35-80% of all patients who are on inpatient treatment regarding eye injury, penetrating wounds of the eyeball are noted - injuries in which a wounding (foreign) body cuts the entire thickness of the outer membranes of the eye (sclera and cornea). This is a dangerous injury because it reduces visual functions(at times - to complete blindness), and sometimes causes the death of the other, undamaged eye.

Classification of penetrating eye injuries

The following types of penetrating wounds of the eyeball are distinguished:
I. By depth of damage:
1. Penetrating wounds, in which the wound channel passes through the cornea or sclera, extends into the eye cavity to varying depths, but does not go beyond its limits.
2. Through wounds - the wound channel does not end in the eye cavity, but extends beyond it, having both an inlet and an outlet.
3. Destruction of the eyeball - destruction of the eyeball with complete and irreversible loss of visual functions.
II. Depending on location: corneal, limbal, corneal-scleral and scleral wounds.
III. By wound size: small (up to 3 mm), average size(4-6 mm) and large (over 6 mm).
V. By shape: linear wounds, irregular shape, torn, chipped, star-shaped, with a fabric defect.
In addition, a distinction is made between gaping and adapted wounds (the edges of the wound are tightly adjacent to each other over the entire area).

Clinic and diagnosis of penetrating eye injuries

Penetrating injuries are often accompanied by damage to the lens (40% of cases), prolapse or pinching of the iris (30%), hemorrhage into the anterior chamber or vitreous body (about 20%), and the development of endophthalmitis as a result of infection entering the eye. In almost 30% of cases with penetrating wounds, a foreign body remains in the eye.
First of all, you need to study the medical history, taking into account the medico-legal consequences of eye damage. Very often, during the initial collection of anamnesis, victims of various reasons may hide or distort important information, the true cause and mechanism of damage. This is especially true for children. The most common causes are industrial, household, and sports injuries. The severity of the injury depends on the size of the wounding object, kinetic energy and its speed during impact.
In almost all cases, regardless of the medical history, in case of penetrating wounds it is necessary to perform radiography, computed tomography, ultrasound, and MRI. These studies will determine the severity of the damage and the presence (or absence) of a foreign body.
Diagnosis of penetrating eye injuries is carried out by identifying characteristic symptoms. The latter, in their significance, can be absolute and relative.
The absolute signs of penetrating eye injuries are:
- through wound of the cornea or sclera;
- loss of the inner membranes of the eye (iris, ciliary body, choroid), vitreous body into the wound;
- leakage of intraocular fluid through a corneal wound (diagnostic fluorescein test);
- the presence of a wound channel passing through the internal structures of the eye (iris, lens);
- presence of a foreign body inside the eye;
- presence of air in the vitreous body.
TO relative characteristics penetrating eye injuries include:
- hypotension;
- change in the depth of the anterior chamber (shallow - with a wound of the cornea, deep - with a wound of the sclera, uneven - with iris-scleral damage);
- hemorrhage under the conjunctiva, into the anterior chamber (hyphema) or vitreous body (hemophthalmos), choroid, retina;
- tears of the pupillary edge and changes in the shape of the pupil;
- tear (iridodialysis) or complete separation (aniridia) of the iris;
- traumatic cataract;
- subluxation or dislocation of the lens.
The diagnosis of a penetrating wound is valid when at least one of the absolute signs is detected.

Urgent Care

A doctor of any profile needs to know the signs of penetrating eye injuries and be able to provide first aid:
1. Apply a binocular bandage and administer an antibiotic intramuscularly wide range actions and tetanus toxoid.
2. Urgently refer the patient to specialized hospital. Transportation should be carried out in a prone position, preferably by ambulance.
3. It is strictly forbidden to remove protruding foreign bodies from the eye (with the exception of foreign bodies located superficial to the tissues of the eye).

Penetrating wounds of the sclera and cornea

Penetrating corneal injuries are characterized by disruption of the integrity of the cornea. According to the location of corneal wounds, they can be central, equatorial, or meridional; in shape - linear, patchwork with smooth and torn, uneven edges, gaping, with a fabric defect. Injury to the cornea leads to the leakage of intraocular fluid, as a result of which the anterior chamber is crushed; often complicated by loss and separation of the iris at the root, injury to the lens (cataract) and vitreous body (hemophthalmos).
Treatment. The main task during surgical treatment of penetrating wounds of the cornea is, if possible, full recovery anatomical structure of an organ or tissue in order to maximize function preservation.
During operations on the cornea, deep sutures (nylon 10.00) are applied to 2/3 of its thickness at a distance of 1 mm from the edges of the wound. Sutures are removed after 1.5-2 months. To treat star-shaped penetrating wounds of the cornea, a technique is used purse string suture- passing through all corners laceration a circular suture to tighten it in the center, with additional application of separate interrupted sutures to all areas that extend from the center of the wound. In case of iris prolapse, it is corrected and repositioned after preliminary removal of impurities and treatment with an antibiotic solution.
If the lens is damaged and traumatic cataracts develop, cataract extraction and artificial lens implantation are recommended. In cases where there is a crushed wound of the cornea and it is not possible to compare its edges, a corneal transplant is performed.

Injuries of the sclera and iris-scleral region

Injuries to the sclera and iris-scleral region are rarely isolated; the severity of their damage is determined by accompanying complications (prolapse of the internal membranes, hemorrhages into the structures of the eye).
With corneal-scleral wounds, the iris and ciliary body fall out or are pinched, and hyphema and hemophthalmos are often observed. With scleral wounds, the anterior chamber, as a rule, deepens; the vitreous body and inner membranes of the eye often fall out; hyphema and hemophthalmos develop. The most severe damage to the sclera is accompanied by a tissue defect, especially with subconjunctival tears.
Treatment. Primary surgical treatment of penetrating wounds is performed under general anesthesia. In this case, the main task is to restore the tightness of the eyeball and the structural relationships inside it. IN mandatory carry out an inspection of the scleral wound; it is necessary to strive for precise definition the direction of the wound channel, its depth and the degree of damage to the internal structures of the eye. It is these factors that largely determine the nature and extent of surgical treatment.
Depending on the specific conditions, treatment is carried out both through the entrance wound and through additional incisions. In case of loss and strangulation of the ciliary body in a wound or choroid it is recommended to straighten them and apply sutures; they are pre-irrigated with an antibiotic solution in order to prevent intraocular infection and the development inflammatory reaction. When a wound of the cornea and sclera becomes infected, acute iridocyclitis, endophthalmitis (purulent foci in the vitreous body), panophthalmitis ( purulent inflammation all shells).
For penetrating wounds of any location, local treatment is carried out, including anti-inflammatory, antibacterial and symptomatic therapy in combination with general antibiotic therapy, correction immune status.

Penetrating eye injuries with the introduction of foreign bodies

If you suspect a foreign body has entered the eye great value have anamnestic data. A carefully collected anamnesis plays a role decisive role in determining the treatment tactics for such a patient. Foreign bodies in the cornea can cause the development of infiltrates and post-traumatic keratitis, which subsequently lead to local opacities of the cornea.
With significant injuries to the cornea and extensive hyphema or hemophthalmos, it is not always possible to determine the course of the wound canal and the location of the foreign body. In cases where the fragment passes through the sclera beyond the visible part, it is difficult to detect the entry hole.
When a large foreign body is introduced, a gaping wound of the cornea or sclera with prolapse of the choroid, vitreous body and retina is clinically determined.
Diagnostics. With biomicroscopy and ophthalmoscopy, a foreign body can be detected in the cornea, anterior chamber, lens, iris, vitreous body or fundus.
To diagnose a foreign body inside the eye, the Komberg-Baltin X-ray localization method is used. The method consists of identifying a foreign body using an eye marker - an aluminum prosthetic indicator 0.5 mm thick with a radius of curvature corresponding to the radius of the cornea. In the center of the indicator there is a hole with a diameter of 11 mm. At a distance of 0.5 mm from the edge of the hole, four lead reference points are located in mutually perpendicular meridians. Before installing the prosthesis, anesthetic drops (0.5% alcaine solution) are instilled into the conjunctival sac; The prosthesis is positioned so that the lead marks correspond to the limbus at 12-3-6-9 o'clock.
All calculations based on X-ray photographs are carried out using three Baltin-Polyak measuring circuits, depicted on transparent film. The latter are imposed on x-rays, made in three projections - anterior, lateral and axial. On a direct photograph, the meridian along which the foreign body is located, as well as its distance from the anatomical axis of the eye, is determined. On lateral and axial photographs, the distance from the limbus to the foreign body along the sclera in the direction of the equator is measured. The method is accurate for diagnosing small foreign bodies of metallic density while maintaining the turgor of the eyeball, the absence severe hypotension and gaping wounds of the outer membranes of the eye. Analysis of the results obtained allows us to determine the depth of the foreign body relative to the outer membranes of the eye and the scope of the planned surgical intervention.
To determine the location of a foreign body in the anterior part of the eye, the method of non-skeletal radiography according to Vogt is successfully used, which can be performed no earlier than 8 days from the moment of injury.
From modern techniques they use A- and B-ultrasound examinations, the results of which allow not only to determine the presence of a foreign body, but also to diagnose complications such as lens dislocation, vitreous hemorrhage, retinal detachment, etc.
At computed tomography you can obtain a series of layer-by-layer images of the eyeball and orbit of higher resolution compared to the previously mentioned methods.

Treatment of eye injuries with the introduction of foreign bodies

A foreign body in the cornea must be removed immediately. When it is located superficially, special tools are used,
needles, tweezers, spears, if located in the deep layers (stroma) of the cornea, a linear incision is made, then the metallic foreign body is removed with a magnet, and the non-magnetic foreign body with a needle or spear. To remove a foreign body from the anterior chamber, an incision is first made above the fragment into which the tip of a magnet is inserted. At central location In a corneal wound, a foreign body may remain in the lens or penetrate into the posterior part of the eye. A foreign body embedded in the lens is removed in two ways: either after opening the anterior chamber using a magnet, or together with the lens in the case of the amagnetic nature of the fragment and subsequent implantation of an artificial lens.
Removing a non-magnetic foreign body from the eye is usually associated with great difficulties. When a foreign body is located in the anterior part of the eye (the space from the posterior surface of the cornea to the lens inclusive), the so-called anterior extraction route is used.
The fragment located in posterior section eyes, until recently were extracted exclusively by the diascleral route, i.e., through an incision in the sclera at the site of its occurrence. Currently, the preferred route is the transvitreal route, in which an extended magnet tip for removing a metal object or an instrument for grasping a non-magnetic foreign body is inserted into the ocular cavity through an incision in the pars plana of the ciliary body. The operation is performed under visual control through a dilated pupil. In case of violation of the transparency of the optical media (traumatic cataract, hemophthalmos), cataract extraction and/or vitrectomy is first performed, followed by removal of the foreign body under visual control.
For penetrating eye injuries with the introduction of foreign bodies, in addition to performing surgical interventions appointment required drug therapy, aimed at preventing the inflammatory reaction of the eye, the development of infection, hemorrhagic complications, hypotension, secondary glaucoma, pronounced proliferative processes in the fibrous capsule and intraocular structures.

Initial treatment of penetrating wounds

Initially, treatment of penetrating wounds takes place only in a hospital setting.
When a diagnosis of eye injury is made, tetanus toxoid is administered subcutaneously at a dose of 0.5 IU and antitetanus serum at a dose of 1000 IU.
Drug treatment carried out using the following groups of drugs.
1. Antibiotics:
aminoglycosides: gentamicin intramuscularly 5 mg/kg 3 times a day, course of treatment 7-10 days; or tobramycin intramuscularly or intravenously
2-3 mg/kg per day;
penicillins: ampicillin intramuscularly or intravenously 250-500 mg 4-6 times a day;
cephalosporins: cefotaxime intramuscularly or intravenously 1-2 g
3-4 times a day; ceftazidime 0.5-2 g 3-4 times a day;
glycopeptides: vancomycin intravenously 0.5-1 g 2-4 times a day or orally 0.5-2 g 3-4 times a day;
macrolides: azithromycin 500 mg orally 1 hour before meals for 3 days (course dose 1.5 g);
lincosamides: lincomycin intramuscularly 600 mg 1-2 times a day.
2. Sulfonamide drugs: sulfadimethoxine (1 g on the first day, then 500 mg/day; taken after meals, course 7-10 days) or sulfalene (1 g on the first day and 200 mg/day for 7-10 days, 30 minutes before meals ).
3. Fluoroquinolones: ciprofloxacin orally 250-750 mg 2 times a day, treatment duration is 7-10 days.
4. Antifungal agents: nystatin orally 250,000-5,000,000 units 3-4 times a day.
5. Anti-inflammatory drugs:
NSAIDs: diclofenac 50 mg orally 2-3 times a day before meals, course 7-10 days; indomethacin 25 mg orally 2-3 times a day before meals, course 10 days;
glucocorticoids: dexamethasone parabulbar or subconjunctival,
2-3 mg, course 7-10 injections; triamcinolone 20 mg once a week, 3-4 injections.
6. H-receptor blockers: chloropyramine 25 mg orally 3 times a day after meals for 7-10 days; or loratadine 10 mg orally 1 time per day after meals for 7-10 days; or fexofenadine 120 mg orally 1 time per day after meals for 7-10 days.
7. Tranquilizers: diazepam intramuscularly or intravenously 10-20 mg.
8. Enzymatic preparations in the form of injections:
fibrinolysin 400 units parabulbarly;
collagenase 100 or 500 KE subconjunctivally (directly into the lesion: adhesions, scar, etc.) or using electrophoresis, phonophoresis; course of treatment is 10 days.
9. Preparations for instillation into the conjunctival sac. At severe conditions and in the early postoperative period the frequency of instillations can reach 6 times a day; as it subsides inflammatory process it decreases:
antibacterial agents: 0.3% solution of ciprofloxacin, 1-2 drops
3-6 times a day; or 0.3% solution of oftaxacin, 1-2 drops 3-6 times a day; or 0.3% solution of tobramycin, 1-2 drops 3 times a day;
antiseptics: 0.05% solution of piclosidine (Vitabact), 1 drop 6 times a day, course of treatment for 10 days;
glucocorticoids: 0.1% dexamethasone solution, 1-2 drops 3 times a day; or 1-2.5% hydrocortisone ointment, put behind the lower eyelid 3-4 times a day;
NSAIDs: 0.1% diclofenac solution, 1-2 drops 3-4 times a day; or 0.1% solution of indomethacin, 1-2 drops 3-4 times a day;
combination drugs: maxitrol (dexamethasone 1 mg, neomycin sulfate 3500 IU, polymyxin B sulfate 6000 IU); tobradex (suspension - tobramycin 3 mg and dexamethasone 1 mg);
mydriatics: 1% solution of cyclopentolate, 1-2 drops 3 times a day; or 0.5-1% solution of tropicamide, 1-2 drops 3-4 times a day, in combination with a 2.5% solution of phenylephrine, 1-2 drops 3 times a day;
stimulators of corneal regeneration: actovegin (eye gel 20% for the lower eyelid, 1 drop 3 times a day); or solcoseryl (eye gel 20% for the lower eyelid, 1 drop 3 times a day); or dexapanthenol (eye gel 5% for the lower eyelid, 1 drop 3 times a day).
After severe injuries to the eyeball, the patient needs lifelong observation by an ophthalmologist, limited physical activity. If necessary, long term carry out surgical and drug treatment for the purpose of visual and cosmetic rehabilitation of the patient.