Eye injuries. Symptoms and treatment of penetrating injury to the eye Non-penetrating injury to the cornea

EYE WOUNDS - mechanical damage to the eyeball, accompanied by a violation of the integrity of its membranes.
Depending on the degree of damage to the eyeball, eye injuries are divided into non-penetrating and penetrating (with perforation of all membranes that make up the wall of the eye), with and without damage to the membranes and contents of the eye, with or without the presence of a foreign body, etc. Injuring objects can be sharp (glass glasses broken in a car accident) and dull (hit with a stick). Non-penetrating eye injuries usually affect the conjunctiva, part of the layers of the cornea, and less often the sclera and ciliary body. Penetrating eye injuries can affect any part of the eye, including the retina and optic nerve, and are divided into actually penetrating (single perforation of the wall of the eyeball with penetration into its cavity), through (with the presence of inlet and outlet holes) and destroying the eye (the walls of the eye collapse, the eyeball loses its shape).

Non-penetrating eye injuries. Injuries to the conjunctiva.

Symptoms. Complaints of lacrimation, photophobia, redness and swelling of the conjunctiva, sometimes the sensation of a foreign body behind the eyelids. Vision usually does not deteriorate. Objectively, conjunctival injection of blood vessels, subconjunctival hemorrhages, severe swelling of the mucous membrane, conjunctival ruptures are noted; foreign bodies can be detected on the surface or in the tissue of the mucous membrane of the eye and eyelids.
The diagnosis is established on the basis of anamnesis, external examination (with mandatory double eversion upper eyelid), biomicroscopy with fluorescein staining, approximate (if indicated - instrumental) determination of IOP. It is necessary to carefully examine the sclera in the area of ​​hemorrhages and ruptures of the conjunctiva; In case of scleral rupture, hypotony of the eye is characteristic. In doubtful cases, the presence of a foreign body in the tissues of the eye and orbit is excluded using ultrasound of the eye, radiography and CT of the orbits and skull.

Ambulance and emergency care. When identifying foreign bodies They are removed from the conjunctiva with a damp cotton swab soaked in a 0.02% furatsilin solution. If a foreign body has penetrated into the thickness of the conjunctiva, it is removed with the end of an injection needle after local anesthesia with a 0.5% dicaine solution. Then drops of sulfacyl sodium solution 30% or chloramphenicol 0.25% are instilled into the conjunctival sac, an aseptic monocular sticker is applied to the eye and anti-tetanus serum 1500-3000 IU is injected.

Treatment. Hemorrhages under the conjunctiva do not require treatment. If there are ruptures and after removal of the foreign body, continue to instill disinfectant drops 3-4 times a day for 3-4 days. Tears and cuts of the conjunctiva up to 5 mm long heal on their own; for tears longer than 5 mm, one continuous or 2-3 interrupted sutures are applied; The stitches are removed on the 4-5th day.
The prognosis is favorable. Healing occurs within a week.

Corneal injuries.

Symptoms. Corneal syndrome is observed; a mixed injection and a defect in the surface of the transparent cornea (erosion) of varying depths, stained with fluorescein, are objectively noted. Vision usually does not change or decreases by 0.1-0.2. There may be foreign bodies on the surface of the cornea or in its layers - a metal splinter or shavings, a glass shard, a wasp sting, etc. A foreign body in the layers of the cornea looks like a small gray, yellow or dark dot; when located in deep layers, it can penetrate one end into the anterior chamber. When a particle of iron-containing metal enters the cornea, a rusty-colored rim is formed around it - scale. After several hours of staying in the thickness of the cornea, any foreign body is usually surrounded by a thin rim of infiltrate. If for some reason foreign particles were not removed, then in the future they can gradually be rejected through demarcating inflammation.
The diagnosis is established on the basis of anamnesis, complaints (corneal syndrome), determination of visual acuity, IOP (by palpation), external examination with eversion of the eyelids, biomicroscopy with fluorescein staining. To exclude the possibility of penetration of foreign bodies into the anterior chamber, you can additionally perform gonioscopy, ultrasound and/or radiography.

Ambulance and emergency care b. An anesthetic (dicaine 0.5%, trimecaine 3%) is instilled into the conjunctival sac. Superficial foreign bodies are removed with a cotton swab soaked in a 0.02% furatsilin solution, and those embedded in the cornea are removed with the end of an injection needle or special tools - a spear for removing foreign bodies or a grooved chisel. The scale is carefully scraped off with the blunt side of a blade fragment clamped in the blade holder. Particles of easily oxidized or toxic metals (iron, steel, copper, lead, brass) should be removed from deep layers, while chemically inert ones (coal, glass, stone, sand, gunpowder) can be left untouched. Foreign bodies penetrating one end into the anterior chamber should be removed in the operating room of an ophthalmology hospital. After removing a foreign body or in the case of simple erosion of the cornea, disinfectant drops are instilled into the conjunctival sac, an epithelialization stimulator (Vitasik, Balarpan 0.01%, Taufon 4%, eye gel solcoseryl or Acto-vegin 20%), placed behind the eyelids eye ointment tetracycline or erythromycin 1%. A follow-up examination by an ophthalmologist every 24 hours is required.

Treatment- By general rules treatment of keratitis (see).

The prognosis for superficial corneal erosions is favorable. Epithelization is completed after 1-3 days without a decrease in visual functions and cosmetic defects; with deep defects in corneal tissue, scar opacities of varying intensity are formed (cloud, spot, cataract), the central location of which can cause decreased vision. Infection of the eroded surface leads to the development of corneal ulcers (see) and serious complications, including loss of the eye.

Penetrating eye injuries.

Symptoms. Complaints of pain in the eye and a sharp decrease in vision, corneal syndrome is usually expressed. Objectively, redness of the eye is noted, often as a mixed injection, swelling and hemorrhages under the conjunctiva. Wounds are detected on the surface of the eyeball various localizations(corneal or corneal, corneolimbal, corneoscleral in the optical and non-optical zone, scleral), shapes and sizes. The inner membranes or contents (lens, vitreous body) of the eye may fall into the wound. Often observed are hemorrhages in the anterior chamber or vitreous body, clouding and displacement of the lens, destruction of its capsule with the release of cloudy lens masses into the anterior chamber. The eye is hypotonic, its complete destruction with collapse of the membranes is possible. Foreign bodies are often detected inside the eye (visually, using ultrasound or radiography). Penetrating injuries to the eye are dangerous due to severe complications - purulent iridocyclitis, endophthalmitis, as well as sluggish fibrinous-plastic iridocyclitis, which provokes a similar disease of the healthy eye - sympathetic ophthalmia.
The diagnosis is established on the basis of anamnesis (circumstances and mechanism of injury), examination of visual acuity, IOP, external examination, biomicroscopy, ophthalmoscopy, mandatory x-ray examination of the eye, orbit and skull (detection of intraocular and intraorbital foreign bodies), according to indications - ultrasound, CT and MRI orbits, paranasal sinuses nose and skull. The absolute signs of a penetrating eye injury are: 1) unadapted (gaping) edges of the wound; 2) loss of membranes and/or contents of the eye into the wound; 3) the presence of an intraocular foreign body. In the case of good adaptation of the wound edges, indirect symptoms of a penetrating wound of the anterior segment of the eye are hypotonia, a small or absent anterior chamber, and deformation of the pupil with a displacement towards the supposed hole in the eye wall. For wounds located posterior to the iris and lens, such signs are hypotony and deepening of the anterior chamber.

Ambulance and emergency care. Antitetanus serum according to Bezredka (1500-3000 IU), tetanus toxoid (1 ml), intramuscular and oral antibiotic are administered. The tissue around the wound is cleaned of superficially located particles of dirt, in the absence of gaping wounds with fallen membranes, a solution of sulfacyl sodium or chloramphenicol is instilled into the conjunctival sac, an aseptic binocular bandage is applied, and the victim is urgently transported to an ophthalmological hospital in a supine position.

Treatment complex, medicinal and surgical, carried out in an ophthalmological hospital.
The prognosis for vision preservation is uncertain.

1. Superficial (non-penetrating) injuries - can be the result of a blow to the eye with a tree branch, an abrasion with a fingernail, an injection with cereals, etc.

   Non-penetrating wounds can have any location in the eye capsule and its auxiliary apparatus and of various sizes. These wounds are more often infected, and metal (magnetic and non-magnetic) and non-metallic foreign bodies are often detected. The most severe are non-penetrating wounds in the optical zone of the cornea and those involving its stroma. Even with a favorable course, they lead to a significant decrease in visual acuity. In the acute stage of the process, it is caused by swelling and clouding in the wound area, and subsequently by persistent clouding of the cornea scar combined with irregular astigmatism. If the wound becomes infected, there is a foreign body in it and there is a delay in seeking help, the eyes may become inflamed, post-traumatic keratitis may develop and become involved in the process. choroid- Keratoiritis or keratouveitis often occurs.

2. Penetrating wounds caused by metal fragments, pieces of glass, cutting and piercing instruments. In this case, the wounding agent cuts the capsule of the eye. The type of penetrating wound (corneal, limbal, scleral) depends on the location of the capsule dissection.

   Wounds with penetrating injuries are almost always (conditionally always) infected, so a severe inflammatory process can occur in them. During the wound great importance have physicochemical characteristics wounding objects, since they can come into contact with the tissue substances of the eye, disintegrate, degenerate and thus cause secondary, sometimes irreversible changes. Finally, one of the main factors is the massiveness and location of the wound. The greatest danger is caused by injuries to the area of ​​the central fovea and the optic nerve, which can result in irreversible blindness. Injuries to the ciliary body and lens are very severe, resulting in severe iridocyclitis and cataracts, leading to sharp decline vision.

3. Penetrating wounds

Every penetrating wound belongs to the group of heavy and essentially combines three groups:

• actual penetrating wound, in which the wounding body once pierces the wall of the eyeball
• perforating wound(double perforation), in which one wounding body twice pierces all the membranes of the eye.
• destruction of the eyeball

Symptoms

Complaints about

• corneal syndrome (lacrimation, photophobia, redness and swelling of the conjunctiva)
• sometimes a sensation of a foreign body behind the eyelids.
• Vision usually does not deteriorate.
• Objectively, conjunctival injection of blood vessels, subconjunctival hemorrhages, severe swelling of the mucous membrane, conjunctival ruptures are noted; foreign bodies can be detected on the surface or in the tissue of the mucous membrane of the eye and eyelids.

The diagnosis is established on the basis of anamnesis, external examination (with the obligatory double eversion of the upper eyelid), biomicroscopy with fluorescein staining, and an approximate (if indicated, instrumental) determination of IOP. It is necessary to carefully examine the sclera in the area of ​​hemorrhages and ruptures of the conjunctiva; In case of scleral rupture, hypotony of the eye is characteristic. In doubtful cases, the presence of a foreign body in the tissues of the eye and orbit is excluded using ultrasound of the eye, radiography and CT of the orbits and skull.

First aid for eye injuries

1. Rinse the eye antiseptic solutions and instill antibiotics. Solutions of furacillin and rivanol are suitable for washing. For instillation any antibacterial agents: albucid, gentamicin, chloramphenicol, cipropharm, tobradex, vigamox, etc.
2. Anesthesia . Solutions of novocaine (lidocaine) are suitable for this, which can be dripped from a syringe without a needle. You can take analgin or any other painkiller intramuscularly.
3. Apply a clean bandage (preferably from a sterile bandage).
4. Urgently consult an ophthalmologist.

Treatment

A survey X-ray of the orbit is carried out in two projections to exclude a foreign body inside the eye, and then surgical treatment of a penetrating wound of the eye, which consists of gentle excision of the membranes that have fallen into the wound.

In modern conditions, wound treatment is carried out using microsurgical techniques. During surgery, foreign bodies are removed and damaged structures are reconstructed (lens removal, hernia excision vitreous, suturing the damaged iris and ciliary body, etc.). Frequent (every 1 mm) sutures are placed on the wound of the cornea and sclera to completely seal it. Antibiotics, corticosteroids and other drugs are administered parabulbarically, and a binocular aseptic dressing is applied. Dressings are done daily. IN postoperative period carry out active general antimicrobial and local (every hour during the day) anesthetic, antibacterial, anti-inflammatory, hemostatic, regenerative, neurotrophic, detoxification, desensitizing treatment. From the 3rd day, resorption therapy is prescribed (lidase, trypsin, pyrogenal, autohemotherapy, oxygen, ultrasound, etc.).

If an intraocular foreign body is detected on radiographs, it is necessary to localize it using the Komberg-Baltin method.
Removal of metal magnetic fragments from the eye must be carried out in all cases in early dates, the phenomena of iridocyclitis make it difficult to remove fragments in late dates and increase the likelihood of postoperative complications.
Magnetic debris is removed using a magnet.

Eye injuries may be accompanied by damage to the cornea or sclera, or a combination of both. If the wound passes through all the membranes of the cornea or sclera, the wound is considered perforated. It is much more dangerous than a non-perforated one. Final diagnosis can only be determined by an ophthalmologist.

Non-perforating (non-penetrating) wounds of the cornea and sclera occur due to superficial exposure to a traumatic agent, or when injured by small foreign bodies.

Clinic (signs) of non-penetrating injury to the cornea and sclera

The patient complains of pain in the eye, photophobia, lacrimation, blepharospasm, and decreased vision. When the conjunctiva or sclera is injured, the pain is usually insignificant, but when the cornea is damaged, very severe pain and sensation of a foreign body in the eye. Objective signs, on the contrary, are more pronounced when the conjunctiva or sclera is injured than when the cornea is injured. Upon examination, the presence of a wound to the cornea, conjunctiva of the eyeball or sclera is noted.

Emergency (first) aid for non-penetrating wounds of the cornea and sclera

For withdrawals pain syndrome - instillation of 0.5% dicaine solution. Prevention infectious complications : 30% sodium sulfacyl solution or sulfacyl ointment; 0.25% solution of chloramphenicol, or chloramphenicol ointment. After applying an aseptic dressing, the patient must be taken to a specialized hospital.

Eye injuries can be non-penetrating, penetrating or through.

Non-penetrating eye injuries. Non-penetrating wounds can have any location in the eye capsule and its auxiliary apparatus and of various sizes.

These wounds are more often infected, and metal (magnetic and non-magnetic) and non-metallic foreign bodies are often detected. The most severe are non-penetrating wounds in the optical zone of the cornea and involving its stroma. Even with a favorable course, they lead to a significant decrease in visual acuity. In the acute stage of the process, it is caused by swelling and clouding in the wound area, and subsequently by persistent clouding of the cornea scar in combination with irregular astigmatism. If the wound becomes infected, there is a foreign body in it and there is a delay in seeking help, the eyes may become inflamed, post-traumatic keratitis may develop and the choroid may be involved in the process - keratoiritis or keratouveitis often occurs.

Penetrating eye injuries. The most severe, both in terms of course and outcome, are penetrating, especially through wounds of the eye. Wounds with penetrating injuries are almost always (conditionally always) infected, so a severe inflammatory process can occur in them. During the course of a wound, the physicochemical properties of wounding objects are of great importance, since they can combine with the tissue substances of the eye, disintegrate, degenerate and thus cause secondary, sometimes irreversible changes. Finally, one of the main factors is the massiveness and location of the wound. The greatest danger is caused by injuries to the area of ​​the central fovea and the optic nerve, which can result in irreversible blindness. Injuries to the ciliary body and lens are very severe, resulting in severe iridocyclitis and cataracts, leading to a sharp decrease in vision.

To formulate a diagnosis, assess the severity of a penetrating eye injury, select a surgical treatment technique and subsequent treatment, as well as predict the process, various classification schemes for penetrating wounds are used. However, practice shows that in order to unify a clear diagnosis of penetrating eye injuries, it is advisable to gradate them according to the depth and massiveness of the lesion, the presence or absence of a foreign body (its nature), as well as infection. In addition, the choice of treatment method and the expected outcome largely depend on the localization of the process. In this regard, it is advisable to distinguish between simple penetrating wounds, in which the integrity of only the outer membrane (corneal-scleral capsule) is damaged, and complex ones, when the internal structures of the eye are also affected (choroid, retina, lens, etc.). In turn, with both simple and complex wounds, foreign bodies (metallic, magnetic and non-magnetic, non-metallic) can be introduced into the eye. In addition, complicated penetrating wounds are distinguished - metallosis, purulent uveitis, sympathetic ophthalmia. Based on localization, it is advisable to distinguish between corneal, corneal-limbal, limbal, limboscleral and scleral wounds of the eye (Fig. 125). It is also important to note whether the injury corresponds to the optical or non-optical zone of the cornea.

Diagnosis of a wound involves a mandatory check of visual acuity and field of vision (control method), examination of the eye area, the eyeball and its auxiliary apparatus, detection of the wound channel, assessment of the condition of the internal structures of the eye and ophthalmotonus (carefully palpation), as well as radiography of the orbital area in the direct and lateral directions. projections. In cases where a foreign body is detected on a survey image, an image is immediately taken to determine the location of the foreign body. Magnetic tests can also be carried out. It is necessary to study the flora for its sensitivity to antibiotics. The diagnosis can be, for example, this: a simple penetrating wound with a non-metallic foreign body, corneal-limbal, or a complex penetrating wound with a metallic magnetic foreign body, corneal in the left eye. If the wound is non-penetrating, then the diagnosis may sound, for example, as follows: the wound of the left eye is non-penetrating, with a metallic non-magnetic foreign body, corneal.

Penetrating wounds occur in approximately 20% of cases. Wounds can be adapted and open (non-adapted, gaping), with smooth and uneven edges. Injuries to the cornea of ​​central or nasal localization (optical zones) are always accompanied by a significant decrease in visual acuity: with adapted wounds it is less, and with open wounds it is greater. Injuries to the cornea and sclera always lead to hypotony of the eye. An important diagnostic sign of injury is the condition of the anterior chamber: when the cornea is injured, in fresh cases, as a rule, even in adapted cases (in the first hours), it is shallow, and in cases of injury to the sclera, it is excessively deep.

Complex penetrating wounds of the cornea and sclera occur in approximately 80% of cases. They are almost always accompanied by more or less pronounced impairment of visual functions. In the wound channel, the internal structures of the eye are often infringed. The choroid (iris, ciliary body, choroid), as well as the retina and vitreous body, and occasionally the lens, often fall into the wound. However, with small wounds (puncture wounds), the internal structures of the eye do not fall out into the wound, retain their previous location, but are damaged. Most often (in 20% of patients), with penetrating wounds of the cornea, the lens is damaged and cataracts occur, and with wounds of the sclera, almost all the internal membranes and structures of the eyeball can be damaged. Damage to the internal contents of the eye may not be detected immediately, but after several days, for example, when hemorrhages resolve.

The presence of foreign bodies can often be determined using biomicroscopy and ophthalmoscopy. However, when foreign bodies are introduced into the area of ​​the angle of the anterior chamber and the ciliary body, as well as in the presence of hemophthalmos, they can only be detected with gonio- and cycloscopy, as well as echography and radiography. Radiography of the orbital area in two projections (front and profile) is carried out for any eye injury. If foreign bodies are detected, it is necessary to establish their localization. If in the photographs the foreign bodies are located according to the area of ​​the eyeball, then repeat radiography is performed to accurately determine the location. This photograph is taken with the Comberg-Baltin indicator prosthesis (Fig. 126).

In cases where there is a suspicion of the introduction of a small non-metallic foreign body into the anterior part of the eye, a so-called non-skeletal X-ray is performed.

Comberg-Baltin prosthetic indicators (a) and measuring circuits for them (b) [Kovalevsky B.I., 1980].

Vogt. For this purpose, X-ray film in protective paper is inserted into the conjunctival cavity. In children under 3 years of age, images to determine localization are usually taken under general anesthesia due to their restless behavior.

Treatment of penetrating wounds consists of urgent surgical treatment of the wound under general anesthesia. In modern conditions, wound treatment is carried out using microsurgical techniques. During the surgical intervention, foreign bodies are removed and damaged structures are reconstructed (removal of the lens, excision of the vitreous hernia, suturing the damaged iris and ciliary body, etc.). Frequent (every 1 mm) sutures are placed on the wound of the cornea and sclera to completely seal it. Antibiotics, corticosteroids and other drugs are administered parabulbarically, and a binocular aseptic dressing is applied. Dressings are done daily. In the postoperative period, active general antimicrobial and local (every hour during the day) anesthetic, antibacterial, anti-inflammatory, hemostatic, regenerative, neurotrophic, detoxification, desensitizing treatment are carried out. From the 3rd day, resorption therapy is prescribed (lidase, trypsin, pyrogenal, autohemotherapy, oxygen, ultrasound, etc.).

If during the initial treatment it was not possible to remove the foreign body, then its exact location is additionally determined using X-ray echography and ophthalmoscopy, and again, under general anesthesia, the appropriate operation is performed to remove the foreign body.

Children do not tolerate blindfolds very well, they are restless and often additionally injure their eyes. Considering that microsurgical treatment of the wound is carried out very carefully and strong antibacterial and anti-inflammatory agents are used, as well as the need to relieve pain, aseptic monocular dressings are applied only at night, and during the day the operated eye is under a curtain. The introduction of sterile drugs into the eye is carried out in the first 3 days using a forced method. In case of retinal detachment, operations are carried out within the first month.

Approximately 6-12 months after clinical recovery, keratoplasty, strabismus correction, contact correction, etc. can be performed.

The outcomes of penetrating wounds vary depending on their type and location. Recovery good vision(l.0-0.3) after any penetrating wounds are achieved in approximately y65% of patients, blindness occurs in 5% and the eye is enucleated in 4%, in the rest vision remains within 0.08 - light perception.

Average hospital stay for children with penetrating wounds until clinical recovery, i.e. healing of the brine and stabilization of all changes of a morphological and functional nature is 25 days. Further treatment carried out on an outpatient basis for a month.

Treatment of non-penetrating wounds is predominantly medicinal: instillations are carried out, as for penetrating eye wounds.

It is necessary to assess the outcomes of eye injuries not only by visual acuity, but also by morphofunctional changes in tissues, membranes of the eye and auxiliary apparatus. All residual morphofunctional pathological changes are eliminated after approximately 3-6 months using reconstructive surgical methods.

Of the complexities of the eye, the most common are infectious and autoallergic processes, less often - metallosis and even less often - the so-called sympathetic ophthalmia.

Treatment of purulent and non-purulent ophthalmitis consists of long-term general and local application, mainly through forced instillations, anesthetics, an antibacterial complex (antibiotics, sulfa drugs) anti-inflammatory (amidopyrine, corticosteroids, pyrogenal, etc.), desensitizing and detoxifying (calcium chloride, suprastin, diphenhydramine), neurotrophic (dibazol, dimexide) and vitamin preparations. In addition, mydriatics are used topically, and if indicated, corneal paracentesis is performed and the anterior chamber is washed with antibiotics.

The presence of foreign metal bodies in the eye is determined on the basis of characteristic clinical signs, anamnestic data and the results of a magnetic test, X-ray and echographic studies.

Siderosis occurs when highly soluble iron compounds enter the eye and remain in it for a long time (weeks, months, and sometimes years). Biochemical changes consist in the dissolution of iron in the eye by carbonic acid to its bicarbonate, which, under the influence of oxygen in hemoglobin, is converted into insoluble iron oxides.

Most early sign siderosis is a change in the color of the iris, but the pathognomotic symptom is the deposition of siderotic pigment under the anterior capsule of the lens. These changes in the iris and, especially, the lens take the form of orange-yellow dots or spots, which are clearly visible during biomicroscopy, and sometimes with the naked eye under lateral illumination. Iris siderosis is often accompanied by mydriasis and sluggish pupil reaction to light.

A fixed and semi-fixed orange or brown dusty and lump-like suspension can also be found in the vitreous body. Morphological changes that occur during siderosis in the retina are most often not detected, but1 phenomena similar to pigmentary degeneration can be detected. It has been established that as a result of the combination of iron with proteins, ganglion cells and optic fibers change. The totality of all changes that are a consequence of siderosis have a more or less pronounced effect on visual functions. In particular, patients with siderosis complain of poor twilight vision, and during an adaptometric* study they reveal a pronounced decrease in dark adaptation. When determining visual acuity notes its decrease, and perimetry can detect a narrowing of the boundaries of the visual field both in white and in other colors (especially green and red). Long-term massive siderosis can lead to the development of diffuse cataract, as well as secondary: glaucoma. In severe cases cicatricial degeneration of the vitreous body, retinal detachment and death of the eye may occur.At the same time, the possibility of good encapsulation of small fragments in the tissues of the eye, as well as their complete resorption, cannot be excluded.

Xalcosis is the most severe course of complicated penetrating wounds, since copper compounds cause not only iridocyclitis. If the inflammation is violent, then the process can involve almost the entire contents of the eye and proceed as endophthalmitis or panophthalmitis. Inflammatory process may also be limited, i.e. occur in the form of an abscess followed by encapsulation. However, quite often Clinical signs eye lesions are detected after months and years, since visual functions are not impaired for a long time. In addition, apparently, the fact that copper compounds are relatively weak and are partially removed from the eye is also important. Thus, in the absence of inflammatory changes, the process may be unnoticeable and slow. There are cases where chalcosis developed several years after injury due to repeated blunt trauma eye or general diseases.

The most pronounced, frequent and typical sign of chalcosis is copper cataract. It is visible under biomicroscopy or lateral illumination in the form of a round disk corresponding to the width of the pupil, from which rays extend to the periphery. In the area of ​​turbidity, diffuse deposits of small grains of golden-blue, greenish, olive, brownish or brownish-red color are found. An inconsistent and later sign of chalcosis is “copper plating” of the cornea. It is detected only during biomicroscopy in the form of small dusty golden-greenish deposits in the endothelium, more intense along the periphery and less noticeable in the center of the cornea.

Characteristic, and often early manifestation chalcosis is a “coppering” of the vitreous body, which, however, is more difficult to detect. The vitreous body is colored greenish, olive or golden. Destructive changes are observed in the form of threads, ribbons, lumps, and areas of liquefaction of the vitreous body. Sometimes you can see a very colorful picture - “golden shower” on an olive background. The phenomena of iseptic iridocyclitis are often noted. The fundus is visible through a soft greenish haze, but “copper plating” of the retina can also be detected. It is difficult to identify this sign if chalcosis of the lens and vitreous body is significantly expressed. The changes, as a rule, are localized in the area of ​​the yellow spot in the form of a wreath, consisting of reddish dotted lumps, in the center of which there is sometimes a rim with an intense metallic sheen. Depending on location and massiveness pathological changes, as well as the duration of the process, visual disorders arise: adaptation and accommodation weaken, the boundaries of the visual field narrow, and paracentral relative and absolute annular scotomas appear. Some patients may experience blindness. Since chalcosis does not form strong compounds, they can dissolve and copper is removed from the eye.

Treatment of metalloses is etiological (removal of foreign bodies surgically or dissolution and removal by physiotherapeutic methods), as well as symptomatic absorbable medication (oxygen, dionine, cysteine, iodide preparations, papain, pyrogenal, unithiol, mannitol, etc.) and OnepaTHBHoef (extraction of cataracts, replacement of destroyed vitreous body, antiglaucomatous operations and interventions for retinal detachment).

Prevention of metallosis consists of the fastest possible detection, accurate x-ray and echolocalization and rapid prompt removal magnetic and amagnetic metal: foreign bodies from the damaged eye.

C i m p a t i c h e s k a i o f t a l m i i - - the most severe complicated process. This is a sluggish, non-purulent inflammation that develops in a healthy eye with a penetrating injury to the fellow eye. Sometimes sympathetic ophthalmia occurs in the healthy eye after surgery on the opposite eye. The process proceeds according to the type of uveitis. The disease develops a week or several years after injury or surgery. It is believed that purulent processes that occur in the eye after a penetrating wound are a certain kind of guarantee that a pathological process - sympathetic ophthalmia - will not develop in the fellow eye. In addition, as observations show, if the postoperative process occurs against the background of normal or slightly increased ophthalmotonus, then the risk of sympathetic inflammation decreases, and if it is accompanied by hypotension, it increases.

II l a t i h e s k a i f o r m a of the disease occurs in the form of fibrinous iridocyclitis. Mild photophobia, blepharospasm and lacrimation appear in a healthy eye. Signs of the disease include a barely noticeable pericorneal injection*, subtle sweating of the corneal endothelium, slight dilatation* of the iris vessels and a slow reaction of the pupil to light. In the fundus of the eye in red-free light, one can see the blurred contours and dullness of the tissue of the optic nerve head. The veins are somewhat dilated and darker than normal. Already in this PaHHeMr period of the disease, acquired disturbances in color perception are noted, dark adaptation decreases, and the time for recovery of initial visual acuity after light stress increases.

Further to those listed initial signs more pronounced symptoms characteristic of iridocyclitis are added: slight soreness of the eye upon palpation in the area of ​​the ciliary body, large gray precipitates on back surface cornea, and sometimes in the vitreous body, severe hyperemia*, blurred pattern and change in color of the iris, narrowing and irregular shape of the pupil, circular posterior adhesions of the iris, deposits of exudate on the anterior surface of the lens. Later*, gross opacities appear in the vitreous body, and signs of papillitis APPEAR. The outflow of intraocular fluid may be impaired, resulting in secondary hypertension7 and glaucoma. Sometimes the process follows the type of very severe posterior plastic uveitis with significant exudation into the choroid, retina and, especially, the vitreous body. The scarring process can lead to wrinkling of the vitreous body, retinal detachment, decreased ophthalmotonus, almost complete loss of vision and quadrant atrophy of the eye (influence of the external rectus muscles). The course of the process is slow, sluggish, periodic exacerbations are possible, but loss of vision even against the background of powerful complex treatment almost inevitable.

The most common form of the disease is characterized by the occurrence of serous iridocyclitis. This form is observed less frequently than the plastic one, and its course is milder. Under the influence of treatment, in more than half of the cases the process is suspended and residual visual functions are preserved.

H e in p i t h e s k a i f o p m a ophthalmia is an independent, relatively rare type of disease. It is characterized by an inconspicuous onset and absence of changes in the anterior part of the eye. However, symptoms of papillitis or mildly expressed neuritis are detected in the fundus. The optic disc and peripapillary zone of the retina are more hyperemic than normal, the tissue of the optic disc and retina acquires a matte tint, and the contours of the disc lose their distinctness. Veins and arteries dilate slightly. Color perception is impaired early, central vision decreases, the boundaries of the visual field narrow, the size of the blind spot increases, and the phenomenon of light stress is clearly registered. The course of the disease with rational treatment is relatively favorable, and in more than half of the cases normal visual functions are preserved.

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 of the normal functioning of the organ of vision, which can lead to disability of the victim. Injury occurs as a result of foreign bodies entering the eye, chemical substances, exposure to temperature or due to physical pressure on 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.

Kinds

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, 1-2 degree burn, permanent wound, eyelid hematoma, 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 eye burns, 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

Causes

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 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 eyes are important organ, failure in their functioning leads to disability of the patient 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 vision problems.

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.

Pronounced symptoms in the patient are the lack of reaction of the pupil to light and 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, excessive tearing, discomfort, a feeling of “sand” in the eyes, sharp pain, redness and swelling of the eyelids.

Consequences

Eye injuries have serious consequences. In severe cases of damage, loss of vision may occur 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 a deterioration in the outflow of 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, you can avoid serious consequences of eye injury.

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 of the negative consequences of 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;

For schoolchildren, it is important to behave competently 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 the reach of children. When buying children's toys, it is important to consider their suitability for the child's age (no sharp corners or traumatic parts).

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