Penetrating eye injury. Injuries to the eye, their classification and treatment Instill sterile disinfectant drops and apply a sterile bandage on both eyes, especially in cases where there is a large wound

Non-penetrating wounds eyeball not associated with a breach of integrity

capsules of the eye (i.e. cornea and sclera). Corneal injuries are especially common.

Injuring objects can be large particles of sand, fragments of stone, metal, coal,

lime, wood. Foreign bodies destroy the corneal epithelium and create conditions for

infection development. With deep penetration of foreign bodies into the corneal tissue, except for

risk of secondary infection, there is a risk of developing scar tissue and

walleye formation.

Superficial foreign bodies of the cornea and conjunctiva are removed using

rinsing eyes with water, isotopic sodium chloride solution or disinfectant

solution (furatsilin 1:5000, potassium permanganate 1:5000, boric acid 2%, etc.).

Introduced foreign body can be removed with a special needle or sterile

needles for intravenous injections, making the movement of the needle from the center to the limbus. At

removal of foreign bodies instrumentally requires anesthesia with a 2% solution of lidocaine,

a solution of 0.5% alkaine or 0.4% inocaine. If a foreign body has penetrated into the deep layers

cornea, then it is removed in a hospital due to the possibility of corneal perforation.

After removing the foreign body of the cornea, antibiotic solutions are prescribed and

sulfonamides, which are instilled 3-8 times a day, and an ointment is applied at night with

antibiotics or sulfonamides.

Penetrating wounds

Penetrating eye wounds are divided into adnexal injuries, i.e.

injuries of the soft tissues of the orbit, injuries of the eyelids and lacrimal organs, and injuries of the eyeball.

Orbital soft tissue injuries can be lacerated, cut, or punctured. Torn

wounds are accompanied by loss of fatty tissue, damage to the oculomotor

muscles and wounds of the lacrimal gland.

With penetrating wounds, the integrity of the outer capsule of the eye is violated

regardless of whether the inner shells are damaged or not. Penetrating frequency

wounds of all injuries is 30% of the eye. With penetrating wounds, there is one entrance

hole, with through - 2.

Stab wounds are accompanied by exophthalmos, ophthalmoplegia, ptosis. These signs

talk about a deep spread of the wound channel into the orbit and often damage

nerve trunks and vessels at the top of the orbit up to damage to the optic nerve.

In all cases, revision and primary surgical treatment of the wound with

restoration of the anatomical integrity of the eyeball.

Eyelid injuries, accompanied by damage to the lacrimal ducts, require

primary surgical treatment (if possible) with the restoration of lacrimal

tubules.

The severity of a penetrating wound is due to the infection of the injuring object,

its physical and chemical properties, size and localization of injury (cornea, sclera

or limbus zone). An important role is played by the depth of penetration of the injuring object into

eye cavity. The severity of the injury may also depend on the body's response to

sensitization by damaged tissues.

There are absolute and relative signs of penetrating wounds. To the first

include: wound channel, prolapsed membranes, and a foreign body. The second ones are

hypotension and change in the depth of the anterior chamber (small with corneal wounds and

deep with scleral).

The ingress of a foreign body into the eye leads to the development of purulent

complications - endophthalmitis and panophthalmitis, especially if the foreign body is wooden

or contains any organic residues (components).

With penetrating wounds in the limbal region, the outcome depends on the size of the wound and

prolapse of the membranes of the eye. Most frequent complication with injuries in this area

there is a prolapse of the vitreous body, often there is hemophthalmus.

Damage to the lens and iris can be both with blunt trauma and with

penetrating wounds of the eyeball. In the case of a rupture of the lens bag, which, as

as a rule, it happens with a penetrating wound, there is a rapid clouding and swelling

all lens fibers. Depending on the location and size of the capsule defect

lens formation of cataracts due to intense hydration of the lens fibers

occurs in 1-7 days. The situation is very often complicated by the release of crystal fibers.

talik in the area of ​​the defect into the anterior chamber, and with a through wound of the lens with

damage to the anterior hyaloid membrane - in the vitreous body. It may

lead to the loss of corneal endothelial cells due to mechanical contact with

her lens substance, the development of phacogenous uveitis and secondary glaucoma.

With penetrating wounds, foreign bodies are often found in the anterior

camera, on the iris and in the lens substance.

Distinguish between superficial and deep located foreign bodies. Surface

foreign bodies are located in the epithelium of the cornea or under it, deeply located -

in the own tissue of the cornea and deeper structures of the eyeball.

All superficially located foreign bodies are subject to removal, as they

prolonged stay in the eye, especially on the cornea, can lead to traumatic

keratitis or purulent ulcer of the cornea. However, if the foreign body lies in the middle or

deep layers of the cornea, a sharp reaction of irritation is not observed. Concerning

remove only those foreign bodies that are easily oxidized and cause the formation

inflammatory infiltrate (iron, copper, lead). Over time, foreign bodies

located in the deep layers, move into the more superficial layers, from where they are easier

delete. The smallest __E2s particles of gunpowder, stone, glass and other inert substances can

remain in the deep layers of the cornea without causing a visible reaction, and therefore not always

are subject to removal.

The chemical nature of metal fragments in the thickness of the cornea can be judged by

staining of the tissue around the foreign body. With siderosis (iron), the corneal rim around

foreign body acquires a rusty-brown color, with chalkose (copper) - gentle

yellowish green, with argyrosis observed small dots whitish yellow or gray

brown, usually located in the posterior layers of the cornea.

A brownish ring after removal of a metal foreign body is also necessary

remove carefully as it may maintain eye irritation.

Penetrating injury of the eye - any mechanical damage that leads to a violation of the integrity of the eyeball and its membranes. Than it is fraught and how to treat?

All wounds can be combined into 2 large groups: penetrating and non-penetrating. In the first case, the process is accompanied by perforation of all the membranes of the eye, the appearance of a foreign body, even if part of the contents of the eyeball was not affected.

Damaging factors are blunt mechanical (punches, sticks), sharp (spectacle glasses, piercing objects such as wire ends, scissors, metal fragments, knives), chemical, thermal, radiation, combined.

According to statistics, non-penetrating wounds most often occur when there is no through passage into the sections of the eye. Also, wounds are penetrating, when the integrity of the eye capsule is violated to varying degrees (cornea, sclera).

A penetrating wound is considered more dangerous and more severe according to forecasts. The localization of the dissection of the capsule divides these wounds into scleral, corneal, limbal (limbal rings - a dark rim around the iris).

In addition, penetrating eye injury is divided into penetrating when there are 2 holes; penetrating when there is a single perforation of the wall; destroying the eye (the contents of the eye are lost, it collapses like an empty bag and changes its shape). Consider penetrating damage.

The essence of the problem

Any always have absolute or reliable symptoms and indirect. Signs of a penetrating injury to the eye, which can be considered absolute:

1. Penetrating damage to the cornea or sclera.
2. Falling into the wound or infringement between its edges of the contents of the inner membranes, the vitreous body. Therefore, no lumps can be removed by ourselves, although they can be mistaken for a foreign body, otherwise this will lead to the death of the entire eye. The vitreous body looks like a transparent capsule. If the wound is large, the vitreous body is completely lost, the organ loses its shape and sinks.
3. The presence of a foreign body in the eye is determined already on an x-ray. Additional signs include the outflow of aqueous humor from damaged eye, hypotension of the eye, when IOP decreases, clouding and shift of the lens to the side, deepening or absence of the anterior chamber of the eye, depending on the location of the injury.

Indirect signs are not the basis for making a diagnosis, because they happen also at contusions of eyes. Therefore, the patient should be examined by an ophthalmologist, to whom the victim is sent with a note of suspicion of an eye injury.

Symptomatic manifestations

Of the common complaints, pain in the eye can be noted, visual impairment is not always the case. In addition, there is a corneal syndrome in the form of lacrimation, photophobia, swelling of the conjunctiva and its hyperemia.

Vessels are injected, there are hemorrhages under the conjunctiva, there may be ruptures, sometimes it is possible to see the foreign body itself. Visible wounds various shapes, magnitude and localization. Among the symptoms are the above or additional signs.

Possible Complications

Penetrating eye wounds almost always have complications due to the development of infection in the wound. It is found most often 2-3 days after injury. The moisture in the anterior chamber becomes cloudy, pus (hypopion) can be detected there, the wound edges swell, irritation increases. Fibrinous exudate appears in the pupil area. All this is accompanied by an increase in pain in the eye, swelling of the eyelids and mucous membranes.

Such an injury can cause other complications:

• purulent iridocyclitis, its sluggish fibrinous-plastic form, endophthalmitis, panophthalmitis (inflammation of all parts of the eye);
• an injury to one eye can provoke a similar lesion in the second, healthy one.

Such lesions are called. If we are talking about metal fragments, then their gradual oxidation occurs, oxides penetrate into the tissues of the eye and lead to the development of metallosis:

1. When iron fragments enter, siderosis develops, we are talking about water-soluble iron compounds. Its earliest sign is an orange shade of the iris. At such moments, the retina is also affected, optic nerve, the choroid (uveitis) may become inflamed, retinal detachment may occur. As a result, siderosis leads to the appearance of secondary glaucoma, cataracts and even complete blindness.
2. With copper fragments, chalcosis develops. This complication is considered more severe, because. Besides dystrophic changes inflammation of various parts of the eye develops. The most noticeable and characteristic changes appear in the lens and in other tissues of the eye: yellow-green opacities appear in the form of a blooming sunflower - "copper cataract". The vitreous body is especially often stained. The insidiousness of chalcosis is also manifested in the fact that its signs can appear months and years after eye injuries, because vision itself does not suffer at first.
3. Iridocyclitis is an inflammatory process in the anterior portion of the choroid. On the back surface of the cornea appear cellular deposits, swelling, exudate accumulates. The pupil narrows, loses its rounded shape. Complaints are pain in the eye, cephalalgia and fever. A healthy eye can also be affected, but the inflammation here is non-purulent - it will be serous, plastic (fibrous) or mixed. With a decrease in IOP, the possibility of sympathetic iridocyclitis increases, and vice versa. The fibrous process eventually leads to organ atrophy and blindness.
4. Endophthalmitis - inflammation develops in the posterior chamber or vitreous. Vision drops noticeably, the transparent media of the eye, namely the lens and the vitreous body, become cloudy.
5. Panophthalmitis - conjunctiva and eyelids are inflamed. Patients have sharp pain, the capsule of the eye is filled with pus, which aggravates the patient's condition. Subsequently, the eye shrinks, scars (phthisis). The outcome of the process is blindness.

Diagnostic measures

Absolute signs make it possible to immediately diagnose. If the injuring object was very small, then the edges of the wound quickly stick together, the anterior chamber can fully recover, hypotension of the eye disappears. In such cases, it is necessary to examine it completely. Foreign bodies may not be visually detectable; this often requires x-rays, ultrasound, MRI, and CT.

To make a diagnosis, in addition to collecting information about the injury, a visual examination, microscopy, and determination of IOP are necessary. Foreign bodies are metallic and non-metallic. The first, in turn, can be divided into magnetic and non-magnetic. In the presence of metal fragments, an x-ray is performed according to the Komberg-Baltin method. It consists in the fact that 2 shots are taken - side and straight, which are perpendicular to each other.

After repeated anesthesia, a special prosthesis with lead marks is applied to the limbus, then calculations are made according to the patterns according to the pictures. To identify the magnetic properties of the fragment, a Geilikman magnetic test is performed: when the patient's head is placed in the ring of an intrapolar electromagnet, the magnetic foreign body begins to vibrate. With a non-metallic foreign body, non-skeletal radiography according to Vogt is performed in a special way.

In addition, for diagnosis, the level of vision, biomicroscopy, and ophthalmoscope examination are carried out.

First aid and urgent care

• mandatory are the introduction of the PSS for Bezredka;
• tetanus toxoid;
• antibiotic intramuscularly and orally.

Around the wound, superficial dirt particles are removed:

• if there are no gaping wounds, Albucid, Levomycetin, Ciprofarm, Vigamox are instilled;
• if possible, wash the eye with Furacilin or Rivanol;
• at severe pain you can drip Novocaine or Lidocaine, intramuscularly inject Analgin.

Then an aseptic dressing is applied, and the patient is urgently sent to the hospital. The patient should lie on their side on the side of the injured eye.

Principles of treatment

Treatment should be comprehensive, i.e. include medical and surgical. The surgeon must carry out the correct topographic and anatomical comparison of damaged tissues and the rapid extraction of foreign objects. Medical therapy pursues the following goals:

• wound sealing;
• regeneration of damaged tissues;
• preventing infections;
• stimulation of immunity and reparative processes;
• prevention of severe scars.

If necessary, plastic surgery is carried out in the long term. For any injuries, treatment is initially carried out only in an ophthalmological hospital. Here, after obtaining x-rays, to exclude a foreign body in the eye, an surgical treatment wounds; the shells that have fallen into the wound are gently excised using microsurgical techniques.

In the presence of foreign bodies, they are removed and the damaged tissues are restored: excision of the hernia of the vitreous body, lens, suturing. When suturing the cornea and sclera, sutures are often applied to seal the wound. Immediately start antibiotic therapy (broad-spectrum antibiotics):

• Gentamicin;
• Tobramycin;
• Ampicillin;
• Cefotaxime;
• Ceftazidime;
• Ciprofloxacin;
• Vancomycin;
• Azithromycin;
• Lincomycin.

Sulfanilamide preparations inside: Sulfadimethoxine or Sulfalen. Means are administered parabulbarno, i.e. into the skin of the lower eyelid. Dressings are carried out daily, aseptic dressings are applied to both eyes. In addition, the treatment includes the use of painkillers, anti-inflammatory (NSAIDs, glucocorticoids), hemostatic, regenerative agents, detoxification and desensitizing therapy.

On the 3rd day, resolving therapy begins to be used - Lidazu, Trypsin, Pyrogenal, Collagenase, Fibrinolysin, oxygen therapy, ultrasound.

Magnetic fragments are removed without difficulty by the action of an electromagnet. Amagnetic bodies are more difficult to remove. Non-magnetic metals include copper, aluminium, gold, lead and silver. With chalcosis, electrophoresis with unithiol (copper antidote) is used.

If it is impossible to pull out a foreign body, absorbable preparations are used. If a inflammatory processes subsided, a foreign non-metallic body (glass, plastic or stone) can be left in the eye under the dynamic supervision of a doctor.

Often glass is used as a foreign body. It usually rarely penetrates into the back of the eye, accumulating in the angle of the anterior chamber or iris. A gonioscope (lenses with high magnification) is used to detect glass.

Forecast and prevention

The prognosis depends entirely on the severity of the damage, its location. An important role is played by the early appeal for help, the quality of its provision. In severe injuries, the patient should always be under the supervision of an ophthalmologist and avoid increased physical exertion.

There are no specific methods of prevention. At work and at home, you need to take safety measures, always use goggles and masks.

Video

Wounds of the eyeball are divided into non-penetrating (non-perforated), when the wound channel ends in the wall of the eye at some depth and penetrating (perforated), when the wound channel passes through the entire thickness of the eye wall. If non-penetrating wounds for the vast majority of patients with timely and qualified medical care ends safely, then penetrating requires urgent hospitalization to prevent severe intraocular complications.

Non-penetrating eye wounds

Allocate non-penetrating wounds of the eyeball according to the localization of the wound - cornea, sclera, corneoscleral zone and by the absence or presence of one or more foreign bodies.

In the presence of a non-penetrating wound, the patient complains of eye irritation, lacrimation, photophobia, pain, decreased vision when the process is localized in the center of the cornea.

When examining the patient, the upper and lower eyelids are turned out to exclude a foreign body, which may be on the conjunctiva of the eyelids or in the vaults. The foreign body is removed from the cornea with a spear. Biomicroscopy is used to determine the depth of the wound.. A fluorescein test is used to determine a tissue defect.

corneal erosion - accompanied by significant painful sensations, photophobia, lacrimation, blepharospasm. To detect defects in the corneal epithelium, a drop of 2% fluorescein solution is injected into the conjunctival sac. After instillation of the disinfectant solution, the coloring matter is washed off from the intact epithelium, and the defect areas turn green.

Urgent care:

• locally - 0.25% dicaine solution once;
• drip 0.3% tobramycin solution or 20% sodium sulfacyl solution;
• for the eyelids 1% chloramphenicol eye ointment;
• bandage - "curtain" on the eye or light-protective glasses;
• drip eye drops "Vitasik"or eye solcoseryl (actovegin)- gel 4-6 times a day;

At night - disinfectant eye ointment.

Foreign body of the conjunctiva

The foreign body is often embedded in the conjunctiva upper eyelid 2-3 mm from the intercostal margin.

The patient is concerned about severe photophobia and pain, aggravated by blinking movements. The foreign body must be removed as soon as possible, since with blinking movements it violates the integrity of the corneal epithelium and thereby creates favorable conditions for the development of a secondary infection.

Mote is usually easily removed without anesthesia using a wet bath.

Urgent care:

• remove foreign body;
• drip solution 0.25% chloramphenicol or 20% sodium sulfacyl;
• laying 1% chloramphenicol eye ointment.

Foreign body of the cornea

Complaints with such an injury are: sharp redness of the eye, pain, a pronounced feeling of a foreign body, photophobia, lacrimation. When viewed using focal illumination, a pericorneal injection, a foreign body in the cornea, is visible.

When a foreign body is introduced into the cornea, the integrity of the epithelium is violated; the tissue surrounding the foreign body is oxidized, a rusty-colored rim ("dross") is formed, the cornea loses its transparency.

When a foreign body penetrates into the deeper layers of the cornea, it is better to refer the patient to an ophthalmologist.

In the presence of multiple foreign bodies in the cornea, it must be remembered that they cannot be removed at the same time - the injury is too great, and therefore the healing process of the cornea is aggravated.

The bodies should be removed in stages, starting with the surface ones.

Urgent care :

• drip 0.25% dicaine solution;
• remove the foreign body with a special spear or injection needle;
• drip 0.25% solution of chloramphenicol and 20% solution of sulfacyl sodium or 0.3% solution of tobramycin;
• instillations 1% tropicamide solution;
• for the eyelids 1% chloramphenicol ointment;
• bandage - "curtain";
• within 5-7 days: disinfectant drops and solcoseryl-gel 3-4 times a day;
• eye drops " Vitasik"3-4 times a day.

Penetrating eye injury

Penetrating wounds include the following injuries:

• penetrating wounds, in which the wound channel does not extend beyond the eye cavity;
• penetrating wounds, when the wound channel extends beyond the eye cavity, that is, there are two wound openings;
• destruction of the eyeball.

These injuries are classified as severe, since with each such injury there is almost always a danger:

• divergence or gaping of the wound with possible loss of intraocular contents;
• penetration of microorganisms from the conjunctival sac into the eye cavity with a high probability of developing purulent iridocyclitis (inflammation of the iris and ciliary body of the eyeball), endophthalmitis (this is a purulent inflammation of the inner membranes of the eyeball) and even panophthalmitis (this is a purulent inflammation of all tissues of the eyeball);
• hemorrhages in the vitreous body from damaged vessels of the choroid (actual choroid);
• development of sympathetic ophthalmia in the healthy eye.

Examination of a patient with a penetrating wound of the eyeball is carried out very carefully and carefully after drip anesthesia.

Diagnostics This type of eyeball injury is based on the identification of absolute and relative signs of penetrating injury.

Absolute signs of a penetrating wound:

• gaping wound of the cornea or sclera with prolapse of the inner membranes or vitreous body;
• penetrating wound of the fibrous membrane of the eye;
• filtration through the corneal wound of chamber moisture;
• the presence of a foreign body inside the eyeball.

Relative signs of penetrating injury:

• shallow anterior chamber (with localization of the wound in the area of ​​the cornea or limbus);
• deep anterior chamber (in case of injury to the sclera and prolapse of the vitreous body or dislocation of the lens into the vitreous body);
• a sharp swelling of the conjunctiva with accumulated blood under it;
• tear of the pupillary edge of the iris and deformation of the pupil;
• cataract;
• hypotension.

A patient with a penetrating wound of the eyeball is always subject to urgent hospitalization in the eye department..

Before sending to the hospital, it is advisable to perform the following activities:

• drip carefully 20% sulfacyl sodium solution(do not use ointment);
• apply a binocular bandage;
• introduce anti-tetanus serum (1500-3000 IU) according to Bezredka;
• inject a single intramuscular dose of a broad-spectrum antibiotic, orally 1 g of sulfanilamide drug and 0.05 ascorutin;
• painkillers according to indications;
• provide transportation of the wounded, preferably in a supine position or by ambulance.

See eyeball injuries

Saenko I. A.

Sources:

1. Ophthalmology: textbook / Ed. E. I. Sidorenko. - 2nd ed., corrected. - M.: GEOTAR-Media, 2009.
2. Ruban E. D., Gainutdinov I. K. Nursing in ophthalmology. - Rostov n / a: Phoenix, 2008.

The cornea is damaged more often than the sclera. Corneal erosions are accompanied by significant pain, photophobia, lacrimation, blepharospasm, foreign body sensation.

To detect defects in the corneal epithelium, one drop of a 2% fluorescein solution is instilled into the conjunctival sac. Even a slight defect in the corneal epithelium will be stained in green color. Emergency care consists in instillation of disinfectant drops and ointment (tetracycline ointment 1%, albucid 30%). Erosion heals quickly, if not complicated by infection. If complicated - treatment, as with corneal ulcers.

There may be non-penetrating wounds of the cornea - linear, patchwork, of various sizes and shapes, with the addition of an infection, infiltration of the edges of the wound is noted. Corneal wounds are not perforated, but deep, and erosions leave opacities, which, when located in the optical zone, can reduce visual acuity.

Foreign bodies may be embedded in the cornea. They are superficial when they are located in or under the corneal epithelium, and deep when they are localized in the corneal tissue itself. Superficial foreign bodies have the same symptoms as corneal erosion. Deep-lying foreign bodies of the cornea give less pronounced subjective sensations. Rendering emergency care depends on the depth of foreign bodies.

Superficial ones are easily removed with a tightly twisted cotton swab dipped in a solution of furacillin (1:5000) or mercury cyanide (1:5000) after preliminary anesthesia with a 1% solution of dicaine, 1% inocaine, lidocaine or are removed using a spear-shaped needle, corneal chisel or conventional injection needles. Drops of sodium sulfacyl 30%, chloramphenicol 0.25% are instilled, a disinfectant ointment is applied. The patient continues to carry out the same treatment at home until the examination by a specialist. To clarify the depth of the foreign body in the cornea, an examination with a slit lamp is necessary, and if it is not available, then with a binocular loupe with good side lighting.

Any deep-seated fragment should be removed only in a hospital setting. As an emergency, instillation of dicaine, disinfectant drops and bandaging. If a foreign body protrudes into the anterior chamber at one end, the wound should be considered penetrating and assistance should be provided in the same way as it should be provided for any penetrating injury. It is very dangerous to push a fragment into the anterior chamber during an attempt to extract it, which every doctor should be aware of. If there is a foreign body in the cornea with purulent infiltration around it, after preliminary anesthesia with a 1% solution of dicaine, the foreign body should be removed using the previously mentioned needles. Instill drops of albucid into the eye, apply an ointment of sulfonamides or antibiotics, sulfonamides inside. Further, the patient should be observed and treated by an ophthalmologist.

Non-penetrating wounds of the sclera are always accompanied by simultaneous damage to the conjunctiva. In order to provide emergency care, disinfectant drops should be dripped, an ointment should be applied, and a light sterile bandage should be applied over the eye. In the conditions of an eye hospital, a revision of the wound is carried out, in the absence of a penetrating wound of the sclera, if the wound is more than 5 mm, nylon sutures are applied to the conjunctiva. If there is a penetrating wound, then the treatment proceeds, as with any penetrating wounds of the eye.

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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 hospitalized for eye injury, penetrating wounds of the eyeball are noted - injuries in which the injuring (foreign) body cuts through the entire thickness of the outer shells of the eye (sclera and cornea). This is a dangerous injury, because it leads to a decrease in visual functions (sometimes to complete blindness), and sometimes it causes the death of another, undamaged eye.

Classification. There are such types of penetrating wounds of the eyeball:

I. According to the depth of damage:

1. Penetrating wounds, in which the wound channel passes through the cornea or sclera, extends into the eye cavity to a different depth, but does not go beyond it.

2. Through wounds - the wound channel does not end in the cavity of the eye, but goes beyond it, having both an inlet and an outlet.

3. Destruction of the eyeball - destruction of the eyeball with a complete and irreversible loss of visual functions.

II. Depending on location: corneal, limbal, corneal-scleral and scleral wounds.

III. According to the size of the wound: small (up to 3 mm), medium (4-6 mm) and large (over 6 mm).

IV. By shape: line wounds, irregular shape, torn, chipped, star-shaped, with a tissue defect.

In addition, gaping and adapted wounds are distinguished (the edges of the wound are tightly adjacent to each other throughout the area).

Clinical picture and diagnosis. Penetrating wounds are often accompanied by damage to the lens (40% of cases), prolapse or infringement of the iris (30%), hemorrhage into the anterior chamber or vitreous body (about 20%), 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 anamnesis, while taking into account the medico-legal consequences of eye damage. Very often, during the initial collection of anamnesis, victims of different 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, domestic, sports injuries. The severity of damage depends on the size of the injuring object, the kinetic energy and its speed during the impact.

In almost all cases, regardless of the anamnesis, with penetrating wounds, it is necessary to conduct an x-ray, computed tomography, Ultrasound, MRI. These studies will determine the severity of the damage and the presence (or absence) of a foreign body.

Diagnostics penetrating wounds of the eye are carried out by identifying characteristic symptoms. The latter, in their significance, can be absolute and relative.

Absolute signs of penetrating wounds of the eye are:

• penetrating wound of the cornea or sclera;
• prolapse into the wound of the inner membranes of the eye (iris, ciliary body, choroid), vitreous body;
• outflow of intraocular fluid through the wound of the cornea (diagnostic fluorescein test);
• the presence of a wound channel passing through the internal structures of the eye (iris, lens);
• the presence of a foreign body inside the eye;
• the presence of air in the vitreous body.

Relative signs of penetrating eye injuries include:

• hypotension;
• change in the depth of the anterior chamber (shallow - when the cornea is injured, deep - when the sclera is injured, uneven - with iridescent-scleral damage);
• hemorrhage under the conjunctiva, in the anterior chamber (hyphema) or vitreous body (hemophthalmus), choroid, retina;
• tears of the pupillary edge and a change in the shape of the pupil;
• tear (iridodialysis) or complete detachment (aniridia) of the iris;
• traumatic cataract;
• subluxation or dislocation of the lens.