Non-penetrating and penetrating wounds of the eyeball. Eye injury Non-penetrating corneal injury

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

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

It is necessary to take this seriously, if you get an eye injury, it is important to immediately consult a doctor. After rendering assistance by a traumatologist, a mandatory consultation with an ophthalmologist is necessary. Despite the severity of the injury, complications can develop 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 may become a reason for a violation, a decrease in the functions of an injured organ. Most often, the cause of injury can be:

• damage by a foreign object to the eye;
• 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 trauma (bruises);
• wound (non-penetrating, penetrating and through);
• uninfected or infected;
• with penetration of foreign objects or without it;
• with or without ocular prolapse.

Classification by location of damage:

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

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

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

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

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

The reasons

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

More serious injuries occur with a direct blow with a hand or a blunt, voluminous object to the face or eye area. Injury to the eye during a fall from a height. These injuries are often accompanied by hemorrhage, fractures, bruises. Eye damage can occur due to traumatic brain injury.

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

Symptoms

The sensations experienced by the injured 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. With this injury, you need to consult an ophthalmologist. 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 is the absence of pupil reaction to light, an increase in its diameter. The patient feels a decrease in the clarity of vision, pain in the eyes upon contact with a light source, profuse tearing.

The most common injury is damage to the cornea of ​​the eye. The cause of mechanical injuries is the insecurity of this part of the eye and the lack of safety elements, its openness to the ingress of foreign objects and particles. These injuries, according to the statistics of visits to the doctor, occupy a leading place among existing eye injuries. From how deeply the body sticks, superficial and deep injuries are distinguished.

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. With a corneal injury, the patient feels a decrease in the clarity of the “picture”, pain in the eyes upon contact with a light source, profuse tearing, discomfort, a feeling of “sand” in the eyes, sharp pain, redness and swelling of the eyelids.

Effects

Eye injuries are serious. In severe cases of damage, loss of vision can occur without its subsequent resumption. 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, the pupil is displaced, the vitreous body is clouded, swelling of the cornea is noticeable, and intraocular pressure increases.

In some cases of damage to the eye, a traumatic cataract occurs (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 the event of an eye injury, the following steps must be taken in the first place:

Regardless of their nature and type, any eye injury requires competent and timely assistance and medical advice. In case of damage to the eye, it is necessary to treat it very carefully. Timely treatment is a guarantee of minimal complications and minimization negative consequences eye injury.

Treatment

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

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

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

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

A penetrating wound requires surgical intervention. This unscheduled and urgent procedure is carried out by an ophthalmological surgeon.

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 have competent behavior in the chemistry classroom, as well as in the workshop, at the machines. Before the start of the lesson in school laboratories, the teacher should be aware of the statistics of childhood eye injuries, so you need to start communication by repeating the rules and requirements for 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 out of the reach of children. When buying children's toys, it is important to consider their age-appropriateness (the absence of sharp corners and traumatic parts).

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

Treatment of non-penetrating wounds of the eyeball

Penetrating eye injury

Classification of penetrating wounds of the eye

Clinic and diagnosis of penetrating eye injuries

Urgent care

Penetrating wounds of the sclera and cornea

Wounds of the sclera and iris-scleral region

Penetrating wounds of the eye with the introduction of foreign bodies

Treatment of eye wounds with the introduction of foreign bodies

Initial treatment of penetrating wounds

The cornea is damaged more often than the sclera. Corneal erosions are accompanied by significant painful sensations, 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, you should drip disinfectant drops, lay an ointment, apply a light sterile dressing approximately. 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.

Eye injury

Eye injuries are conditions in which the integrity and functions of the organ of vision are impaired. By type, they can be industrial, agricultural, transport, sports, household, criminal, etc.

Causes of eye injury

Any aggressive external impact on the eye, be it a solid object, a caustic chemical, radiation, can lead to eye injury.

Types of eye injuries

According to the severity of the injury, it can be mild (do not lead to a decrease in the functions of the organ of vision), moderate(decrease in function is temporary), severe (persistent decline in eye function), especially severe (loss of the eye is not excluded).

According to the depth of the lesion, non-penetrating (extraocular foreign bodies, erosion, burns, contusions) and penetrating (the integrity of the fibrous membrane of the eye is violated throughout its entire thickness) are distinguished.

Orbital trauma have various manifestations: pain, diplopia occurs almost immediately. With fractures, exophthalmos or enophthalmos, subcutaneous emphysema, edema and hematomas of the eyelids, restriction of eye movements, ptosis (drooping of the eyelid) are possible. Soft tissue wounds, closed and open fractures are possible. Often combined with injuries of the eyeball.

Orbital contusion- blunt injuries in which the integrity of the tissues is not violated. Complaints of pain, limited mobility, hematoma formation, redness. Visual acuity is reduced, because. damage to the eyeball occurs.

At soft tissue injury eye sockets, nearby organs can be damaged - the lacrimal gland, the external muscles of the eye.

Eyeball injuries have different mechanisms of origin and different clinical picture. There may be blunt (concussion), non-penetrating and penetrating injuries.

Eyelid wounds there are not through and through; without damage and with damage to the free edge of the eyelid; torn, chipped or cut. With through, the eyelid is damaged to its full thickness (skin, muscles and cartilage).

shell shock there are direct (with direct impact on the eyeball) and indirect (due to concussion of the head or torso). Depending on the force of impact, the elasticity of the tissues of the eye and the presence of concomitant pathology, the shells can tear or tear. The patient is concerned about pain, nausea, dizziness, redness of the eye, decreased vision, fog before the eyes, floaters. On physical examination, there may be corneal edema, hemorrhage into the anterior chamber (hyphema), partial or complete detachment of the iris, paralysis of the sphincter of the pupil ( irregular shape pupil, lack of reaction to light), Fossius ring on the anterior capsule of the lens (an imprint of the pigment border of the iris), paresis or paralysis of the ciliary muscle (accommodation is disturbed), traumatic cataract, dislocation and subluxation of the pupil, hemorrhages in the choroid, on the retina - Berlin opacification and / or hemorrhages, its ruptures, detachment (may occur in the long term).

Non-penetrating wounds happen with presence or absence of foreign bodys. At the same time, the integrity of the outer shell (cornea, sclera) is not violated throughout its entire thickness. The most common injuries are foreign bodies of the cornea. Occur when safety precautions are not observed and work without goggles. Often there are foreign bodies after working with a grinder and in windy weather. There is a sensation of a foreign body, lacrimation, photophobia, inability to open the eye. An objective examination shows foreign bodies of the eyelids, corneas or conjunctiva, superficial and deep injection of the eyeball.

Non-penetrating eye injury

Signs of penetrating wounds: a through wound in the cornea or sclera, a hole in the iris, moisture filtration of the anterior chamber, prolapse of the inner membranes of the eye or vitreous body, the presence of an intraocular foreign body. Also, indirect signs are a shallow or deep anterior chamber, irregular pupil shape, detachment of the iris, eye hypotension, hemophthalmos, etc.

Penetrating injury with prolapse of the iris and ciliary body

The most severe complication of penetrating wounds is endophthalmitis- inflammation of the vitreous body of a purulent nature, 60-80 percent of cases lead to blindness. There is a general malaise, fever, the eye is hypotonic, the eyelids and conjunctiva are edematous and hyperemic, behind the lens there is an abscess of the vitreous body of a yellow-gray color.

Endophthalmitis

Panophthalmitis in all cases leads to blindness and is dangerous to the life of the patient. This inflammation of all the membranes of the eye quickly passes into the orbit and the inflammatory process can spread to the brain. The infection enters at the time of injury or after it. The most common pathogen is staphylococcus aureus. First, purulent iridocyclitis occurs, then an abscess of the vitreous body is formed, then the retina, vascular and fibrous membranes of the eye are involved in the process. There is pus in the anterior chamber, nothing is visible behind it, the cornea and eyelids are edematous, exophthalmos appears.

Sympathetic ophthalmia- sluggish inflammation of a non-purulent nature on the unaffected eye with a penetrating wound of the second eye. It often develops 1-2 months after the injury. It proceeds in the form of iridocyclitis or neuroretinitis. The first signs are a slight injection of the vessels of the conjunctiva, slight pain, photophobia. Then there are symptoms of iridocyclitis, hypertension is replaced by hypotension, and then subatrophy of the eye.

Eye burns there are thermal (the action of high or low temperatures), chemical (alkalis and acids), thermochemical, radiation.

According to the depth of the lesion, 4 stages are distinguished:

1. Hyperemia of the skin and conjunctiva, the presence of superficial erosion of the cornea. 2. Bubbles on the skin of the eyelids, films on the conjunctiva, translucent clouding of the corneal stroma. 3. Necrosis of the skin, conjunctiva, cornea has the appearance of "frosted glass". 4. Necrosis of the skin, conjunctiva, cornea in the form of a "porcelain plate".

Patients are concerned about severe pain, lacrimation, photophobia, inability to open their eyes, decreased visual acuity.

Eye burns

Examination of a patient with an eye injury

The examination is carried out very carefully in order to correctly diagnose and prescribe treatment. With any eye injury, you should immediately contact an ophthalmologist so as not to miss a serious pathology and prevent the development of complications.

External examination - often visible damage in the form of wounds, bleeding, foreign bodies. Edema, eyelid hematomas, exophthalmos or enophthalmos are possible - determination of visual acuity - in many injuries it is reduced due to the lack of complete transparency of the optical media of the eye - perimetry - determination of corneal sensitivity (with many injuries and burns reduced) - determination of intraocular pressure - possible as hypertension, and hypotension - examination in transmitted light - foreign bodies or injuries associated with trauma are visible (clouding of the lens and / or vitreous body, etc.) - always carry out eversion upper eyelid, in some cases double, in order not to miss foreign bodies on the mucous membrane - biomicroscopy - must be carried out very carefully, always with fluoroscein staining of the cornea - gonioscopy is performed to examine the angle of the anterior chamber and diagnose damage to the ciliary body and iris - direct and indirect ophthalmoscopy, as well as using a Goldman lens helps to determine such pathologies as retinal contusion, intraocular foreign bodies, retinal detachment - radiography of the orbit and skull in two projections - radiography using the Baltin-Komberg prosthesis to locate the intraocular foreign body. To do this, a prosthesis is placed on the anesthetized eye exactly at the points of 3, 6, 9, 12 hours. A picture is taken, and then it is applied to special tables - computed tomography of the orbit and eye to determine the presence of X-ray negative foreign bodies - Ultrasound of the eye helps to determine the condition of the internal membranes and environments of the eye, as well as the location and number of foreign bodies - fluorescein angiography is indicated to identify areas that must be delimited by laser photocoagulation of the retina. It is possible to carry out only with transparent media of the eye - general clinical tests of blood, urine, sugar, blood for RW, HIV infection, HBs antigen - consultations of a traumatologist, neurosurgeon, therapist if necessary.

Treatment for eye injury

Treatment should be started as soon as possible after the injury.

Mild eye contusion(for example, when punched in the eye) in most cases requires outpatient treatment, but an examination by an ophthalmologist is required. Immediately after the injury, it is necessary to apply cold to the area of ​​damage, drip disinfectant drops (you can use ordinary albucid), with severe pain take painkillers and go to the nearest emergency room. The doctor can already prescribe hemostatic drugs orally or intramuscularly (etamsylate or dicynon), as well as calcium, iodine and trophic-improving drugs (emoxipin injection intramuscularly or parabulbarno - under the eye).

In more severe cases, strict bed rest is required. In case of any damage to the integrity of tissues, the introduction of tetanus toxoid and / or toxoid is mandatory.

Eyelid wounds are subject to surgical treatment with suturing, and if the lacrimal canaliculus is damaged, a Polak probe is inserted into it.

Foreign bodies of the cornea if they are located superficially, they are to be removed in the conditions of the emergency room, followed by the appointment of antibacterial drops and ointments. At the same time, after local anesthesia, the foreign body and scale around it are removed using an injection needle.

At contusion of the eyeball Treatment can be conservative and operative. Mandatory is bed rest and cold on the area of ​​injury. The following groups of drugs are prescribed: hemostatic (stop bleeding), antibacterial (topical and general action), diuretics (reduce tissue swelling), anti-inflammatory (nonsteroidal and hormonal), physiotherapy (UHF, magnetotherapy). Surgical treatment is subject to ruptures of the sclera and retina, secondary glaucoma, traumatic cataract).

At penetrating wounds an approximate treatment plan: drops with antibiotics are instilled (Floxal, Tobrex, etc.), a sterile binocular bandage is applied, transportation is performed in a reclining position, if necessary, anesthetize (local or general), tetanus toxoid or serum is administered, intramuscularly or intravenously - broad-spectrum antibiotics actions (penicillins, cephalosporins, macrolides, etc.). In the hospital, depending on the type and degree of injury, surgical treatment is performed. This may be a revision of the wound and primary surgical treatment, removal of intraocular foreign bodies, prevention of retinal tears in case of their threat (sclerofilling, laser coagulation), removal of foreign bodies, implantation of an intraocular lens in case of traumatic cataract. In severe cases, the issue of enucleation of the eyeball is resolved within 1-2 weeks after the injury.

Prevention of sympathetic ophthalmia provides for the removal of a blind injured eye in the first 2 weeks after injury. Treatment should be carried out under the obligatory supervision of an immunologist. Topically applied instillations of corticosteroids, as well as their subconjunctival administration, mydriatics in the form of drops and injections. Systemically used hormonal drugs, and if they are ineffective - immunosuppressive therapy (mntotrexate, azathioprine). Effective methods of extracorporeal detoxification - plasmapheresis, ultraviolet blood irradiation.

Treatment of endophthalmitis involves the introduction of high doses of antibiotics parenterally and locally, as well as vitrectomy with the introduction of antibacterial drugs into the vitreous body. With the ineffectiveness of treatment or the development of atrophy of the eyeball, enucleation is performed. With panophthalmitis - evisceration.

For all burns 2-4 degrees tetanus prophylaxis is mandatory. Stage 1 is subject to outpatient treatment. Antibacterial drops and ointments are prescribed (Tobrex, Floksal, Oftakviks). The rest of the burns are being treated in the hospital. Appoint conservative treatment; from stage 3 also surgical. It is possible to use therapeutic contact lenses.

Medical therapy:

Mydriatics locally - instill 1 drop 3 times a day (Mezaton, Midriacil, Tropicamide) or subconjunctivally - antibiotics locally in the form of drops and parabulbar injections (first every hour, then reduce the frequency of instillation to 3 times a day - Tobrex, Floksal, Oftakviks; parabulbarno gentamicin, cefazolin) or ointments (Floxal, erythromycin, tetracycline), as well as for systemic use - locally and systemically non-steroidal anti-inflammatory drugs (Indocollir, Naklof, Diklof drops 3-4 times a day) or hormonal (Oftan-dexamethasone drops, parabulbarnodexone) - inhibitors of proteolytic enzymes - contrykal, gordox - detoxification therapy (intravenous drip solutions - Hemodez, reopoliglyukin 200.0-400.0 ml) - diuretics (diacarb, lasix) - desensitizing drugs (diphenhydramine, suprastin) - vasodilators (no-shpa , papaverine, cavinton, nicotinic acid) - vitamin therapy (especially group B)

Surgical treatment: layer-by-layer or penetrating keratoplasty, for conjunctival burns - mucosal transplantation from the oral cavity, for stage 4 burns, oral mucosal transplantation is performed on the entire anterior surface of the eye and blepharorrhaphy (sewing of the eyelids).

Complications of eye injuries

With untimely wound treatment and inadequate conservative therapy, complications may occur, such as endophthalmitis, panophthalmitis, sympathetic inflammation, persistent decrease in visual acuity, loss of an eye, brain abscesses, sepsis, etc. Many conditions threaten the patient's life, so even the slightest injury requires examination by an ophthalmologist in a hospital setting.

Ophthalmologist Letyuk T.Z

Eye diseases- organic and functional lesions of the visual analyzer of a person, limiting his ability to see, as well as lesions of the adnexal apparatus of the eye.

Diseases of the visual analyzer are extensive and it is customary to group them into several sections.

Diseases of the eyelids

Cryptophthalmos - total loss eyelid differentiation.

Coloboma of the eyelid is a full-thickness sementary defect of the eyelid.

Ankyloblepharon - partial or complete fusion of the edges of the eyelids.

Upper eyelid ptosis is an abnormally low position of the upper eyelid.

Hunn's syndrome is an involuntary lifting of the upper eyelid.

Inversion of the eyelid - the edge of the eyelid is turned towards the eyeball.

Blepharitis is inflammation of the edges of the eyelids.

Trichiasis is an abnormal growth of eyelashes with irritation of the eyeball.

Eyelid edema is an abnormal amount of fluid in the tissues of the eyelids.

Preseptal cellulitis - diffuse swelling of the eyelids.

Eyelid abscess - purulent inflammation of the eyelids.

Barley - inflammation of the meibomian glands of the edge of the eyelid.

Lagophthalmos - incomplete closure of the palpebral fissure.

Blepharospasm is an involuntary contraction of the muscles of the eyelid.

Diseases of the lacrimal organs

Malformations of the tear-producing apparatus

Neoplasms of the lacrimal glands

Pathology of the lacrimal apparatus

Diseases of the conjunctiva

Conjunctivitis - inflammation of the conjunctiva

Trachoma - a type of chlamydial conjunctivitis

Dry eye syndrome - lack of hydration of the conjunctiva

Pinguecula - dystrophic formation of the conjunctiva

Pterygium - fold of the conjunctiva

Diseases of the sclera

Episcleritis - inflammation of the superficial layer of the sclera

Scleritis - inflammation of the deep layers of the sclera

Sclerokeratitis - inflammation of the sclera extending to the cornea

Corneal diseases

Anomalies in the development of the sclera

Keratitis - inflammation of the cornea

Keratoconus

Corneal dystrophy

Megalocornea

Diseases of the lens

Anomalies in the development of the lens

Cataract - clouding of the lens

Aphakia is the absence of the lens.

Vitreous diseases

Opacification of the vitreous body Myodesopsia

Vitreous detachment

Iris disease

Polycoria - multiple pupils in the iris

Aniridia - absence of the iris

Iridocyclitis - inflammation of the iris and ciliary body

Retinal diseases

Retinitis - damage to the epithelial layer of the retina

retinal dystrophy

Retinal detachment

retinopathy

Retinal angiopathy

Diseases of the optic nerve

Neuritis - inflammation of the optic nerve

Toxic lesions of the optic nerve

neuropathy

optic nerve atrophy

Disturbances in the circulation of aqueous humor

Glaucoma

Diseases of the oculomotor apparatus

Ophthalmoplegia

Strabismus

Diseases of the orbit

exophthalmos

Refractive errors (ametropia)

Myopia

farsightedness

Astigmatism

Anisometropia

Strabismus(strabismus or heterotropia) - any abnormal violation of the parallelism of the visual axes of both eyes. The position of the eyes, characterized by non-crossing of the visual axes of both eyes on a fixed object. An objective symptom is the asymmetrical position of the corneas in relation to the corners and edges of the eyelids.

[Edit] Types of strabismus

Distinguish congenital (present at birth or appears in the first 6 months) and acquired strabismus (appears before 3 years).

Most often, obvious strabismus is horizontal: convergent strabismus (or esotropia (esotropia)) or divergent strabismus (or exotropia (exotropia)); however, sometimes a vertical one can also be observed (with a deviation upwards - hypertropia, downwards - hypotropia).

Also, strabismus is divided into monocular and alternating.

With monocular strabismus, only one eye is always mowed, which a person never uses. Therefore, the vision of the squinting eye is most often sharply reduced. The brain adapts in such a way that information is read only from one, unsquinting eye. The squinting eye does not participate in the visual act, therefore, its visual functions continue to decline even more. This condition is called amblyopia, that is, low vision from functional inactivity. If it is impossible to restore the vision of the squinting eye, the strabismus is corrected to remove the cosmetic defect.

Alternating strabismus is characterized by the fact that a person looks alternately with one or the other eye, that is, although alternately, he uses both eyes. Amblyopia, if it develops, is much milder.

Due to the occurrence of strabismus is friendly and paralytic.

Concomitant strabismus usually occurs in childhood. It is characterized by the preservation of the full range of movements of the eyeballs, the equality of the primary angle of strabismus (that is, the deviation of the squinting eye) and the secondary (that is, healthy), the absence of doubling and impaired binocular vision.

Paralytic strabismus is caused by paralysis or damage to one or more oculomotor muscles. It can occur as a result of pathological processes that affect the muscles themselves, nerves or the brain.

Characteristic of paralytic strabismus is the limitation of the mobility of the squinting eye in the direction of the action of the affected muscle. As a result of images hitting the disparate points of the retinas of both eyes, diplopia appears, which increases when looking in the same direction.

The causes of strabismus are very diverse. They can be either congenital or acquired:

The presence of ametropia (farsightedness, myopia, astigmatism) of medium and high degrees; -trauma; - paralysis and cuts; - anomalies in the development and attachment of the oculomotor muscles; - diseases of the central nervous system; -stress; - infectious diseases (measles, scarlet fever, diphtheria, influenza, etc.); - somatic diseases; - mental trauma (fright); - a sharp decrease in visual acuity of one eye

[Edit] Symptoms

One or both eyes may deviate to the side, more often towards the nose, or as if "floating". This phenomenon is common in infants, but by 6 months it should disappear. It happens that parents take for strabismus a peculiar location and shape of the eyes (for example, in children with a wide nose bridge). Over time, the shape of the nose changes, and the imaginary strabismus disappears.

Refer to serious violations health. They are accompanied by infection, a violation of the physiological structure of the orbit and the eye itself, in difficult cases, loss of the internal components of the visual analyzer can be observed.

In case of a penetrating wound in the eye area, the victim should be urgently delivered to medical institution. Such injuries are urgent conditions that require urgent intervention! If help is not provided, visual impairment of varying severity develops, up to complete blindness.

Penetrating wounds of the eyeball are both domestic and industrial

Penetrating trauma to visual analysis can occur for a variety of reasons. This is a fall on a sharp object, a blow to the head in the eye socket area, glass hit and exposure to piercing or cutting objects.

A separate line in the classification of causes is occupied by gunshot wounds. In terms of prevalence, sports injuries occupy the first place. In second place are household items.

The severity of the pathology depends on the shape and density of the injuring object, its linear dimensions, and the speed with which the injury was inflicted. The classification of eye injuries is extensive:

• According to the degree of penetration of a foreign body into the physiological structures of the organ:

1. penetrating - the outer shells are damaged, the foreign object plunged to different depths, but at the same time did not go beyond the body of the eye;
2. through - a sharp object pierced the shell of the visual analyzer in at least 2 places. The entrance and exit openings in the sclera are determined;
3. destruction - violation of the integrity with the destruction of the membranes and internal structures of the body. Restoration of visual functions is impossible.

• According to the size of the wound surface are distinguished:

1. small - no more than 3 mm in length;
2. medium - no more than 5 mm;
3. heavy - from 0.5 cm and more.

• In shape - elongated, stellate, with tissue pathology, chipped and torn. In addition, adapted or wounds with closed edges and gaping open areas are distinguished.
• Depending on location:

1. corneal - the wound site is located only on the tissues;
2. scleral - only the white shell of the eye is injured;
3. mixed - both the cornea and the sclera are affected.

Signs of pathology

When examining a patient, the doctor should carefully study the history of the victim, since a deliberate distortion of information by the patient is possible. Diagnostic measures consist in a visual examination and identification of characteristic symptoms of pathology.

Absolute signs of damage to the eye analyzer:

• visually defined penetrating wound in the body of the eye;
• the presence of air bubbles and foreign objects in the structures of the eye;
• falling into a wound internal organs eyeball;
• visually and instrumentally, the wound channel passing through the structures of the eye is determined;
• leakage of intraocular fluid through perforation in the sclera or.

If at least 1 of the absolute symptoms is observed, then the diagnosis of "penetrating injury" is confirmed. Indirect symptomatology, indicating a pathology in the visual analyzer system:

1. point hemorrhage in various structures of the eye;
2. low total and intraocular pressure;
3. change in the shape of the pupil, iris;
4. displacement, dislocation.

If a penetrating wound is suspected, the appointment of an x-ray examination, ultrasound, tomography is indicated. This will determine the severity of the pathological process, visualize the presence of foreign bodies in the wound, determine their size and number.

First aid

If the visual analyzer system is damaged, the victim should be urgently taken to the hospital. Methods of first aid for eye injuries are standard. The necessary measures should and can be provided by a doctor of any specialty.

First aid technique:

• Apply a sterile bandage to the damaged organ. It should not put pressure on the eye. If assistance is provided medical worker, then a single administration of a broad-spectrum antibiotic is indicated.
• Take the victim to a medical facility. The patient during transportation should be in the supine position.
• Do not try to remove the foreign body yourself. This is fraught with an increase in the wound surface and additional trauma to the organ.
• In the emergency room, the victim is given antitetanus drugs.

Corneal injuries: treatment tactics

This type of injury is characterized by damage to the cornea. When this occurs, the outflow of intraocular moisture, drying of the chambers of the eye. Often, such injuries are accompanied by damage to the lens, detachment of the cornea.

Treatment is carried out exclusively by surgery. If the cornea, the lens falls out, they should be put back in place. The goal of therapy is to restore the integrity of the eyeball. The sutures are removed no earlier than 6 weeks after the intervention.

In extreme cases, when the iris is crushed, it is exchanged. If the lens is damaged, an implant is also recommended.

Scleral injury

Injuries to the white membrane of the eye are rarely independent. They are accompanied by prolapse and damage to the internal structures of the eyeball.

Treatment is exclusively surgical. In case of scleral injuries, all manipulations, starting from the initial examination, are carried out under general anesthesia.

The goals of therapy are the examination and evaluation of the wound and the wound channel, the revision of internal structures and their installation in a physiological place, the extraction of foreign bodies, and the restoration of the integrity of the sclera.

After the initial examination, the doctor decides on the extent of the surgical intervention. All manipulations are carried out through the inlet in. Severe injuries may require additional incisions.

After restoring the integrity of the membranes, the appointment of general and local antibiotic therapy is indicated in order to prevent the development of purulent processes in the wound.

Injuries with the introduction of foreign objects

If foreign bodies are suspected of entering the internal structures of the eye, a thorough diagnosis of the pathology should be carried out. hallmark such wounds is the presence of a gaping hole in the outer shells of the eyeball.

Foreign objects provoke the development of purulent processes, the appearance of infiltrates, clouding of the cornea. The complexity of the situation lies in the fact that with significant damage to the eye it is quite difficult to visualize a foreign body.

If the object has large linear dimensions, then complications such as prolapse of the internal structures of the eye are possible. Mandatory procedures for diagnosing an injury:

• biomicroscopy - examination of the structures of the eye using a slit lamp;
• – examination of the fundus with the help of an ophthalmoscope;
• x-ray studies if it is impossible to detect a foreign object by the first two methods;
• Ultrasound - to determine the location of a foreign object, to identify other pathological processes in the internal structures of the eye that develop when a foreign body enters;
• CT - multiple high-precision images to determine further tactics for managing the patient.

Treatment is carried out surgically. The foreign body is removed using needles, spears with magnetic tips. Surgical intervention is performed either through a wound or through an additional incision in the sclera at the location of the foreign object.

If the lens is damaged or a foreign body has penetrated the biological lens, then the removal of the lens and its replacement with an artificial one is indicated. After the intervention, massive antibiotic therapy is indicated to prevent the development of purulent processes.

gunshot wounds

Such injuries are considered extremely severe diagnoses. Gunshot wounds can be obtained not only during military operations, but also in peacetime.

A feature of such injuries is massive damage to the eyeball, bone structures of the orbit, the introduction of foreign objects into the internal structures and adjacent areas of the skull, infection of the wound surface.

The classification of gunshot wounds is extensive and covers all possible injuries of the eye analyzer. But initially, all damage of this type is divided into 2 groups:

• isolated - such injuries are rare, the outcome depends on the degree of damage, but generally favorable;
• combined - more than 80% of gunshot wounds of the eye - in addition to damage to the eye analyzer, injuries of bone structures are observed, maxillary sinuses, eye sockets.

The outcome depends on the degree of damage to the eyeball and nerve nodes, the depth of the wound channel, concomitant damage to the brain and bones of the skeleton, the size and number of foreign bodies. The prognosis is unfavorable.

Diagnosis of gunshot wounds is carried out under general anesthesia. The doctor examines the damage, shows the methods of diagnostic imaging - X-ray, tomography. After that, probing of the wound channel is carried out. Additionally, consultations of a neurologist, otolaryngologist and dentist are shown.

Treatment of pathology is exclusively surgical. The intervention is carried out in a complex on all damaged areas of the head. The technique of surgical intervention for gunshot wounds:

• Initially, the eyeball is treated, fragments of foreign bodies, bone fragments are removed.
• In the second stage of the operation, surgeons work on injuries to the head, maxillary sinuses, jaw bones and articular surfaces.
• At the last stage, the doctor eliminates the defects of the eyelid and orbit.
• Seams are applied. If the wound is isolated and without additional destruction of bone structures, then permanent sutures are applied. If the wound is extensive and there is a possibility of developing purulent process then temporary sutures are used.
• After 4 days, the wound is revised, and permanent sutures are applied.
• If any complications have developed, then this procedure is carried out after the inflammatory process subsides. Sometimes after 2-3 weeks.

Penetrating wounds of the eye analyzer are classified as severe pathologies. Self-treatment is inappropriate and can end sadly!

What to do in case of an eye injury, you will learn from the video consultation: