Eye piercing injury

Introduction to eye piercing injury A sharp object or a foreign object perforates the wall of the eyeball, which is called an eyeball perforation injury. According to the different parts of the perforation, it can be divided into corneal perforation injury, scleral perforation injury and corneoscleral perforation injury across the limbus. Corneal perforation is the most common clinically due to corneal exposure. Eye perforation injuries can be divided into two categories: one is simple perforation, the wound is less than 3 mm, and there is no incarcerated tissue in the wound; the other type is wound larger than 3 mm, and the intraocular tissue is incarcerated in the wound. Eyeball perforation is the most common hit by the metal splashing debris. Most of the injured are young and middle-aged workers; knives, needles, and thorns often occur in eyeballs, which are more common in children and life events. In the war or during training, you may be injured by the broken shrapnel. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: iridocyclitis cellulitis orbital cellulitis purulent meningitis intraocular foreign body sympathetic ophthalmia

Cause of eyeball perforation

Eyeball perforation is the most common hit by the metal splashing debris. The injured are mostly young and middle-aged workers. Knives, needles, and stab wounds often occur. They are more common in children and life events, during wartime or training. Can be injured by the broken shrapnel.

Eyeball perforation prevention

The disease is important in prevention, and the wound is properly treated when injured. Early application of corticosteroids plays a role in reducing the incidence. Once sympathetic ophthalmia occurs, do not rashly remove the injured eye, especially those with residual vision in the injured eye. Topical application of a large number of corticosteroids, if necessary, combined with immunosuppressive agents, supplemented by energy mixture, etc., treatment must be thorough to prevent recurrence.

Eyeball perforation injury Complications, iridocyclitis, cellulitis, orbital cellulitis, purulent meningitis, intraocular foreign body, sympathetic ophthalmia

1. Traumatic iridocyclitis: due to direct damage to the iris or infiltration of the iris tissue in the wound, or the appearance of inflammatory manifestations in the eye, the treatment should be dilated, localized with corticosterone, Dexamethasone is usually injected under the conjunctiva.

2. Suppurative eye content inflammation: often due to perforation injury, infected bacteria from the wound or caused by injury or foreign matter into the eye, vision can be rapidly reduced, eye pain, tearing, examination can be seen conjunctival congestion, edema, corneal edema It is foggy and turbid, the aqueous humor is highly turbid, and even there may be empyema. In severe cases, yellow reflection in the pupil area (indicating pus in the vitreous body) can be seen. In addition to systemic and local application of a large number of antibiotics, vitrectomy should be performed early. Injecting antibiotics directly into the vitreous cavity, the prognosis of this disease is poor, often leading to total ocular inflammation or eyeball atrophy.

3. Total ocular inflammation: On the basis of endophthalmitis, inflammation develops further and affects the wall of the eye and its surrounding tissues. It is called full ocular inflammation. In addition to the performance of endophthalmitis, it is accompanied by eyeball protrusion and high edema of the conjunctiva. , congestion, eye movement restricted, visual acuity completely disappeared, even corneal abscess perforation, intraocular pus out, if not treated in time, often converted into orbital cellulitis, and spread to the brain, causing purulent meningitis, life-threatening In the treatment, eyeball content should be performed. If eyeball removal is selected, the infection may be brought into the skull. Drainage strips should be placed in the wound after surgery, and local and systemic antibiotics should be applied.

4. Foreign bodies in the eye: foreign objects are divided into two categories, one is magnetic foreign matter, one is non-magnetic foreign matter, foreign matter can be located in any part of the eye, foreign matter can also be large or small, the magnetic foreign body in the eye needs to be carefully positioned and the nearest from the foreign body. The incision is taken out at the wall of the ball. For non-magnetic foreign objects, if the chemical property is stable and the foreign matter is located at the back of the eyeball, it is not necessary to remove it.

5. Sympathetic ophthalmia: When the perforated eye is especially combined with intraocular foreign body injury, persistent uveitis occurs after the injury. After a period of time, the same nature of uveitis occurs in the contralateral healthy eye. Sympathetic ophthalmia, the injured eye is called "inducing eye", the uninjured eye is called "sympathetic eye", the incubation period is mostly 2 to 8 weeks after injury, and there are very few cases as short as several days or as long as several decades. The incidence of sympathetic ophthalmia accounts for about 1.2% of eye perforation injuries in China. It is related to the location of perforation injury and the presence or absence of pigmentation incarceration. It is generally considered that the incidence of damaged ciliary body is high and there is pigmented membrane tissue. The incidence of incarceration is high, and repeated intraocular surgery in the short term after injury can also lead to the onset of the disease. This disease is also occasionally seen in some intraocular surgery, corneal ulcer perforation or intraocular melanoma, etc. Sexual autoimmune disease.

Eyeball perforation injury Symptoms Common symptoms Visual impairment Eyeball perforation Eyes open Eyelid foreign body Pupil deformation Iris root disconnection

Usually, the perforation site is divided into three types: corneal perforation injury, corneoscleral perforation injury and scleral perforation injury. Each type can be caused by the size, shape and nature of the wound, and the depth and location of the eyeball. Tissue damage.

Sharp or foreign body perforation of the wall of the eyeball, known as perforation of the eyeball, according to the location of the perforation, can be divided into corneal perforation injury, scleral perforation injury and corneoscleral perforation across the limbus, due to corneal exposure, clinical Upper corneal perforation is the most common. Eye perforation can be divided into two categories: one is simple perforation, the wound is less than 3mm, and there is no intraocular tissue incarceration in the wound; the other is wound is larger than 3mm, and there is intraocular tissue incarceration in the wound. .

1. Corneal perforation injury, common, the wound is located in the cornea, leaving the corneal leukoplakia after the injury. When the wound is small, it often closes itself. The examination only sees punctate turbidity or white streaks. The large wound is often accompanied by iris prolapse and incarceration. There are obvious eye pains, tears and other irritations, causing the wounds to penetrate deeper, causing perforation or rupture of the lens capsule, limited crystal turbidity, and even crystal rupture, and the crystal material is invaded into the wound or prolapsed.

2. Angle scleral perforation, the wound involving the cornea and sclera, can cause iris ciliary body, crystal and, prolapse and intraocular hemorrhage, accompanied by obvious eye pain and irritation.

3. Scleral perforation, less common, smaller scleral wounds are easy to ignore, perforation may only see subconjunctival hemorrhage, large wounds often accompanied by choroid, vitreous and retinal damage and vitreous hemorrhage, damage to the macula will cause a permanent center .

Examination of eyeball perforation

1. Vision: Due to the different perforation sites, the degree of vision loss is also different, such as simple perforation in the peripheral part of the cornea, the wound is small, and the visual acuity can be unaffected.

2. Anterior chamber: If the perforation is in the cornea or cornea, the aqueous humor is constantly overflowing, the front is shallow, and the wound is larger. The iris tissue can be pulled out and invaded in the wound, and the pupil is deformed; for example, the perforation is in the sclera, and the eye content is The wound is prolapsed, and the depth of the anterior chamber can be unchanged or deepened.

3. Intraocular pressure: due to the perforation of the eye wall, the aqueous humor overflows, the eye content is prolapsed, and the intraocular pressure is significantly reduced. Care should be taken when checking the intraocular pressure to avoid aggravation of the eye contents.

Diagnosis and differentiation of eyeball perforation injury

Careful examination of the injury mechanism, careful eye examination, it is not difficult to make a diagnosis.

Need to identify with other mechanical eye injuries such as eye foreign body injury and non-mechanical ocular trauma.

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