Eyeball contusion

Introduction Eyeball contusion refers to the impact of boxing, ball and other external forces on the eyeball, but no eyeball rupture. Eyeball blunt trauma is an organic lesion that directly injures the eye, causing organic lesions and dysfunction of the eye tissue, but does not cause the eye wall to break. In addition to direct damage to the striking site, blunt force can also cause indirect damage through the transmission in the eye and the ball wall. Eye contusion is a common condition of ocular trauma, and its prevalence rate accounts for about 1/3 of ocular trauma.

Cause

According to the location of the contusion, it is divided into anterior segment contusion, posterior segment contusion and eyeball rupture. Contusion in the anterior segment of the eye includes corneal contusion, iris contusion, ciliary body contusion, anterior chamber hemorrhage, retrograde corner, lens contusion, and traumatic low intraocular pressure. Posterior contusion includes vitreous hemorrhage, choroidal contusion, retinal contusion, and optic nerve contusion.

Anterior segmental contusion:

1. Corneal contusion: when blunt force acts on the cornea, it can scratch the surface layer of the cornea; it can also cause the cornea to collapse rapidly, causing the corneal endothelium and the posterior elastic layer to rupture, which in turn causes edema of the corneal stroma; in severe cases, corneal rupture can occur. . Severe corneal contusion often combined with other tissue damage in the eye, such as iris contusion, lens contusion, and even macular degeneration. Among them, corneal abrasion is one of the most common eye injuries.

2. Iris contusion: Indirect or direct damage to the iris caused by eyeball contusion. Including pupillary margin and pupil sphincter paralysis, rupture, tearing, pupil deformation, part or all of the iris root disconnection.

3, ciliary body contusion: the eyeball contusion caused by the separation between the ciliary body and the scleral process to become ciliary body separation; separation between the ciliary body and the sclera, known as ciliary body detachment. The ring fibers of the ciliary muscle are separated or torn from the longitudinal fibers, which are called ciliary body lacerations. In the early stage of the injury, there is a combination of iridocyclitis, called traumatic iridocyclitis.

4, anterior chamber hemorrhage: eyeball contusion can be directly or indirectly stimulated by the iris ciliary body, pulling caused by rupture of the iris ciliary body blood vessels or vascular permeability disorders, resulting in anterior chamber hemorrhage. Can be divided into primary hemorrhage or secondary hemorrhage, the former refers to the bleeding immediately after the injury, the latter refers to the bleeding occurred 2 to 5 days after the injury. It can cause elevated intraocular pressure (hemolytic glaucoma, blood cell glaucoma), corneal blood staining, anterior and posterior adhesion formation, cataract and related pathological changes.

5, the corner of the room retreat: the contusion affects the front of the ciliary body caused by the separation of the ring fibers of the ciliary muscle and the longitudinal fibers, the iris roots are displaced backwards, the anterior chamber angle is widened and deepened. Can be followed by glaucoma.

6, traumatic low intraocular pressure: mainly due to ciliary body damage or ciliary body separation caused by low intraocular pressure.

7, lens contusion: lens contusion can cause changes in lens position and transparency. Transparency changes lead to traumatic cataract, partial ligament rupture can lead to subluxation of the lens, the lens shifts to the opposite direction of the fracture; complete rupture of the suspensory ligament can lead to complete dislocation of the lens, forward into the anterior chamber, and then into the vitreous cavity.

Contusion in the posterior segment of the eye:

1. Vitreous blood: Contusion causes blood clots in the ciliary body, retina or choroid to cause bleeding and flow into the vitreous. Contusive vitreous hemorrhage is prone to degeneration of vitreous, fibrosis, tissue adhesion, and formation of traction retinal detachment.

2, choroidal contusion: the external force directly injured the eye wall or indirectly from the vitreous conduction to the choroid, causing the damaged blood vessels to rupture. Most of the lacerations are located in the posterior pole and around the optic disc. There are many hemorrhages, and tissue proliferation and choroidal neovascularization can occur.

3, retinal contusion: 1 retinal edema caused by mild contusion called retinal concussion, mostly located in the macula; retinal contusion is severe contusive retinal edema, retinal production of organic changes, can cause permanent damage to the function. 2 retinal tears and retinal detachment: retinal tears caused by blunt contusion are more complex, the number of holes can be single or multiple, the location has serrated edge, large retinal tears, equator horseshoe-shaped holes, etc., statistics show sawtooth edge and It is more common in the upper part of the nose and the lower quadrant. Retinal detachment can occur after a retinal tear. 3 traumatic macular hole. 4 retinal bleeding.

4, optic nerve contusion: for the blunt blow or squeeze of external force, especially from the blunt or crush injury above the eyebrow arch, resulting in distortion or deformation of the optic canal, resulting in optic nerve compression.

Eyeball rupture:

Severe blunt trauma can cause the eyeball to rupture, the common site is at the limbus. A small number of patients can occur under the subconjunctiva, under the rectus muscle or the posterior sclera, which is difficult to detect and is called occult scleral rupture.

an examination

Related inspection

Eye and sacral area CT examination of the eyeball and eyelid ultrasound examination fundus contact lens

Examination and diagnosis of eyeball contusion:

Light eyelid edema, subconjunctival hemorrhage, severe anterior chamber hemorrhage, pupil dilation, iris root fracture, pupil deformation. More severe can cause crystal dislocation, vitreous hemorrhage, choroidal tear in the fundus, retinal edema, optic nerve contusion, blurred vision or blindness.

The medical history is the key to diagnosis and treatment. It is in turn to understand the time of injury, the environment (to judge the cleanliness of the wound), the injured object (nature, size, shape, number, direction of action, distance and strength), and post-injury treatment. Situation (including tetanus antitoxin and antibiotic use). Then the patient is examined for purpose: if the patient can cooperate, the patient's binocular vision, visual field and pupil's light reflection should be checked; the slit lamp should be used to observe the anterior segment of the eye; if the intraocular pressure is low, the eyeball should be arrested for rupture. If necessary, apply eye mask protection. Do not force the eyelids apart to avoid further damage. For detailed examination of the fundus, you can use FFA or indocyanine green angiography, OCT, UBM, eye B ultrasound, X-ray, CT and other related auxiliary examinations. The diagnosis can be confirmed based on the collected medical history, symptoms, signs and auxiliary examination results.

Differential diagnosis

Symptoms of eyeball contusion confusing:

Spontaneous intrabulbar hemorrhage: a common malignant tumor in the uvea, usually seen in 40 to 60 years old, regardless of gender or left and right eyes, can occur in any part of the choroid, but is common in the posterior pole of the eye, sometimes spontaneous Intra-ballial hemorrhage, but the overall incidence of disease is one in two to two.

Eye movement: Mostly due to congenital hypoplasia, trauma or disease, resulting in abnormal anatomical position of both eyes. Ocular symptoms of sinus cysts: diagnosis of clinical manifestations such as eye pain, diplopia, tearing, and eyeball shift.

Eyeball retraction: The retreat of the eyeball position is called the eyeball invagination. It is the opposite of the eyeball, which is less common than the eyeball. Eyeball invagination refers to the eyeball invagination caused by reasons other than the eyeball. It must be differentiated from the eyeballs that reduce the lesions (small eyeballs, eyeball atrophy, eyeball spasm) and the collapse of the eyeball position caused by the reduction of the cleft palate. Open.

Light eyelid edema, subconjunctival hemorrhage, severe anterior chamber hemorrhage, pupil dilation, iris root fracture, pupil deformation. More severe can cause crystal dislocation, vitreous hemorrhage, choroidal tear in the fundus, retinal edema, optic nerve contusion, blurred vision or blindness.

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