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Types of strabismus. Non-penetrating wounds of the cornea and sclera Wounds of the eyeball

Based on the nature of the wound, non-penetrating and penetrating eye wounds are distinguished. Each type has its own clinical picture, size of damage and treatment tactics.

Non-penetrating wounds

This is damage to part of the cornea or sclera. They are not dangerous and do not affect the functioning of the eye. They account for 75% of all eye injuries.

More often they occur in everyday life (accidental scratches, injections) and in nature (a sudden blow to the eyes from a branch of a bush, tree, reeds, sedge). Superficial damage to the epithelium is often observed, and traumatic keratitis may develop.

Superficial eye injuries are caused by foreign bodies such as sand, stones, scale, rust, thorns and debris. Sometimes foreign bodies do not penetrate the eye capsule, remaining inside the cornea, conjunctiva or sclera. It is important to see an ophthalmologist immediately after any eye injury.

It is important for the doctor to know the depth of the foreign body. A binocular magnifying glass, a side illumination source and biomicroscopy are used for the study.

When foreign bodies enter the superficial layers of the eye, increased lacrimation and photophobia occur.

Further treatment of non-penetrating eye wounds

Any foreign body must be removed from the eye, eliminating the risks of purulent corneal ulcer, purulent keratitis and other complications.

Foreign bodies are removed in an ophthalmology clinic on an outpatient basis. In simple situations, they are removed with a swab by dropping a 0.5% alcaine solution into the affected eye.

More dangerous are wounding bodies that penetrate the middle layers of the cornea. They are removed with a special spear, a grooved chisel or the tip of an injection needle.

Foreign bodies that have entered the deepest layers of the eye are removed by a surgeon under the control of an operating microscope. Metal foreign bodies are removed from the cornea using a magnet.

After removal, the patient is prescribed sulfa drugs, ointments, methylene blue with quinine and Corneregel.

Penetrating eye injuries

Penetrating eye injuries, due to their diversity, are classified into three groups of injuries with different etiologies. Approximately 40-80% of patients treated in hospital for eye injuries have penetrating eye injuries. With such injuries, the wounding body often cuts through the entire thickness of the cornea and sclera.

Unlike the relatively harmless non-penetrating injuries described above, such eye damage can significantly impair visual function, cause complete blindness and affect the functioning of the second healthy eye.

Classification of penetrating eye injuries

Currently, penetrating wounds of the eyeball are divided into

  1. By depth of damage:
    • Penetrating wounds, when the wound passes through the cornea or sclera, irradiates into the eye cavity to varying depths, but remains within its limits.
    • Penetrating wounds, when the wound extends beyond its boundaries and has an entrance and exit opening.
    • Destruction of the eyeball with permanent loss of vision.
  2. By location:
    • limbal;
    • corneal;
    • corneal-scleral;
    • scleral wounds.
  3. By wound size:
    • small (less than 3 mm);
    • medium (4-6 mm);
    • and large (more than 6 mm).
  4. By form:
    • linear wounds;
    • irregular shape;
    • chopped;
    • torn;
    • star shape;
    • with a fabric defect.

It is also necessary to distinguish between gaping and adapted wounds (with edges adjacent to each other).

There are many types eye injuries. They can be household, industrial, criminal, agricultural, children's, military. They can also be due to chemical or thermal burns. Injuries can vary in severity, external and penetrating. But in fact, with any eye injury, there is a deterioration in visual function.

The most common are work-related eye injuries. They account for more than 70% of all traumatic injuries to the eyeball. Most often they are received by workers involved in metal processing.

Statistics show that men (90%) are more susceptible to eye injuries than women (10%). In 22% of all cases, eye damage occurs in children and adolescents under the age of sixteen. Typically, childhood injuries occur as a result of careless handling of sharp and piercing objects.

Any damage to the organ of vision, even those that at first glance seem completely harmless and do not require medical attention, can lead to serious consequences, including complete loss of visual function and disability. In case of eye injuries, until they are completely healed, ophthalmologists recommend using glasses to correct vision, since contact lenses themselves are a foreign body and can cause additional trauma to the eye tissue.

Depending on the degree of loss of visual function, three degrees of severity of eye injuries are distinguished:

  • In mild cases, visual acuity usually does not suffer;
  • With moderate injuries, temporary visual impairment is observed;
  • Severe injuries are usually accompanied by a significant and persistent decrease in visual acuity.

In especially severe cases, the development of complete blindness is possible.

Penetrating eye injuries

Penetrating wounds of the eye, there is a violation of the integrity of its membranes. They can be torn, cut or chipped. In this case, ptosis, exophthalmos, and ophthalmoplegia develop. Such complications indicate deep wounds with damage to the deep structures of the eye and blood vessels, and damage to the optic nerve is possible.

Due to foreign bodies entering the eye, purulent complications may develop. The greatest danger in this regard is posed by organic substances or those containing any toxic components. If a penetrating wound occurs in the limbal region, then, depending on the depth and size of the wound, a serious complication such as vitreous prolapse may develop.

When the lens or iris of the eye is injured, as well as when the lens bag ruptures, rapid clouding of the lens occurs and all its fibers swell. In such cases, post-traumatic cataracts form within a week. Metal fragments that get into the eye stain its tissues in unique colors. Around the foreign body (if it consists of iron), the rim of the sclera around the cornea turns rusty-brown; in the presence of copper, yellow or green.

First aid for penetrating eye injuries

Treatment should be carried out by an ophthalmologist. First aid includes the removal of superficial foreign bodies. To do this, the victim should rinse his eyes with clean boiled water. After this, the eye is covered with a bandage and the patient is taken to the hospital. Upon admission to the hospital, the patient is examined, aimed at identifying foreign bodies and determining their exact location. After surgical treatment and removal of the foreign body, anti-inflammatory and antibacterial therapy is necessary. The administration of antitetanus serum is mandatory.

Complications of penetrating eye injuries

When injured in the limbus, purulent or serous iridocyclitis usually occurs, with the formation of pus in the inner membranes of the eye and the vitreous body. Painful sensations occur, vision decreases, the pupil becomes narrow and the accumulation of purulent contents in the anterior chamber is clearly visible. One of the complications of eye injuries is traumatic cataract. It is formed when the limbus or area of ​​the cornea is injured; the lens may not become cloudy immediately, but some time after the injury.

The most severe complication is sympathetic inflammation, which threatens the loss of a healthy eye. Sympathetic inflammation is manifested by photophobia. Then, due to fibrin effusion, the iris adheres to the lens, which leads to complete occlusion of the pupil. Against this background, secondary glaucoma develops, from which the eye completely dies. To prevent the development of glaucoma in a healthy eye, doctors are forced to resort to removing the injured one.

From the long-term presence of metal foreign bodies in the tissues of the eye, diseases such as siderosis and chalcosis can develop, from which the boundaries of the visual field narrow, pigments form on the retina, secondary glaucoma, retinal detachment and complete atrophy of the eye can develop.
For any type of penetrating injury, the patient must seek help and treatment in a hospital.

Non-penetrating eye injuries

These injuries are not associated with a violation of the integrity of the cornea or sclera. They usually occur as a result of large particles of sand, small insects, etc. getting into the eyes. In this case, the doctor can easily remove the foreign body under anesthesia. After which, the eye is washed with antiseptic solutions. For several days, the victim should instill antibiotic eye drops into the damaged eye several times a day, and at night put antibacterial ointments, such as tetracycline, behind the eyelid.

Eye burns

The greatest danger to the eyes is burns. As a rule, they lead to significant damage to eye tissue. Their treatment is quite difficult and does not always lead to complete restoration of visual function. About 40% of victims eventually become disabled.

Of all burns, 75% are acid burns. They cause coagulative necrosis. The severity and consequences of such a burn are determined after a couple of days, since the acid does not immediately penetrate into the thickness of the eye tissue.

25% of burns are caused by exposure to alkalis. In this case, tissue protein dissolves. With such injuries, damage to the eye can occur from 5 minutes to several days. The exact severity of the burn can be determined only after 3 days. The greatest danger is a combination of acid, alkaline and thermal burns.

First aid for burns

For a burn, first aid consists of flushing the eyes with plenty of water. If it is established what substance caused the burn, then it is necessary to use a substance that neutralizes its pathogenic effect. Sodium sulfate (20% solution) is usually instilled into the affected eye, antibacterial ointment is applied, or inert vaseline or olive oil is instilled. After providing the necessary first aid, the victim must be taken to the hospital for further examination and treatment.

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

To identify defects in the corneal epithelium, one drop of a 2% fluorescein solution is instilled into the conjunctival sac. Even a minor defect in the corneal epithelium will turn green. Emergency care consists of instilling disinfectant drops and applying ointment (tetracycline ointment 1%, albucid 30%). Erosion heals quickly if not complicated by infection. If it becomes complicated, treatment is the same as for corneal ulcers.

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

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

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

Any deeply located fragment should be removed only in a hospital setting. As an emergency aid, instillation of dicaine, disinfectant drops and application of a bandage. 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 wound. It is very dangerous to push a fragment into the anterior chamber while trying to remove it, which every doctor should remember. If there is a foreign body in the cornea with purulent infiltration around it, after preliminary anesthesia with a 1% dicaine solution, remove the foreign body using the needles indicated earlier. Instill drops of albucide into the eye, apply an ointment of sulfonamides or antibiotics, sulfonamides inside. Next, the patient should be observed and treated by an ophthalmologist.

Non-penetrating injuries to the sclera are always accompanied by simultaneous damage to the conjunctiva. In order to provide emergency assistance, disinfectant drops should be instilled, ointment should be applied, and a light sterile bandage should be applied to the eye. In an eye hospital, the wound is inspected; in the absence of a penetrating wound to the sclera, if the wound is more than 5 mm, nylon sutures are placed on the conjunctiva. If there is a penetrating wound, then treatment proceeds as with any penetrating wounds of the eye.

Non-penetrating wounds of the eyeball are damage to the cornea or sclera, which involves part of their thickness. Such injuries, as a rule, do not cause serious complications and less often affect the functions of the eye. They account for about 70% of all eye injuries.
Superficial damage or microtrauma occurs when the eye is hit by a tree branch, pricked with a sharp object, or scratched. In these cases, superficial erosion of the epithelium is formed, and traumatic keratitis can develop. More often, superficial damage occurs when small foreign bodies (pieces of coal or stone, scale, small metal bodies, particles of animal and plant origin) enter, which, without piercing the eye capsule, remain in the conjunctiva, sclera or cornea. As a rule, their sizes are small, so to identify such bodies, side lighting and a binocular magnifying glass are used, and best of all, biomicroscopy. It is important to find out the depth of the foreign body. If it is localized in the superficial layers, photophobia, lacrimation, and pericorneal injection are noted, which is explained by irritation of the large number of nerve receptors of the trigeminal nerve located here.

Treatment of non-penetrating wounds of the eyeball

All foreign bodies must be removed, since their prolonged presence in the eye, especially on the cornea, can lead to complications such as traumatic keratitis or purulent corneal ulcer. Superficial bodies are removed on an outpatient basis. Often they can be removed with a damp cotton swab after instilling a 0.5% alcaine solution into the eye. However, most often bodies that have entered the superficial or middle layers of the cornea are removed with a special spear, a grooved chisel or the end of an injection needle. At a deeper location, due to the danger of opening the anterior chamber, it is advisable to remove the foreign body surgically, under an operating microscope. The metal body can be removed from the cornea using a magnet; if necessary, the surface layers above it are first cut. After removing the foreign body, disinfectant drops, ointments with antibiotics or sulfonamides, methylene blue with quinine, Korneregel (to improve epithelization of the cornea), and an aseptic bandage are prescribed for 1 day.
Foreign bodies from the deep layers of the cornea, especially in the only eye, should only be removed by an ophthalmologist.

Penetrating eye injuries

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 an eye injury, penetrating wounds of the eyeball are noted - injuries in which a wounding (foreign) body cuts the entire thickness of the outer membranes of the eye (sclera and cornea). This is a dangerous injury, since it leads to a decrease in visual functions (at times to complete blindness), and sometimes causes the death of the other, undamaged eye.

Classification of penetrating eye injuries

The following types of penetrating wounds of the eyeball are distinguished:
I. By depth of damage:
1. Penetrating wounds, in which the wound channel passes through the cornea or sclera, extends into the eye cavity to varying depths, but does not go beyond its limits.
2. Through wounds - the wound channel does not end in the eye cavity, but extends beyond it, having both an inlet and an outlet.
3. Destruction of the eyeball - destruction of the eyeball with complete and irreversible loss of visual functions.
II. Depending on location: corneal, limbal, corneal-scleral and scleral wounds.
III. By wound size: small (up to 3 mm), medium-sized (4-6 mm) and large (over 6 mm).
V. By shape: linear wounds, irregular in shape, torn, punctured, star-shaped, with a tissue defect.
In addition, a distinction is made between gaping and adapted wounds (the edges of the wound are tightly adjacent to each other over the entire area).

Clinic and diagnosis of penetrating eye injuries

Penetrating injuries are often accompanied by damage to the lens (40% of cases), prolapse or pinching of the iris (30%), hemorrhage into the anterior chamber or vitreous body (about 20%), and the 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 medical history, taking into account the medico-legal consequences of eye damage. Very often, during the initial collection of anamnesis, victims, for various reasons, can hide or distort important information, the true cause and mechanism of injury. This is especially true for children. The most common causes are industrial, household, and sports injuries. The severity of the injury depends on the size of the wounding object, kinetic energy and its speed during impact.
In almost all cases, regardless of the medical history, in case of penetrating wounds it is necessary to perform radiography, computed tomography, ultrasound, and MRI. These studies will determine the severity of the damage and the presence (or absence) of a foreign body.
Diagnosis of penetrating eye injuries is carried out by identifying characteristic symptoms. The latter, in their significance, can be absolute and relative.
The absolute signs of penetrating eye injuries are:
- through wound of the cornea or sclera;
- loss of the inner membranes of the eye (iris, ciliary body, choroid), vitreous body into the wound;
- leakage of intraocular fluid through a corneal wound (diagnostic fluorescein test);
- the presence of a wound channel passing through the internal structures of the eye (iris, lens);
- presence of a foreign body inside the eye;
- presence of air in the vitreous body.
Relative signs of penetrating eye injuries include:
- hypotension;
- change in the depth of the anterior chamber (shallow - with a wound of the cornea, deep - with a wound of the sclera, uneven - with iris-scleral damage);
- hemorrhage under the conjunctiva, into the anterior chamber (hyphema) or vitreous body (hemophthalmos), choroid, retina;
- tears of the pupillary edge and changes in the shape of the pupil;
- tear (iridodialysis) or complete separation (aniridia) of the iris;
- traumatic cataract;
- subluxation or dislocation of the lens.
The diagnosis of a penetrating wound is valid when at least one of the absolute signs is detected.

Urgent Care

A doctor of any profile needs to know the signs of penetrating eye injuries and be able to provide first aid:
1. Apply a binocular bandage, inject intramuscularly a broad-spectrum antibiotic and tetanus toxoid.
2. Urgently send the patient to a specialized hospital. Transportation should be carried out in a prone position, preferably by ambulance.
3. It is strictly forbidden to remove protruding foreign bodies from the eye (with the exception of foreign bodies located superficial to the tissues of the eye).

Penetrating wounds of the sclera and cornea

Penetrating corneal injuries are characterized by disruption of the integrity of the cornea. According to the location of corneal wounds, they can be central, equatorial, or meridional; in shape - linear, patchwork with smooth and torn, uneven edges, gaping, with a fabric defect. Injury to the cornea leads to the leakage of intraocular fluid, as a result of which the anterior chamber is crushed; often complicated by loss and separation of the iris at the root, injury to the lens (cataract) and vitreous body (hemophthalmos).
Treatment. The main task during the surgical treatment of penetrating wounds of the cornea is, if possible, the complete restoration of the anatomical structure of the organ or tissue in order to maximize the preservation of function.
During operations on the cornea, deep sutures (nylon 10.00) are applied to 2/3 of its thickness at a distance of 1 mm from the edges of the wound. Sutures are removed after 1.5-2 months. To treat star-shaped penetrating wounds of the cornea, the purse-string suture technique is used - passing a circular suture through all corners of the lacerated wound to tighten it in the center, with the additional application of separate interrupted sutures to all areas that extend from the center of the wound. In case of iris prolapse, it is corrected and repositioned after preliminary removal of impurities and treatment with an antibiotic solution.
If the lens is damaged and traumatic cataracts develop, cataract extraction and artificial lens implantation are recommended. In cases where there is a crushed wound of the cornea and it is not possible to compare its edges, a corneal transplant is performed.

Injuries of the sclera and iris-scleral region

Injuries to the sclera and iris-scleral region are rarely isolated; the severity of their damage is determined by accompanying complications (prolapse of the internal membranes, hemorrhages into the structures of the eye).
With corneal-scleral wounds, the iris and ciliary body fall out or are pinched, and hyphema and hemophthalmos are often observed. With scleral wounds, the anterior chamber, as a rule, deepens; The vitreous body and inner membranes of the eye often fall out; hyphema and hemophthalmos develop. The most severe damage to the sclera is accompanied by a tissue defect, especially with subconjunctival tears.
Treatment. Primary surgical treatment of penetrating wounds is performed under general anesthesia. In this case, the main task is to restore the tightness of the eyeball and the structural relationships inside it. It is mandatory to inspect the scleral wound; it is necessary to strive to accurately determine the direction of the wound channel, its depth and the degree of damage to the internal structures of the eye. It is these factors that largely determine the nature and extent of surgical treatment.
Depending on the specific conditions, treatment is carried out both through the entrance wound and through additional incisions. In case of loss and pinching of the ciliary body or choroid in the wound, it is recommended to straighten them and apply sutures; They are first irrigated with an antibiotic solution in order to prevent intraocular infection and the development of an inflammatory reaction. When a wound of the cornea and sclera becomes infected, acute iridocyclitis, endophthalmitis (purulent foci in the vitreous body), panophthalmitis (purulent inflammation of all membranes) can develop.
For penetrating wounds of any location, local treatment is carried out, including anti-inflammatory, antibacterial and symptomatic therapy in combination with general antibiotic therapy and correction of the immune status.

Penetrating eye injuries with the introduction of foreign bodies

If a foreign body is suspected of entering the eye, anamnestic data are of great importance. A carefully collected anamnesis plays a decisive role in determining the treatment tactics for such a patient. Foreign bodies in the cornea can cause the development of infiltrates and post-traumatic keratitis, which subsequently lead to local opacities of the cornea.
With significant injuries to the cornea and extensive hyphema or hemophthalmos, it is not always possible to determine the course of the wound canal and the location of the foreign body. In cases where the fragment passes through the sclera beyond the visible part, it is difficult to detect the entry hole.
When a large foreign body is introduced, a gaping wound of the cornea or sclera with prolapse of the choroid, vitreous body and retina is clinically determined.
Diagnostics. With biomicroscopy and ophthalmoscopy, a foreign body can be detected in the cornea, anterior chamber, lens, iris, vitreous body or fundus.
To diagnose a foreign body inside the eye, the Komberg-Baltin X-ray localization method is used. The method consists of identifying a foreign body using an eye marker - an aluminum prosthetic indicator 0.5 mm thick with a radius of curvature corresponding to the radius of the cornea. In the center of the indicator there is a hole with a diameter of 11 mm. At a distance of 0.5 mm from the edge of the hole, four lead reference points are located in mutually perpendicular meridians. Before installing the prosthesis, anesthetic drops (0.5% alcaine solution) are instilled into the conjunctival sac; The prosthesis is positioned so that the lead marks correspond to the limbus at 12-3-b-9 o'clock.
All calculations based on X-ray photographs are carried out using three Baltin-Polyak measuring circuits, depicted on transparent film. The latter are superimposed on x-rays taken in three projections - anterior, lateral and axial. On a direct photograph, the meridian along which the foreign body is located, as well as its distance from the anatomical axis of the eye, is determined. On lateral and axial photographs, the distance from the limbus to the foreign body along the sclera in the direction of the equator is measured. The method is accurate for diagnosing small foreign bodies of metallic density while maintaining the turgor of the eyeball, the absence of severe hypotension and gaping wounds of the outer membranes of the eye. Analysis of the results obtained allows us to determine the depth of the foreign body relative to the outer membranes of the eye and the scope of the planned surgical intervention.
To establish the location of a foreign body in the anterior part of the eye, the method of non-skeletal radiography according to Vogt is successfully used, which can be performed no earlier than 8 days from the moment of injury.
Modern methods include ultrasound A- and B-examination, the results of which allow not only to determine the presence of a foreign body, but also to diagnose complications such as lens dislocation, vitreous hemorrhage, retinal detachment, etc.
With computed tomography, you can obtain a series of layer-by-layer images of the eyeball and orbit of higher resolution compared to the previously mentioned techniques.

Treatment of eye injuries with the introduction of foreign bodies

A foreign body in the cornea must be removed immediately. When it is located superficially, special tools are used,
needles, tweezers, spears, if located in the deep layers (stroma) of the cornea, a linear incision is made, then the metallic foreign body is removed with a magnet, and the non-magnetic foreign body with a needle or spear. To remove a foreign body from the anterior chamber, an incision is first made above the fragment into which the tip of a magnet is inserted. If the corneal wound is centrally located, the foreign body may remain in the lens or penetrate into the posterior part of the eye. A foreign body embedded in the lens is removed in two ways: either after opening the anterior chamber using a magnet, or together with the lens in the case of the amagnetic nature of the fragment and subsequent implantation of an artificial lens.
Removing a non-magnetic foreign body from the eye is usually associated with great difficulties. When a foreign body is located in the anterior part of the eye (the space from the posterior surface of the cornea to the lens inclusive), the so-called anterior extraction route is used.
Until recently, the fragment located in the posterior part of the eye was removed exclusively by the diascleral route, that is, through an incision in the sclera at the site of its location. Currently, the preferred route is the transvitreal route, in which an extended magnet tip for removing a metal object or an instrument for grasping an amagnetic foreign body is inserted into the ocular cavity through an incision in the pars plana of the ciliary body. The operation is performed under visual control through a dilated pupil. In case of violation of the transparency of the optical media (traumatic cataract, hemophthalmos), cataract extraction and/or vitrectomy is first performed, followed by removal of the foreign body under visual control.
For penetrating eye injuries with the introduction of foreign bodies, in addition to surgical interventions, the prescription of drug therapy is required, aimed at preventing the inflammatory reaction of the eye, the development of infection, hemorrhagic complications, hypotension, secondary glaucoma, pronounced proliferative processes in the fibrous capsule and intraocular structures.

Initial treatment of penetrating wounds

Initially, treatment of penetrating wounds takes place only in a hospital setting.
When a diagnosis of eye injury is made, antitetanus toxoid is administered subcutaneously at a dose of 0.5 IU and antitetanus serum at a dose of 1000 IU.
Drug treatment carried out using the following groups of drugs.
1. Antibiotics:
aminoglycosides: gentamicin intramuscularly 5 mg/kg 3 times a day, course of treatment 7-10 days; or tobramycin intramuscularly or intravenously
2-3 mg/kg per day;
penicillins: ampicillin intramuscularly or intravenously 250-500 mg 4-6 times a day;
cephalosporins: cefotaxime intramuscularly or intravenously 1-2 g
3-4 times a day; ceftazidime 0.5-2 g 3-4 times a day;
glycopeptides: vancomycin intravenously 0.5-1 g 2-4 times a day or orally 0.5-2 g 3-4 times a day;
macrolides: azithromycin 500 mg orally 1 hour before meals for 3 days (course dose 1.5 g);
lincosamides: lincomycin intramuscularly 600 mg 1-2 times a day.
2. Sulfonamide drugs: sulfadimethoxine (1 g on the first day, then 500 mg/day; taken after meals, course 7-10 days) or sulfalene (1 g on the first day and 200 mg/day for 7-10 days, 30 minutes before meals ).
3. Fluoroquinolones: ciprofloxacin orally 250-750 mg 2 times a day, treatment duration is 7-10 days.
4. Antifungal agents: nystatin orally 250,000-5,000,000 units 3-4 times a day.
5. Anti-inflammatory drugs:
NSAIDs: diclofenac 50 mg orally 2-3 times a day before meals, course 7-10 days; indomethacin 25 mg orally 2-3 times a day before meals, course 10 days;
glucocorticoids: dexamethasone parabulbar or subconjunctival,
2-3 mg, course 7-10 injections; triamcinolone 20 mg once a week, 3-4 injections.
6. H-receptor blockers: chloropyramine 25 mg orally 3 times a day after meals for 7-10 days; or loratadine 10 mg orally 1 time per day after meals for 7-10 days; or fexofenadine 120 mg orally 1 time per day after meals for 7-10 days.
7. Tranquilizers: diazepam intramuscularly or intravenously 10-20 mg.
8. Enzymatic preparations in the form of injections:
fibrinolysin 400 units parabulbarly;
collagenase 100 or 500 KE subconjunctivally (directly into the lesion: adhesions, scar, etc.) or using electrophoresis, phonophoresis; course of treatment is 10 days.
9. Preparations for instillation into the conjunctival sac. In severe conditions and in the early postoperative period, the frequency of instillations can reach 6 times a day; as the inflammatory process subsides, it decreases:
antibacterial agents: 0.3% solution of ciprofloxacin, 1-2 drops
3-6 times a day; or 0.3% solution of oftaxacin, 1-2 drops 3-6 times a day; or 0.3% solution of tobramycin, 1-2 drops 3 times a day;
antiseptics: 0.05% solution of piclosidine (Vitabact), 1 drop 6 times a day, course of treatment 10 days;
glucocorticoids: 0.1% dexamethasone solution, 1-2 drops 3 times a day; or 1-2.5% hydrocortisone ointment, put behind the lower eyelid 3-4 times a day;
NSAIDs: 0.1% diclofenac solution, 1-2 drops 3-4 times a day; or 0.1% solution of indomethacin, 1-2 drops 3-4 times a day;
combination drugs: maxitrol (dexamethasone 1 mg, neomycin sulfate 3500 IU, polymyxin B sulfate 6000 IU); tobradex (suspension - tobramycin 3 mg and dexamethasone 1 mg);
mydriatics: 1% solution of cyclopentolate, 1-2 drops 3 times a day; or 0.5-1% solution of tropicamide, 1-2 drops 3-4 times a day, in combination with a 2.5% solution of phenylephrine, 1-2 drops 3 times a day;
stimulators of corneal regeneration: actovegin (eye gel 20% for the lower eyelid, 1 drop 3 times a day); or solcoseryl (eye gel 20% for the lower eyelid, 1 drop 3 times a day); or dexapanthenol (eye gel 5% for the lower eyelid, 1 drop 3 times a day).
After severe injuries to the eyeball, the patient needs lifelong observation by an ophthalmologist and limitation of physical activity. If necessary, in the long term, surgical and medicinal treatment is carried out for the purpose of visual and cosmetic rehabilitation of the patient.

Non-penetrating wounds of the eyeball are not associated with a violation of the integrity

capsules of the eye (i.e., cornea and sclera). Injuries to the cornea 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

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

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

formation of a cataract.

Superficial foreign bodies of the cornea and conjunctiva are removed using

washing the eyes with water, isotopic sodium chloride solution or disinfectant

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

An embedded foreign body can be removed using a special needle or a sterile

needles for intravenous injections, moving the needle from the center to the limbus. At

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

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

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

After removal of the corneal foreign body, antibiotic solutions are prescribed and

sulfonamides, which are instilled 3-8 times a day, and ointment with

antibiotics or sulfonamides.

Penetrating wounds

Penetrating eye injuries are divided into injuries to the appendage apparatus, i.e.

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

Injuries to the soft tissues of the orbit can be torn, cut and punctured. Torn

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

muscles and wounds of the lacrimal gland.

With penetrating injuries, the integrity of the outer capsule of the eye is compromised

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

of all injuries accounts for 30% of the eye. For penetrating wounds there is one entrance

hole, with through holes - 2.

Puncture wounds are accompanied by exophthalmos, ophthalmoplegia, and ptosis. These signs

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

nerve trunks and vessels at the apex of the orbit until 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.

Injuries to the eyelids accompanied by damage to the lacrimal canaliculi require

primary surgical treatment (if possible) with restoration of lacrimal


tubules.

The severity of a penetrating wound is determined by the infection of the wounding object,

its physicochemical properties, size and location of the wound (cornea, sclera

or limbus zone). An important role is played by the depth of penetration of the wounding 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, prolapse of membranes and foreign body. The second ones include

hypotension and changes in the depth of the anterior chamber (shallow with corneal wounds and

deep for scleral ones).

If a foreign body enters the eye, it subsequently leads to the development of purulent

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

or contains any organic residues (components).

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

loss of eye membranes. The most common complication of injuries in this area

vitreous prolapse occurs, and hemophthalmos often occurs.

Damage to the lens and iris can occur both due to blunt trauma and

penetrating wounds of the eyeball. In the event of a rupture of the lens bag, what, how

usually occurs with a penetrating wound, rapid clouding and swelling occur

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

lens formation of cataracts due to intense hydration of lens fibers

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

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

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

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

loss of the lens substance, the development of phacogenic uveitis and secondary glaucoma.

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

chamber, on the iris and in the substance of the lens.

There are superficial and deeply located foreign bodies. Superficial

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

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

All superficially located foreign bodies must be removed, since they

prolonged exposure to the eye, especially on the cornea, can lead to traumatic

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

deep layers of the cornea, no sharp irritation reaction is observed. Due to this

remove only those foreign bodies that easily oxidize and cause the formation

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

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

delete. The smallest __E2 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

subject to removal.

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

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

foreign body acquires a rusty-brown color, chalcose (copper) - delicate

yellowish-green, with argyrosis there are small dots of whitish-yellow or gray-

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

A brownish ring after removing a metal foreign body is also necessary

remove carefully as it may cause eye irritation.