Eye contusion is a lesion of the organ of vision caused by a blunt object or a shock wave. Clinical manifestations are determined by the nature of the injury. Common symptoms include decreased visual acuity, increased lacrimation, photophobia, the appearance of a “veil” in front of the eyes, soreness in the orbit. Diagnostics is based on the use of biomicroscopy, visometry, radiography, ophthalmoscopy, MRI, gonioscopy, tonometry. Anti-inflammatory, antibacterial, hypotensive and antiseptic agents are used as conservative therapy. Operatively eliminate ruptures of the membranes of the eyeball.
General information
Eye contusion account for about 1/3 of all traumatic injuries of the visual organ, leading to blindness and disability of the patient. According to statistics, the most common mild degree of lesion is 84.9%. In 55.5% of cases, the cause of pathology is a household injury. 79.4% of patients subsequently suffer from accommodation spasm. In 68.3% of patients, erosive defects on the surface of the cornea are diagnosed. The prevalence of subconjunctival hemorrhage in eye contusions is 98%. After 6-12 months, 3.4% of patients have a recession of the CPC, 0.5% have persistent mydriasis and 2.3% have fundus pigmentation.
Causes of eye contusion
The etiology of the disease is directly related to the impact of a traumatic agent. The determination of etiological factors plays an important role in the diagnosis and the choice of treatment tactics. The main causes of the disease are presented:
- Traumatic brain injury. Leads to the development of an indirect form of pathology. Patients note the appearance of symptoms on the part of the organ of vision, but there are no pathological changes in the anterior part of the eyes during visual examination.
- A direct blow. It is most often found in domestic injuries. The effect of the etiological factor causes injury to the eyeball with predominant damage to the external structures.
- A blast wave. Entails the most severe consequences, which is caused by a combined lesion of the external and internal parts. The pathological process develops symmetrically.
Pathogenesis
The direct contusion is based on the direct effect of the damaging factor on the eyeball. After a mechanical shock, the intraocular structures are deformed, leading to a sharp increase in intraocular pressure. Violation of hemodynamic processes and intraocular hydrodynamics entails the appearance of hemorrhage foci. A change in the biochemical parameters of liquid media provokes a stress reaction. With an indirect type of exposure, the pathological agent does not come into contact with the eye, but has an indirect effect through the bones of the skull. With the affected inner membranes and optical media, the integrity of the conjunctiva and cornea is not violated. The severity of the contusion is affected by the weight and area of the traumatic agent. With a high speed of movement of the object and a large impact surface area, the probability of heavy flow increases significantly. The severity of the disease also depends on the point of application of the damaging factor.
Classification
Contusion of the eye is an acquired disease. There are direct and indirect forms of pathology. According to the clinical classification accepted in Russian ophthalmology, the following degrees of severity are distinguished:
- I degree. With mild contusion, subcutaneous hemorrhages in the ocular region, signs of hyposphagma are detected. The nature of the wound is torn and bruised. There are no tears or ruptures of the eyelids and conjunctiva. Slight swelling and erosive defects of the cornea are visualized.
- II degree. The corneal lesion area is limited by edema, tearing of the surface layers of the eye membranes. There is a rupture of the iris at the pupillary edge. The intraocular muscles are spasmed.
- III degree. Complete rupture or separation of the eyelid and iris with spreading to the sclera. The edges of the defect are uneven. The cornea is soaked with blood. It is complicated by a fracture of the bone wall of the orbit.
- IV degree. Particularly severe contusion is accompanied by crushing of the eyeball. Compression or rupture of optic nerve fibers in the bone canal is noted.
Symptoms
At the first degree of eye contusion, patients complain of increased lacrimation, photophobia, a feeling of pain in the eye, the inability to open the eyelids. Spasm of accommodation does not lead to visual dysfunction. The intensity of subconjunctival hemorrhage increases during the first 2 hours from the moment of injury, then regresses independently for 2-3 weeks. The second degree is characterized by the development of a pronounced pain syndrome, which increases when trying to make movements with the eyeballs. Visual acuity is sharply reduced. Patients note the appearance of a “veil” or “fog” in front of their eyes.
In severe cases, only light perception is preserved. A pronounced cosmetic defect is formed. Pain radiates into the brow arches, temporal and frontal parts of the head. The sensitivity of the cornea is sharply reduced. Dislocation of the lens is manifested by phacodonaise (trembling of the lens) or iridodonaise (oscillatory movements of the iris). At the fourth degree, complete loss of vision is noted. The appearance of “flies” or “floating opacities” in front of the eyes indicates the detachment of the inner shell. Pronounced exophthalmos is visually determined. The mobility of the eyeballs is sharply hampered.
Complications
The defeat of 2-4 st. severity is complicated by hyposphagma, hemophthalmos and hemorrhage in the anterior chamber. Traumatic recession of the anterior chamber angle underlies the development of secondary glaucoma. When the uveal tract is affected, chorioretinitis occurs. Post-traumatic reactions of surrounding tissues lead to the formation of goniosynechiae. In severe trauma, neuroretinopathy, chorioretinal dystrophy, and optic nerve atrophy are observed. Patients with a history of this pathology have a high risk of secondary cataracts and traumatic retinal detachment. When the sclera ruptures along the circumference of the limb, traumatic aniridia may occur.
Diagnostics
Eye contusion is made taking into account anamnestic information, the results of physical examination and instrumental research methods. When collecting anamnesis, it is necessary to clarify how much time has passed since the traumatic injury, to establish the causes and mechanism of the injury. The complex of ophthalmological examination includes:
- Biomicroscopy of the eye. With a mild lesion and contusion of moderate severity, edema and erosion of the cornea are detected. On the anterior surface of the lens, a “pigment imprint” (the Fossus ring) is determined. At grade 3, there is turbidity, dislocation or subluxation of the lens.
- Ophthalmoscopy. Post-concussion changes of the fundus are divided into early (up to 2 months) and late. A change in the retina of the “Berlin” type is visualized, in which cloud-like opacities of gray or whitish color occur. Hemorrhage foci, ruptures of the inner and vascular membranes are visible. There are signs of sub- and atrophy of the optic nerve.
- Gonioscopy. The examination is carried out under regional instillation anesthesia, provided that the transparency of the cornea is preserved. At 2 st. pathology, blood is detected in the anterior chamber.
- Visometry. The degree of visual acuity reduction varies from minor dysfunction to complete blindness.
- Radiography of the facial part of the skull. It is indicated for moderate to severe damage. The study is carried out in a straight and lateral projection to exclude fractures and deformations of the bone walls of the orbit, diagnosis of hemorrhage in the paranasal sinuses. If necessary, an additional CT scan of the head is performed.
- MRI of the head. Magnetic resonance imaging makes it possible to most accurately determine the level and nature of damage to optical fibers and intraocular muscles, to identify local areas of hemorrhage.
- Ultrasound of the eyes. The examination is used in case of opacity of optical media. The technique allows you to visualize the signs of hemorrhage in the vitreous and anterior chamber, to clarify the nature of the lesion of the lens and the posterior segment of the eyeball.
- Non-contact tonometry. In the early period, intraocular pressure rises sharply. Further, changes in ophthalmotonus vary from pronounced hypertension to hypotension, which is determined by the mechanism of striking.
Treatment of eye contusion
Therapeutic tactics depend on the severity of pathological changes and the nature of damage to intraorbital structures. At 1 art. special treatment is usually not required. Hyposphagma resolves itself within 14-21 days. The epithelium of the cornea in the erosion zone regenerates in 3-4 days. Depending on the extent of the lesion, conservative or surgical treatment is used for concussion of 2-4 degrees. Drug therapy is based on the use of:
- Anti-inflammatory drugs. At grade 1, nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated. Starting from the 2nd art. it is advisable to prescribe glucocorticoids in the form of parabulbar injections.
- Enzymes. Fibrinolysin is used in ophthalmological practice for hemorrhages of traumatic genesis. Collagenase is injected subconjunctivally by electrophoresis.
- Antibacterial agents. They are used throughout the entire period of treatment in order to prevent the development of bacterial complications.
- Antiseptics. Assign a course lasting 10 days. Instillations of antiseptics are carried out from 2 to 6 times a day.
- Sympathomimetics. Mydriatics are used to dilate the pupil, prevent the formation of scarring, anterior goniosynechiae.
- Antihypertensive drugs. If increased intraocular pressure is detected in the early postoperative period, local hypotensive therapy is indicated.
Surgical interventions are necessary for ruptures of the eyelids, cornea and sclera. Identification of traumatic iridodialysis requires iridoplasty. The root of the iris is fixed to the limb at the scleral edge. If a rupture of the outer connective tissue membrane is suspected, the wound is audited. With retrobulbar hematoma, a puncture is performed with further drainage. If the bone walls of the eye socket are damaged, consultation with an otolaryngologist, a neurosurgeon is indicated. While maintaining the integrity of the optic nerve, an organ-sparing operation is performed. In case of complete atrophy of nerve fibers, enucleation is recommended.
Prognosis and prevention
The outcome of the disease is determined by the severity of the contusion, the nature of the damage to the structures of the eyeball. The prognosis for visual functions at 3-4 degrees is unfavorable. The patient must be registered at the dispensary with an ophthalmologist for 1 year. During a routine examination, tonometry and direct ophthalmoscopy are necessary. If hypotensive therapy is ineffective, surgical treatment of glaucoma is indicated. Specific methods of prevention have not been developed. Non-specific preventive measures are reduced to the use of personal protective equipment at work (wearing glasses, helmets).
