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CLASSIFICATION OF EYE TRAUMATISM

According to the conditions and reasons causing injuries of the eye, there are distinguished the following kinds of the eye trau­matism: industrial, agricultural, domestic, children's, military and sporting. Each aspect of the traumatism has its peculiarities.

The industrial traumas, as a rule, are the consequence of dam­age of the eye by drilling breaks of metal, swaft, different buil ding material, in 40.6% of cases refer to severe penetrating inju­ries, quite often with availability of the foreign body.

Agricultural traumas now, in connection with the broad intru­sion of engineering, by nature come nearer to industrial. Howe­ver, there are injuries particular to the countryside trauma (cow's horn, etc.), leading to severe inflammation of the eye.

Every day traumas are extremely miscellaneous: a puncture by the needle, cuts by scissors, the shocks by the fist, and in 53,7% are referred to the high-gravity injuries.

Children's traumas are the result of dangerous games, or non-ob­servance of the accident prevention at home and working skills lessons.

Battle injuries of the eye are characterized by considerable dam­age of tissues of the eye and orbit, multiple intrusion of drilling breaks, quite often non-magnetic, combinated with trauma of the face and other parts of the body.

Of all the eyes damages classifications proposed before, any does not correspond to requirments of the modern ophthalmology: to mirror the diversity of traumas, to be brief (like in glaucoma clas­sification), easily stored and yielding machining. The best classifi­cation was proposed by N. O. Puchkovska with the co-authors in 1985 (Table 5).

Determination of the severely level

Mechanical injuries:

I — mild injuries, which don't cause the loss of the eye functions;

II — middle severity injuries threatening with the decrease of
functions of the eye;

²²I — severe injuries threatening with the loss of the eye func­tions;

IV — high-gravity injuries threatening with loss of the eye.

 

Burns:

I — mild — hyperemia, erosion, mild oedema of the cornea;

II — middle severity — hemosis, ischemia, surface the oedema,
film of the conjunctiva, intensive clouding of surface layers, and
erosion of the cornea;

III — severe — necrosis of the skin, conjunctiva and sclera no more than 1/2 surface, sharp ischemia of the limbus up to 1/2 of circumference, deep clouding of all strata of the cornea;

²V— high-gravity — necrosis of the skin, conjunctiva and sclera more than 1/2 of surface, "porcelain cornea" or defect of its tis­sue, perforation.

  Table 5. Classification of the eye injuries  
Kind of the trauma Type of injury Localisation of injury Degree of severity Concomitant injuries
Industrial Mechanical: Appendages of the eye (a) I —mild Iris
Agricultural — contusion (C) Orbit (o) II — middle Lens
Everyday — non-penetrating wounds (NPW) Cornea (c) III — severe Vitreous body
Children's — penetrating wounds (PW) Limbus (1) IV — most severe Retina and choroid
Sport — perforating wounds (PW) Sclera (s)   Optic nerve
Military Burns: — chemical burn — termical burn — termochemical burn — ray burn     Disturbance of the intraocular pressure Foreign bodies Inraocular haemorrhages Intraocular infections
  — thermal-mechanical      
   

The determination of the degree of severity is conditional to a certain extent, as it is difficult to foresee the course of the trau­matic process in the eye and possible posttraumatic complications. So, a mild penetrating wound of the cornea can become compli­cated by endophthalmitis with the full loss of sight.



Wounds of the Organ of Vision

Wounds of the organ of vision are divided into wounds of the orbit, adnexa oculi and eye-ball.

Wounds of the Orbit

Wounds of the orbit and especially gun-shot ones are related to extremely severe traumas by their severity, variability and pecu­liarities. They may be single with or without foreign body in the orbit, combined if there is simultaneous damage of the eye or or bit wound is accompanied by craniocerebral, facial wounds and injuries of the maxillary sinus adnexa.

All patients with orbit traumas are performed roentgenography in two projections.

Depending on the weapon the orbit wounds may be lacerated, incised, stab.

Lacerated wounds are peculiar for prolapse of the fatty tissue, damage of the external eye muscles, injuries of the lacrimal glands, there may be ophthalmoplegia, exophthalm.

Treatment. In lacerated wound first of all a revision should be made (determination of size and depth of the wound, involvement of the os-seal walls of the orbit). The ophthalmologist must solve the question whether the wound canal involves the cranial and paranasal sinus. The initial surgical treatment of the lacerated wounds of the soft orbit tis­sues consists in economic dissection of the soiled wound edges within 0.1-1 mm. The wound canal is washed by hitrofurazone, rivanol or hy­drogen peroxide. When there are indications wound plastics by the ad­jacent tissues is performed, catgut or biological sutures are applied to the injured fascia, ligaments or muscles, and silk ones to the skin.

Distinctive signs of the stab wounds are exophthalmos, ophthal­moplegia, ptosis of the upper eye-lid which are evidence of deep spread of the wound canal and injury of the nerve trunk and ves­sels at the orbit top by the wound object. The severity of the stab wound is determined by impairment of the optic nerve.

Treatment includes thorough revision of the wound's canal and initial surgical treatment. The soft tissues are dissected for 2-2.5 cm; the wound canal is examined carefully, following the princi­pal of maximum spare of the tissues. When there is no penetration of the wound canal into the cranial cavity or paranasal sinus or foreign body in the orbit, the wound is sutured.

In incised wounds we make revision of the wound and initial sur­gical treatment with restoration of anatomical structure of the soft orbit tissues.

Foreign body in the orbit makes the course of the traumatic process considerably complicated. Marked inflammatory oedema of the tissues, exophthalm and pus from the wound are evidence of possible wooden foreign body in the orbit.

To establish localization of the foreign body it is necessary to make X-ray examination or computer tomography, additional in­formation may be obtained in ultrasonic investigation including US scanning of the orbit.

After localization of the foreign body it is surgically removed by simple orbitotomy, magnets are used in magnet foreign bodies.

Fractures of the bone walls of the orbit are observed almost in half of cases of orbit traumas in peace time.

Treatment of fractures is given by ophthalmologist, neurosur­geon, otolaryngologist and dentist.

Early surgical treatment of the orbit wounds allows not only to eliminate cosmetic defect but also to restore patient's vision.


Date: 2015-02-03; view: 895


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