Wounds of the eyelids may be perforating and nonperforating, with slightly torn edge, with partial or complete abruption at the internal or the external eye corner. Abruptions of the eyelids at the internal eye corner are especially dangerous, as ductules of the lacrimal gland become injured.
In surgical treatment one should always remember physiological and cosmetic role of the eyelids. Treatment should be performed at the microsurgical level. The line of eyelashes, the anterior and posterior eyelid ribs must be set precisely, the cartilage, muscular fascial layer and skin should be sutured separately. In such technique the consequences of trauma may be quite invisible after final healing.
In rupture of the lacrimal ducts it is necessary to set the torn parts, restore their patency with the help of special ductile probes. After that the rupture edges are sutured. The probe is left for several days or replaced by a silicon tube. After treatment of the lacrimal ducts the eyelid wound is sutured, the tube is removed in 3-4 weeks.
The eyelid wounds heal well, even in complete abruption, thanks to their plentiful blood supply.
Wounds of the Eyeball
Wounds of the eyeball may be nonpenetrating, penetrating and perforating. In especially severe traumas there may be destruction of the eye characterized by considerable injuries of all ocular membranes with complete loss of its content.
A nonpenetrating wound is a nonperforating injury of the cornea or sclera. As a rule, it does not cause severe complications and effects eye functions.
In penetrating wounds the object dissects all external membranes of the eye (sclera and cornea). It is a dangerous injury, as it may cause reduction of the visual functions of the eye up to absolute blindness and sometimes it may ruin the second, unhurt eye.
Perforating wounds differ from penetrating ones by two openings when the object pierces the membranes of the eyeball forming inlet and outlet openings.
Nonpenetrating Wounds of the Eyeball
Nonpenetrating wounds of the eyeball constitute about 70% of all injuries.
These superficial injuries or microtraumas may be due to blow of the tree branch, nail scratch, prick of cereals. In these cases superficial erosion of the epithelium occurs and traumatic keratitis may develop. More often superficial injuries are a result of foreign bodies (a piece of coal, a hunk of stone, fine metallic foreign bodies, particles of animal and plant origin) which remain in the conjuctiva, sclera or cornea without piercing the capsule. We may observe photophobia, lacrimation, pericorneal infection because of irritation of a great number of nervous receptors of the trigeminal nerve located here.
All foreign body should be removed as their long stay, especially on the cornea, may lead to such complications as traumatic keratitis or purulent ulcer of the cornea. The superficial foreign bodies are removed at the outpatient clinic. Not infrequently they can be removed by wet cotton ball after putting drops of 0.25% dicaine solution. As a rule, however, foreign bodies inculcated into superficial and medium layers should be removed by special lance, channeled chisel or injection needle's end. In deeper localization of the foreign body because of danger of opening of the anterior chamber, it should be removed in the operating room under operating microscope. A metallic foreign body may be extracted from the cornea with the help of magnet, if necessary the superficial layers of the cornea are dissected over it. After removal of the foreign body we administer disinfecting drops, methylene blue with chinine (for improvement of the cornea epithelization), aseptic bandage for a day.
Foreign bodies from deep layers of the cornea especially on a single eye, must be removed only by ophthalmologists.