Contusions of the Eye Appendages

Of the eye appendages lids and lacrimal ducts are mostly af­fected. A minor blunt trauma can result in appearing of various fruises (lids haematomas). It is explained on one hand by lids vas­cularization, on the other hand — by peculiarity of hypodermic tissue: it is friable does not contain fat and the run out blood spreads quickly under the lids skin. An active openning of the lids is im­possible under such conditions and a passive one is hampered.

The time period within which the haematoma appears is of great diagnostic value. The haemorrhage occuring just after the trauma arises from the damaged lids vessels; if haematoma appears in some hours after the trauma it testifies to penetration of the blood un­der the the lids skin from haematoma in the orbit. The late hae­matoma appearance (in a day and more) can be evidence of the skull base fracture (the sign of "glasses").

Sometimes at contusion of the lids it is possible to detect der­mal emphysema by palpation, by characteristic crunching under fingers (the sign of the crepitation), that points damage of the or­bit bone walls and penetration of air from paranasal sinus. If there is the hypodermic emphysema the patient should be made X-radi-ography in two projections to clear up localization and size of bones

damage.

Treatment. At first cold is administered, then in a day — ther­mal procedures for resorption of haemorrhages. If ethmoidal cells are suspected to be damaged, the patient should be carefully fol­lowed up because the infection may spread into the skull's cavity.

At blunt traumas of the upper lid ptosis (blepharoptosis) quite often takes place. It arises due to damage of the elevator muscle or a corresponding branch of the oculomotor nerve. Treatment is conservative: electroprocedures, massage. The problem on surgi­cal removal of ptosis can be decided not earlier, than in 6 months after the trauma.

Contusion of the upper lid in its external third leads sometimes to damage of the lacrimal gland, therefore dacryadenitis occurs. More rare the trauma of this area may cause downward disloca­tion of the lacrimal gland.

Contusion of the upper lid in its internal third is quite often ac­companied by damage of the lacrimal ducts. The lower lacrimal point dislocation, rupture of lacrimal canalicula and lacrimal sac are possible.

Damage of conjunctiva manifest in subconjunctival haemorrhag­es and oedema (hemosis). Severe traumas may be complicated by conjunctival rupture. The localization of conjunctival damage near the limbus may cause the rupture of the sclera.

The breaking of the conjunctiva less than 5 mm does not require surgical treatment, disinfecting drops are administered. If conjunc­tival injury is more than 5 mm the sutures 8/0-9/0 are placed un­der dicainum epibulbar anaesthesia, then disinfecting drops and ointments are administered. The sutures are removed on the 5th-6th day.

Date: 2015-02-03; view: 1205