Any Trauma or Injury to Your Eye Can Be Vision Threatening

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Penetrating trauma

Any trauma or injury to your eye can bevision threatening. Many, but not all,

injuries can be prevented by wearingprotective eye gear when playing sports,and working with hand or power tools.Since traumatic or other injuries canhappen to anyone

What You Should Know About... A enetrating !rauma

Penetrating trauma

refers to injuries in which the eye is pierced by asharp object such as a knife, or by a high-velocitymissile such as a piece of metal or a BB pellet.Surgery is often needed to repair the damage. Afterany penetrating eye injury, a serious intraocular

infection may develop that can rapidly lead topermanent blindness in that eye. he advent ofmodern microsurgical techni!ues and thedevelopment of new antibiotics have improved thechances of saving many of these severely injuredeyes

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causes of penetrating trauma"-

sharp objects"-knives,scissors,needles,etc

flying #B"-air gun pellet , pieces of metals ,glasses

Most commonly seen in children at play with

sharp object Shattered windscreen in road traffic accidents

High velocity missles at work place

At home, every day objects like pencils, pens and even sticks can

become eye penetrating missiles. So can hammering nails, "ling

metal and working with tools. More danger lurks in your yard and

garden. #t only takes a split second $or a normally harmless activity %

such as mowing your lawn or trimming your bushes, to result in

something lodged in your eye. And, depending upon your job, the

risks can be even greater. #$ something penetrates your eye, it is an

ocular emergency that re&uires immediate attention.

!he risk may be even greater $or children, as they don't reali(e how

&uickly child's play can turn to an accident. )or e*ample, a stick

used as a +sword can easily penetrate another child's eye. So can

playing with pellet guns.

#n some cases, a tiny piece o$ metal or a shard o$ glass can penetrate

the eye, and may not be visible to the naked eye. !here$ore, i$ you

have the sensation that something is in your eye, eye pain, redness,

tearing and blurred vision, you should immediately contact your eye

doctor.

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pathology:-

Penetrating injuries, overall, carry a poorer prognosis

than blunt injuries.

The extent of damage depends on where and how far the

object enters the eye.

Wounds that are isolated to the cornea , may not

penetrate the anterior segment structures and, if small,

may self seal with little visual morbidity, especially ifthey are off the visual axis. The iris may plug the wound,

resulting in an irregular pupil

Larger or more complex corneal wounds require closure

resulting in scarring, which itself may be visually

disabling.

Penetrating injuries of the anterior segment may involve

the anterior capsule of the lens, causing a localied or,

more commonly, a diffuse lenticular opacity.

!s part of the protective reflex, the eye rotates upwards

as it closes "#ell$s phenomenon%, and penetrating injuries

are often situated inferiorly in the sclera.

The vast majority of such scleral and corneo&scleral

wounds involve underlying structures, and prolapsed iris

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or choroid need to be replaced or removed prior to

closure of the wound.

Posterior wounds involve the retina, and the development

of vitreo&retinal traction and scarring in the period after

the injury are important factors in the development ofcomplex retinal detachments.

Figure 5: An irregular pupil: the iris has plugged the small

corneal wound

Clinical efects:-

1-Mechanical:-

Any ocular tissue can be lacerated or damaged

Penetrating injuries can cause:-

- corneal or scleral lacerations,/ vitreous incarceration into the wound or hemorrhage,

0 retinal tears or detachments,

1 prolapse o$ iris ,

2 e*posure o$ uveal tissue and lens damage

3ver time, scarring can also lead to cataracts and

glaucoma.

2-Introduction o the micro organisms:-

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Infection will lead to endophthalmitis andpanophthalmitis

* Endophthalmitis :-

It is acute suppurative inammation of the intraocular structures.

* Panophthalmitis:-

It is acute suppurative inammation of the globe

which involves all the ocular tissue including theocular coat (cornea and sclera), tenon's capsuleand the soft orbital tissue.

-!"mpathetic ophthamia:-

to the other eye

.. ..

$omplicationsMultiple complications are known to occur following eyetrauma. Some of them are listed here: Cornealscarring,hyphema, iridodialysis, post-traumatic glaucoma, uveitiscataract, vitreous hemorrhage and retinal detachment.The complications risk is high with retinal tears,penetrating injuries .The cornea is the curved, transparentlayer that covers the front part of the eye and protects itsinner structures. ... Caused y a lunt low to the eye. ...!veitis specifically refers to inflammation of the middlelayer of the eye, termed the uvea ut in common usagemay refer to any inflammatory process involving theinterior of the eye. ... " cataract is an opacity that developsin the crystalline lens of the eye or in its envelope. ...#etinal detachment is a disorder of the eye in which the

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retina peels away from its underlying layer of supporttissue. ...

PrognosisThe overall prognosis for eye trauma is grim,with a grave risk of complications even withthe est medical and surgical treatment.#hile not e$er" penetrating injur" can %epre$ented& 'earing protecti$e e"e 'ear 'hile'or(ing 'ith hand and po'er tools can pre$entman" injuries.

#hat )ou !hould o in the E$ent o aPenetrating +rauma

enetrating trauma can happen to anyone.!here$ore, you should develop an action planbe$ore an emergency event occurs.

-!he most important thing you can do isleave the penetrating object in the eye. !oavoid $urther damaging the eye, such objectsshould only be removed by an eye carepro$essional.

/atients with a penetrating eye traumashould see their eye doctor the same day.

4ntil then, the patient should avoid touchingor manipulating the eye.

0#$ the patient wears contact lenses, do notattempt to remove the lens as this can cause$urther damage to the eye. !he lens shouldbe removed by the doctor.

15all your eye doctor's o6ce. 7*plain that

you have a penetrating traumatic injury.

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rovide as much in$ormation as possible,including a description o$ what is in the eye,its $ull si(e, how the accident occurred etc.!his will allow the o6ce to prepare to treatthe patient immediately upon arrival.

2 Keep the patient calm until he8she can beseen by the doctor.

,o' is amage rom Penetrating +rauma

etected

9 :ilated 7ye 7*am8Slit ;amp 7*amination

acomprehensive e*amination o$ your eye and retina

9 !onometry% measuring your intraocular pressure

9 3phthalmoscopy % evaluating any optic nerve or

retinal damage

Eamination

Visual acuity is reduced due to cornea distortion or blood .

Most injuries involves the cornea or at the corneoscleral

junctions. Therefore displacementof the iris or pupil should

alert the possibility of open eye injury.

,o' is Penetrating +rauma +reated!reatment o$ the penetrating trauma will depend

entirely on the results o$ your e*amination. Surgical

treatment may be re&uired to remove the $oreign body

$rom your eye. #$ a retinal tear or detachment is

diagnosed, immediate laser or surgical treatment may

be necessary to prevent permanent vision loss.

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trauma, other surgical or laser treatment may also be

re&uired at a later date.

:epending on the severity o$ the damage, $urther $ollow

up e*aminations may be re&uired to monitor how youreye is healing.

While some penetrating traumatic injuries can be

prevented or minimi(ed by wearing protective eyewear,

not all injuries are preventable. !here$ore, knowing the

steps to take in the event o$ an accident is the key to

preventing permanent vision loss in the event o$ a

traumatic injury.

a-Immediate treatment:-

1 wash any obvious dirt or contaminating material by

gentle irrigation with saline.

!determine the site of the laceration and e"tent ocular

damage.

#free the incarcerated tissue from the wound and

reposite e"posed viable uveal tissue as far as possible

to their normal anatomical positions . large iris

incarceration is abscised. prolapsed vitreous is cut ush

with the wound.

$ ade%uate closure of the wound.

&systmatic antibiotics and antititanic serum.

%-secondar" repair:-

usually carried out 11$ days after primary repair due

to

to clear opacities of the media

eg cataract and vitreous hg

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to stabili*e abnormal vitreoretinal interaction to

prevent tractional retinal detachment

Prevention

Protective eye glassesare a must for populationsand workers at risk for eye trauma. Carpenters,plumers, agricultural workers, metal foundryworkers are at special risk for eye injuries. "nyonetrying to hammer a nail, chip a piece of wood or

reak a stone should wear protective eye glassesefore performing such work. Children should esupervised in high-risk situations like firecrackersand ow-and-arrow games.

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REFERENCES

'. Parver L. (ye trauma. The neglected disorder.Arch Ophthalmol

')*+ 104(10: '-/&0

/. 1egrel !2, Thylefors #. The global impact of eye injuries.

Ophthalmic Epidemiol '))* 5(!: '-0&+)0. 3lynn 45, 6eddon 57, #erlin #7. The incidence of eye injuries in

1ew (ngland.Arch Ophthalmol ')** 10"(": 8*&)

-. 2esai P, 7ac(wen 95, #aines P, 7inaissian 29. (pidemiology

and implications of ocular trauma admitted to hospital in 6cotland.

J Epidemiol Community Health '))+ 50(4: -0+&-'

. 6chein :2, ;ibberd PL, 6hingleton #5, inger P=. The spectrum and burden

of ocular injury. Ophthalmology ')** #5(!: 0??&

+. 7ac(wen 95. (ye injuries@ a prospective survey of +8' cases.Br

J Ophthalmol ')*) $!(11: ***&)-

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8.

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/. G ab6inclair 6!, 6mith 3!, Hiang ;. F(yeglasses&related injuries

treated in A.6. emergency departments in /??/&/??0.F Ophthalmic

Epidemiol./??+ =eb'0"'%@/0&0?. P7B2 '+'?0-0.

0. '7ay 24,