How Do I Treat a Corneal Perforation?

Eyeball perforation injury

A sharp object or foreign body perforates the eyeball wall, which is called an eyeball perforation injury. According to the location of the perforation, it can be divided into corneal perforation injury, scleral perforation injury and corneal scleral perforation injury across the scleral limbus. Corneal perforation injuries are the most common clinically due to corneal anterior exposure. Eyeball perforation injuries can be divided into two types: one is simple perforation, the wound is less than 3mm, and there is no incarriage of the eye tissue in the wound; Perforation of eyeballs is most commonly caused by the impact of debris from metal splashes. Most of the injured are young and middle-aged workers. Knife, needle, and stab wounds also occur frequently. They are more common in children and life events. Explosive shrapnel can cause injuries during wartime or training.

Eyeball Perforation Injury Overview

Causes of eye puncture injuries

Perforation of eyeballs is most commonly caused by the impact of debris from metal splashes. Most of the injured are young and middle-aged workers. Knife, needle, and scissors puncture eyeballs. Explosive shrapnel can cause injuries during wartime or training.

Clinical manifestations of eyeball perforation injury

1. Vision: Depending on the location of the perforation, the degree of vision loss varies. For example, a simple perforation in the periphery of the cornea results in a small wound and no effect on vision.

2. Anterior chamber: if the perforation is in the cornea or corneal sclera, the aqueous humor constantly overflows, the front becomes shallower, and the larger the wound, the iris tissue can come out and incarnate in the wound, and the pupil deforms; if the perforation is in the sclera, the eye content is oriented The wound comes out, and the anterior chamber depth may not change or become deeper. The eyes should be contrasted and distinguished carefully.

3. Intraocular pressure: due to perforation of the wall of the eyeball, aqueous humor overflows, the content of the eye prolapses, and the intraocular pressure is significantly reduced. Pay attention when checking the intraocular pressure to avoid exacerbation of eye contents.

Eyeball perforation complications

1. Traumatic iridocyclitis: inflammation caused by direct damage to the iris or irritation of the iris tissue in the wound, or the presence of foreign bodies in the eye. Pupil dilation should be treated, and corticosteroids should be strengthened locally. Dexamethasone is usually injected under the conjunctiva.

2. Pyogenic ophthalmitis: often caused by puncture wounds, infected bacteria enter from the wound or caused by wounding or foreign matter into the eye. Vision can rapidly decrease, eye pain, and tears. Examination shows conjunctival congestion, edema, corneal edema, haze, high turbidity of the aqueous humor, and even pus, and severe reflection of yellow light in the pupil area (indicating pus in the vitreous body) ). In addition to the systemic and local application of large amounts of antibiotics, early vitrectomy should be performed to inject antibiotics directly into the vitreous cavity. The disease has a poor prognosis and often leads to pancreatitis or eye atrophy.

3. Pancreatitis: On the basis of endophthalmitis, the inflammation develops further. When it spreads to the wall of the eyeball and its surrounding tissues, it is called pancreatitis. In addition to the manifestations of endophthalmitis, accompanied by exophthalmos, high conjunctival edema, congestion, restricted eye movements, complete disappearance of vision, even perforation of corneal abscesses, and outflow of pus in the eyes, if not treated in time, they often turn into orbital honeycombs. Weaving inflammation, and spread to the skull, cause purulent meningitis, life-threatening. In terms of treatment, eyeball excision should be performed. If you choose eye removal, you may bring the infection into your skull. A drainage strip should be placed in the postoperative wound, and antibiotics should be applied locally and systemically.

4. Foreign bodies in the eye: Foreign bodies are divided into two types, one is magnetic foreign body, and the other is non-magnetic foreign body. Foreign bodies can be located anywhere in the eye, and foreign bodies can be large or small. The magnetic foreign body in the eye needs to be carefully positioned and removed from the ball wall closest to the foreign body. For non-magnetic foreign bodies, such as chemically stable and the location of the foreign body is at the back of the eyeball, you do not need to forcefully remove it.

5. Sympathetic ophthalmia: When the perforated eye is especially combined with intraocular foreign body injury, persistent uveitis occurs after the injury. After a period of time, the contralateral healthy eye also has uveitis of the same nature. This condition is called Sympathetic ophthalmia. The injured eye is called "induced eye" and the uninjured eye is called "sympathetic eye". The incubation period is mostly 2 to 8 weeks after injury, and there are very few cases as short as a few days or as long as decades later. The incidence of sympathetic ophthalmia in China accounts for about 1.2% of eyeball perforation injuries, which is related to the site of perforation injury and the presence of pigmented membrane incarceration. It is generally considered that the incidence of damage to the ciliary body is high, and the incidence of pigmented tissue incarceration is high. Repeated internal eye surgery in the short term after injury can also lead to disease. The disease is also occasionally seen in some cases after intraocular surgery, perforation of corneal ulcers, or melanoma in the eye. Most of the causes are thought to be delayed autoimmune diseases.

There are two types of clinical manifestations: The main symptoms of uveal inflammation at the time of onset are photophobia, tearing, eye pain, conjunctival congestion, turbid aqueous humor, post-corneal sedimentation, pupil diminution, post-iris adhesion, etc .; Another type of uveitis manifests mainly after the onset of the disease, with decreased vision, hyperemia of the optic disc, edema, blurred borders, edema in the macular area, disappearance of foveal reflection, retinal detachment, and a large number of yellow-white exudates seen in the choroid of the elderly The vitreous body is cloudy, but it will develop into full uveitis in the future, which will cause blindness in both eyes.

This disease focuses on prevention, wounds are handled properly when injured, and early application of corticosteroids can all reduce the incidence. Once symptomatic ophthalmitis occurs, do not rashly remove the injured eye, especially those who have residual vision in the injured eye, apply a large amount of corticosteroids systemically and locally, and combine immunosuppressants if necessary, in addition to energy mixtures. Treatment must be thorough to prevent repetition.

Eyeball puncture diagnosis

Diagnosis can be confirmed based on clinical manifestations.

Eye ball perforation treatment

Close the wound to prevent infection. For simple perforation wounds, if the wound is clean, antibiotics are given locally and systemically, and the monocular bandage is lightly bandaged. After 1 to 2 days, the wound is closed and the anterior chamber is formed. If the wound is larger than 3mm, it should be sutured. If the wound has a complete iris tissue incarceration, the injury time is within a few hours, and the area is cleaned, the antibiotic solution can be cleaned and rinsed and carefully incorporated into the eye, and the wound is closed (generally 10-0 nylon thread). Otherwise, the eye tissue in the wound should be removed and sutured. The scleral perforation wound with a 7mm marginal scleral edge should be scleral condensation or electrocoagulation on both sides of the wound after suture to prevent retinal detachment. After wound treatment, local and systemic antibiotics and corticosteroids, tetanus antitoxin were applied.