|Year : 1968 | Volume
| Issue : 4 | Page : 163-165
Injuries of the eye
Editor- Indian Journal of Ophthalmology, India
|Date of Web Publication||24-Dec-2007|
S N Cooper
Editor- Indian Journal of Ophthalmology
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Cooper S N. Injuries of the eye. Indian J Ophthalmol 1968;16:163-5
We are bringing out a special number on "Injuries of the eye" because of papers read at two symposia on the same subject, held during the last year, one at Madras and the other at Ahmedabad. Along with these papers we have received a number of case records on injuries of the eve and a few free papers. This makes a formidable collection of some 20 papers, covering different aspects of injuries, which collection should make a reasonable reference number.
On viewing through the subjects, it is disappointing to find that in quite a number of papers the matter overlaps, covering more or less the same aspects. In symposia, it should be the task of the moderator to think out and allocate the different aspects of the subject to different members. One notable omission one finds is that of traumatic glaucoma. It is a subject that has intrigued the editor and sometimes he is at a loss to discover the cause of glaucoma in such cases. Usually, it is a haemorrhagic type of glaucoma with acute pain, which is controllable with one thing only, and that is subconjunctival injection of vasodilators. It is a useful point to remember, because if one waits for the haemorrhage to get absorbed and hopes for relief of pain, he has hoped too much. With half to one cc of a vasodilator like "Carbachol" or "Priscol" injected retrobulbar in Tenon's space relieves the pain miraculously.
Again, one misses a subject like injuries of the eye in children, which can form a separate paper in itself. Such a paper would bring out the most amazing types of lethal objects which only a school-going child can think of using on his school companion. Pencil points, fishing-hooks, bows and arrows and the silly practice of throwing dust into the eyes, cracker injuries, marbles in the eye, beatles and insects - all these can produce a variety of injuries of the eye with considerable damage, for which the surgeon will have to exercise all his ingenuity and imagination for treatment in subjects which offer little co-operation.
Some injuries of the eye, though common-place can be quite interesting, e.g. a foreign body on the cornea. Dr. Venkataswamv in his paper has remarked that certain individuals seem to get a foreign-body in their eye more often than their associates. Similar must be the experience of other industrial ophthalmologists. Why should it be so? Is there an anatomical or physiological cause for the same? An investigation on these lines can be quite interesting. In any case such a man would need a change of job.
Another interesting form of injury is the only type of compound fracture which is not visible from the outside, a fracture of the medial wall of the orbit, communicating outside through the thin walls of the nasal accessory sinuses. Such an injury follows a punch on the nose or on the eye in the course of an argument or a boxing match. The characteristics are: (1) a swelling of the lids with or without ecchymosis, (2) an invariable history of bleeding from the nose, (3 , surgical emphysema. The only advice the patient needs is not to blow his nose, for every time he does that the swelling blows up.
Finally, the course and prognosis in injuries of the eye form a chapter by itself. By experience we have come to learn that on most occasions the eye can stand a lot of insult, but at other times it cannot stand the slightest. We give below an example of each.
In the early days of our practice, nearly forty years ago, that is even before the sulphonamides came on the scene, we had to treat a ease of a colleague, a general surgeon, whose right eye got damaged by the shattered pieces of the lens of his spectacles, as he was cranking the engine of his car and the engine back-fired ejecting the cranking key with some force against his spectacles.
A large lacerated wound was seen in the sclera, through which the contents of the eye were emerging. An X-Ray revealed some foreign bodies with very faint shadows which appeared to be intraocular. On the operation table as we tried to excise the prolapsed portion of the ciliary body and iris, some more vitreous came out. The theoretical knowledge of my early days made me put the eye in the category of an eye, grossly damaged, incapable of recovering useful vision with a + + risk of sympathetic ophthalmia, as the wound was through the so-called "danger zone". An enucleation was advised. However, a joint-consultation with an older experienced ophthalmologist was arranged, who advised a policy of wait and watch, of suturing the wound and fomentations. As we did not wish to take the responsibility of further conservative treatment, springing out of arrogance of a young man just returned from abroad, the case was further treated by the senior ophthalmologist.' As he was suturing the sclera, some more vitreous came out, along which also came out a piece of broken glass. Next day the eye was intensely chemosed and fixed. There was a suppressed smile of ridicule on our face, but it had to change into a very humiliating one expressing amazement as the eve under further conservative treatment - nothing more than hot formetitrtious, milk injections and a little aspirin for the relief of pain, began to recover. After three months, the eye recovered a vision, enough for the surgeon to drive his old jalope once again by himself.
We had learnt at some cost our first practical lesson on injuries of the eye, "Do not be hasty to enucleate, the eye can take a lot of insult".
On the other hand, we now give you an example of a minor injury culminating into a major one.
A grinder from a factory got a foreign body in his eye, while working on a lathe. The foreign body was removed and he was sent home with the routine: antibiotic, homatropin pad and bandage. The next day, he came with a ciliary flush and watering. The abrasion had rot quite healed. The third day, he complained of severe pain which was attributed to iridocyclitis, which he was developing. The next day, there was a definite hypopyon without any discharge from the eye. The condition worsened to the extent that enucleation of the eye was advised. At that time, we were toying with the idea of using tuberculine injections in such cases, which we tried in this case before enucleating. The patient showed a remarkable improvement the next day, and with further tuberculine desensitizing therapy, we could get the eye quiet and improve his vision to 6/18 within 2 weeks.
This shows how trauma of a minor degree can trigger off an attack of iridocyclitis in an eye, due to some hidden focus of infection, which remains dormant but is stirred into activity by a tiny trauma.
Hence injuries of the eye should be divided into those that cause destruction and those that activate an inflammation of an eye, which otherwise would remain dormant. It is therefore necessary to remember that no form of injury should be considered trivial, as far as the eyes are concerned.
In papers of both these symposia, we also missed an important form of injury, namely injuries of the eye due to chemicals. In India, industries that have to deal with radiations, except perhaps the glass-blowing one, are almost non-existent, whereas those that have to deal with chemicals can be found by the basketful and are multiplying every day. It is surprising therefore that radiation hazards have been honoured with a lengthy and thorough treatment, whereas injuries of the eye due to chemicals found only a secondary place in one of the papers. In order to make the issue complete we have asked two ophthalmologists to deal with the subject.
We have had some interesting cases of intentional injuries of the eye, which form of injury springs from the ever present human instinct to make a quick-rupee through any loop-hole in the Insurance system. Our description of these cases, we hope will make the subject complete from all modern aspects.
We are fortunate in having one paper from the United States which describes the system of giving compensation prevailing in the States. The law is an ass they say, and so are the laws of compensation. Undoubtedly, these laws are a blessing to the millions of workers in industry who form single cogs in the wheels of industrial machinery. Whereas formerly these cogs, when damaged were just discarded with no hope for any reemployment or just compensation for the loss of a vital organ that got injured in the cause of the very industry the injured helped to prosper, he is now considered a part of the machinery and is compensated. On the other hand, these very cogs, helped and incited by their respective lawyers, who find loop-holes for them, sometimes claim undeserved compensation. Dr. Pritkin's paper has many such examples. In such cases, the expert ophthalmologist has to match his wits with those of the employee and his lawyer. In some cases the ophthalmologist comes out second best, but the struggle against dishonest compensation should be our sacred pledge. However, is it not better to allow an undeserving man to have compensation than to deny compensation to an innocent victim!
One important fact emerges from the papers here. It is most important to have an eye-examination before employing a workman or taking out an insurance policy. The workman and the assured can otherwise bite hack, if you are not careful in this respect.