|Year : 1968 | Volume
| Issue : 4 | Page : 238-239
Corneal surgery in industrial injuries
M and J. Institute of Ophthalmology, Ahmedabad, India
|Date of Web Publication||24-Dec-2007|
R P Dhanda
M and J. Institute of Ophthalmology, Ahmedabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhanda R P. Corneal surgery in industrial injuries. Indian J Ophthalmol 1968;16:238-9
Enough has already been said about the common types of accidents, common ocular injuries, and the prognosis of visual recovery. From what has been said, it is evident that cornea is the commonest victim of industrial accidents, being the most exposed part protected only by a blink reflex.
FOREIGN BODY IN THE CORNEA is the commonest industrial injury to the eye. 7 per cent of the 1507 patients which were referred to the Institute of Ophthalmology from the ESI Centres in Ahmedabad were cases of foreign body in cornea, mostly iron particles. An iron foreign body becomes a corneal problem if it is too deeply embeded and would need a deep dissection with hazard of perforation. More difficult is to remove the rust of the iron particle if removal of foreign body is delayed by more than a few hours. Repeated foreign bodies in the cornea leaving behind multiple small opacities may grossly affect the vision and in such cases a corneal graft may be the choice.
A corneal graft is also the suitable treatment in cases of gun powder explosions with cornea besmeared with numerous particles in different levels of corneal thickness. Gun powder particles incite a violent iridocyclitis. A keratoplasty therefore should be done before plastic iridocyclitis has set in or after the control of iridocyclitis. Most cases can be adequately treated with lamellar corneal grafting if 80-90 per cent of the particles in the superficial layers can be included in lamellar dissection. Occasionally however a penetrating graft may be necessary when the particles have perforated the cornea, caused a central opacity with anterior synechia and a secondary cataract. In such cases keratoplasty should be done first and extraction of cataract later.
Apart from simple foreign body in the cornea, more serious are the problems when even a single foreign body may cause infected ulcer of the cornea which rapidly extends with an associated hypopyon leaving behind a dense corneal scar with or without iris incarceration. Most such cases need a penetrating keratoplasty. I can recollect an epidemic of infected corneal ulcers following foreign bodies in the cornea in Telco Factory in Jamshedpur. 7 of the 9 cases had corneal graft and all of them fully rehabilitated back to work.
Perforating corneal injuries may vary from an abrasion to an extensive laceration. Treatment will therefore depend on the extent and severity of the injury.
A corneal repair of a perforating injury should be done soonest possible and before the cut edges become oedematous. Most cases however reach the hospital late by which time iris is incarcerated and adherent to the cut edges and the surrounding cornea markedly oedematous. Repair in such cases involves separation of the iris on either side from both the cut edges which should be turned forward and examined under bright illumination and loose tags hanging into the anterior chamber excised. The cut surfaces of the two lips should be cleaned so that the healing results in minimum scarring. Lens substance from a traumatic cataract may some times have to be scooped at the time of reparative surgery.
The stitches should be applied fairly closely preferably a milli-meter apart. These stitches should bite deep in to the corneal tissue to prevent gaping of the posterior cut edges which could easily catch the iris resulting in anterior synechia which should be our aim to avoid. The ideal would be to be able to inject air and restore the anterior chamber at the end of stitching. The ultimate result and the effectiveness of the reparative surgery will depend on the time since the injury and presence or absence of secondary infection. Everybody will agree that if the lacerations are extensive, lens has been extruded and vitreous has escaped, chances of visual recovery are very slim indeed. One should not hesitate to remove the eye if indicated provided of course the patient has the other eye which could suffer from sympathetic ophthalmitis.
Chemical injuries of the eye are among the most difficult propositions Alkali burns caused by liquor ammonia, caustic soda and lime cause apparently superficial corneal lesions but with severe tissue reaction. Intense vascularisation has to be treated by surgical procedures like peritomy, beta radiation and mucous membrane grafting around the cornea. Then alone a lamellar corneal graft may succeed. It however needs to be emphasised that the results of lamellar surgery in alkali burns are among the poorest as compared to 90 per cent successes in more suitable cases. Thin keratectomy not more than 0.25 mm. deep could some times be considered in place of lamellar keratoplasty because the space interface in lamellar surgery is a favourable situation for the blood vessels to grow postoperatively while open raw surface after keratectomy inhibits growth of blood vessels and when they do, they are more readily exposed to therapy. Cornea with a chemical burn and heavily vascularised is however a soft tissue and keratectomy therefore can not always be surgically feasible.
Acid burns like that by sulphuric acid are more destructive, very quickly necrosing the lids, causing exposure keratitis. The primary surgery in such cases is plastic repair for providing coverage of the cornea rather than corneal surgery.
Corneal surgery from a simple removal of the foreign body to a full thickness corneal graft is often needed for cases of industrial eye accidents. Important however is the immediate service and first aid help that can appreciately affect the ultimate outcome of the treatment. It is therefore important that not only the facilities for immediate first-aid handling of eye injury are necessary in every industrial health centre but the medical officer concerned working in the Industrial unit should have clear concept as to when and what to do in a case of ocular injury.