Year : 1984 | Volume
: 32 | Issue : 5 | Page : 293--294
Management of lacerated injuries of the eye and its adnexa
IS Roy, JN Mitra, PL Saha, SC Sen
Regional Institute of Ophthalmology, Medical College Calcutta, India
I S Roy
Regional Institute of Ophthalmology, medical College, Calcutta
|How to cite this article:|
Roy I S, Mitra J N, Saha P L, Sen S C. Management of lacerated injuries of the eye and its adnexa.Indian J Ophthalmol 1984;32:293-294
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Roy I S, Mitra J N, Saha P L, Sen S C. Management of lacerated injuries of the eye and its adnexa. Indian J Ophthalmol [serial online] 1984 [cited 2021 Sep 28 ];32:293-294
Available from: https://www.ijo.in/text.asp?1984/32/5/293/27495
Ocular injury is one of the major causes of impairment of vision and blindness. Of the injuries-lacerated wounds of the eye and its adnexa are much variable due to nature of innumerable types of injuring agents. They are mostly non-occupational or domestic in nature. Nature has provided us with some protective measures for the eye and still we get sometimes badly lacerated wounds of the eye from trauma with different objects.
Some interesting cases of such lacerated injuries of the eye and its adnexa from various types of injuring agents are presented.
Injury from a submerged foreign body during swimming:
B.N., 20 yr. male attended the eye emergency with history of injury with a bamboo piece-while swimming in the pond. On examination, the left eye lids and left side of the face was much swollen and the eye ball was not visible at all. A bamboo stick of about 2 cm. broad was firmly stuck to the swollen lower lid. Under general anaesthesia the bamboo piece was pulled out with much difficulty. It was about 15X2X0.6 cm in size and entered the orbit through the lower lid and fornix pushing the eye ball against the roof of the orbit and it was firmly stuck up at the inferior orbital fissure. The eye ball was uninjured, very soft, with concave cornea. Vision and ocular movements could not be examined as the patient was under general anaesthesia. The wound was properly cleaned and stitched leaving a gap for drainage and the patient was put on local and systemic antibiotics. There was profuse purulent discharge for about a week. Gradually the wound healed up and the eye ball came back to the normal condition with 6/6 vision, normal intraocular tension and full ocular movements.
Injury as a result of criminal violence:
AM., a young man of23 yr. was brought to the eye emergency with multiple injuries mainly on his face and eyes resulting from explosion of a bomb thrown at him. His right eye was completely destroyed with almost an empty socket and few unusual things were covering the left eye. On removing these we saw a complete finger nail about 2 cm. long, few pieces of palm skin and few matallic particles covering the grossly damaged left eye. Patient's hands and fingers were intact The nail and palm skin belonged to the person who threw bomb at the victim and it happened as the bomb exploded at his hand before he could throw it. The left eye ball and the lids were repaired properly and as there was light perception present, we tried a combined cataract extraction and penetrating keratoplasty in that eye later on as a desparate measure and thus tried to give him some vision but failed.
Injury in travel:
M.S., a middle aged person met with an accident while he was travelling on his scooter. He was brought to the general emergency in a semiconscious condition with multiple injuries all over the body and scalp. There was avulsion of skin of right side of the face extending from mid-line of the nose, right side of the upper lip, cheek-skin extending upto upper part of the neck and right lower lid upto the front of the ear. Avulsed skin and subcutaneous tissues were hanging exposing the maxilla, cheek muscles, few blood vessels and nerves but the eye ball was uninjured. The avulsed skin of the face along with lower lid was placed in position and repaired properly when the general surgeon managed the other injuries of the body simultaneously. As the lower lid margin was grossly lacerated with loss of some tissues of lid margin it did not heal up properly. He needs plastic repair of the lid margin for improvement of appearance.
Ocular injury during electricity failure:
A.D., an 8 yr. old boy accidently fell down on a curved iron hook and sustained multiple lacerations of the right eye lids. The lid wounds were repaired by conventional methods that is in 3 layers taking care of lavator muscle and its expansion in particular and ptosis was thus could be prevented. The boy was put under antibiotics and there was uneventful recovery.
Dog bite injury:
P.M., a 24 yr. young engineer attended Eye emergency with multiple lacerated wounds over his face, fore-head, lids and nose. Sustained when his pet dog suddenly got angry and attacked him while he was sitting with it at his house. After proper cleaning, the wounds were repaired in layers and there was uneventful recovery. His eye ball was intact which was protected by orbital bony rims and the nose. Ocular movements were normal.
Injury by cock's beak stroke:
M. S., 28 years female sustained injury over right eye when her pet cock suddenly pecked her right eye with its beak. There was an irregular rupture of cornea in its upper part with prolapse of uveal tissue. The prolapsed iris was excised and the corneal wound was repaired with 8-0 Virgin silk under operating microscope (Zeiss). The patient developed traumatic cataract in the postoperative period which was removed after two months and corrected vision in the aphakic eye was 6/18.
Ocular injuries are as old as man. With advancement of science and technology, we get more and more cases of different types of injuries involving eye and its adnexa caused from various types of injuring agents in our day to day practice. Some interesting cases of such lacerated injuries of the eye and its adnexa from various types of injuring agents like-injury from submerged foreign body during swimming, injury as a result of criminal violence, injury in travel, injury during electricity failure, dog bite injury and injury by cock's beak stroke etc. have been presented. We have observed that in the management much better results are obtained if an early surgery in a fully equipped departmental operation theatre under perfect general anaesthesia with fine suture materials is done. Prevention of infection and restoration of the structural integrity by meticulous repair in layers is equally important and if it is not strictly followed during surgery, late complications like notching at the lid margin, overlapping and various types of deformities are bound to occur.