Eye

Pictures of eye trauma: 12 Eye Injury Types & Causes, Pictures, Symptoms, Treatment, Prognosis

Содержание

7 Common Eye Injuries and How to Treat Them

Some common eye injuries, such as deep puncture wounds from accidents, could require immediate treatment or surgery to prevent permanent eye damage resulting in vision loss.

Minor surface scratches, on the other hand, may need only simple monitoring after an initial visit to the eye doctor to make sure complications such as eye infections don’t occur.

If you’re worried about a possible eye injury, play it safe and visit an eye doctor.

This guide to common eye injuries can help you determine your next step following an accident, especially if you are in an emergency situation. Remember also that common sense safety precautions such as wearing safety goggles or glasses may be your best approach to preventing eye injuries altogether and maintaining healthy vision for a lifetime.

Common conditions associated with eye injury and trauma include:

Scratched eye (corneal abrasion)

Eye lacerations usually require emergency care. Don’t hesitate to visit an eye doctor immediately.

Common causes of abrasions to the eye’s surface (corneal abrasions) are getting poked in the eye or rubbing the eye when a foreign body is present, such as dust or sand. Corneal abrasions are very uncomfortable and cause eye redness and severe sensitivity to light.

If you know something has scratched your eye, it’s very important to see your eye doctor or an emergency room/urgent care center to seek treatment for your eye injury.

Scratches also can make your eye susceptible to infection from bacteria or a fungus. Certain types of
bacteria and fungi can enter the eye through a scratch and cause serious harm in as little as 24 hours. Even blindness can result. This is especially true if whatever scratched your eye is dirty or contaminated.

Remember also that infections from eye injuries such as scratches can originate from unexpected sources such as a baby’s fingernails or tree branches.

If you have a scratched eye, don’t rub it. And don’t patch your eye, either. Bacteria like dark, warm places to grow, and a patch might provide the ideal environment. Simply keep the eye closed or loosely tape a paper cup or eye shield over it. See your doctor as soon as possible to check out this type of eye injury.

Penetrating or foreign objects in the eye

If a foreign object such as metal or a fish hook penetrates your eye, visit the emergency room/urgent care center right away. You could cause even more injury to your eye if you attempt to remove the object yourself or if you rub your eye.

If possible, try loosely taping a paper cup or eye shield over your eye for protection; then seek help.

Your eye also may have corneal foreign bodies that are small, sharp pieces of a substance (usually metal) that have become embedded in the eye’s surface (cornea), but have not penetrated into the interior of the eye.

Metal foreign bodies can quickly form a rust ring and a significant scar. Your eye doctor should remove these foreign bodies as soon as possible.

Caustic foreign substance in the eye (chemical burn)

Getting unexpectedly splashed or sprayed in the eye by substances other than clean, harmless water can be scary. Some substances burn or sting but are fairly harmless in the long run, while others can cause serious injury. The basic makeup of the chemical involved can make a lot of difference, such as:

  • Acid. As a general rule, acids can cause considerable redness and burning but can be washed out fairly easily.

  • Alkali. Substances or chemicals that are basic (alkali) are much more serious but may not seem so because they don’t cause as much immediate eye pain or redness as acids. Some examples of alkali substances are oven cleaners, toilet bowl cleaners and even chalk dust.

Chemical exposures and burns are usually caused by a splash of liquid getting in your eye. But they can be caused in other ways as well, such as by rubbing your eyes and transferring a chemical from your hands to your eyes or by getting sprayed in the eye by hair spray or other aerosols.

If you’re splashed in the eye, put your head under a steady stream of barely warm tap water for about 15 minutes. Just let it run into your eye and down your face.

Then call your eye doctor or an emergency room/urgent care center to see what is recommended for your eye injury. Tell the person on the phone exactly what kind of substance got into your eye and what you’ve done about it so far.

If you know your eye is at risk because it’s extraordinarily red or blurry, then just go immediately to your eye doctor or an emergency room or urgent care center after you’ve rinsed it with water. You can put a cool, moist compress or an ice pack on your eye, but don’t rub it.

Depending on the substance, the effects of chemical exposures causing eye injuries can range from minor irritation and red eyes to serious eye damage and even blindness.

Eye swelling

Eye swelling and puffy, swollen eyelids can result from being struck in the eye such as from a baseball moving at a high speed.

The best immediate treatment for this type of eye injury is an ice pack.

You may have a simple black eye (bruising around the eye), but you should see an eye doctor to make sure there’s no internal damage.

Subconjunctival hemorrhages (eye bleeding)

This eye injury usually looks worse than it really is. A subconjunctival hemorrhage involves leakage of blood from one or more breaks in a blood vessel that lies between the white of the eye (sclera) and its clear covering (conjunctiva).

Subconjunctival hemorrhages are quite common and can occur from even minor injury to the eye. They may be limited to a small sector of the eye, or they can extend over the entire eye, making the white sclera appear bright red.

A subconjunctival hemorrhage is painless and does not cause temporary or permanent vision loss. No treatment is required. Over the course of several weeks, the blood will clear and the eye will return to a normal appearance.

Traumatic iritis

Traumatic iritis is inflammation of the colored part of the eye (the iris) that surrounds the pupil and occurs after an eye injury. Traumatic iritis can be caused by a poke in the eye or a blow to the eye from a blunt object, such as a ball or a hand.

Traumatic iritis usually requires treatment. Even with medical treatment, there is a risk of permanent decreased vision.

Hyphemas and orbital blowout fractures

A hyphema (high-FEE-mah) is bleeding in the anterior chamber of the eye, the space between the cornea and the iris. Orbital blowout fractures are cracks or breaks in the facial bones surrounding the eye.

Hyphemas and blowout fractures are serious eye injuries and medical emergencies. They are caused by significant blunt force trauma to the eye and face, such as getting hit by a bat, baseball, hockey stick or puck, or getting kicked in the face.

Steps to take in case of eye injury

If you have any eye injury, contact your eye care practitioner immediately for advice.

Most eye doctors have emergency contact numbers for injuries that occur after normal business hours or on weekends.

In certain extreme situations such as a penetrating eye injury or an eye knocked out of the socket, it may be better to get to the hospital immediately without taking the time to try calling anyone.

Once you are in the care of a doctor, be sure to mention if you wear contact lenses so you can be advised whether to leave them in or remove them.

Depending on the type of eye injury, the doctor may want you to flush your eye with water or saline solution. In more serious situations, you may need surgery.

Treat all eye injuries as potential emergencies, and never hesitate to contact or see an eye doctor immediately. Don’t take risks with your eyesight. Remember, you have only one pair of eyes.

Page published in February 2019

Page updated in October 2021

Eye injuries in children: the current picture

Eye injuries are an important cause of ocular morbidity in children, being a leading cause of non-congenital unilateral blindness in this age group. 1 Such injuries cannot always be prevented, but by identifying any underlying factors in the aetiology of serious injuries, it may be possible to determine the most effective methods of reducing the incidence of visually damaging trauma.

This study was carried out as part of a larger study in order to (1) identify the current causes of severe eye injuries in children in this country, (2) determine their outcome, and (3) explore any possible methods of reduction.

Methods

This study formed part of a larger prospective observational study of all patients admitted to hospital with ocular trauma in Scotland over a 1 year period, the full methods and results of which have been published elsewhere.2
3 The entire population of Scotland constituted the study population and for the purposes of this study all children of 14 years or under were included in the analysis. All data were collected on standardised proforma by the admitting consultant and sent to a central base at the audit unit at the Royal College of Ophthalmologists and entered into a dedicated database. Data were collected on the demographic characteristics of patients, the cause, mechanism, and place of injury. Duration of hospital stay was recorded and the final visual acuity in the injured eye was documented. All patients were followed up for a minimum of 3 months.

Results

A total of 415 patients, who were Scottish residents, were admitted to hospital with an ocular injury during the study period, and of these 93 (22%) were children less than 15 years of age. Sixty seven (70%) of the children were male and 26 (30%) were female. Fifteen (16%) children were aged 4 years or less and 78 (84%) were in the 5–14 age group.

The injury involved the left eye in 43 (46%) cases, the right eye in 48 (52%) cases, and both eyes in two (2%) cases. The overall incidence for hospitalised ocular trauma was 8.85/100 000 of the population in 1 year in the 0–14 age group (compared with an overall incidence of 8.14/100 000 for the total population2).

MECHANISM OF INJURY

The mechanisms of injury sustained are shown in Table 1. The commonest type of injury was blunt trauma, accounting for 65% (n=60) of the total and penetrating injuries without retained foreign bodies were next (24%, n=22), with all other types of injury being very rare. Fifty six (60%) of the patients who were admitted had a hyphaema.

Table 1

Mechanism of injury

PLACE OF INJURY

The place of injury is shown in Table 2. Overall, injuries necessitating admission occurred most frequently at home (n=47, 51%), and in the 0–4 age group 73% (n=11) occurred at home.

CAUSE OF INJURY

The causes of injury are many and varied and no one cause can be identified as being predominant, especially in the younger age group. Sporting activities and, rather worryingly, assaults were the commonest causes in the 5–14 age group (Table 3). No injuries were caused by road traffic accidents or fireworks.

MANAGEMENT

Forty five children (48%) required surgical management, 36 (39%) were treated medically, and nine (10%) were simply observed. There was no further information on the remaining three (3%) patients. It was not possible to obtain this information as the data were collected anonymously and there was, therefore, no method of collecting data missed at the time of collection.

Patients were admitted to hospital for a mean of 4.2 days (range 1–25 days, mode 4 days). Nine patients were admitted for more than 1 week and of these six (67%) required surgery.

OUTCOME

The final visual acuities were taken at time of final discharge. One (1%) child had an acuity in the affected eye in the “visually impaired” range (6/18–6/60) and one (1%) was “blind” (<6/60) in the affected eye (Table 4). The child who was rendered visually impaired had been assaulted, sustaining a penetrating injury, and the child who was blinded in the affected eye had fallen over at home and suffered a retinal detachment. No child was bilaterally blinded by injury and none required blind or partial sight registration.

Table 4

Final visual acuities

Discussion

There have been no recent studies into the pattern of ocular injuries in children in the United Kingdom. Most of the recent work has concentrated on specific types of injury4-7 or on the epidemiology in other countries,8-14 which may not reflect our own experience, although the studies from North America may be the most relevant. The pattern of ocular injury in adults is known to have changed significantly with a reduction both in occupational trauma, which predominated in the first part of this century,15 and injuries occurring in road traffic accidents which became commoner latterly.16-18 These changes have occurred because of a combination of a changing socioeconomic climate with education to increase awareness of risk and legislation. Such factors may also influence childhood injuries although an excess risk of severe trauma among the very young has been recognised in many studies with more than one third of all eye injuries occurring in the paediatric age group.9
10
19-23 The larger study, of which this formed a substudy, found that 22.3% of those with serious eye injuries were in the 0–14 age group (this age group makes up 18. 8% of the entire population24). The incidence was 8.85/100 000 of the paediatric population which represents a reduction of at least 50% in the rate of injuries affecting children compared with previous work.8
25

Other studies have identified that boys tend to be affected more commonly than girls,6
8
10-15
21
25
26 which is in keeping with our findings. This probably reflects boys’ more adventurous or possibly aggressive behaviour. School aged children are more susceptible than the younger age group as, although they are still relatively immature, these children are slightly more independent which may make them more vulnerable.8
10

The commonest location for an injury to take place was the home, accounting for more than 50% of all accidents. This was almost exclusively the place for preschool children injuries, but was also very common in schoolchildren, which reflects both the amount of time that all children spend at home and the risks around the home. Many of these risks remain unrecognised as most of the younger age group were injured by toys or domestic utensils which are found in any home. The domestic setting has previously been recognised as potentially dangerous, particularly with regard to penetrating injuries,6 but the incidence of injuries in the home in this study is significantly higher than found previously.9
10
12
21 This may be due to the climate in the United Kingdom, different standards of living or customs, or a change in pattern of injury.

Toys are a common cause of injury in the younger age group. In many cases the mechanism of injury is not clear, but may be due to inappropriate use of the toy, such as throwing it! However, toys are made to be used by children and, as such, inappropriate use should be considered and taken into account when devising safety standards for the manufacture of toys. Toys should be made safer and should be sold only if they comply with the appropriate British standard.

The injuries in the older age group were the result of a very diffuse number of causes, although participation in sports was the commonest cause of injury (Table 3). With increased time available for sport and leisure activities and more emphasis on fitness, sport is already recognised as being a leading cause of serious eye injury in Britain.26
27 Sport associated eye trauma is largely preventible and has been previously highlighted as a major cause of serious eye injury in the young age group.10
21Protective eye wear is available for a number of sports, although there are certain barriers to this such as poor education in this area and many sports are played on an informal and unsupervised basis by children. This explains why sport is the commonest cause of injury (Table 3) but sports/leisure facilities are not the commonest places for an injury to occur (Table 2).

Assaults have been recognised as a frequent cause of eye injury in the young.10
15
28 Although the term assault suggests malicious intent, injuries in this category may be unintentional, usually aiming at another part of the body or a genuine accident. Children are not always aware of the possible consequences of their actions and effective countermeasures for injuries caused by assaults are very difficult to devise as the circumstances are not well delineated.

In this series blunt injuries predominate, most children being admitted because of hyphaema. This represents further evidence that there is a trend of increased incidence of blunt trauma in children8-10 compared with perforating injuries which were more common in the past.9
15
29 This is a pattern to be welcomed as penetrating injuries, in general, carry a poorer prognosis as those who suffer from penetrating trauma are more likely to require surgery and to suffer from long term visual impairment.9 However, penetrating injuries were still a significant problem, accounting for 24% of cases which required admission. Other types of injury were rare, with very few intraocular foreign bodies (IOFBs) or chemical burns. Injuries caused by IOFBs usually produce significant intraocular damage and have a dismal prognosis. Chemical injuries are commonly bilateral and consume resources owing to initial intensive treatment and the need for prolonged topical therapy. The outlook for serious chemical burns is also poor.

OUTCOME

Two children (2%) in this series suffered from a serious loss of vision in one eye but no eye required to be enucleated. This is a better outcome for children’s injuries than previously reported, where the outcome of paediatric ocular trauma has been noted to be particularly severe.9
10
12
13
15
22 This may reflect changing mechanisms of injury, with more blunt trauma and fewer penetrating injuries and intraocular foreign bodies than seen previously. However, on closer inspection the visual outcome is better than that found in studies which had similar patterns of injury.12
13
15
24 An alternative explanation for this improved prognosis may be better trauma management in the form of surgical techniques and medical treatments. Better management may be a factor, especially compared with studies carried out many years ago, but this is only part of the answer as this paediatric subgroup had a better outcome than that of the entire population which was studied.2
3 Thirteen per cent of the entire population had a poor visual outcome (2. 5% with final acuities of 6/18–6/60 and 10.7% with acuities of < 6/60)2 compared with only 2% of the children. The paediatric population would be offered similar management options as the rest of the population, and therefore modern treatment cannot be entirely responsible for the improved outcomes.

Previous studies identified that most ocular injuries in children take place in outdoor locations,8
9
14
21 whereas in this study the home, followed by school, is the most common location for a paediatric ocular injury to take place. These areas tend to have an adult presence with some degree of control and the improved prognosis for this age group may simply reflect the current increased awareness of child safety which has resulted in more supervision.

METHODS OF PREVENTION

Prevention of injury depends, firstly, on identifying the cause and, secondly, targeting this by education and legislation. Some causes of ocular trauma are particularly conspicuous by their absence in this series, indicating that preventative strategies have been effective in certain areas. There were no injuries due to road traffic accidents and these seem to have been effectively eliminated as a cause of eye injury in the young (and in adults) owing to successful implementation of legislation regarding the use of seat belts in the front and back seats of cars.16-18 Fireworks, similarly, caused no injuries and this is probably the result of a combination of legislation regarding the sale of fireworks to those younger than 14 years of age and education, which has increased the number of organised displays.

Airgun injuries have a poor prognosis owing to the extensive damage caused by the high velocity pellets and often result in loss of vision or even enucleation.30 Legislation alone is not always successful, in that it is illegal for those under 17 years of age to handle firearms unsupervised by an adult, and airguns were responsible for 3% of injuries in this series. Until recently this has been a very low profile area, although the new firearms legislation in the light of the Dunblane tragedy may now completely eliminate these injuries. In contrast, there is no legislation regarding the safe keeping of domestic chemicals. However, they have been identified as dangerous, mainly because they are sometimes accidentally ingested, and parents are aware that they must be stored safely away from children; this is reflected in the small number of chemical burns found in this study.

Sports have frequently been reported as a source of major ocular trauma in all age groups, but especially the young.21
26 Clear cut methods of prevention have been identified in the form of eye protection where indicated (racket sports, hockey) and promoting safe play. The recent introduction of a British standard for eye protection in squash may help to reduce this source of injury as it will be aimed at those starting out in the sport, although many injuries occur because of the haphazard nature of the games which take place on an unsupervised basis.

The dangers of day to day household items are often not evident until it is too late, and such injuries may prove very difficult to prevent. Raising awareness of the dangers in the domestic situation by promoting avoidance and safer practices is the only method available and, although all injuries are, in theory, preventible this may not be easy in the preschool age group in the home. Perhaps factors such as immature motor skills, carelessness, and uncontrolled emotions which are inherent in young children may be more important in causing injury than most preventable causes.

SUMMARY

This study has identified that serious eye injuries requiring hospital admission in children remain a problem. However, only a small proportion (2%) of all children admitted with an eye injury were visually impaired in the affected eye as a result of the injury and none was bilaterally affected. This is a considerable improvement on previous studies and must be viewed as progress, especially as this study has shown that the incidence of ocular trauma in children has reduced and the outcome for this paediatric population is significantly better than in previous studies. Prevention, as the optimum management of trauma, must however remain a priority in order to reduce existing morbidity and costs.

This study has shown that the most common place for a paediatric eye injury to occur is the home, and it may be more difficult to influence the occurrence of domestic trauma, although by continuing to increase parental awareness, supervision may improve and exposure of young children to potentially dangerous objects and situations will be reduced.

Acknowledgments

We would like to thank all the ophthalmologists in Scotland and their clerical staff, without whose support and assistance this study could not have been conducted; Miss Kate Bullock and Miss Marisa Tomlinson at the Royal College of Ophthalmologists; and Mrs Lynda Rose at Ninewells Hospital Ophthalmology Department.

This study was supported by a grant from the Scottish Home and Health Office, Clinical Resources and Audit Group, grant no CA 91/9.

Parul Desai was supported by core audit funding from the Department of Health for the Royal College of Ophthalmologists, London, to conduct this study.

Photos of Trauma – Orbital and Zygoma Fractures


Right Orbital Floor Fracture, Male, 15 years old

Button

“White-eyed” right orbital floor blowout fracture

“White-eyed” right orbital floor blowout fracture

Button

Moderate limitation of upgaze right eye

Moderate limitation of upgaze right eye

Button

Moderate limitation of downgaze right eye

Moderate limitation of downgaze right eye

Button

Coronal CT

Coronal CT

Button

After orbital fracture repair showing normal upgaze right eye

After orbital fracture repair showing normal upgaze right eye

Button

After orbital fracture repair

After orbital fracture repair


Left Orbital Floor Fracture, Male, 7 years old

Button

Moderate limitation of upgaze left eye

Moderate limitation of upgaze left eye

Button

After orbital fracture repair showing normal upgaze left eye

After orbital fracture repair showing normal upgaze left eye

Button

After orbital fracture repair

After orbital fracture repair


Left Orbital Blow-Out Fracture, Male, 9 years old

Button

Baseball to the left eye “White-Eyed” blow out fracture

Baseball to the left eye “White-Eyed” blow out fracture

Button

Severe limitation of upgaze left eye

Severe limitation of upgaze left eye

Button

After orbital fracture repair showing normal upgaze left eye

After orbital fracture repair showing normal upgaze left eye


Left Orbital Rim Fracture, Female, 6 years old

Button

Left orbital rim fracture

Left orbital rim fracture

Button

Coronal CT

Coronal CT

Button

Intraoperative photo

Intraoperative photo

Button

After left orbital rim fracture repair

After left orbital rim fracture repair


Left Orbital Floor Fracture, Male, 51 years old

Button

Left orbital floor fracture

Left orbital floor fracture

Button

Coronal CT

Coronal CT

Button

Intraoperative photo

Intraoperative photo

Button

After orbital fracture repair

After orbital fracture repair


Right Orbital Floor Fracture, Eyelid Laceration, Pupil Dilation, Male, 14 years old

Button

Right orbital floor fracture, laceration and pupil dilation

Right orbital floor fracture, laceration and pupil dilation

Button

Moderate limitation of upgaze right eye

Moderate limitation of upgaze right eye

Button

CT Scan showing small fracture with entrapment

CT Scan showing small fracture with entrapment

Button

After orbital fracture repair showing normal upgaze right eye

After orbital fracture repair showing normal upgaze right eye

Button

2 months after orbital fracture repair

2 months after orbital fracture repair


Left Superior Orbital Rim and Orbital Roof Fractures, Male, 44 years old

Button

Baseball to the left eye

Baseball to the left eye

Button

Repair using Titanium plate fixation

Repair using Titanium plate fixation

Button

Endoscopic view of orbital rim and roof fracture

Endoscopic view of orbital rim and roof fracture

Button

After orbital roof and rim fracture repair

After orbital roof and rim fracture repair


Right Orbital Floor Fracture, Male, 13 years old

Button

Right orbital floor fracture

Right orbital floor fracture

Button

Moderate limitation of upgaze right eye

Moderate limitation of upgaze right eye

Button

After orbital fracture repair

After orbital fracture repair


Right Orbital Floor Fracture, Female, 56 years old

Button

Right orbital floor fracture

Right orbital floor fracture

Button

Mild limitation of upgaze right eye

Mild limitation of upgaze right eye

Button

Coronal CT

Coronal CT

Button

Axial CT showing air behind globe

Axial CT showing air behind globe

Button

After orbital fracture repair showing normal upgaze right eye

After orbital fracture repair showing normal upgaze right eye

Button

After orbital fracture repair

After orbital fracture repair


Right Orbital Floor and Zygoma Fractures, Male, 53 years old

Button

Right orbital and zygoma fractures

Right orbital and zygoma fractures

Button

Coronal CT

Coronal CT

Button

Axial CT

Axial CT

Button

After orbital and zygoma fracture repair

After orbital and zygoma fracture repair


Right Orbital Floor Fracture, Male, 11 years old

Button

Right orbital floor fracture

Right orbital floor fracture

Button

Moderate limitation of upgaze right eye

Moderate limitation of upgaze right eye

Button

CT scan showing small fracture

CT scan showing small fracture

Button

After orbital fracture repair

After orbital fracture repair

All clinical photographs are actual patients of Dr. Klapper.

Corneal Abrasion in Adults: Condition, Treatments, and Pictures – Overview

53835
34

Information for
Adults

caption goes here…

Images of Corneal Abrasion

Overview

A corneal abrasion is a scratch or cut (abrasion) of the clear outer layer (cornea) of the eye. Injury (trauma) is the most common cause for corneal abrasions. The most common trauma causes are:

  • Scratches from fingernails (human and animal).
  • Foreign objects hitting the cornea (eg, dirt, wood splinters, metal shavings, plants, tree branches, etc).
  • Curling irons.
  • Excessive rubbing of the eye.
  • Overexposure to ultraviolet light.
  • Arc welding light exposure.
  • Over wearing of contact lenses.
  • Ill-fitting contact lenses.
  • Torn contact lenses.
  • Makeup brushes.
  • Paper cuts.
  • Chemical burns.
  • Irregular eyelashes rubbing the cornea or falling off into the eye.
  • A foreign object that gets caught under the eyelid, which then irritates the cornea each time you blink.

Other causes include underlying eye conditions, such as:

  • Inability to fully close the eyelids.
  • Abnormalities of the lid position.
  • Severe dry eye conditions.
  • Severe, chronic blepharitis (inflamed eyelids).

Who’s at risk?

Corneal abrasions are fairly common. Those who wear contact lenses or work in dusty, dirty, windy, or debris-laden areas are more likely to get a corneal abrasion.

Signs and Symptoms

Although it is very difficult to see a corneal abrasion with the naked eye, you have to be suspicious of this if you have experienced any of the causes of trauma mentioned above. Along with that is the unrelenting painful feeling that something is in your eye that just won’t wash out, plus:

  • Lots of watery tearing.
  • Sensitivity to light (especially bright light).
  • Blurry vision.
  • Redness of the eye.
  • Spasm of the muscles surrounding the eye resulting in squinting.

Self-Care Guidelines

Most simple corneal abrasions will heal on their own within a day or two at most. Other things that help include:

  • Keeping the eye shut.
  • Never rubbing the injured eye.
  • Immediately removing a contact lens. Contact lens wearers should always have a back-up pair of glasses for when contact lenses shouldn’t be worn.
  • Using artificial tears to bathe the eye.
  • Using clean water to rinse the eye and wash out suspect foreign matter.
  • Using sunglasses to reduce light sensitivity.

There are precautions that you can take to prevent getting a corneal abrasion. These include:

  • Wearing protective eyewear for all conditions that might result in a corneal abrasion, such as working around the garden, working on grinding machines, etc.
  • Being extra careful when using makeup brushes and curling irons.
  • Taking excellent care of and using excellent hygiene with contact lenses.
  • Never sleeping in contact lenses, regardless of manufacture notes.

Note:
If the corneal abrasion heals and then suddenly recurs days later, this may be a sign of recurrent erosion, which requires specific medical care by an eye care professional. Use of topical anesthetic solutions is only for purposes of diagnosis. Using these drops more than once or twice is dangerous because it slows healing and could lead to more serious conditions.

When to Seek Medical Care

  • Persistent pain beyond the first day or pain that is increasing despite self-care.
  • You suspect that a piece of metal, wood, or plant material hit the eye with high speed and may have penetrated the eye, not just irritated it.
  • Any abrasion caused by chemicals, heat burn, makeup brushes, or plant materials.
  • You suspect that a foreign object really is stuck in your eye.
  • Recurrence of the pain and other symptoms days after the initial injury.
  • Mucoid or pus-like discharge.
  • No improvement with self-care after 24 hours.
  • Progressive vision loss.

Treatments Your Physician May Prescribe

After assurance that there is nothing more serious than an abrasion, your doctor will most likely tightly patch the eye for a day or two after instilling an anesthetic drop and antibiotic ointment. Very tight patching is indicated for those abrasions that are felt to be essentially clean. Otherwise, patching may not be done. Your doctor may also clean and sweep (débride) the area of the abrasion to remove any possible dirty or contaminated tissue. If there is an underlying basis for the abrasion, care for this is needed to prevent recurrence. If the abrasion was contact-lens–related, you may be required to be reevaluated regarding your contact lenses as to fit and type. If the problem is recurrent erosion, your doctor will begin specific treatment for that condition.

Trusted Links

MedlinePlus: Corneal Disorders
MedlinePlus: Eye Injuries

Clinical Information and Differential Diagnosis of Corneal Abrasion

References

Yanoff M, Duker JS, eds. Ophthalmology. 2nd ed, pp. 415-416. St. Louis, MO: Mosby, 2004.

Firecracker eye injuries during Deepavali festival: A case series

Indian J Ophthalmol. 2010 Mar-Apr; 58(2): 157–159.

Ravi Kumar

Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India

Manohar Puttanna

Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India

K S Sriprakash

Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India

B L Sujatha Rathod

Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India

Venkatesh C Prabhakaran

Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India

Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India

Correspondence to: Dr. Kumar Ravi, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Chamrajpet, Bangalore – 02, India. E mail: [email protected]

Received 2009 Mar 4; Accepted 2009 Oct 16.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS). Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public education regarding proper use of firecrackers may help in reducing the incidence of ocular injuries.

Keywords: Deepavali, firework, firecracker injuries

Firecracker injuries can cause serious and irreparable damage to vision. In India, firecracker injuries are common during the festival of ‘Deepavali’ where traditionally, firecrackers form an essential part of the celebrations.

While a number of papers have dealt with firecracker injuries, very few large case series on this subject exist in literature.[1–3] We report a series of firecracker injuries seen during a single week to highlight the importance of firecrackers as a cause of ocular injuries in India.

Materials and Methods

This was a retrospective case series. All patients with firecracker injuries who attended the emergency eye care services of a tertiary eye care hospital in South India, during the ‘Deepavali’ festival week (from 26 October to 2 November 2008) were included in this study.

The patients underwent a detailed ocular examination. Ultrasonography (USG) A and B scans, Gonioscopy and fundus photography and X-ray orbit was done as and when indicated. The injuries were classified according to Birmingham eye trauma terminology system (BETTS) [].

Table 1

Glossary of terms used in classification of injuries

Open globe injury Full-thickness injury of the eye wall
Closed globe injury No full-thickness injury of the eye wall
Contusion A closed globe injury due to direct energy delivery to the eye wall, e.g. – Angle recession
Lamellar laceration Partial thickness injury of eye wall
Laceration Full-thickness injury of eye wall caused by a sharp object
Penetrating injury An open globe injury with an entrance wound
Perforating injury An open globe injury with an entrance and exit wound

Although patients with closed eye injuries were treated on an outpatient basis, most cases with open eye injury were advised admission for further management and observation. Admitted cases included patients with corneal and scleral tears, traumatic iridodialysis with hyphema, suspected intraocular foreign body (IOFB), and globe rupture.

Results

Of the 51 patients seen, 40 were males. The age range of these patients was 3 to 70 years (mean of 19 years). Thirty-one patients were less than 20 years of age. The most common cause of ocular injuries were bombs (37%), followed by sparklers (19%) []. Bottle rockets and bombs were responsible for the most serious ocular injuries observed in our patients.

Type of fireworks causing injury

Twenty-nine patients were onlookers and 22 patients were actively involved in igniting the firecrackers. None of the firecracker victims reported using any protective eye wear at the time of injury. The right eye was involved in 31 cases and left eye in 27 cases. According to the initial assessment of vision at the time of presentation to the hospital two eyes of two patients had no perception of light (PL negative), 13 eyes of 11 patients had visual acuity of hand movement to perception of light (PL positive) while eight patients had counting fingers to 20/200 vision []. Vision of five patients was not recorded (all were less than seven years of age and not cooperative for vision assessment at initial presentation). The distribution of severe eye injury (hand movement-PL negative) was nearly equal in bystanders and actively involved individuals. According to BETTS, nine cases were open globe injuries and 49 cases were closed globe injuries [Figs. –].

Initial visual acuity of the patients attending ocular emergency department; CF – counting finger, HM – Hand movement, PL – Perception of light

Distribution of eye trauma according to birmingham eye trauma terminology system

Clinical photograph of a patient with burn injuries due to firecrackers showing superficial lid burns, seething of eyelashes, limbal ischemia in the inferotemporal quadrant and melting of cornea. The cornea shows combined chemical and burn injury

Clinical photograph of a patient with an open globe penetrating firecracker injury. Patient underwent primary scleral tear repair

Clinical photograph of a patient with firecracker injuries showing soot particles over cornea following firecracker injury. Fluorescent staining showed extensive epithelial defect. Following treatment patient’s visual acuity improved from Snellen 20/200 to 20/40

In all, 10 patients were admitted to our hospital with firecracker injuries. All patients except one had visual acuity of hand movement or worse at the time of initial evaluation. Three of these patients underwent surgical repair for scleral tear. Two patients underwent surgery for corneoscleral tear repair. One patient required amniotic membrane graft and autologous serum drops for non-healing epithelial defects []. Visual outcome in all these cases was poor (three patients had no PL and two patients had only PL). One patient with total hyphema had visual recovery following anterior chamber wash from visual acuity of hand movements at presentation to 20/40 Snellen at discharge. Four others were treated conservatively as per the standard treatment protocol for ocular burns and chemical injuries.[4] Injured eyes were irrigated with copious amount of normal saline and particulate matter and soot particles were removed with forceps under local anesthesia; pH was monitored before and after ocular irrigation. Patients were prescribed antibiotic steroid eye drops (tapered after a week), lubricating solution and ointment and cycloplegic eye drops. Later, two patients underwent lid reconstruction for correction of cicatricial entropion.

Clinical photograph of a patient with firecracker injuries showing multiple superficial foreign bodies. This patient subsequently underwent amniotic membrane graft for nonhealing corneal ulcers

The average number of days of stay of admitted patients was seven days (median = six days). Though three patients ended up with no PL, most had a moderate visual recovery [].

Table 2

Visual outcome of 12 eyes of 10 admitted patients

Vision At admission (number of eyes) At discharge (number of eyes)
>20/40 0 2
20/40 – 20/200 1 2
<20/200 – CF 1 2
HM+ 5 1
PL+ 4 2
PL− 1 3

Discussion

This study was a hospital-based, single-center, retrospective case series of firecracker injuries. [3,5–8] The injuries reported ranged from conjunctival or corneal burns to globe rupture with interventions ranging from ocular wash to repair of globe perforation. Most of the patients were below the age of 20 years. Unlike the findings in some studies where victims were mostly those who were actively involved in igniting the firecracker, more than half of the victims in our study were bystanders.[7,9,10] The most common firecracker causing injury in our study were bombs followed by sparklers and homemade devices. Even though sparklers were reported to cause minimal injuries in one of the studies, were not found to be innocent in our study.[5] Most bottle rocket injuries were of a serious nature.

Many of the injuries were caused as a result of negligence of those igniting the firecrackers. Some of the severely injured patients reported device malfunction as the cause of their injury. In three cases, the attempt to reignite or recover a failed device was the cause of injury. In one instance, the patient suffered severe facial and bilateral ocular injuries when he attempted to ignite a homemade device made up of unburnt firecracker powder [].

Ocular injuries by firecrackers are common during ‘Deepavali’. Lack of knowledge about safety measures or not following them was a reason for eventualities. Absence of parental supervision, and failure to maintain safe distance from firecrackers were contributory in some cases of injuries. The other major cause of injury is the common practice of igniting firecrackers in the streets thus exposing passersby to injury.

The fact that so many cases were seen in a single center highlights the enormous health importance of regulating firecracker use and enforcing safety precautions. The single most effective measure may be to restrict the fireworks to public open spaces (such as parks or playgrounds). Regulating the quality of firecrackers and promoting safe use via schools and media will also have a positive impact.

References

1. Kuhn FC, Morris RC, Witherspoon DC, Mann L, Mester V, Modes L, et al. Serious fireworks-related eye injuries. Ophthalmic Epidemiol. 2000;7:85–6. [Google Scholar]3. Arya SK, Malhotra S, Dhir SP, Sood S. Ocular fireworks injuries. Clinical features and visual outcome. Indian J Ophthalmol. 2001;49:189–190. [PubMed] [Google Scholar]4. Shingleton BJ, Hersh PS, Kenyon KR. Eye trauma, part 2. St Louis: MO: Mosby Year Book; 1991. pp. 63–184. [Google Scholar]5. Puri V, Mahendru S, Rana R, Deshpande M. Firework injuries: A ten-year study. J Plast Reconstr Aesthet Surg. 2008;62:1103–11. [PubMed] [Google Scholar]6. Sacu S, Segur-Eitz N, Stenng K, Zehetmayer M. Ocular firework injuries at New year’s eve. Ophthalmologica. 2002;216:55–9. [PubMed] [Google Scholar]7. Witsaman RJ, Comstock RD, Smith GA. Pediatric fireworks related injuries in the United States: 1990-2003. Pediatrics. 2006;118:296–303. [PubMed] [Google Scholar]8. Smith GA, Knapp JF, Barnett TM, Shields BJ. The rockets’ red glare, the bombs bursting in the air: Fireworks related injuries to children. Pediatrics. 1996;98:1–9. [PubMed] [Google Scholar]9. Vassilia K, Eleni P, Dimitrios T. Firework related injuries in Greece: A national problem. Burns. 2004;30:151–3. [PubMed] [Google Scholar]10. Mansouri MR, Mohammadi SF, Hatef E, Rahbari H, Khazanehdari MS, Zandi P, et al. The Persian Wednesday Eve Festival “Charshanbe-Soori” Fireworks Eye Injuries: A Case Series. Ophthalmic Epidemiol. 2007;14:17–24. [PubMed] [Google Scholar]

Top 5 Causes & When to Call 911

It’s enough to make you want to blink, just thinking about it. A baseball comes sailing right at your eye. Or you accidentally splash drain cleaner and a bit gets into your eye. And just like that, you have an eye injury.

The delicate tissues inside and around your eye need protection and TLC. Find out what causes most eye injuries, and how to prevent them.

Blow to the Eye

A strike to the eye with a hard object like a baseball, rock, or fist can damage the eye, eyelids, and muscles or bones that surround the eye.

If the injury is mild, you may get a swollen eyelid or black eye. If it’s more severe, you might also notice bleeding inside the eye.

If you’re hit hard enough, it could break the bones around your eye. Sometimes the eye muscles get trapped inside the broken bone, and will need to be freed with surgery.

Cut or Scratch

A stick, finger, or other object can accidentally get into your eye and scratch the cornea, the clear dome-like cover over your eye. A scratch can cause symptoms like:

Small scratches usually heal on their own. Deeper injuries can cause long-term vision problems.

Object in the Eye

Grains of sand, wood chips, metal shavings, or slivers of glass can get into the eye. A sharp object inside your eye can scratch or cut your cornea.

Having something in your eye will feel uncomfortable and it might make your eye water. When the cornea is scratched, it will feel like something is inside your eye and you can’t get it out.

Chemical Burns

It’s common to get soap, shampoo, or makeup in your eyes. While these might burn a little bit, flushing out your eyes with water should help.

Certain chemicals can cause very serious burns inside your eyes. Among the most dangerous chemicals are alkalis, such as oven or drain cleaners and fertilizers. They attack the tissues of the eye very quickly and cause damage or even blindness. Acids like bleach and swimming pool chemicals can also cause injury, but aren’t as harmful. Vapors from chemicals can cause irritation.

The amount of damage depends on the chemical, how long it’s in the eye, and how deep inside it went. The best way to treat a chemical burn is to flush out the eye with cool water for at least 15 minutes. Then get medical help.

Radiation

The sun’s ultraviolet, or UV, rays can burn your eyes, just like they can burn your skin. Signs that you’ve been exposed to too much UV radiation are red eyes, light sensitivity, tearing, and a feeling like something is in your eyes.

In the long run, too much sun and other forms of radiation can make you more likely to get cataracts or macular degeneration, a breakdown of a small area of the retina.

When to Call a Doctor

You can treat lots of minor eye injuries on your own. A deep cut and injuries associated with a loss of vision, pain, or broken bone need medical help. Also see a doctor for anything sharp in your eye, like a piece of metal or glass.

Call your doctor if you have any of these signs of a more serious eye injury:

  • A noticeable change in vision
  • Swelling in the eye
  • Double vision
  • Severe pain
  • Torn eyelid
  • Deep ache around the eye and brow
  • Headache

When to Call 911

Go to an emergency room or call 911 right away if:

  • A piece of metal, glass, or other object is stuck in your eye
  • A chemical got into your eye, and the pain didn’t go away after you flushed the eye with water

How to Protect Your Eyes and Prevent Injuries

The best way to protect your eyes is to wear safety glasses or goggles whenever you work with chemicals or are around metal, glass, or other objects that could fly into your eyes. Also put on safety glasses when you use tools like a lawnmower, trimmer, or leaf blower.

Eye guards are a must for sports like squash and racquetball. If you play baseball or football, protect your eyes with a shield attached to your helmet.

Other ways to guard against eye injuries:

  • Remove small rocks and other debris from your lawn before you mow, so your lawnmower doesn’t kick them up into your eyes.
  • Fix or replace any tools or equipment that might break apart while you use them.
  • Read the instructions before using chemicals like fertilizer or cleaning products. Never mix chemicals unless the label says to do so.
  • Use machine guards and work screens while working with equipment on the job.
  • When you go outside, wear sunglasses that block out 99% to 100% of the sun’s radiation.

Andrea J. Stein, OD: Optometrist

Have you ever scratched your eye or splashed it with a chemical and wondered if you needed emergency care? A quick Google search may say to call your eye doctor, while another search may recommend flushing your eye with cool water.

At Eye See Ravenswood, we understand the worry and frustration that can occur when you have an eye emergency. That’s why we’re here to help you learn when your eye injury is an emergency and when to seek care.

Symptoms of an eye injury

We recommend seeking immediate medical attention anytime you experience swelling, redness, or pain in your eye, especially if it occurs after an injury or having a foreign object or chemical in your eye. When left untreated, these injuries can damage your eye even more, leading to partial and/or permanent blindness.

If you’ve injured your eye and experience symptoms, you may also need emergency eye care. While not all eye injuries require emergency care, we suggest seeking immediate medical attention if you have:

  • Vision loss
  • Different size pupils
  • Double vision
  • Bleeding from the eye
  • Swelling
  • Eye pain that doesn’t lessen on its own
  • Eye pain accompanied by a headache

Some eye scratches may also need medical care. If you think you’ve scratched your eye but you don’t know with what, don’t rub it, which can make your scratch worse. Instead, try rapidly blinking your eye to see if you can remove the debris.

Wash your hands and look in your eye to see if you can find anything. Look under both your bottom and top lid (use a cotton swab to flip your upper lid and allow you to see underneath it). Opt for artificial tear eyedrops to flush your eye and rinse away any foreign object. If this doesn’t solve your problem, seek emergency eye care.

Specific eye injuries that require emergency care

With certain eye injuries, it doesn’t matter what type of symptoms you’re having — you should seek emergency medical attention. For instance, if you have glass, metal, or plastic enter your eye at high speeds, it can become stuck in your eye. Do not remove it on your own, and try to keep eye movement to a minimum. Leave the object in place and head to your closest emergency center.

If you get a harsh chemical in your eye, we recommend the following:

  • Wash your hands before looking at your eye
  • Turn your head to the side so your injured eye is down
  • Hold open the eyelid and rinse the eye with cool tap water for 15 minutes
  • Remove your contacts
  • Head to the closest emergency room or urgent care
  • Continue flushing your eye while you wait to see the doctor

Anytime the eye or the skin surrounding the eye receives a blow or gets cut, you should seek emergency medical care. Use a clean cloth to cover your eyes until you can see the doctor.

Avoid further eye damage

Once your eye is injured, it’s important that you don’t do further damage. Some important things to avoid include:

  • Rubbing your injured eye
  • Taking out your contacts unless you experience rapid swelling or a chemical injury
  • Removing a foreign object that’s embedded in your eye
  • Using tweezers or cotton swabs directly on your eye

Many eye emergencies can be treated with little lasting effect, but you must seek medical attention right away. When left untreated, some eye injuries can lead to permanent damage, including blindness.

For more information or to schedule an appointment with Dr. Andrea J. Stein at Eye See Ravenswood, call us or book an appointment online.

Pathology of the fundus

Age-related macular degeneration

Age-related macular degeneration is one of the leading causes of central vision loss in the adult population. An increase in the life expectancy of people and an improvement in the quality of diagnostics brings this disease to the first place among the causes of persistent decrease in vision.

The causes of the onset and progression of this disease are still not well understood and at present all the efforts of doctors are directed only to stabilizing the pathological process and visual functions.

The disease includes a set of age-related pathological changes in the central retinal zone, which can be subdivided into stages or forms. Various treatments are offered depending on the form and course of AMD. All methods of treating AMD are based on early and accurate diagnosis, therefore, in the early stages of the disease, adequate treatment can stop the progression and prolong the vigorous activity associated with the writing and reading of our patients for years.

Non-exudative forms of AMD are the initial stage of the disease, the period of precursors. As a rule, there is no decrease in visual function. At this stage, follow-up, antioxidants and retinoprotectors in the form of nutritional supplements are important.

Atrophic forms of AMD develop slowly, but inevitably lead to loss of central vision. As a rule, the disease is found in both eyes, possibly with varying degrees of severity. Currently, periodic courses of vascular and retinoprotective (improving nutrition of the retina) treatment are carried out as a treatment.Patients are advised to wear sunglasses outdoors.

Exudative forms of AMD are characterized by a severe course and a sharp decrease in vision. At first, before the loss of central vision, patients notice the curvature of the contours of objects, straight lines, and text. It is more and more difficult to do small work at a distance from the eyes (sewing, knitting, reading and writing). The reason lies in the rapid growth and high activity of the newly formed vessels located under the retina. Newly formed vessels have a thin permeable wall, which ultimately leads to the appearance of edema (accumulation of fluid under the retina) and hemorrhage in the central area of ​​the retina. In the final stage of AMD, there is a loss of central visual functions due to the development of atrophy or scarring, peripheral vision, as a rule, remains unaffected. All efforts in the treatment of exudative AMD are aimed at combating newly formed vessels. Currently, the use of anti-VEGF drugs is widely used.

Epiretinal macular fibrosis

Epiretinal macular fibrosis can be both a primary retinal disease and a consequence (complication) of other eye diseases (inflammatory, vascular, trauma, etc.)etc.).

Most often, primary epiretinal macular fibrosis occurs after 50 years, but recently there has been a tendency towards “rejuvenation”. The disease begins with the appearance of a membrane (thin film) on the surface of the retina, usually in or near the central zone. Shrinking the membrane causes wrinkling and deformation of the underlying retina, and as the membrane thickens, pronounced deformation and even partial flat retinal detachment occurs.

At the initial stages of development, epiretinal fibrosis is asymptomatic. This condition does not require intervention, dynamic observation is sufficient. As the progression progresses, there may be a curvature of the outlines of objects and straight lines and a noticeable decrease in visual acuity. In such cases, it is advisable to carry out a surgical intervention – separation and removal of the membrane.

In rare cases, the membrane can peel off on its own, which leads to the disappearance of all symptoms.

Idiopathic macular rupture

Idiopathic macular rupture is a penetrating tissue defect in the center of the retina.Typically occurs over the age of 60. The reason lies in the traction of the detached posterior hyaloid membrane fixed to the center of the retina. The disease develops in stages, and in the early stages it is asymptomatic. In later stages, the patient will notice a black spot in front of the eye, often discovered by accident when the healthy eye is closed. Peripheral vision is not affected. To make a diagnosis, often only an examination of the retina is sufficient; optical coherence tomography may be required to document the diagnosis and clarify the stage. At the first stage of the disease – the threat of the formation of a macular hole – no treatment is carried out, since at this stage a spontaneous reverse development can occur. At later stages, surgical intervention is indicated – posterior vitrectomy with the elimination of the traction factor.

Central serous chorioretinopathy

This is a common fundus pathology, affecting mainly young patients. This disease is idiopathic and so far, much in the causes and development of this disease remains unclear.Vision is usually not severely affected. Patients often complain of blurred vision in one eye, the appearance of curvature of objects and straight lines. Diagnostics does not present any difficulties, however, fluorescence angiography is indicated to determine the further tactics of treating the patient. It depends on the results of this examination whether you will be offered simply observation and conservative treatment, laser treatment or intravitrial administration of an anti-VEGF drug.

Diabetic rhinopathy

Damage to the organ of vision in diabetes mellitus occupies a special place, since it significantly affects the quality of life of people.Moreover, of all the clinical manifestations of diabetic eye damage, the greatest danger is retinopathy, being the main cause of progressive and irreversible visual impairment up to blindness, which occurs in diabetic patients 25 times more often than in the general population.

The main factor in the development and progression of DR is chronic hyperglycemia, i.e. high sugar levels.

Currently, in most European countries, a classification is used, according to which there are three main forms of retinopathy:

  • non-proliferative retinopathy;
  • preproliferative retinopathy;
  • proliferative retinopathy.


The decrease in visual acuity in diabetic retinal lesions occurs as a result of three reasons. First, due to the presence of maculopathy (retinal edema in the central zone), central vision may suffer. Secondly, at the stage of proliferative retinopathy, hemorrhages that arise from newly formed vessels cause a sharp deterioration in vision. Third, the formation, proliferation and contraction of fibrovascular tissue leads to tractional retinal detachment, resulting in severe and often irreversible loss of vision.

Timely identification of the earliest manifestations of eye diabetes is a top priority, since treatment is not promising in the later stages of the process.

However, at the initial stages of eye diabetes, pathological changes in the retina are not accompanied by visual disturbances, therefore, patients themselves seek medical help, as a rule, late. In this regard, great responsibility is placed on the work of the dispensary ophthalmological observation and on the shoulders of the patient himself, whose serious attitude and responsible approach will help to reduce the existing risk of loss of vision in eye diabetes.


There are two main directions in the treatment of diabetic retinal lesions:

Maximum stable compensation of diabetes mellitus and direct treatment of diabetic retinopathy.

Retinal laser coagulation is the only effective treatment for diabetic retinopathy. Laser coagulation in diabetic retinal lesions is aimed at stabilizing the process, and an increase in visual acuity is not always achieved. In severe proliferative retinopathy with the development of recurrent vitreous hemorrhages and tractional retinal detachment, laser coagulation is futile.In such cases, surgical treatment may be indicated – vitrectomy.

In case of persistent maculopathy, intravitrial anti-VEGF drug regimens are being developed.

Retinitis Coates

Coats disease is a congenital disorder that typically occurs during childhood in boys and affects one eye. Most cases are diagnosed before age 20, with a peak detection rate at the end of the first decade.

The reason for treatment may be squint, leukocoria, or a red sore eye in a distant form.Older children and less often adults may complain of decreased visual acuity in one eye.

The diagnosis is usually made by examining the fundus – cycloscopy may sometimes require fluorescence angiography.

In mild cases of the disease, dynamic observation is sufficient – examinations every six months. With a progressive course, numerous repeated sessions of laser coagulation are shown and more careful observation is required, since relapses of the disease are possible within 5 years after complete regression.At a far advanced stage of the disease with the development of retinal detachment, surgical treatment is indicated.

Eales’ disease

The disease has been known since 1880, when the occurrence of repeated hemorrhages in the vitreous humor in young people against the background of complete health was first described.

Eales disease is a chronic inflammation of the retinal peripheral vessels, accompanied by repeated hemorrhages and a gradual decrease in vision. The disease mainly affects middle-aged males and is usually bilateral.

Patients complain about the appearance of floating “flies” or a decrease in visual acuity in one eye. In severe cases, repeated hemorrhages lead to traction retinal detachment and secondary neovascular glaucoma.

There is no medical treatment for Eales disease. Hormone therapy is usually not effective. The only effective method of treatment is a timely laser coagulation of the retina, which allows stabilizing the pathological process and preserving the remaining vision.

In some cases, when a retinal detachment occurs, it becomes necessary to carry out surgical treatment.

Fundus examination – cycloscopy should be performed annually. A case of relapse of the disease tens of years after the apparent stabilization of the process is described.

Thrombosis of the central retinal vein or its branches

This condition is an acute circulatory disorder in the central retinal vein or its branches, which threatens with irreversible loss of vision.

The disease usually occurs in people over 50 years old with arterial hypertension, diabetes mellitus, atherosclerosis, thrombophilia and other blood diseases.

Usually, patients notice a unilateral painless sharp decrease in vision, which occurs against the background of high blood pressure, after physical or emotional stress, after overheating, and drinking alcohol. Typically, patients can clearly indicate when their vision has decreased. Depending on the localization of the process, there may be complaints about the appearance of a spot in front of the eye, the appearance or increase of floating “flies”, loss of visual fields, distortion of the contours of objects.

Treatment should be started immediately. This is an emergency condition that requires urgent hospitalization. The best effect will be observed with timely and comprehensive treatment of the patient, the prognosis for vision will largely depend on visual acuity during treatment. To dissolve a blood clot that occludes a vein, thrombolytic drugs are used, which are effective only in the first seven days from the onset of the disease. In the future, there will be no effect from their use.

Another area of ​​complex treatment is the maximum reduction in intraocular pressure, resorption therapy and antioxidants.In the presence of diffuse edema in the center of the retina, the question of performing lattice laser coagulation is resolved. Recently, intravitrial administration of an anti-VEGF drug has been successfully used as a method of treating macular edema.

With the threat of the appearance of newly formed vessels as a result of prolonged retinal ischemia and the development of neovascular glaucoma, as a complication of central retinal vein thrombosis, panretinal laser coagulation of the retina should be performed, which is carried out in several sessions.The goal of laser treatment is not to improve visual function, but to prevent the development of neovascular glaucoma.

Occlusion of the central retinal artery

The disease is an acute blockage of blood circulation in the central retinal artery by a thrombus. It usually occurs in people over 60 years of age. The development of this disease is based on various reasons, the main ones are:

  • arterial hypertension;
  • atherosclerosis;
  • heart valve pathology;
  • tumors;
  • 90,049 eye injuries;

  • systemic diseases.


As a rule, patients notice acute unilateral and painless vision loss that develops within a few seconds. Sometimes, episodes of transient loss of vision are observed before complete loss of vision.

The prognosis for vision in the future is usually unfavorable. In most cases, visual acuity remains at the level of light perception. An exception is in the case of additional blood supply to the region of the central fossa of the retina of the cilioretinal artery, when visual acuity can be restored to the initial one, but nevertheless there are significant losses in the fields of vision.

There is no proven treatment for visual acuity, but it is an ophthalmic emergency and, in theory, timely displacement of a blood clot can prevent the development of irreversible changes in vision. Attempts to dislodge the clot make sense in the first 48 hours after the onset of the disease. Therefore, in this case, it is necessary to urgently turn to an ophthalmologist for help, and at the stage of first aid, massage the eyeball, the purpose of which is to first cause a collapse of the vessel lumen, and then sharply expand it. If necessary, the patient can massage the eyeball on his own using the following technique.

  1. The patient’s head should lie low to avoid orthostatic relative impairment of the blood supply to the retina.
  2. With the fingers of the hand, press through the closed eyelid onto the eyeball.
  3. The eyeball is pressed into the orbit at first weakly, then with reinforcement, and after 3-5 seconds it is suddenly released.
  4. After a few seconds, the process is repeated.
Anterior and posterior ischemic neuropathy

The disease most common in older people.It is based on partial or complete infarction of the optic nerve head or its retrolamillar part, caused by occlusion of the vessels supplying the optic nerve.

Risk factors for development are arterial hypertension, diabetes mellitus, hypercholesterolemia, collagenosis, antiphospholipid syndrome, hyperhomocysteinemia, sudden hypotensive states, etc.

The onset of the disease is most often manifested by a sudden unilateral loss or significant decrease in vision without any previous visual impairment.Decreased vision is usually detected upon awakening, suggesting a possible association with nocturnal hypotension.

Medical care is aimed at restoring and improving blood circulation in the system feeding the optic nerve and preventing the development of complete atrophy of the optic nerve.

Stagnant disc of the optic nerve

The stagnant optic disc is characterized by edema that develops against the background of increased intracranial pressure. A stagnant disc is almost always bilateral.Usually, visual impairment manifests itself only at the stage of optic nerve atrophy (distant), therefore, a congested optic nerve head is often a diagnostic finding during an examination by an ophthalmologist.

The clinical manifestations of increased intracranial pressure can be headache, sudden nausea and vomiting, impaired consciousness, transient episodes of blurred vision, and double vision.

Reasons for increased intracranial pressure:

  • Ventricular obstruction (congenital or acquired)
  • Volumetric intracranial lesions, including hematomas
  • Meningitis, subarachnoid hemorrhage, previous trauma accompanied by diffuse cerebral edema
  • Severe systemic arterial hypertension
  • Idiopathic intracranial hypertension
  • Hypersecretion of cerebrospinal fluid by a tumor of the vascular plexus of the brain.


All patients with congestive discs should be evaluated by a neuropathologist and neurosurgeon to exclude intracranial lesions.

Optic neuritis

Optic neuritis is damage to the optic nerve due to an inflammatory, infectious or demyelinating process.

Demyelinating neuritis occurs most frequently in multiple sclerosis. The onset of the disease is manifested by a subacute unilateral decrease in vision.Sometimes reduced vision is accompanied by dotted white or colored flashes or sparks. Pain with eye movement or discomfort is common, preceding reduced vision and usually lasting for several days. In most cases, defects appear in the field of vision.

Deterioration of visual functions lasts from several days to two weeks; further, the restoration of vision occurs within six months. With repeated attacks, optic nerve atrophy develops.

Despite the fact that some patients with optic neuritis do not have signs of clinically detectable systemic demyelinating disease, the following series of observations indicate a close relationship of optic neuritis with multiple sclerosis.

In patients with optic neuritis and an initially normal MRI picture of the brain, the risk of developing multiple sclerosis over the next 5 years is 16%, and in patients with established multiple sclerosis, optic neuritis develops in 70% of cases.

Considering all of the above, when making a diagnosis of optic neuritis, the doctor will definitely refer you to an MRI of the brain.

The proposed treatment with hormonal drugs and interferon allows you to accelerate recovery up to 2-3 weeks.However, the treatment does not affect the final visual acuity.

Optic neuritis in infectious diseases is much less common. The cause may be diseases of the paranasal sinuses. This neuritis is characterized by recurrent episodes of unilateral vision loss, severe headaches, and signs of sinusitis. In this case, treatment is carried out in conjunction with an otolaryngologist. Therapy is local and systemic use of antibiotics.

The main cause of parainfectious optic neuritis is a viral infection.In addition, it can develop after vaccination. In children, this form of neuritis is much more common than in adults. The disease usually develops 1-3 weeks after a viral infection and decreased vision is accompanied by neurological symptoms (headache, attaxia).

Treatment, as a rule, is not required due to a favorable prognosis, which implies a rapid restoration of visual functions. However, with severe or bilateral lesions, hormone therapy is indicated.

Chorioretinal inflammatory diseases (chorioretinitis)

The causes of chorioretinitis can be infectious and non-infectious.

Toxoplasmosis is the most common infectious cause of chorioretinitis. The causative agent of the disease is an intracellular parasite that lives in the intestines of cats.

Most often, the disease is detected in young, healthy adults who come to the doctor with complaints of decreased vision and floating opacities in front of the eye, photophobia. With the localization of the focus of inflammation in the central zone of the retina, central vision suffers significantly.

In addition to toxoplasmosis, the infectious cause of chorioretinitis can be: toxocariasis, cytomegalovirus, herpes virus, secondary syphilis, candidiasis, histoplasmosis, tuberculosis.

With a reliably established diagnosis, confirmed by laboratory research methods, treatment is carried out by an infectious disease specialist.

Hereditary degenerative and degenerative diseases of the retina

Retinitis pigmentosa is a group of hereditary degenerative diseases of the retina, characterized by subjective night blindness and loss of peripheral vision. Almost a quarter of all patients retain high visual acuity and the ability to read throughout their lives.However, an annual check-up is needed to detect a significant drop in visual acuity that can be caused by a potentially treatable cause such as cystic macular edema or cataracts.

Stargardt’s disease is the most common form of genetically inherited retinal dystrophy that occurs during adolescence. The onset of the disease occurs at the age of 10-20 years. There is a bilateral gradual decrease in central vision. Most patients maintain average visual acuity in at least one eye.

Best’s disease is a rare hereditary degenerative disease of the retina. The disease usually progresses slowly, going through five stages and ends with macular atrophy with loss of central vision. In general, the prognosis is good, as most patients retain sufficient reading vision in at least one eye throughout their lives. If it has a pronounced decrease in vision, it usually happens slowly and begins after 40 years.

Albinism is a group of genetically inherited diseases, which are based on a violation of the synthesis of the pigment melanin and which can be characterized by either isolated ocular damage (ocular albinism) or systemic damage to the eyes, skin and hair.


Important clinical signs are

  • Low visual acuity
  • Pendulum horizontal nystagmus
  • Red tint of the iris.

There is no pathogenetically substantiated treatment for hereditary retinal diseases. There is an opinion and several experimental clinical studies indicating the positive dynamics and stabilization of the degenerative process of the retina with the periodic use of drugs – tissue bioregulators.

Retinal detachment

This is the separation of the retina from the underlying layer of the pigment epithelium. The main types of retinal detachment: rhegmatogenous, exudative, traction.

Rhegmatogenous retinal detachment occurs a second time against the background of a through retinal rupture, as a result of which fluid from the vitreous body enters under the retina. Retinal tears are common and occur more often with myopia, pseudophakia, and after trauma. In many cases, tears are bilateral and multiple, occur against the background of degenerative anomalies, developmental abnormalities and injuries.

Many breaks are asymptomatic; sometimes breaks appear as floating cloudiness in front of the eye and flashes of light without affecting visual acuity. However, if retinal detachment develops, a progressive loss of visual field occurs.

About 60% of all ruptures occur against the background of specific changes – peripheral degenerations. These are pathologically thin areas of the retina in which breaks form spontaneously. Peripheral retinal degeneration, predisposing to retinal detachment (lattice, “snail trace”, degenerative retinoschisis), as well as breaks, are subject to laser coagulation in order to prevent rhematogenous retinal detachment.

Rheumatogenic detachments are subject to surgical treatment, and the postoperative prognosis for vision depends on the duration of the disease and the extent of the detachment. If the retinal detachment does not cover the central (macular) zone and is fresh, the postoperative prognosis for visual restoration is relatively high.

Exudative retinal detachment is retinal detachment due to intraretinal or subretinal fluid leakage. By definition, such detachment is not associated with retinal tear.Look for signs of an underlying cause of fluid exudation, such as inflammation, vascular changes, or swelling. Depending on the causes of exudation, etiopathogenetic treatment is used.

The main causes of tractional retinal detachment are: proliferative diabetic retinopathy, retinopathy of prematurity, penetrating trauma of the posterior segment of the eye. This is the most severe complication of the underlying disease, leading to blindness. In such cases, surgical treatment is indicated.

90,000 Treatment of astigmatism – diagnosis and prevention

Stock! Discount 20% on the first appointment for new patients of the clinic with the promo code “FIRST20”.

A common ophthalmic pathology (to a small extent it is found in 25% of people) – astigmatism. We will tell you the main thing about the disease, how to detect, treat and avoid it.

Astigmatism – Main

The human eye has the shape of a sphere.The light beam hits the retina through the cornea and lens. To see the object clearly (at a distance or near), the degree of convexity of the lens changes, and the light beam is focused directly into the center of the retina.

In astigmatism, the shape of the lens is not a uniformly rounded sphere, but with a curvature or bulge that changes in different areas. Passing through such an optical lens, the light beam does not hit the center of the retina, and the visible objects are partially distorted, they are indistinct, in the form of a “figure eight” or flat.A rough understanding of how a person with astigmatism sees is giving a reflected image from an uneven surface (for example, an oval metal spoon).

Astigmatism is a problem with focusing vision. Each eye, instead of one focus, may have several, and all of them are not in the center of the retina (as it should be normal).

Classification

Astigmatism is divided into corneal and lens types, depending on where the distortion occurs.

To choose the optimal method of treating eye astigmatism, it is important to understand such an indicator as the degree of astigmatism:

  • Weak – visual impairment within 3 D (diopters).In this case, the symptoms are barely noticeable to a person, and the patient learns about the diagnosis from an ophthalmologist after examinations.
  • Medium – from three to six. With it, vision is already noticeably worse than it should be normal. The image is indistinct, there are curvatures of straight lines and shapes of objects.
  • High – over six diopters. This is not only a significant deterioration in vision, but also additional symptoms due to constant eye strain. The patient complains of headaches, eye fatigue, discomfort in them.

Classify astigmatism and because of development:

  • Congenital – to a small extent (up to 0.5 diopters) is present in most children and can be considered functional. It does not significantly reduce visual acuity and does not require correction. Astigmatism exceeding 1 D needs to be corrected because it impairs vision clarity.
  • Acquired – the result from the consequences of operations and injuries on the cornea and other causes.

Pathology is often combined with myopia or hyperopia.This astigmatism is called myopic or hyperopic.

Causes

The main causes of astigmatism:

  • Congenital anomalies of the cornea or lens.
  • Injuries to the eye.
  • Age-related changes in which the lens ligaments weaken.
  • Complications from glaucoma and cataracts.
  • Pathology of the teeth and upper jaw, which led to deformation of the shape of the orbit.

Symptoms

The following symptoms should induce an adult to be examined and suspect astigmatism:

  • Blurred vision.
  • The fall of its sharpness.
  • Lachrymation.
  • Frequent pain in the forehead and temples after eye strain.
  • Forced squinting to examine objects.

It is more difficult to identify congenital astigmatism in children – they cannot say about visual impairment, because they do not know how it should be normal. Parents should pay attention to the child’s refusal to read or view pictures, complaints of headaches, dizziness after reading.

Diagnostics

To identify astigmatic changes, to classify the disease will help skiascopy or retinoscopy – a shadow test. It is performed with dilated pupils in a dark room. With the manual method of checking, the ophthalmologist at the appointment assesses the shadow to the patient’s eye using a system of mirrors and lenses. A more modern version of the examination is done using computer diagnostic systems. The pain-free method, slight discomfort and time restrictions after the procedure can be caused by the use of eye drops that dilate the pupil.

For a more complete assessment of the eye, other diagnostic methods can be used:

Treatment methods

Vision correction for astigmatism is possible in two ways:

  • Spectacle correction – wearing glasses with specially selected cylindrical lenses for each eye. With a high degree of pathology, at first the patient may be uncomfortable in them – they are worried about headaches, discomfort in the eyes.
  • Contact lenses – soft toric lenses or rigid gas permeable lenses.

When prescribing lenses and glasses, the patient must periodically repeat the examination by a doctor in order to track changes and change corrective devices to weaker or stronger ones. How often a doctor’s consultation is needed is an individual question; on average, it is recommended to visit an ophthalmologist every 3-6 months.

Laser correction can also help in the treatment of astigmatism. However, its use is limited by an insignificant degree of astigmatism (up to 3 diopters), the patient’s age (from 18 years) and other factors.

The best prevention of astigmatism – periodic examination of vision by a doctor for the timely detection and correction of violations.

A large list of ophthalmological services – from comprehensive examinations to prescribing conservative methods of treatment – is offered by the Kutuzovsky Medical and Diagnostic Center.

We work seven days a week at the address: Davydkovskaya street, 5. Consultation on the cost of clinic services and make an appointment by calling the call center: +7 (495) 478-10-03.

The clinic also has a convenient comprehensive vision test program – “Ophthalmological Check Up”. Based on the diagnostic results obtained, the optometrist selects the required lenses.

Prices

Name

Price

Appointment (examination, consultation) of an ophthalmologist, primary 1 750 ₽
Appointment (examination, consultation) of an ophthalmologist repeated 1 550 ₽

Publication checked by:

Ophthalmology “Oculus”

Contents of the article:

  • Causes of sparks in the eyes
  • Treatment

Sparks, or flickering white dots in front of the eyes are an important sign of abnormalities in the functioning of the retina.

If you notice that a large number of whitish or yellowish dots appear in your eyes from time to time, this is a manifestation of the symptom of sparks. They are clearly visible in bright sun or intense light, when looking at a very light background.

Causes of sparks in the eyes

  • Destructive changes in the vitreous – the patient sees floating spots of various sizes and shapes.
  • Detachment of the vitreous body – Progresses after 50 years of age due to shrinkage of this structure and retinal tension.The symptom appears during the motor activity of the eyes.
  • Vascular spasms due to such common pathologies as hypertensive pathology and diabetes mellitus.
  • Ruptures of the retina with damage to its tissues. May be accompanied by haemorrhage, blurred vision, and hazy veil around the eye. This dangerous condition requires an urgent visit to the clinic to prevent retinal detachment.
  • Detachment of the retina – Symptoms listed above are worse, sparks become reddish or dark, vision deteriorates rapidly.
  • Injuries to the eye and head is a familiar term for “sparks from the eyes”. The symptom is especially pronounced when it hits the back of the head, because it is there that the visual centers are located.
  • Tumors of the eyeball can also be accompanied by sparkling spots.

The sensation of sparks appears when pressing on the organ of vision. The glowing spot resembling a spark disappears immediately after the end of the mechanical action.

Treatment

Since sparks from the eyes are an important symptom of diseases, including those dangerous to the visual apparatus, if they are present, you should consult your doctor.

Treatment will address the cause.

Be careful if this symptom appears after severe stress or heavy exertion – this can provoke tearing and detachment of the retina.

90,000 Retinal detachment: causes, symptoms, treatment

There are various eye diseases. But when it comes to retinal detachment, many of us immediately diagnose ourselves: that’s it, this is definitely a loss of vision. However, modern medicine has learned to deal with this pathology, including with the help of a laser.Moreover, the disease can be prevented. We are talking about this with Elena Valerievna Burlakova, an ophthalmologist “Clinic Expert” Irkutsk.

– Elena Valerievna, what is a retinal detachment?

– This is a disease in which fluid appears under the retina, or rather between the pigment epithelium and the neuroepithelium. It can be either a transudate, a non-inflammatory fluid that comes from the vitreous, or an exudate, an inflammatory fluid that accumulates under the retina when inflammation begins inside the eye.

Retinal detachment

– What are the causes of retinal detachment?

– There are many of them. These can be embryological, anatomical, or biochemical reasons. I will focus on the main ones.

The first place is occupied by myopic disease – that is, myopia. About 30% of retinal detachments are caused by this particular disease. With myopia of absolutely any degree, PDS may appear – peripheral retinal degeneration.They can be both conditionally safe and dangerous in terms of the development of retinal detachment. The latter include: “snail track” type degeneration, traction, “lattice” degeneration. As soon as retinal breaks appear against the background of such dystrophies, fluid begins to flow from the vitreous under the retina through them. The larger the gap, the higher the rate of accumulation of fluid under the retina. The longer the liquid that appears is under the retina, the worse its cells work, which can then die altogether.

The second place is taken by degenerations caused by congenital anomalies. In third place are injuries (25% of cases). Moreover, men have them much more often than women. These are both penetrating wounds and contusions – that is, blunt trauma to the eye, as well as the removal of cataracts with prolapse of the vitreous body. Diabetes mellitus ranks fourth, but this is only 1.2% of all cases.

– What are the symptoms of retinal detachment?

– First of all, a person may suspect it by the appearance of so-called flashes inside the eye: there are sensations that something is blinking inside the eye, like a flashlight.Some kind of glow, lamp shake effect may appear. Such signs of retinal detachment are characteristic when a small amount of fluid appears under it, which mechanically irritates the retina. If the detachment begins to spread to the central area of ​​vision – the so-called macula, then vision deteriorates. Moreover, at the initial stages, the quality of vision may fluctuate in the morning and evening hours. Another symptom is distortion of the image of objects. In some cases, a loss of the field of vision, resembling a curtain, appears in front of the patients’ eyes.

Also, a significant decrease in intraocular pressure testifies to retinal detachment. When examining the fundus, bubbles of various sizes and densities are found on the retina. In any case, with a retinal detachment, an ultrasound scan of the eyeball is done to determine whether another, very dangerous disease is hidden behind the retinal detachment – an eye tumor, which can lead to complete loss of vision.

– How is retinal detachment treated? Is it curable?

– This is, first of all, a surgical pathology.Surgical treatment of retinal detachment began to be practiced in the 70s of the last century. The essence of the operation is to remove fluid and bring the retina closer to the choroid of the eyeball. In this case, it is imperative to form a joint between them, a scar – it will serve as a seam. Various surgical techniques are used to achieve these goals.

Unfortunately, we have to admit that the treatment of retinal detachment cannot always prevent the deterioration and loss of vision.A positive result can be achieved only in 90% of cases, in the remaining 10% of patients, retinal detachment continues to progress. Modern medicine has not yet succeeded in achieving a 100% cure. Local changes in any case remain, the loss of some part of the visual field is inevitable.

Cauterization of the retina with a laser

– How effective is the use of a laser in the treatment of this disease?

– The scar, which acts as a suture and holds the detached retina in the desired position, is precisely formed using a laser beam.Previously, the method of “cauterization” with cold (cryopexy) was used more often, but now it is mainly laser correction of retinal detachment that is used. It is a safer method, it causes fewer complications, and it can be used more than once, unlike cryopexy.

– How to prevent the development of this pathology? Tell us about the prevention of retinal detachment.

– Peripheral retinal degeneration with myopia or congenital anomalies, causing more than 50% of retinal detachments, can be detected at a stage when they have not yet led to detachment.And this is exactly the optimal period when you need to engage in laser treatment.

My deep conviction: literally everyone – even people with 100% vision – should undergo a routine examination by an ophthalmologist once a year. Modern methods allow you to examine the entire area of ​​the retina and detect the first signs of an approaching disease in time.

Well, let’s not forget that in men, a third of cases of retinal detachment are caused by trauma. That is, do not neglect eye protection and safety measures.

The editors recommend:

What is diabetic retinopathy and how is it treated?

For information:

Burlakova Elena Valerievna

Graduated from the Faculty of General Medicine of Irkutsk State Medical University in 1998.

1998 – 1999 – internship, and 2002 – 2004 – residency in the specialty “Ophthalmology” at the Irkutsk State Institute for Advanced Medical Studies.

Currently, an ophthalmologist, laser surgeon of the highest qualification category at the “Expert Clinic” Irkutsk. Receives at the address: street Kozhova, 9A.

90,000 diagnostics and treatment in Moscow, price

03.11.2021

The article was checked by an ophthalmologist Nazyrov A.A. is for general informational purposes only and does not replace specialist advice.
For recommendations on diagnosis and treatment, a doctor’s consultation is required.

Eye burn – chemical, thermal, radiation injury to the eyeball, as well as the tissues around the eye.

Causes and pathogenesis of eye burn

Causes of chemical burns – contact with the eyes of acids (hydrochloric, acetic, hydrofluoric, sulfuric), alkalis (ammonia; sodium hydroxide, magnesium, potassium; hydrated lime), medicines, juice of a poisonous plant (for example, hogweed), building varnishes, mixtures, solutions, etc.

If acid gets into the eye, coagulation tissue necrosis becomes a response, a film forms on the damaged area, which prevents the penetration of acid into the interior.

Burning with alkali leads to the so-called colliquation necrosis, in which tissue softening is observed, which causes the substance to penetrate into the deep layers.

Thermal burns – exposure to incendiary mixtures, boiling fat, hot metal, steam, boiling water, etc. As a result, coagulation necrosis develops.

Eye burns with infrared, ultraviolet rays, ionizing radiation are referred to as radiation burns. The risk group includes metallurgists; electric welders; people whose work is connected with laser sources.If ultraviolet rays are not sufficiently retained by the layers of the atmosphere, this can also cause radiation burns (for example, in the mountains).

Eye burn symptoms

Burns of the eye can be of varying severity:

  • I degree – mild – hyperemia of the eyeball, eyelid skin, conjunctiva; edema of the epithelium, corneal erosion. Patients complain of pain and blurred vision
  • II degree – moderate severity – hyperemia, blisters on the skin of the eyelids, erosion of the conjunctiva, corneal epithelium, ciliary injection.It is characterized by severe pain, visual impairment
  • III degree – severe – eyelid skin necrosis; swelling of the conjunctiva; opacity of the cornea, moisture in the anterior chamber; difficult-to-remove films form on the conjunctiva
  • IV degree – very severe – extensive necrosis of the skin of the eyelids, conjunctiva, sclera; significant corneal opacity

Diagnostics of the eye burn in the Clinical Hospital on Yauza

The victim needs urgent first aid, so diagnostic procedures are performed later to assess the condition of the eye and test visual acuity.

In addition to external examination of the eye, we carry out:

  • biomicroscopy with fluorescein staining
  • ophthalmoscopy
  • tonometry
  • Eye ultrasound
  • electrophysiological studies

Treatment of eye burns at the Clinical Hospital on Yauza

Ophthalmologists at the Yauza Clinical Hospital will provide you with effective first aid for eye burns, and then carry out treatment.

First of all, it is necessary to remove the substance that caused the burn (rinsing, extraction).We carry out instillation with anesthetic and antibacterial drops, we put antibacterial ointments in the conjunctival cavity.

Further therapy consists in the appointment of drugs that reduce pain and prevent the formation of adhesions; antibiotics in the form of ointments and drops; lacrimal fluid substitutes; means for lowering intraocular pressure (if necessary), glucocorticoids to relieve inflammation; physiotherapy procedures.

You can look at the prices for services in the price list or check the phone number indicated on the website.

Literature:

  1. Brovkina A.F. Ophthalmic Oncology: A Guide for Physicians // Medicine. 2002.

  2. Egorov E.A., Astakhov Yu.S., Stavitskaya T.V. Ophthalmopharmacology: A Guide for Physicians // GEOTAR. 2004.

90,000 “Flying midges” and “glassy worms” in the eyes, or where do “broken pixels” in the vitreous come from

Raise your head and look at something evenly colored, at some light background (snow, sky without sun ).If something like this suddenly began to slowly float before your eyes:

… Then meet these “broken pixels” in your eye , formed by the vitreous body (in the picture below it is in all its glory). Many such “glitches” appear in childhood and multiply over the years or gradually change. For most people, their presence is not a cause for concern, but their sudden appearance or a sharp increase is a reason for an urgent visit to an ophthalmologist.Especially if lightning before the eyes, a dark veil or fine “tobacco dust” are added to this.

But to understand the full situation, let’s talk about what this phenomenon is in general and where it comes from.

Where is the most vitreous body

The eye is a ball, most of which is occupied by the vitreous body (as much as 2/3 of the volume). It can be clearly seen in the diagram above – this is the space between the lens and the retina in the eye cavity. In a normal eye, the vitreous body is so transparent that it appears empty when translucent.

The vitreous humor is a jelly-like, viscous and well-stretching slurry like jelly or jelly. Transparent only. This “jelly” consists of water, colloids and microelements – collagen fibers that resemble intertwined ropes impregnated with hyaluronic acid. Unlike the cornea, which consists of the same matrix, the density of filaments in the vitreous body is lower, so the cornea is dense and tough (by the standards of what is in the eye), but here we are in for a viscous medium.

This environment is heterogeneous, it contains voids and “cisterns”, various gaps.You can inject a special solution into the eye, which will stain the vitreous humor, and all this beauty will be visible. For example:

The vitreous body is adjacent to the posterior surface of the lens, for the rest of the length it is in contact with the inner bordering membrane of the retina. A special hyaloid canal passes from the optic nerve head to the lens through the vitreous humor, and the vitreous body frame forms a thin network of intertwining fibers of various forms of collagen protein.And the gaps are filled with liquid – this structure gives it the appearance of a gelatinous mass.

Thanks to the vitreous body, the eye has a regular spherical shape, it provides incompressibility and eye tone, absorbs in case of shock, nutrients move through the channels. But its refractive function is very small.

If we need to deliver a medicinal substance to the deep parts of the eye, then we inject it directly into the vitreous cavity with a microneedle, because the eye is such a rather isolated organ from the body as a whole, and not everything that enters the blood reaches the internal the contents of the eye.The blood-ophthalmic barrier interferes.

It happens like this:

Where do the “glassy worms” come from

For the most part, translucent “ghosts” that appear in the field of vision when, for example, a sharp fall or parachute jump, lifting a weight or against the background of complete well-being and subsequently discernible upon careful examination of light objects, are natural gaps in the vitreous body caused by it design. They sometimes close on their own, move or form new ones by themselves (slowly, for months).

In general, any noticeable “worms” are something in the vitreous that prevents light from reaching the retina normally. In English literature, referred to as “floaters” –
like specks of dust on a camera matrix. This condition is called “destruction of the vitreous body” (DST).

The state of the presence of small single fragments in the vitreous cavity is the norm from a medical point of view.

Another story is common. But now we need to delve a little deeper into the anatomy.By itself, the vitreous is not attached to the retina in the main area, but just very close. However, in the macula (center of the eye, macula), near the optic nerve and along the equator of the retina, there are attachments, and they are quite strong. If in the eye with age, with an injury or the appearance of another disease of the eye and the body as a whole, there is not just destruction (in general, not dangerous), but some blood cells, inflammation – this is a very dangerous problem. Everything that gets into such a closed cavity is absorbed for a long time, difficult and not always completely with a transparent effect.As a rule, stained opacities, rough adhesions and strands remain, which reduce visual acuity. Everything is explained by the close, I would even say, intimate contact with such an important tissue as the retina (the retina and the vitreous body suffer simultaneously in case of illness).

Such a terrible picture can be seen with hemorrhage into the vitreous body (this is called hemophthalmos).

And if droplets of cholesterol accumulate in the vitreous body, it looks like “golden rain”.

With a blunt blow of the eye, the vitreous body will take over the main deformation as a result of mechanical trauma and will begin to change shape. Where it just adhered to the retina, it will boldly move away and come back. But where there were adhesions, the vitreous body, during deformation, will pull the retina behind it into the eye. From this, a much more serious injury can be formed – a rupture or detachment of the retina. And this is all the chances of losing sight or deteriorating the optical quality of the eye to a few percent of the norm.

Laser-delimited retinal rupture

What happens in myopia?

In myopic people, as a rule, the axial length of the eye is more than 24 mm (the average parameter, the measurement of which tells us about the progression of myopia). The eye changes from a soccer ball to a rugby ball. In this case, the posterior pole of the eye is stretched, but if this is not dangerous for the outer sclera (it is elastic enough), then the middle (choroid) and inner membrane (retina) do not stretch.Therefore, in the posterior pole, the nutrition of the retina worsens, and dystrophic zones of stretching and tearing appear along the periphery. The vitreous body plays an important role in this. At the attachment points, it pulls the retina – and holes are formed.

What happens with age?

Somewhere after 30 years, new “midges” often begin to appear, and after 40 years hyaluronic acid is gradually lost, the transparency of the vitreous body decreases, and visualization of fibers appears.

Even later, the vitreous body dries up altogether and begins to peel off from the retina (it just leaves in places where there is no attachment).

Detachment of the vitreous humor is a normal sign of aging, it is caused by liquefaction of the vitreous humor, leads to tension on the retina in places of strong attachment, which can lead to retinal rupture. Acute detachment of the vitreous body in 15% of cases leads to retinal ruptures.

Figuratively speaking, a kind of “snot” made of gel (this is a very imprecise description of this type of tissue, but gives a very good understanding) dangles inside the eye. Then this “lump of gel” comes off from the optic nerve.As a rule, the separation zone looks like a ring (Weiss ring), that is, when projected onto the retina, what patients call a “spider”, “big midge”, “figure eight”, “dark spot”, “analemma”, “circle ” etc. The kaleidoscope can change: a new shape every day. If the fastening ring did not come off, but simply stretched out – to hell with it, with a kaleidoscope, you can live. But if it pulled the retina and tore off a piece, then there are retinal breaks, and detachments, and in general a lot of trouble.

This is how the ophthalmologist sees the Weiss ring:

Treatment of tears before retinal detachment occurs – laser coagulation of tear zones in several rows along the edge, so that the formed fusion sites hold the retina in place.

All this is treated with a good prognosis in case of contacting an ophthalmologist during the first days, with an average prognosis – in case of treatment within a month. If the detachment has begun and the fluid that has entered through the gap continues to flow under the retina, flaking it, the problems begin to become irreversible, and the question is about preserving vision as such, at least with some optical quality.

Therefore, if you suddenly saw a lot of new “midges”, or they behave in some strange way, or something else is incomprehensible in the eye, you urgently need to go to an ophthalmologist.

“Midges” in the eye: so what to do with them?

If after examination the doctor does not find damage to the retina in the fundus and only notes the presence of microinclusions in the vitreous, then

there is no need to worry

– there are no serious risks to vision in this case.

If at the same time the patient sees “garbage and midges” that bother him, but knows that there is no danger in this, the issue of dynamic observation and getting used to minor deficiencies in the quality of vision is most often discussed.In addition, after a couple of months, patients really stop noticing these inclusions and do not focus their attention on them.

But in some cases, complaints can be caused by decreased vision due to “turbidity” floating in front of the eye. Then, together with an ophthalmologist, a specialist in the retina (and not just a doctor in a polyclinic, who knows something from modern ophthalmology approximately enough), the question of treating this condition can be discussed.

There are two options: the first involves the destruction of fragments in the vitreous body using a modern YAG laser for laser vitreolysis, the second – surgical removal of a part of the vitreous body within the optical axis – vitrectomy operation.

Treatment without surgery

The whole trick with the problem of “midges” and “spiders” is how to find a doctor who correctly interprets changes in the eye. The difference in case of incorrect diagnosis is colossal: to distinguish the degenerative calm state of simple destruction of the vitreous body from the pathological appearance in the vitreous body of inflammation cells, blood, the beginning of retinal detachment, vascular disorders and other things.

That is, the patient is faced with the task of finding that expert who will calm him down or notice the problem in time.

The difference is in further tactics: destruction does not need to be treated, you need to get used to it.
In polyclinics with a clear picture of DST (usual “garbage” in the eyes without the risk of further complications) they say: “Let’s prescribe resorption therapy.” And some kind of “placebo” is prescribed: emoxipin, taufon, katachrom. “Holy water” in this case will help better if you believe in it. A person is pleased, and the brain builds a map of “broken pixels” in a couple of weeks and removes them on its own (at a high level, if you start peering, they will be visible again).If you start catching the “glitch” on purpose (as you may be doing right now), the distortion will be more noticeable. If you don’t think about them, you won’t see. Which is what is required. The brain is very adaptable.

Another thing is to overlook inflammation or the beginning of retinal detachment. Here, “sedative” methods make the patient lose a week or two, which will then lead to serious complications.

When operation is indicated

Let’s agree that we are talking about degenerative changes in the vitreous body, and not about the other conditions mentioned above.That is, when it is reliably known that there are no risks from a medical point of view, but something floating in front of your eyes still greatly interferes with seeing.

Option 1. Laser vitreolysis.
Any work in the closed cavity of the vitreous body is potentially dangerous. It must be performed very accurately, since there are such sensitive structures as the retina (especially its central zone) and the lens nearby.

Ellex has recently proposed a new minimally invasive method for treating vitreous pathology: Weiss rings, intravitreal opacities and adhesions, vitreous degeneration.This is a YAG laser device for treating the anterior and posterior parts of the eye using a sighting red diode laser. Since the structures adjacent to the vitreous body are very delicate, they invented a reduction in the total energy due to the ultra-Gaussian profile of the laser beam. The small spot size and low optical breakdown energy (less than 1.8 mJ in air) is used for photodestruction of inclusions in the vitreous body.

In practice, the efficiency is 50%, because if the opacity is located close to the retina or close to the posterior capsule of the lens, or too dense, well, etc.then the application is not possible. Often one large fragment turns into several smaller ones, they can be displaced from the optical axis, or they can be added. In general, only after being examined by a specialist with experience in laser surgery on this unit, you will be able to find out if this is your method.

Option 2. Vitrectomy.
This is a full-fledged abdominal operation with all the ensuing consequences. That is, it does not matter whether a small “midge” is swimming or a “big spider” – the technology assumes the work of a vitreoretinal surgeon.A vitrectomy is performed – an operation to remove the vitreous body – as follows:

3 small punctures are made into the cavity of the eyeball in the projection of the plane of the ciliary body, that is, 3.5-4 mm from the limbus – the border of the transparent and opaque parts. The size of the puncture is measured in G (imperial unit of radius) gauges. The standard 3-port seamless technique is 23 G. Now, most of the operations are carried out using the 25G technique – this is 0.445 millimeters. The relationship is as follows: the larger the G, the smaller the size of the puncture.The most gentle technique is 27G (0.361 mm). By the way, the smaller the puncture, the more expensive the cost of a set of consumables. Ideal for removing floaters is 27 G.

Through one port, a solution balanced in salt and pH composition is supplied to maintain the tone of the eye and maintain its volume during the operation, so that when the vitreous humor is removed, the eye does not “collapse”. The second incision is needed to shine into this “cave”, that is, the cavity inside the eye, where the vitreous body is located.In the third is inserted, in fact, an instrument – a vitreotome, such a small guillotine with a tube. It looks like a micromincer, with the help of which the surgeon chops the fibers of the vitreous body and sucks them into the cavity of the tube.

At the end of the operation, a balanced solution remains in the eye, which is then replaced with intraocular fluid. The ports are removed from the self-sealing sutures and a bandage is applied for a couple of hours.

In experienced hands, this operation takes 20 minutes under local anesthesia and the result is no rough floating flocs in front of the eyes, but any opening surgery has a wide range of potential risks, posterior eye surgery doubles these risks.

In any case, I always make it clear to the patient that this is a very serious intervention with a minimal problem from a medical point of view.

From time to time, with gross opacities that reduce vision, it is necessary to perform such an operation for drivers, pilots, etc. – in the case when even a slight short-term “fogging” can affect safety.

“Scarecrow”

In my beloved Fedorov center, such patients who are worried about trifles because of a “midge” are told a story about a patient who came to the clinic with a complaint about a “midge”.He was told that it was not dangerous, there was no need to treat it. He insisted, the doctor from Fedorov’s clinic in every possible way dissuaded from the operation. He even suggested visiting a psychiatrist to find the answer to the question “How to live with such a” midge “? The patient did not persuade the doctor from Fedorov’s clinic for the operation and flew to look in the States for someone who would agree to operate on him. Found. After the operation, there was an inflammation of the membranes of the eye. The eye went blind, became small, reddish and began to disturb the patient. Already in Russia, the eye had to be removed.Final: no eye – no “midge”.

Conclusion

How much, in principle, the body needs this structure – the vitreous – is very difficult to judge. It seems possible without it, but the need for it in the structure of the eye has not yet been fully understood. While it is intuitively clear what is better to save, if possible.

A large number of doctors of the last century and the current one are examining the structure of the vitreous body – this can be seen from the number of names that name its structures (canals, ligaments, etc.).

With age, the vitreous body ages, shrinks and can cause certain problems. You need to watch your eyes, if symptoms of visual impairment in any form and age appear, seek help from specialists.

“Lightning” and flashes in the eyes. Ophthalmologist – About Retinal Surgery | HEALTH: Medicine | HEALTH

Sometimes ophthalmologists work miracles and help those who, it would seem, were doomed to exist in a world without sight.So, Tyumen surgeons gave the opportunity to see a deaf-mute patient.

How often such unique operations are carried out, and which surgical interventions are the easiest and most difficult for doctors, AiF-Tyumen correspondent found out from the head of the ophthalmology department of the Regional Clinical Hospital No. 1 Grigory Simonenko .

Where do lightning and flashes come from?

Someone loses sight with age, someone due to concomitant diseases or injuries.Grigory Symonenko recalled another case from his practice, when a young girl practically remained blind due to eye inflammation.

The only thing she could discern was light and darkness; she could not see either the faces of her relatives or nature outside the window. Doctors did not dare to return her vision. Only the ophthalmologists of the Regional Clinical Hospital No. 1 in Tyumen have come to help. According to Symonenko, the biggest risk was that after surgery, inflammation could occur, which caused the loss of vision.

“The operation was carried out in two stages: first, the lens was replaced, then the vitreous was“ cleaned ”. Fortunately, there were no complications, – said the doctor. – After the second surgical intervention, the girl saw the faces of her relatives, and this is already a great progress. Unfortunately, there is no need to talk about one hundred percent restoration of vision, since in this situation it was generally about preserving the eye as an organ, and this is great happiness. ”

Ophthalmologists of OKB No. 1 often have to perform complex multi-stage operations.Today, the pinnacle of ophthalmic surgery is surgical interventions on the posterior segment of the eyeball: the retina, the vitreous body. Sometimes, they last two to three hours.

“Most often we are faced with damage to the retina in the background of diabetes, but there are other reasons. For example, retinal detachment due to high myopia, ”says the head of the ophthalmology department.

Vision deteriorates. Photo: Shutterstock.com

The peculiarity of operations on the retina is that it is very delicate and cannot be touched with instruments.Therefore, it is spread with special solutions, gases, silicones. This allows, without damaging the thinnest shell of the eye, to achieve the necessary results. The most important thing in case of problems with the retina is to seek medical help in time. Depends on this, by what percentage it will be possible to restore vision.

According to the doctor, if the detachment is fresh and it was operated on within two weeks, then there is a better chance of maintaining good vision. If the patient walks with detachment for months, then after the operation it is not possible to achieve the desired results, since the retina experiences hypoxia and gradually the cells that receive light begin to die.

To understand that there are problems with the thinnest layer of the eye, “lightning” and flashes will help. When, during physical exertion, emotional upheavals, sparks appear in the eyes, this is the first bell and reason to consult an ophthalmologist. When the detachment already begins to form, then a curtain seems to fall on the eye and vision is lost.

To replace the lens or not?

The simplest operation in ophthalmology today is lens replacement. Most often it is carried out with cataracts.Against the background of age-related changes and a decrease in metabolism, the fibers of the lens begin to cloud. The only treatment is to replace the clouded one with an artificial one.

“200 out of 10 thousand people have cataracts, usually this is an age-related disease, and in young people this ailment occurs against the background of severe somatic diseases: diabetes mellitus, rheumatoid arthritis, etc. Or it can be the result of trauma. But there are exceptions: if earlier it was believed that cataracts develop after 60 years, this year a man aged only 32 turned to us for help.He was worried about the deterioration of his eyesight. After detecting cataracts, he was operated on. And after a few days he was able to return to normal life, ”says Grigory Symonenko.

By the way, a number of other problems can be solved with cataracts. Special lenses act as lenses and, depending on the situation, can at the same time correct both myopia and hyperopia, astigmatism. This can be a salvation for very high myopia.

Replacing the lens for cataracts can solve a number of other problems.Photo: pixabay.com

But in comparison with the same laser vision correction, such operations are less popular. The fact is that this is a lane surgical intervention, and, in fact, is the implantation of a prosthesis.

“Patients cannot make up their minds for years”

“Lens replacement operations take on average about seven minutes. Rehabilitation lasts a month, this is the time when you cannot lift heavy things, take a steam bath, work in the garden, ”the specialist comments.

It would seem that the operation is simple, but despite this, many patients do not go to the doctor, even if they completely lose their eyesight due to cataracts.The story of the 90-year-old Tyumenka, who was almost completely blind for ten years and only in 2018 decided to undergo surgery, spread throughout the country. The restoration of vision after so many years of blindness has become a real breakthrough in domestic medicine.

By the way, after the story in OKB # 1, patients with various complex diseases, as well as at a later age, began to seek help. For example, ophthalmologists operated on a 95-year-old veteran of the Great Patriotic War, who, along with the underlying cataract disease, had concomitant eye diseases.

According to Grigory Symonenko, cases when patients cannot decide on an operation for years and live practically without seeing anything are not uncommon. On average, visits to doctors are delayed for five years. But after the restoration of vision, grandmothers sometimes see the faces of their grandchildren for the first time.

Four stages of cataract

Cataract, the symptoms of which appear to varying degrees depending on the progression of the disease, has four stages of its own development, namely:

  • Initial – lens opacity appears on the periphery – outside the optical zone.
  • Immature – the movement of opacities into the central optical zone. In immature cataracts, clouding of the lens leads to a noticeable decrease in visual acuity.
  • Mature – the entire area of ​​the lens is occupied by opacities. Decrease in visual acuity to the level of light perception.
  • Overripe – further progression of cataract symptoms is accompanied by the disintegration of the lens fibers, the lens substance liquefies, the lens acquires a uniform milky-white hue.

What is the threat?

A formidable complication of cataract when delayed with surgical treatment is the development of secondary glaucoma.

The clouded lens, swelling and increasing in size, takes up more and more space inside the eye and prevents the normal outflow of intraocular fluid. With an increase in intraocular pressure, the functioning of the internal structures of the eye, including the retina and optic nerve, is disrupted.

If the cause of secondary glaucoma (in this case, an enlarged swollen lens) is not eliminated in a timely manner, irreversible death of the optic nerve fibers will occur and it will be impossible to return the lost visual functions in full.