Penetrating Injuries&Intra ocular Foreign bodies

Things to do in a case of Open Globe injury

• 1)Evaluate the other system injury

• 2)Apply shield over the involved eye

• 3)Do not apply Drops / ointments

• 4) Examine under Anaesthesia

Suspect open globe injury

• 1)When the Globe is Distorted

• 2) When the intra ocular contents are seen

• 3) When the AC is shallow

• 4) History of injury with Sharp objects

Corneal wounds

• May be Linear or Lacerated• May be associated with Iris Prolapse• If Iris tissue is Non- viable, it has to be Excised• Wounds are sutured with 10 “0” Nylon• Scleral wounds more than 3 mm posterior to

the Limbus are to be sutured and Cryo application to be done

Corneal laceration

Wounds of the LENS

• Cause Traumatic Cataract

• may result in Posterior Capsule injury

• May result in Irido cyclitis

Traumatic cataract( Rosette)

Intra ocular Foreign Body

• The effects are due to;• 1) Mechanical Effects• 2) Introduction of infection• 3) Specific action of metal on the Tissues

Mechanical Effects

• Depending on the velocity, the Foreign body can lodge in the Angle, Iris or Pentrate the lens

• It may be retained in the vitrous and cause Degn

• If it lodges in the Retina,it gets encapsulated by Fibrous Tissue

• In the Posterior sgt, they cause Degnerative changes.

Infection

• This is a ever present danger in Penetrating• injuries

• Common with sand, wood.

• Metallic foreign bodies are usually sterilised by the velocity

Reaction of ocular tissues

• A) Inert: Glass, Plastics, Porcelein• Gold, silver, Platinum& Titanium

• B) Local tissue reaction- Aluminium

• C) Severe Reaction- siderosis bulbi- Iron• Chalcosis - copper

Diagnosis

• Careful search for wound of entry• Diligent slit lamp examination• Radiography For Radio-opaque foreign bodies• Computerized axial tomography• MRI is contraindicated• Ultra sonography

Treatment

• Fb in the Lens- lens removal• FB in the Vitreous removal after vitrectomy• FB On The Retina Removal after vitrectomy• If it is an Inert Fb it is better left alone