Traumatic injuries to the eye and its adnexa

Abstract

1. 1. Restoration of proper function and appearance of the lids after injury, requires a knowledge of the anatomy and physiology of the parts and of the fundamental principles of plastic surgery. Many emergency operations are poorly done. 2. 2. The extraocular muscles themselves are rarely injured but their functions are often disturbed by contusion of the nerve supply, fractures and lacerations. 3. 3. Contusions of the globe, however simple, often prove serious to sight; therefore every eyeball so injured should receive careful scrutiny both inside and out. 4. 4. The importance of detection of minute perforations of the globe is emphasized because of their aid in detecting possible intraocular foreign bodies. Bed rest and careful observation for complications in all perforating wounds of the globe are indicated. Sympathetic ophthalmia has not developed in this group. 5. 5. Traumatic cataracts may arise from contusions as well as from penetrating wounds of the globe and should be removed at the proper time, provided the posterior segment of the eye is intact. 6. 6. Intraocular foreign bodies may or may not prove serious to sight; their character and location plus the element of infection are the determining factors. All foreign bodies should be removed as soon as detected whenever, possible. Sometimes, however, haste makes waste and should be avoided. 7. 7. Injection of foreign protein in some form to produce fever and stimulate antibody formation is widely used in the practice of ophthalmology. The amount of fever produced seems to be the criterion of its effectiveness. Typhoid H-antigen is generally preferred for prophylactic purposes, although its exact value is difficult to judge. Induced fever by the use of the Kettering hypertherm cabinet does not destroy exogenous intraocular infection. 8. 8. Second and third degree burns of the eye are destructive to sight and disappointing to treat. Research investigation so far has contributed little to improvement in method of treatment. 9. 9. Fractures of the malar bone and zygomatic arch are the most disfiguring and may produce binocular imbalance and asymmetry of the eyes. Intraocular damage is also a possibility. Repair should be done if possible before swelling occurs or immediately after it subsides. The Caldwell-Luc operation is the method of approach mostly employed. Fractures of the optic foramen may produce optic atrophy.