Foreign body of the eye and orbit. Surgical tactics for intraocular foreign bodies What to do in case of a foreign body in the eye

In the studied cohort, 619 patients were hospitalized for intraocular foreign bodies. These are mainly patients referred from other ophthalmological institutions after an unsuccessful attempt to remove a foreign body (478 cases, or 77.2%).

When deciding on treatment tactics, the following criteria are usually considered:

Size and location of the fragment;

Nature of the foreign body;

Preservation of the retina and optic nerve;

Associated damage to the optical media and membranes of the eye.

In the studied population, this issue was resolved at the stage of a consultative examination when deciding on hospitalization, so the majority of admitted patients underwent surgery. The question of surgical tactics was determined primarily by the size, localization of the fragment, the threat of additional trauma to the eye with moving fragments, and the risk of developing metallosis with fixed or embedded fragments.

The size and location of the fragment determined the possibility and probability of its removal. Giant foreign bodies larger than 10 mm, present in 5.2% of patients (32 eyes), as well as the presence of multiple foreign bodies, were combined with gross changes inside the eye: hemophthalmos in the organizing stage (in 59 eyes), moorings in the vitreous body (in 12 eyes), retinal detachment (in 56 eyes), ciliochoroidal detachment (in 31 eyes), therefore, removal of fragments was not performed due to the traumatic nature of such an intervention. In these cases, organ-preserving treatment was performed.

In case of large foreign bodies measuring 5-10 mm (10% of patients), the question of the advisability of their removal was decided depending on the safety of the eye, the location of the fragment, its mobility, and the risk of developing metallosis. This was usually determined before the patient was hospitalized. When the size of foreign bodies is less than 5 mm, other criteria determined the indications for their removal.

The localization of the foreign body determined the feasibility of removing the fragment and the choice of surgical method.

If the fragment was localized in the anterior chamber (1.3% of cases), regardless of the nature of the fragment, it was removed. The fragment visible during biomicroscopy was removed through a corneal incision with a magnet (1 eye) or tweezers (2 eyes). In 5 cases, a fragment less than 1 mm in size was located in the corner of the anterior chamber. It was removed through an incision in the posterior part of the limbus under the conjunctival flap with gonioscopic control of localization during the operation. The foreign body was successfully removed in all 8 eyes without any complications.

When the amagnetic fragment was localized in the transparent lens (1 eye), given the high visual acuity (1.0 without correction), it was decided to refrain from removing it.

The patient was discharged without surgery under clinical observation.

If the fragment is localized in the ciliary body and its size is up to 5 mm (16%), its removal is indicated due to the threat of developing metallosis and recurrent uveitis. The foreign body was removed diascleral with intraoperative clarification of its location (transillumination and echography). The operation was performed according to the classical method using a permanent magnet or tweezers, depending on the nature of the fragment.

When performing 99 similar operations, in 1 case of an amagnetic fragment less than 1 mm in size, it was not possible to detect it visually during the operation. A fragment of the ciliary body was excised according to its location. A control radiography after 7 days did not reveal a foreign body in the eye.

In the remaining cases (99.0% of operations), the foreign body was visualized during the operation and successfully removed. In 7 cases (7.1%) after surgery, the development of hemophthalmos was observed, which required conservative treatment, and in 3 cases, vitrectomy 3 weeks after removal of the fragment.

In the postoperative period, in 1 case bleeding into the vitreous also occurred on the third day after surgery. No other complications were noted. Visual acuity in 90 patients (90.9%) did not change after surgery. In 9 patients, there was a decrease by 0.2 in one case and to 0.01-0.1 in 8 patients with hemophthalmos.

When the fragment was localized in the anterior parts of the vitreous body (6.3% of patients) and in the membranes of the eye no further than 15 mm from the limbus (19.1% of patients), their diascleral removal was indicated (157 eyes), however, in 9 cases there was CTO, therefore surgical treatment was divided into 2 stages. Surgical removal of ciliochoroidal detachment was performed as the first stage. It was successful in 7 patients, who underwent diascleral removal of the foreign body after 10-17 days.

In another 37 cases, there were moorings in the vitreous body, which were excised by vitrectomy with simultaneous removal of the fragment.

Thus, removal of foreign bodies in this group was performed in 155 cases (98.7% of patients). It was not indicated only if it was impossible to eliminate CTO due to the threat of rapid development of eyeball atrophy.

During the operation, in 8 cases there were bleedings into the vitreous body (4.6% of patients). After surgery, 2-4 weeks later, retinal detachment was found in 2 cases (1.1%). As a result of the operation, it was possible to preserve the visual functions that were present before the operation in 92.4% of patients (145 eyes).

Rice. 6.12. The foreign body in the posterior part of the vitreous body is prethecal, partially moored. Its removal is indicated.

There were fragments in the posterior parts of the vitreous body in 73 patients. In 39 cases they were combined with hemophthalmos of varying severity and were not visible during ophthalmoscopy. In these cases, the question of the advisability of removing the fragment was decided after vitrectomy.

During the operation, the fragment was exposed and its topography relative to the membranes of the eye and the mooring of the vitreous body were determined. In 11 cases, the fragment was located pre-shell and was moored (Fig. 6.12).

In 7 cases, the fragment was immured in the moorings of the vitreous body. Given the density of encapsulation of the fragment, it was not removed in these cases.

In 5 cases, during vitrectomy, hemophthalmos recurred. Considering that the fragment could not be visualized, it was not removed.

In the remaining patients with hemophthalmia (16 eyes), after exposure of the fragment, it was removed with a magnet (12 eyes) or collet tweezers (4 eyes).

In 27 cases, the fragment was located in the moorings of the vitreous body and was visible ophthalmoscopically. In these cases, using a vitreotome, the fragment was released from the moorings and removed.

were performed using a magnet (20 eyes) or collet tweezers (7 eyes).

In 7 cases, the fragment floated freely near the membranes of the posterior pole, but was semi-fixed on the delicate moorings of the vitreous body. In 5 cases it was possible to remove it with a magnet. In 2 cases, vitrectomy was required to sever the translucent cord holding the fragment inside the eye.

During the operation, in addition to the described 5 cases of hemophthalmos, no other complications were recorded.

Thus, removal of a foreign body when it was localized in the posterior layers of the vitreous was performed in 68.5% of cases (50 eyes). Contraindications for fragment removal were encapsulation of the fragment in the vitreous moorings (7 eyes) or prethecally (11 eyes), as well as recurrence of hemophthalmos during exposure of the fragment (5 eyes).

As a result of the operation, it was possible to improve vision in 43 patients (58.9% of patients in this group): before surgery 0.01-0.2; after surgery 0.1 -0.7.

A foreign body was located in the membranes of the posterior pole in 210 patients. In 73 cases the foreign body was encapsulated (Fig. 6.13). However, in 49 eyes there was progressive

Rice. 6.13. Encapsulated foreign body in the membranes of the posterior segment, progression of metallosis according to electrophysiological studies.

Rice. 6.14. Encapsulated foreign body embedded in the membranes of the posterior pole, vitreoretinal mooring. Laser coagulation was performed around the fragment.

metallization. In these cases, removal of the fragment was indicated. It was performed after preliminary dissection of the capsule with a YAG laser. In 3 cases, acute hemophthalmos and development of retinal detachment occurred during surgery.

10-14 days after surgery.

In 24 cases, taking into account the density of the capsule and the high probability of tractional retinal detachment during surgery, additional strengthening of the capsule was performed using perifocal laser coagulation (Fig. 6.14).

In 28 cases, retinal breaks were found at the edge of the fragment localized in the membranes. In these cases, laser barrage of ruptures was performed.

In 9 cases, when the fragment penetrated deeply into the shells, laser strengthening of its capsule was performed. The foreign body was removed in 17 cases when the fragment remained in the vitreous cavity 14-21 days after laser intervention.

In 49 eyes, when a foreign body was localized in the membranes of the posterior pole in the vitreous body, there were various severity of shvarts. In these cases, removal of the foreign body was combined with vitrectomy to prevent tractional retinal detachment.

In 60 cases there were no obvious changes in the vitreous body or gross damage to the retina. Short periods after injury and preservation of high vision served as the basis for transvitreal removal of the foreign body. The fragment was removed with a magnet in 46 cases and with collet tweezers in 14. As a result of the operation, acute hemophthalmos developed in 2 cases. There were no other complications. High vision was preserved in

96.7% of patients in this subgroup (58 eyes).

Thus, the foreign body, when localized in the membranes of the posterior pole, was removed in 83.3% of patients in this group (175 eyes). Contraindications for removal were the presence of a dense capsule around the fragment (24 eyes) or an embedded fragment with a retinal rupture (9 eyes).

The results obtained allow us to formulate contraindications for the removal of intraocular foreign bodies:

Large size foreign body (more than 10 mm in diameter);

Multiple foreign bodies; post-traumatic CTO and the impossibility of its surgical treatment;

Encapsulation of the fragment in vitreous moorings or membranes;

Recurrence of hemophthalmos during exposure of the fragment;

An impacted fragment with a retinal rupture.

In other cases, the foreign body must be removed.

Maintaining injuries with suspected intraocular foreign bodies begin even before confirming the diagnosis. At the same time, excessive manipulation of the injured eye is avoided. A protective covering is placed over the eye and the patient is given strict instructions not to touch the eye.

At treatment of patients with foreign bodies of the eye pursue four main goals:
1. Preservation of vision;
2. Prevention of infectious complications;
3. Restoration of the normal structural integrity of the eye;
4. Prevention of long-term consequences. If indicated, tetanus prophylaxis is carried out. Most surgeons prefer to start prophylactic antibiotics immediately. In emergency situations, antibiotics are started before or during the examination. The choice of antibiotic should be determined by the flora most often found in open eye injuries. The use of antibiotics is controversial and will be discussed later in this chapter.

Final localization of the foreign body and the degree of associated damage determine the approach and extent of surgical intervention. The localization of foreign bodies in the anterior chamber, in the lens or in the posterior segment of the eye determines the characteristics of surgical treatment.

Foreign bodies in the anterior chamber of the eye

From 1/4 to 1/3 intraocular remain in the anterior segment until the posterior capsule of the lens. Technically, their removal is less difficult than the removal of foreign bodies with posterior localization. Corneal and limbal wounds are freed from the prolapsed iris, and it is always better to reposition the prolapsed choroid if feasible. The wound is closed with 10/0 nylon sutures.

After restoring the depth of the anterior cameras make a limbal paracentesis or an oblique corneal incision, retreating for several hours from the foreign body. Viscoelastic is used to maintain the depth of the anterior chamber and protect the endothelium of the cornea and the anterior capsule of the lens. Viscoelastic can also be used to remove small foreign bodies, this method provides safe and effective removal. If visualization of a foreign body is difficult, a surgical gonioscopic lens can be used to directly visualize the foreign body, reducing the risk of iris damage that often occurs when attempting to grasp a foreign body blindly. After localizing the foreign body, it is grabbed with tweezers and removed through the created incision, which can be enlarged if necessary.

For removal of foreign bodies located in the iris, sometimes requires the use of bimanual methods. A magnet can sometimes be used to remove metallic foreign bodies.

Foreign bodies in the lens

Intralenticular foreign bodies are rare, accounting for only 7-10% of all intraocular foreign bodies. Most of them are removed immediately during primary surgical treatment in order to prevent infection, the development of inflammation, secondary cataracts or siderosis. Rupture of the lens capsule significantly increases the risk of developing post-traumatic endophthalmitis. Surgical removal of intralenticular foreign bodies is well described.

You can do the usual phacoemulsification with removal of the foreign body using tweezers. Small intraocular foreign bodies may spontaneously resolve, become encapsulated, lose their magnetic properties, and become radiolucent. Such intralenticular foreign bodies can remain in the eye for a long time without requiring surgical removal.26 Similar clinical cases have been described in the literature, for example, an 18-year-old patient with an intralenticular foreign body with visual acuity of 20/20 13 years after injury, a 61-year-old patient with 20/25 vision 23 years after injury, a 58-year-old patient who had maintained good visual acuity for 40 years without developing siderosis.
It is believed that small wounds of the anterior capsules The lens can heal and re-epithelialize on its own, isolating the foreign body.

Thus, at low risk of infectious complications, limited inflammation and no signs of cataract formation, the optimal method for managing intralenticular foreign bodies is observation. However, if the foreign body in the lens has magnetic properties, electroretinograms (ERG) should be performed periodically, every 2-3 months, to monitor the development of siderosis.

This is dangerous complication Iron-containing intralenticular foreign bodies are characterized by heterochromia, mydriasis, cataracts, chronic uveitis, secondary glaucoma, retinal pigmentary degeneration and papilledema. ERG changes characteristic of siderosis include an increased a-wave and initially normal b-wave, followed by a decrease (or attenuation) as the process progresses.

Clinical case: intralenticular foreign body. A 23-year-old man presented to the emergency room complaining of a foreign body sensation in his left eye. He was hit in the face by a piece of metal 3 days before treatment while he was working metal with a hammer without safety glasses. During the examination, visual acuity was 20/20, IOP was normal, a wound in the healing stage was detected on the cornea, a rupture of the anterior capsule of the lens and a foreign body in the lens were noted. The anterior chamber was deep, the Seidel test was negative. No foreign bodies were found in the vitreous body. Ultrasound and CT of the orbit confirmed the presence of an isolated metallic foreign body in the lens.

Given good eyesight patient, absence of infection, siderosis or cataracts, a wait-and-see approach was chosen. The patient received oral and topical antibiotics along with steroids. Periodic monitoring was recommended for the patient. The patient missed several appointments but showed up 6 weeks after injury. An ERG was performed, which revealed an increase in the a-wave, which is characteristic of the early development of siderosis. Rod and cone ERGs also had increased amplitude and latency. In addition, the patient complained of blurred vision and developed traumatic subcapsular cataract (C). Considering the ERG changes and the development of cataracts, the foreign body was removed using forceps (D), and phacoemulsification of the lens was performed with IOL implantation. The patient's vision at discharge was 20/20, and no further complications were noted.

Foreign bodies in the posterior segment of the eye

Posterior segment of the eye is the most common site of localization of intraocular foreign bodies; with such injuries, consultation with a vitreoretinal surgeon is required to choose patient management tactics. The surgical technique for localizing intraocular foreign bodies in the posterior segment of the eye has changed significantly with the advent of closed vitrectomy. Although several studies have found no difference in visual outcomes between the use of an electromagnet and pars plana vitrectomy, the vitrectomy technique allows visually guided removal of foreign bodies, improves visual function, and reduces the risk of endophthalmitis.

Deletion period intraocular foreign bodies remains a matter of debate. Posterior localization of intraocular foreign bodies is usually an indication for urgent surgical intervention. Immediate removal is thought to reduce the risk of endophthalmitis. Removal of ocular foreign bodies localized in the posterior segment of the eye usually requires the use of a wide range of vitreoretinal techniques. The usual course of action usually includes PSO of the primary wound, extraction of the lens through the pars plana of the ciliary body, stabilization and restoration of the retina, and the actual removal of the foreign body using tweezers or a magnet.

Prophylactic scleral filling, since in such cases there is a high risk of developing proliferative vitreoretinopathy. Although the need for intravitreal antibiotics has not been proven, the authors advocate their use if circumstances permit.

Clinical case: intraocular foreign body. The 30-year-old man was hammering metal when he felt something hit him in the left eye. He immediately felt moderate pain in the eye and a slight decrease in vision. He was admitted to the emergency department for treatment. On examination: visual acuity 20/20-OD and 20/70-OS, no relative afferent pupillary defect, IOP 22 at OD and 23 at OS. Slit-lamp examination of the anterior chamber revealed no injuries to the cornea or transillumination defects of the iris or lens capsule.

Vision is one of the main sources of receiving information from the outside world. It is not surprising that the receptor part of the visual analyzer (the eye) is a rather sensitive organ. When foreign objects enter it, the following reactions immediately begin: lacrimation, a feeling of discomfort. There is a desire to get this item yourself, often with untreated hands. If the object causing inconvenience is not located deep, then removal can be achieved without resorting to medical assistance. It should be noted that the entry of foreign particles into the ocular structures is the most common circumstance in which patients seek emergency services from an ophthalmologist. Therefore, this problem is quite relevant. Moreover, most often the problem arises in domestic conditions or during the work process. The article draws attention to the nature of foreign bodies, their impact on the visual analyzer and methods of safe removal.

Any organic matter, for example, wood or copper and aluminum objects (for example, shavings) must be removed immediately, since the oxidation products of these materials will chemically react with the tissues of the eye structures within 24 hours. Blindness may occur as a complication. Removing brick or coal is a rather difficult procedure even for a professional, since the material crumbles. A particular difficulty is caused by the volatile particles of the grinder. The flying hot particle of metal penetrates deeply into the eye structures and remains there. This foreign body also crumbles easily during the extraction procedure. Therefore, below we will tell you how to remove scale from your eye.

Dust or eyelashes also very often get into the eye tissue. Foreign bodies can also be living: for example, midges and other small insects. But unlike hot bodies, such as scale, these objects are not fixed to the cornea. Therefore, their removal is comparatively easier.

Clinical picture

Metal bodies entering the eye tissue can result in mechanical injuries. Depending on the severity of the impact, the following types of damage are distinguished.

Damage is localized in the following structures:

eye sockets;
eyeballs;
adnexal structures (conjunctiva, lacrimal glands, retrobulbar tissue).

Symptoms:

instant sharp pain when hit by a hot spark;
(increased sensitivity to light);
difficulty opening eyelids;
dot ;

An ophthalmologist can accurately classify an injury using his or her instruments based on microscopic magnification of the site of the injury. After the extraction procedure, symptoms of damage may remain, especially for injuries that are deeper than the top layer of the cornea. Residual signs are associated with post-traumatic local.

Scale recovery methods

It is advisable to remove a foreign object from the eye with a needle no larger than 25 gauge (on the packaging of a disposable syringe there is a 25G mark - the larger the numerical value, the smaller the gauge). You cannot remove a foreign object with untreated hands and especially with your tongue. Removing scale with these objects can lead to the introduction of foreign particles deeper, and contact of eye tissue with the tongue is fraught with infection and an increased risk of the need for enucleation (removal of the eyeball).

In case of deep contact or artificial introduction of objects into the eyes, it is recommended to blink less often and rinse the eyes only with boiled water. You should not use remedies based on folk recipes and advice. Removal of scale and bodies of a different nature must be carried out by an ophthalmologist (if necessary, an ophthalmic surgeon). The procedure is performed by a specialist.

Survey

First of all, the doctor collects the patient's medical history. He asks about the details of the foreign particle entering the eye, how well the patient followed the rules for safe operation of the welding machine and for other activities. This information is important for approximate determination of the presence and depth of the body. In addition, visual acuity is assessed. An ophthalmologist instills a few drops of anesthetic to relieve pain and blepharospasm(involuntary contraction of the orbicularis oculi muscle, which manifests itself in closing the eyes) the doctor evaluates the location using microscopic analysis. The presence of infiltrates is assessed and the immunological reaction occurring in the anterior chamber, which is limited by the cornea and iris, is monitored. Next, the pupil is dilated with medication. This is necessary for examination.

If there is a risk of serious damage to the eye due to an ingested foreign body, there is a need for additional instrumental studies. For example, radiography of the orbit. In complicated situations, in addition to the ophthalmologist, a neurologist and an otorhinolaryngologist are included in the treatment.

Scale that gets into the eyes will instantly cause a burn, since it is a spark - a hot metal body that is tightly fixed and cools right on the surface of the eye. It is almost impossible to get it on your own. After the removal is carried out, the consequences of the burn must be treated by a professional. The patient must unquestioningly follow the doctor's recommendations. The ophthalmologist prescribes antibiotics and NSAIDs, both in the form of ointments and drops, and in forms for oral administration.

Vision may be impaired if scale gets into the central cornea. Then the recovery will last longer than usual (rehabilitation on average takes from a week to two weeks).

Extraction technique

The following technique is used by a professional ophthalmologist. Execution of this algorithm requires appropriate equipment and professionalism. First, the specialist cleans his hands with soap and a 70% alcohol solution; instills a 2% lidocaine solution, having first taken the solution with a disposable sterile syringe and disconnected the needle. The sterile needle is held with three fingers at the connecting part of the needle with the syringe. The dominant hand with the needle is fixed with the edge of the palm on the patient’s cheekbone or cheek (necessary to prevent injuries due to involuntary movements). The eyelid is pulled back with the left hand. The doctor asks the patient to look at one point, which is selected so that the position of the eyeball facilitates access to the foreign body. The light is directed into the eye and the procedure is controlled with a magnifying glass. The tip of the needle is used to remove the foreign object and clean the wound. If necessary, the doctor will instill an additional dose of lidocaine. After removal, antibiotics are applied topically (in the form of drops or ointments). 1% tetracycline ointment can be used. The doctor prescribes medications for outpatient use.

Video: How to remove scale from the eye at home

If the scale is deep, then independent removal is not recommended. You should seek professional help as soon as possible. In case of serious complications, an orbitotomy may be necessary.

Forecast

Incorrectly provided first aid leads to negative consequences:

scarring of soft tissues;
increased intraocular;
eyelash growth disorders;
difficulty opening and fusion of eyelids;
obstruction of the tear ducts and;
and lens;
chronic local inflammation.

In severe cases, enucleation may be necessary. After removal of the foreign body, patient management depends on the condition of the ocular structures.

If the eccentric (located behind the central section) epithelial defect is clean and does not exceed 2 mm and if there are no suspicious symptoms, then only local antibiotics are prescribed for several days. Central and large epithelial defects, complicated by purulent exudate, infiltrates or deposits on the cornea, are examined again every other day. The same applies to a moderate immunological reaction of the eye chamber.

Infiltration, accompanied by a strong immunological reaction of the eye chamber, exudate, pain and redness, requires targeted systemic antibacterial therapy based on bacteriological analysis.

Video: An ophthalmologist removes scale from the eye

To prevent foreign bodies from entering the eye, it is necessary to strictly follow the safety rules prescribed for any type of activity. You should wear a hat (preferably with a visor) when doing home renovation work. It is recommended to wear sunglasses in strong winds. To prevent small insects from getting into your eyes, it is advisable not to wave your hands - it is better to cover your eyes with them. It is important to be vaccinated against tetanus (transmitted by contact, the risk of transmission increases with injuries, including the cornea) in accordance with the specified dates in the state calendar. Vaccination and passive immunization may be additionally prescribed by a doctor.

Let's sum it up

Getting scale into the eye is an extremely unpleasant and also dangerous thing. You should not rely only on yourself and try to remove a foreign object from the eye on your own - this is fraught with the fact that the scale will move deeper, followed by damage to the cornea. If the discomfort does not subside within half an hour after contact, you should not hesitate and contact an ophthalmologist.

Video: How to remove a foreign body from the eye?

CM - canto-meatal line connecting the lateral commissure of the eyelids and the external auditory opening; CRL - central x-ray beam),
A- nasofrontal (anterior fronto-occipital) Caldwell projection,
b- nasochin styling,
V- anterior semi-axial (mental) Waters projection,
G-basal (axial, submentovertex) projection,
d- oblique anterior projection according to Rhese

X-ray diagnosis of foreign bodies in the eye is often carried out using special prostheses with marks or contact glasses, but in case of severe damage to the eye and the impossibility of using traditional methods, the Vodovozov marking method should be used - a small piece of paper with a glued grain of contrast agent (bismuth) is placed on the limbus or cornea , barium, etc.).

X-ray diagnostics of foreign bodies in the eye consists of two stages:

the first is the establishment of the very fact of the presence of a foreign body in the eye or orbit, i.e. its definition. An x-ray of the skull in the anterior direct projection allows one to get a general idea of the condition of the bones of the vault, cranial sutures, and pyramids of the temporal bone. Interpretation of the state of the orbit is difficult due to the layering of images of the bones of the base of the skull on its upper parts. However, the entrance to the orbit and its bottom are visible quite clearly.
the second stage, if a foreign body is identified, is to establish its exact location in the eye, i.e. its localization.

Patient positioning

Basic (standard) styling for this study are

nasofrontal (anterior frontoccipital) Caldwell projection.Lying on stomachThe patient touches the cassette with the tip of his nose and forehead. Angle between x-ray directionray and cantomeatal line, which is 15-23°, removes the shadow of the temporal bonedown from the orbit image.
nasochin styling. The patient lying on his stomach touches the cassette tightly whilepinched nose and chin.
Waters anterior semi-axial (mental) projection. Patsi lying on his stomachent touches the cassette only with his chin, the tip of his nose is located 0.5-1.5 cm above the cassettethat one. The angle between the canthomeatal line and the central x-ray beam is 37-45°.
basal (axial, submentovertex) projection. Under the shoulders of someone lying on their backthe patient is placed on a cushion so that the head thrown back touches the chestseta vertex, and the infraorbitomeatal line (IM) was parallel to the cassette and perpendicularcular to the central x-ray beam.
Rhese oblique anterior projection. The patient's head is positioned on his stomachin such a way that the eyebrow, cheekbone and tip of the nose are pressed against the cassette. CenterThe beam is applied to the opposite parietal tubercle, alternate photographs of botheye sockets are performed strictly symmetrically.

In addition to the indicated basic (standard) styling, three additional (special) ones are used:

nose styling
placement on the “frontal mounds”,
oblique anterior (posterior) projection according to Rhese

Nasofrontal (anterior frontoccipital) placement according to Caldwell (1918) allows you to study the contours of the entrance to the orbit, the fossa of the lacrimal sac (1),medial (2) and lateral (3) walls of the orbit, ethmoidal labyrinth (7), frontal sinus (8). Infraorbital margin score (4) fordifficult due to the imposition of the shadow of the lower wall of the orbit on it, in front ofthe lower third of which is located below the edge, the middle third - at its level,the back one is higher. Such important anatomyical formations, such as the superior and inferior orbital fissures, wings of the climaxThe new bone (6 - the large wing of the sphenoid bone) in this image is overlapped by the pyramids of the temporal bones (9).

Photo taken with nasochin styling with the nose tightly pressed, is an overview image of the eye sockets in a direct projection, allowing one to compare the shape and size of the margo orbitalis. In addition, this arrangement is the main one in the study of the frontal, maxillary sinuses and ethmoidal labyrinth. Finally, with the nasal-chin position, the bones of the facial skeleton are clearly visible.

Anterior semi-axial (mental) projection according to Waters and Waldron (1915) is indispensable in assessing the condition of the anterior sections of the medial wall, the roof and bottom of the orbits, the zygomatic bones, the lesser wing of the sphenoid bone, the infraorbital foramen, as well as the maxillary sinuses and the ethmoidal labyrinth.

Due to the retraction of the shadow of the temporal bone pyramid downward, the placement provides clear visualization of the medial (1), lower (2) and upper (3) walls of the orbits, the infraorbital margin (4) and the canal of the same name (5), the frontozygomatic suture (6), and the zygomatic arch (7), lesser wing of the sphenoid bone (8), as well as frontal (9), maxillary sinuses (10) and ethmoidal labyrinth (11). 12 - unnamed line (linea innominata); 13 - cribriform plate of the ethmoid bone; 14 - cockscomb

Due to the clear image of the superior orbital wall, as well as the anterior and middle thirds of the inferior orbital wall, the projection is useful for visualizing vertically displaced fragments of the roof and floor, including the diagnosis of their “burst” and depressed fractures.

When interpreting the image, it should be remembered that due to the peculiarities of its placement, the image of the orbital floor appears 10 mm below the contour of the infraorbital margin. Thus, a full analysis of the condition of the lower wall of the orbit involves the use of chin and nasofrontal placement.

Basal (axial, parietal, submentovertex) projection according to Schuller (1905) and Bowen (1914) allows you to visualize the lateral wall of the orbit and the maxillary sinus along its entire length, the nasopharynx, the pterygoid processes of the sphenoid bone, the pterygopalatine fossa, the sphenoid sinus and the ethmoid labyrinth. At the same time, the medial half of the orbits is covered by the image of the dentition of the upper jaw. Due to the need to hyperextend the neck, positioning is not applicable if injury to the cervical spine is suspected.

Laying on the nose (anterior sagittal projection) designed to assess the condition of the wings of the sphenoid bone and superior orbital fissures. Since the analysis of images of the superior orbital fissures obtained when placing them on the nose is significantly difficult due to the variability of its structure, when evaluating the images one should first of all pay attention to the symmetry of their shape and size. Mild interorbital asymmetry is a variant of the norm, which cannot be said about pronounced (2 mm or more) differences.

Basic styling used for orbital diagnostics fractures
	Visualized structure	Pathological changes
Submental	Anterior two thirds of the lower walls of the orbit, zygomatic arch	Fractures of the upper and lower walls with vertical displacement of fragments
Submental	Maxillary sinus	Sinusitis, hemosinus
Nasofrontal	Frontal sinus, ethmoidal labyrinth	Hemosinus, mucocele, sinus wall fracture
	Unnamed line	Fracture of the medial and lateral walls of the orbit
	Sphenoid bone	Lateral wall fracture
	Posterior third of the lower wall	"Burst" fracture
	Superior wall of the orbit	Upper wall fracture
	Turkish saddle	Pituitary gland diseases
Basal (submentovertex)	Sphenoid sinus and ethmoidal labyrinth
	Lateral wall of the orbit	Fracture of the lateral wall of the orbit
	Zygomatic arch	Zygomatic arch fracture
Rhese anterior oblique	Visual channel	Fracture of the canal walls

Laying on the “frontal mounds” (in which a 3-4 cm thick bandage is placed under the tip of the nose, and the central beam is directed anterior to the external auditory canals) allows visualization of the inferior orbital fissures.

To display the optic canals, sequential radiography of the right and left orbits is performed in oblique anterior (posterior) projections according to Rhese (1911). Normally, the vertical size of the optic foramen in the resulting image is 6 mm, the horizontal size is 5 mm, and the interorbital asymmetry of the size of the optic foramina in 96% of patients does not exceed 1 mm. Both an increase in the vertical diameter to 6.5 mm or more, and obvious (over 1 mm) asymmetry of the optic openings indicates pathology.

In addition to the optic foramen, the roots of the lesser wing of the sphenoid bone and the upper parts of the ethmoidal labyrinth are visible in the image. Sometimes the pneumatized anterior inclined process can be mistaken for the optic foramen. To avoid erroneous interpretation of the radiograph, it should be remembered that the optic foramen is located at the lateral edge of the wedge-shaped eminence (jugum sphenoidale).

With the introduction of CT into everyday practice, Rhese placement is rarely used. The interpretation of radiographs of orbital fractures differs significantly from that for fractures of any other location. Certain difficulties are created by the complex image of the facial skeleton on an x-ray, about projection distortions and the effect of layering of various bone formations.

To reduce the irradiation fields and obtain more contrast radiographs, on which even small foreign bodies can be seen quite clearly, radiography is performed with a narrow aperture (10-15 mm), directing the central beam to the eye socket being examined.

In cases of injury to both eyes (after an explosion or gunshot wound), complete photographs of each eye socket should be taken separately. When examining each patient, ordinary bone radiographs must be supplemented with overview non-skeletal photographs of the anterior segment of the eye, since small and low-contrast fragments located in the anterior segment of the eye can often be visible only in these photographs.

A non-skeletal examination should be carried out even in cases where the shadow of a foreign body is detected on ordinary photographs, since in addition to it, there may be other, less radiopaque fragments in the eye.

Standard X-ray examination of the orbit and paraorbital structures includes the Caldwell nasofrontal (anterior fronto-occipital) position, the nasomental position, the Waters anterior semiaxial (mental) position, the lateral and parietal (submentovertex) position.

In most cases, to localize a foreign body, the Komberg-Baltin technique is used, in which an indicator prosthesis with lead points applied to it on meridians 3-9 and 6-12 is placed on the eye.

In cases where a foreign body is poorly visible or not visible at all on a direct projection image, but is identified on radiographs in axial and lateral projections, it should be localized using the Abalikhin-Pivovarov method.

Additional ways to indicate the dial

In cases where extensive penetrating wounds of the eye or rough scars do not allow the application of a prosthesis on the eyeball, the limbus can be marked with points from bismuth slurry (basic bismuth nitrate with vaseline oil in equal parts) or points of A. M. Vodovozov, applying them along the above meridians. This procedure is performed by the ophthalmologist immediately before the shooting, when the patient is already lying on the table. First, the eyelids are pulled back using strips of adhesive tape or special clip-blepharostats. In most cases, it is still not possible to place a point along the 12 o’clock meridian, since the upper limbus, as a rule, remains covered by the corresponding eyelid. But using three points you can make calculations quite accurately. The principle of calculation remains the same as when marking the limbus with an indicator prosthesis.
If radiography is performed after surgery, when applied to the conjunctiva seams and they interfere with the application of a prosthesis to the eyeball, you can use a prosthesis with a cut segment. The cut part of the prosthesis falls on the protruding seams.
When the membranes fall out eye marking of the eyeball can be done using a Bowman probe. During frontal (face up) and lateral images, the doctor touches the tip of the probe to the center of the cornea.
When calculating a frontal image, the measuring circuit is applied so that the anatomical axis of the circuit aligns with the tip of the probe, and the horizontal meridian of the circuit is parallel to the anatomical horizontal. On a lateral radiograph, the tip of the probe corresponds to the anterior pole of the eye. The side diagram is applied so that the front pole of the diagram is aligned with the tip of the probe, the bullet line of the diagram, indicating the plane of the limb, would be parallel to the corresponding edge of the film. Further calculations are made in the same way as when marking the limbus with a prosthesis.
In this way, all three main coordinates are determined that characterize the location of the fragment in the eye.

Combination of primo and axial localization images

In practice, there are cases when a foreign body, due to weak contrast, is not detected on a lateral image, but its shadow is visible on direct and axial images. In such cases, it is possible to localize the fragments by combining photographs in frontal and axial projections taken with the Baltin prosthesis on the eye.

The meridian of the location of the fragment and its distance from the anatomical psi are determined from the direct image; the distance from the limbal plane is determined from the axial image.

Techniques for non-skeletal radiography of the anterior part of the eye

The essence of the non-skeletal examination of the eye is to obtain an X-ray image of its anterior segment without imposing bone shadows on it, as a result of which it is possible to obtain shadows of very small and low-contrast fragments. Therefore, every patient with a suspected presence of a foreign body, in addition to bone photographs of the orbit, must undergo non-skeletal radiographs of the anterior segment of the eye.

according to Baltin's method and Polyak's modification

The technique is as follows

The patient's head is placed on the imaging table so that the sagittal plane of the skull is at an angle of 45° relative to the table.
A film measuring 6x6 cm, placed in an appropriately sized envelope made of opaque paper, is applied to the outer wall of the orbit and fixed with a cotton-gauze roller.
The tube is centered on the nose bridge.
The focal length is 60 cm.
The patient is asked to open his eyes as wide as possible during the shooting.

If on a non-skeletal radiograph performed using this technique, the shadow of the fragment is not detected, and clinical data indicate the possibility of a foreign body in the eye, it is necessary to conduct an examination

according to Vogt's method

To take photographs, double films measuring 5.5x2.5 cm are used, rounded at one end (they are cut out using a metal template). Such films are wrapped first in black, then in wax paper to protect them from exposure to light and tears. Double films must be made in order to distinguish random artifacts from shadows of fragments - the latter will be visible on both films in identical places.
Survey non-skeletal photographs according to Vogt are taken in 2 mutually perpendicular projections: lateral and axial.
The distance from the focus of the tube to the film for both shots is 50 cm.

To take a picture in the lateral projection, the patient is placed on the side of the healthy (!) eye, having previously installed a 0.5% alcaine solution into the conjunctival sac. The film is inserted with a rounded end into the conjunctival cavity and pushed as far as possible into the depth of the orbit between its inner wall and the eyeball, while the film is slightly bent, modeling it along the curvature of the eyeball.

The X-ray beam is centered on the front part of the eye, directing it perpendicular to the film. At the moment of shooting (this applies to photographs in both projections), the position of the eye should be such that its visual axis is parallel to the longitudinal edges of the film, and the plane of the limb is perpendicular to the latter.

After taking the image, it is necessary to immediately mark the upper corner of the end of the film that was not inserted into the conjunctival sac, so that later you can firmly know that this particular corner corresponds to the upper part of the eyeball. The easiest way to make this mark is by folding the film.

Axial shot performed with the patient sitting, with the head slightly thrown back, or in a supine position, with the chin brought to the weight. In any case, the position of the head should be such that the brow ridges do not cover the anterior segment of the eye. The film with a rounded end, slightly modeled along the curvature of the eye, is inserted into the lower conjunctival fornix and, as far as possible, pushed deep into the orbit between its lower wall and the eyeball. After taking the picture, remove the film from the conjunctival cavity and bend its corner in the nasal half in order to further distinguish the nasal half of the picture from the temporal one.

After identifying the shadow of a foreign body on boneless images, the fragment is localized.

Localization images are performed in lateral and axial projections in the same way as survey images using the Vogt method, but with obligatory marking of the limbus. One of the marking methods is to apply a small drop (1-1.5 mm in diameter) of bismuth slurry to the limb along the 6 o'clock meridian using a muscle hook or a glass rod. After performing localization images, always first carefully remove the bismuth slurry from the limbus with a damp cotton swab, and only then remove the film from the conjunctival sac, marking the corresponding corners of it.

When performing both survey and localization images using the non-skeletal technique, the doctor only inserts the film into the conjunctival sac, and the patient himself holds it during the entire duration of the study using any clamp, between the jaws of which the non-rounded end of the film can be clamped. If this examination is performed on a child, the film is held by the person accompanying him.

A correctly performed lateral non-skeletal localization image shows the soft-tissue profile tissues of both eyelids and a rounded shadow of the cornea between them. Adjacent to the contour of the cornea in its lower part is the contour of the bismuth point; if it extends beyond the contour of the cornea, this means that at the time of shooting either the position of the eye was incorrect, or the bismuth point was not placed strictly along the 6 o’clock meridian, but was shifted towards the 5 o’clock meridian. - and or 7 o'clock. In this case, the photo must be redone.

On the axial image, the soft tissue shadow of the anterior segment of the eye and the upper eyelid has the outline of symmetrical semicircles. The bismuth point should be located inside this shadow along the midline between the longitudinal edges of the film.

Localization calculations

A method for calculating the localization of foreign bodies from non-skeletal images was proposed by E. S. Vainshtein. They are based on the principle of calculations applied by A. A. Abalikhin and V. P. Pivovarov.

Calculations for lateral and axial images are made using the same measuring circuit, which represents a special contour of the meridional section of the eyeball against the background of a grid of square divisions equal to 1 mm. The diagram highlights the axial and limbal lines.

Using an x-ray in a lateral projection, the state of the fragment from the limbus plane and at the same time its distance from the horizontal axial plane (up or down) are determined. To do this, the measuring circuit is superimposed on the picture so that the intersection point of the cornea contour and the limbus line on the diagram would coincide with the shadow of the bismuth point on the picture, and the image of the cornea on the diagram would fit into the contour of the cornea on the picture.

After this, according to the divisions marked on the diagram, the number of mm separating the fragment from the plane of the limb and from the horizontal axial plane is counted.

Using the axial image, the distance of the fragment from the vertical axial plane (to the nose or temple) is determined. To apply the measuring circuit to the axial image, it is rotated so that it corresponds to the section of the eyeball along the horizontal axial plane.

Then the diagram is superimposed on the image so that the longitudinal edges of the diagram and the image are parallel to each other, and the intersection point of the sagittal axis and the limb line in the diagram coincides with the bismuth point in the image. After this, it is determined at what distance from the sagittal (vertical axial) plane of the eye the fragment is located.

Based on the two values obtained - the distance of the fragment from the vertical and horizontal axial planes - its distance from the anatomical axis and the meridian of occurrence is determined, using either the diagrams of A. A. Abalikhin, or the table and meridional diagram of E. S. Weinstein.

Examination of the upper eyelid and external commissure of the eyelids

To differentiate foreign bodies located in the eyeball from fragments projected onto the eye from the upper eyelid and external commissure, isolated non-skeletal photographs of the upper eyelid and external commissure should be taken.

To do this, a double film wrapped in dark and wax paper or placed in a cassette for non-skeletal images is inserted into the upper conjunctival fornix or inserted between the external commissure of the eyelids and the eyeball. The X-ray beam is directed perpendicular to the film.

The technical conditions for shooting in this case must differ from those when taking a picture of the anterior segment of the eye along with the eyelids: tension and exposure must be reduced, otherwise the soft tissues of the eyelids and adhesions, as well as low-contrast fragments in them, will be “pierced” through.

Diagnosis of fragments in the border zone of the eye

The difficulty of diagnosing foreign bodies located in the so-called border zone of the eye lies in the fact that the size of the eyeball varies widely among different people - from 21.3 to 31 mm. Thus, the width of the so-called border zone can be about 10 mm. Such fluctuations in the size of the eye, if not taken into account, can become a source of errors in the localization of fragments. It follows from this that information about the individual dimensions of the injured eyeball is of great importance.
There is a complex technique - x-ray-ultrasound localization of foreign bodies. It consists in the fact that in addition to X-ray localization of foreign bodies, ultrasound biometry (USB) of the injured eye is performed, i.e., measuring the distance from the anterior pole of the eye to the posterior membranes. Since the thickness of the posterior membranes, according to different authors, ranges from 0.5-0.8 to 1.7 mm, we recommend adding 1.0-1.5 mm to the UZB data to obtain the entire length of the anteroposterior axis of the eye.

In the case of a borderline location of a foreign body, having data on its distance from the limbus plane and the anatomical axis, as well as knowing the size of the eyeball, to resolve the issue of the intra- or extraocular location of the fragment, you can use the one compiled by V. A. Rogozhin. It contains information about the length of the radii of the frontal sections of the eye, removed from the plane of the limbus at any possible distance in spherical eyes of different diameters - from 20.0 to 28 mm. In other words, it contains numbers indicating the maximum possible distance of intraocular fragments from the anatomical axis at their different distances from the limbus plane in eyes of different sizes.

The numbers in the first vertical row of the table indicate the possible distance of the fragments from the plane of the limb within the eye. The numbers in the first horizontal row indicate the diameters (sizes) of the eyes. At the intersection of the vertical and horizontal rows, numbers are placed that indicate the maximum possible distance from the anatomical axis of the intraocular fragment, removed from the plane of the limbus at a specific distance in an eye of a certain size. If, as a result of X-ray localization, it is established that the distance of the fragment from the anatomical axis exceeds that in the corresponding column of the table, then the fragment is located outside the eye; if it does not exceed (equal to or less than the number indicated in the table), then the fragment is intraocular.

For example, according to the UZB, the diameter of the injured eye is 25 mm. According to X-ray localization data, the fragment is removed from the plane of the limbus by 10.0 mm, from the anatomical axis by 12.0 mm. In the first vertical row of the table we find the number 10.0, corresponding to the distance of the fragment from the plane of the limb, in the first horizontal row we find the number 25, corresponding to the size of the eye. At the intersection of the horizontal and vertical rows we find the number 12.49 - the maximum possible distance from the anatomical axis for an intraocular fragment at a distance of 10.0 mm from the limbus plane in an eye of a given size. In our example, the distance of the fragment from the anatomical axis is 12 0 mm. Consequently, the intraocular fragment is located in the membranes. If in our example the distance of the fragment from the anatomical axis was, say, 13.5 mm, then the fragment should already be considered extraocular.

Thus, the use of radiography, ultrasonography and the proposed table in combination significantly increases the efficiency of diagnosing foreign bodies located in the border zone of the eye, but does not completely solve this problem. The question of the intra- or extraocular location of the fragment in some cases remains unresolved, and then it is recommended for X-ray surgical examination in an operating room using the technique developed by I. Ya. Shitova.

This technique, in addition to x-ray localization of foreign bodies and ultrasound, includes the production of posterior boneless x-ray of almost the entire eyeball. For X-ray surgical examination, a cassette is used for non-skeletal radiography of the anterior part of the eye, in which the working part, made of aluminum, is extended to 7 cm.

If a special cassette is not available, the film can be wrapped in light-proof paper and placed in a sterile rubber fingertip.

Previously, the coordinates of the location of the foreign body are determined using the Komberg-Baltic method or some other x-ray technique. Then, after preparing the surgical field and anesthesia, the conjunctiva is cut in the meridian of the foreign body at the limbus and the conjunctiva is deeply peeled off. The success of diagnosis largely depends on how thoroughly the sclera is freed from the adjacent soft tissues.

Next, the corresponding rectus muscles are ligated and, if necessary, cut off. A thorough examination of the sclera is performed. In the meridian of the foreign body at the appropriate distance from the plane of the limbus, the place for the subsequent diascleral incision is marked with brilliant green, and a small metal mark is sewn episcleral to serve as a guide during the operation.

A film is inserted close to the sclera under the control of the eye, making sure that no soft tissue is pinched between it and the eyeball. The X-ray beam is directed perpendicular to the plane of the film through the entire eyeball. If in the path of the rays between the anode of the X-ray tube and the film there is a fragment that delays the rays, then its tone image will remain on the film. In these cases, we can speak with confidence about the location of the fragment in the eye, since a foreign body located outside the eyeball will not create a shadow on the film.

The most common reason for foreign bodies getting inside the eyes is working with a hammer, chisel or other tool without appropriate protective equipment.
Two types of traumatic effects of foreign bodies on intraocular structures can be distinguished:
Structural damage. Occur at the time of injury and continue until the foreign body is removed from the eye.
Toxic damage. They develop when a foreign body remains in the eye for a long time. Directly depend on the chemical composition of the foreign body and its location inside the eye.

Location of foreign bodies.

The location of a foreign body inside the eye depends on its size, speed of movement and shape.
Often, foreign bodies that enter the eye through the cornea can be located in the structures of the anterior segment of the eye - in the humor of the anterior chamber, on the iris, in the lens. Having pierced the sclera, the foreign body can stop in the ciliary body.

Having a higher speed, the foreign body passes through the structures of the anterior segment of the eye and stops in the vitreous body or wedges into the retina.

Finally, a foreign body can fly through the eye and stop in the socket behind the eye or even penetrate the skull. The latter often occurs with gunshot wounds, while the eye is damaged not only by the bullet itself, but also by its explosive action, which in combination leads to severe tissue destruction.

Toxic effect of foreign bodies

Our body is designed in such a way that it always tries to separate everything foreign from itself. When a foreign object gets inside the eye, it is quickly covered with a connective tissue capsule, as if delimiting it from the surrounding tissues. The further course of events is determined by the nature of the foreign body:

Glass and plastic can remain inside the formed capsule for many years without having a toxic effect on the eye tissue.
Iron-containing materials (the most common type of foreign bodies), even in very small sizes, over time (most often 6-12 months) lead to toxic damage to the eye - siderosis. In this case, all structures of the eye are affected without exception, a chronic inflammatory process develops, visual acuity decreases, intraocular pressure increases, which leads to functional death of the eye.

Copper-containing materials, when left in the eye for a long time, also have a toxic effect on all structures of the eye - chalcosis. The clinical picture develops more slowly than with siderosis; pronounced changes are observed 1-2 years after the injury.
With siderosis and chalcosis, the manifestation of a toxic reaction depends on the location of the foreign body: if it is located in the structures of the anterior segment of the eye or the ciliary body, then the toxic effect affects the retina last. At the same time, the location of a foreign body in the vitreous body and retina may not affect the structures of the anterior segment for a long time.

Diagnostics

In addition to examination using a slit lamp, which allows you to see the intraocular foreign body itself or suspect its presence based on a set of signs (penetrating wound, damage to the internal structures of the eye), the following diagnostic procedures are used:

Ultrasound examination (ultrasound) - allows you to assess the volume and location of intraocular hemorrhages, the degree of displacement and integrity of intraocular structures, the presence and location of a foreign body (including those not visible during radiography), and the condition of the tissues behind the eye.

Magnetic resonance imaging is contraindicated if a metallic foreign body is suspected inside the eye.
X-rays, computed tomography (CT) - allow you to determine the location, size and number of foreign bodies in the orbit and eyeball
Magnetic resonance imaging is contraindicated if a metallic foreign body is likely to be present inside the eye.

Principles of treatment

The main goal of treatment is to restore the integrity of the eye (see principles of treatment of penetrating eye injuries) and remove the foreign body. The timing of removal is determined by several factors, including the nature and location of the foreign body, the availability of the necessary equipment and qualified medical personnel.

The main goal of treatment is to restore the integrity of the eye and remove the foreign body as quickly as possible.

Organic foreign bodies (plant parts) pose the greatest danger to the eye, because they quickly rot, causing a powerful inflammatory process. Therefore, they require immediate removal. However, in all other cases one should also strive to remove the foreign body from the eye as early as possible.
It is imperative to prevent infectious complications by intramuscular, intravenous and local (near the eye, inside the eye in the operating room) administration of antibiotics and anti-inflammatory drugs. If necessary, get a tetanus vaccination.

With the development of siderosis and chalcosis, it is necessary (in addition to removing the foreign body) to carry out a course of detoxification therapy and remove toxic products from the eye as much as possible (including surgically).

Consequences

The consequences of eye injuries directly depend on the extent of the injury and the timing of treatment.

Hospitalization and surgical treatment are required. The consequences depend both on the extent of the injury and on the timing of treatment.
Anatomical changes in the structures of the anterior segment of the eye can contribute to decreased vision due to astigmatism, corneal opacities, damage to the iris, as well as increased intraocular pressure and the development of secondary glaucoma.
Retinal injury is often combined with vitreous hemorrhage. As a result of scarring processes, retinal detachment may form. All this requires surgical and laser treatment, the scope and timing of which are determined individually in each case.
Pathogenic microorganisms that enter the eye through a wound along with a foreign body can lead to the development of a severe infectious process (endophthalmitis), which is extremely dangerous for the eye. In such cases, general and local antibacterial and anti-inflammatory therapy is carried out, and possibly surgical intervention (vitrectomy).

A large amount of trauma, repeated surgical interventions and the presence of an inflammatory process can lead to a serious complication - sympathetic ophthalmia. In this case, the victim’s immune system begins to attack both the diseased and healthy eye. In such cases, an urgent course of anti-inflammatory therapy is required, and sometimes removal of the previously injured eyeball.