Anterior chamber hemorrhage (hyphema) is a common clinical symptom found in most patients with blunt eye trauma. The source of hyphema is damage to the vessels of the iris and ciliary body.
Hyphema can be of varying intensity, from small to total, depending on the degree of damage to the vascular plexus. Minor hemorrhages give an opalescence to the moisture of the anterior chamber with an admixture of a small amount of red blood cells, which often settle on the endothelium of the posterior surface of the cornea in the form of a triangle, with the sharp end directed toward the center. Partial hyphemes occupy the lower part of the anterior chamber; in some cases, they may look like a blood clot that has settled on the iris or in the pupil. Often a secondary hyphema occurs when suspended blood or a bright scarlet layer of blood appears above the old hyphema. With total hyphema, the anterior chamber is completely filled with blood; this condition may be accompanied by a slight increase in intraocular pressure, and in some cases be the cause of an acute attack of secondary glaucoma. With prolonged non-absorbable or recurrent hyphema, a complication such as corneal imbibition with blood occurs. However, with timely conservative therapy or surgical methods of treatment, this complication is quite rare.
In case of eye contusion, a clouding of the lens (traumatic cataract) or a change in its position (dislocation or subluxation of the lens) is often observed.
Clouding of the lens can occur as a result of penetration of aqueous humor through capsule ruptures (even the smallest). Clinically, the anterior and posterior subcapsular cataracts appear within 1-2 weeks from the moment of injury. With opacities located in the center, visual acuity is significantly reduced, while in case of damage outside the central zones, it can remain high for a long time. With a significant lesion of the anterior capsule of the lens, the damaged fibers become cloudy and fill its cavity in the form of a swelling mass. In some cases, they can block the angle of the anterior chamber, thereby hindering the outflow of aqueous humor, which leads to an increase in intraocular pressure and the development of secondary glaucoma. Treatment. In such cases, an urgent operation is indicated – cataract extraction. A change in the position of the lens occurs due to a partial or complete rupture of the zinc ligaments. Depending on the mechanism of contusion, the lens can move into the anterior chamber or vitreous body. The lens subluxation is characterized by symptoms such as unevenness of the anterior chamber, iris trembling (iridodonesis); possible prolapse of the vitreous body and increased intraocular pressure. When the lens is dislocated anteriorly, the anterior chamber is deepened, the iris is displaced posteriorly, and the lens has the appearance of a fat drop. A dislocation of the lens into the vitreous body is accompanied by a deepening of the anterior chamber, iridodonez, and a decrease in visual acuity. When the eyeball moves, the dislocated lens can move or fall to the fundus. Using the methods of ophthalmoscopy and ultrasound (A- and B-study), you can determine the location of the dislocated lens and further treatment tactics. Treatment. With a complete dislocation of the lens, its removal is indicated.
Ciliary body contusion
In case of blunt trauma, accommodation disorders due to spasm or paralysis of the ciliary muscle can be observed. Often there is a detachment of the ciliary body, which leads to free communication between the anterior chamber and suprachoroid space. When the ciliary muscle is split, the ciliary body, together with the iris and lens, is shifted back, which causes a recession of the iris-corneal angle and can cause secondary glaucoma. Damage is often accompanied by vitreous hemorrhages, sometimes hemophthalmus (filling the entire eye cavity with blood), as well as impaired secretion of aqueous humor, which often leads to an increase or decrease in ophthalmotonus.
Vitreous hemorrhages can look in the form of threads, cobwebs. A small amount of blood in the front of it may go unnoticed. Going down and gathering in the lower part, they are found in the place of contact of the lower part of the boundary layer and the posterior lens capsule. If there is more blood, then it looks like reddish masses of various shapes. Hemorrhages can be more massive when the reflex from the fundus cannot be obtained, and visual acuity drops to light perception. With biomicroscopy, it is clear that the blood saturates the vitreous body. The degree of hemorrhage can be judged by the results of ultrasound (B-study, which allows you to determine the degree of hemophthalmus). Such a hemorrhage resolves slowly and, in the process of resorption, helps to thin the vitreous body. As a result, persistent opacities and connective tissue moors are formed, which subsequently can cause detachment of the vitreous body and retina. Treatment. Immediately after the injury, bed rest is prescribed, a binocular dressing is applied, hemostatic preparations are introduced (Vikasol, Dicinon, Ascorutin, aminocaproic acid, etamsylate, Doxium). After 3-5 days, if there is no recurrence of hemorrhage, resorption therapy is indicated (hypertonic solutions of sodium chloride and potassium iodide are administered intravenously), autohemotherapy, enzyme therapy (fibrinolysin, trypsin, lidase, hemase), tissue and vitamin therapy, plasmapheresis, ultrasound and laser therapy. If conservative therapy is ineffective, surgical treatment is indicated – closed vitrectomy through the flat part of the ciliary body; the optimal period for her is 1 month. after an injury.