The most common type of damage to the choroid is its ruptures, which are always accompanied by hemorrhages. As a rule, the detection of a rupture is preceded by the detection of a hemorrhage in the choroid, since only after the resorption of the blood do the whitish or pink stripes of the rupture of the choroid become visible. The resulting circulatory disorders in the choroid with vascular damage ultimately lead to the development of atrophic changes.
Contusion of the iris
Clinical contusion of the iris can be clinically manifested by a tear of the pupil edge, mydriasis, iridodialysis, aniridia.
During shell contusions, the pupil acquires an irregular, polygonal shape, often in the form of an elongated oval with tears of the pupil edge and deposition of pigment on the anterior capsule of the lens (Fossius ring). Myosis with contusion is rare and is the result of a spasm of accommodation or vegetative dystonia.
Paresis or paralysis of the sphincter of the iris can cause paralytic mydriasis. At the same time, deterioration of vision at a short distance is noted, the reaction of the pupil to light is absent or remains lethargic. In conditions of safety of the dilator, it is necessary to use mydriatics with caution, since the pupil in such cases expands as much as possible and remains dilated for a long time. The immobilized pupil against the background of the developed inflammatory reaction promotes the formation of circular synechia, pupil occlusion, impaired outflow of aqueous humor from the posterior to the anterior chamber, which leads to an increase in intraocular pressure and the development of secondary glaucoma.
With iridodialysis – separation of the root of the iris from the ciliary body – the pupil acquires a D-shape. The presence of a second hole (except for the pupil) can lead to diplopia, as well as photophobia as a result of excessive exposure to the inner parts of the eye. Through the separation area, the edge of the lens is often visible. When the iris is torn near the pupil edge, the pupil acquires an irregular shape. When dialysis is more than 1/2 the circumference of the iris, it is inverted with pupil deformation and exposure of the anterior lens capsule. With severe concussions, a complete detachment of the iris from the root is possible – aniridia. Damage to the iris, as a rule, is accompanied by bleeding from blood vessels to the anterior chamber, which is filled with blood partially or completely (partial or total hyphema). Damage and violation of the permeability of the vessels of the iris can lead to repeated hemorrhage, in connection with which there is a threat of secondary glaucoma and hematocornea. Treatment. Showing rest, bed rest, the application of a binocular dressing with an elevated position of the head for 2-3 days. First, hemostatics are prescribed (ascorutin inside, dicinone parabulbarno, aminocaproic acid inside or intravenously, 10% solution of calcium chloride intravenously, etamsylate inside or parabulbarno), and from the 4th to 5th day – absorbable therapy (fibrinolysin, parabulbar hemase), physiotherapy (phonophoresis papain). If there is no positive effect, on the 4th-6th day it is necessary to do paracentesis with washing the anterior chamber. Surgical removal of iridodialysis, mydriasis, coloboma of the iris with an optical purpose is performed after 2-3 months. after an injury. Surgical treatment of patients with aniridia, when partial or complete iridoprosthetics are necessary to restore the integrity of the iris, is carried out no earlier than after 5-6 months. after an injury.
Retinal damage
With a blunt injury, shaking of the retina, the so-called Berlin clouding, is possible. More often it is located in the central part, along large vessels, and in the disk area. Depending on the intensity of turbidity, the retina acquires a color from pale gray to milky white, which is associated with the disintegration and intracellular edema of the elements of the retina. As a rule, central vision is not significantly reduced, except when the changes cover the macula (macular region). Most often, a concentric narrowing of the field of vision is noted. Such changes are short-term and pass without a trace, the functions of vision are restored. In the case of severe edema in the macula, subsequently, the development of postcontusional maculopathy is possible.
In case of eye bruises, preretinal, retinal and subretinal hemorrhages can be observed. Retinal hemorrhages are most often localized in the macular and paramacular regions, around the optic nerve disc and along large vessels. In the macular region, they lead to a sharp decrease in visual acuity. Usually, even after resorption of hemorrhages, visual acuity is not fully restored. Hemorrhages located on the periphery do not significantly affect visual acuity.
Traumatic retinal detachment is a very serious lesion. The retina is not tightly fused with the tissues located below (with the exception of the exit point of the optic nerve and the serrated edge), but only adjoins them. At the time of a blunt injury, the retina is stretched, as a result of which it may rupture or tear away from the serrated edge. The concussion is characterized by hole retinal rupture in the fossa, which is explained by the morphological features of this very thin part of the retina. With such a gap, vision decreases sharply, a central absolute scotoma appears. Contusion gaps can be single and multiple, linear, perforated or valve, of different sizes. Liquid enters the formed hole and exfoliates the retina, which protrudes into the vitreous bubble. This is accompanied by a narrowing of the visual field and a decrease in visual acuity. In the late stages after concussion, tears and detachment of the retina arise as a result of cystic degeneration and formation of adhesions in the vitreous body (traction detachment). Treatment. With traumatic lesions of the retina, anti-inflammatory and hemostatic therapy, osmotic diuretics inside, injections of vitamin and tissue preparations intramuscularly are prescribed; fibrinolytic agents, enzymes, corticosteroid preparations are further indicated. In the case of post-traumatic retinal breaks, as well as cystic degeneration, laser or photocoagulation of the retina is indicated. Treatment of traumatic retinal detachment is only surgical; in the presence of adhesions in the vitreous, it must be combined with closed vitrectomy through the flat part of the ciliary body.