The goal is to eliminate the consequences associated with mechanical damage to the inner membranes of the eye, eyelids and orbit tissues; correction of vascular disorders, post-concussion inflammatory reaction and eye hydrodynamics.
The main areas of treatment include:
1. Diagnostics with determination of the localization and extent of damage.
2. Specialized surgical care and subsequent rehabilitation.
3. Prevention of the development of infectious complications.
4. Normalization of the psychological state of the patient.
Treatment of patients with mild concussion is carried out on an outpatient basis, patients with severe and moderate injuries are subject to hospitalization. In the first day after the injury, all patients are recommended rest, bed rest, the use of cold compresses is possible.
The treatment of postcontusional lesions depends on the clinical manifestations. It includes the integrated use of drugs and, if necessary, surgical treatment.
Drug treatment is carried out using the following groups of drugs.
1. Anti-inflammatory drugs:
• glucocorticoids: dexamethasone parabulbar or under the conjunctiva, 2-4 mg, per course – up to 10 injections; phlosterone, diprospan parabulbar 3 injections with an interval of 2-3 weeks;
• non-steroidal anti-inflammatory drugs: diclofenac orally 50 mg 2-3 times a day before meals, course 7-10 days, or indomethacin orally 25 mg 2-3 times a day before meals, course 7-10 days.
2. HI receptor blockers: loratadine orally 10 mg once a day after meals for 7-10 days; tavegil (clemastine hydrofumarate) intramuscularly or intravenously, 2 ml 2 times a day, morning and evening. 3. Tranquilizers: diazepam intramuscularly or intravenously 10-20 mg for psychomotor agitation, 5-10 mg for conditions associated with sleep disturbance, anxiety and fear. 4. Enzyme preparations: fibrinolysin 400 units parabulbarno, 5-10 injections; hemeza at 5000 IU in isotonic sodium chloride solution, 5-10 injections; lidase 6-12 units, 5-10 injections; chymotrypsin in the form of compresses 2-3 times. 5 . Angioprotectors: dicinone (sodium ethamylate) parabulbar 40-60 mg, 5-10 injections; dicinone intravenously, 250-300 mg, 5-8 injections, or by mouth, 1 tablet 3 times a day for 10-30 days. 6. Diuretics: diacarb inside, lasix intramuscularly or intravenously. 7. Preparations for instillations in the conjunctival sac: • antibacterial agents: vigamox (moxifloxacin hydrochloride 0.5% solution) 1 drop 3 times a day for 4 days; phloxal (ofloxacin 3 mg) 1-2 drops 4 times a day for 5-7 days; • oftaxvix (levofloxacin 5 mg), 1-2 drops up to 8 times a day for several days, then 1 drop 4 times a day; • antiseptics: ophthalmic septonex (carbetopendicinia bromide 0.002 g, boric acid 0.19 g, sodium tetraborate 0.005 g); • glucocorticoids: dex-pos, maxidex, dexamethasone; • non-steroidal anti-inflammatory drugs: indocollyr, uniclofen. 8. Combined preparations: maxitrol (dexamethasone 1 mg, neomycin sulfate 3500 ME, polymyxin B sulfate 6000 ME); tobradex (suspension of tobramycin 3 mg and dexamethasone 1 mg). Different surgical interventions are performed depending on the clinical manifestations of eye contusion. So, with a subconjunctival rupture of the sclera, surgical treatment of the wound is indicated; with persistent hyphema, it is necessary to wash the blood from the anterior chamber and fill it with an isotonic sodium chloride solution. In cases of hemophthalmus, vitrectomy is performed in combination with conservative treatment.
Optic nerve damage
Damage to the optic nerve most often occurs as a result of a violation of its integrity or infringement by bone fragments, eye socket hematoma, hemorrhage between the membranes of the optic nerve. Infringement or rupture are possible at different levels: in the orbit, in the channel of the optic nerve, in the cerebral zone. Symptoms of damage to the optic nerve – a decrease in visual acuity and a change in the field of view.
An impairment of the optic nerve is characterized by a decrease in visual acuity, a picture of thrombosis of the central retinal vein can be determined on the fundus, and in case of a more severe injury, signs of occlusion of the central retinal artery appear.
Optic nerve rupture may be partial or complete. In the first days after the injury, the fundus is most often unchanged, therefore, the patient’s complaints about a sharp decrease or complete loss of vision may cause the doctor to suspect aggravation. Subsequently, an optic atrophy picture develops on the fundus. The closer the gap is localized to the eyeball, the earlier changes in the fundus occur. With incomplete atrophy of the optic nerve, it is possible to maintain reduced visual acuity and part of the visual field.
The detachment of the optic nerve occurs in the case of a severe blunt injury in the medial part of the orbit (the end of the stick, etc.), if the back of the eye suddenly shifts outward. Detachment is accompanied by complete loss of vision, a large hemorrhage is first determined on the fundus, and subsequently a tissue defect in the form of a depression surrounded by hemorrhage.
Treatment. Assign hemostatic and dehydration therapy; if there is suspicion of an orbit hematoma, a surgical incision is possible – orbitotomy. Further, in conditions of partial atrophy of the optic nerve, repeated courses of ultrasound, vasodilator and stimulating therapy are carried out.