INTRODUCTION
Ocular trauma is an important cause
of visual loss and disability. With
the modem diagnostic techniques,
surgical approaches and
rehabilitation many eyes can be
salvaged with retention of vision.
Despite advances in medical and
surgical management penetrating
trauma continues to be a complicated
and challenging condition.
Ocular
trauma could be further subdivided
into categories based upon the type
and extent of damage. They may be
classified as rupture secondary to
blunt injuries, lacerating injuries,
injuries related to intra ocular
foreign bodies.
Despite
all interventions the prognosis in
many cases could be quite different
from that expected from the initial
presentation.
CASE
I
30 Year old with alleged history of
road side accident, presented with
complaint of sudden diminution of
vision and pain left eye following
the injury. On examination the
visual acuity was PL+ve and PR
inaccurate with lacerations over the
left upper lid. Conjunctiva showed
sub conjunctival hemorrhage. A full
thickness corneal tear extending
from the 12 o'clock to 6 o'clock
position was seen. Hyphaema was
seen in the anterior chamber. There
was associated prolapse of the uveal
tissue and vitreous through the
wound. No red glow was seen on
ophthalmoscopy. X ray orbit did not
show any radio-opaque foreign body.
An informed consent was taken and
patient was duly informed about the
visual prognosis. Corneal tear
repair was undertakne with clearing
of the hyphaema, prolapsing uveal
tissue and the vitreous. Post
operatively patient was put on
antibiotics, steroids and
cycloplegics and was on regular
follow up. following this the
paitent had a visual acuity of 6/60
with aniridia, aphakia and resolving
vitreous hemorrhage. In due course
the corneal sutures were removed and
after refraction patient's vision
improved to 6/9. With the use of
hard contact lenses the patient's
vision was 6/9 and with soft lenses
the patients vision is 6/12. The
patient still has a complaint of
photophobia due to aniridia. Thus
his final visual outcome was quite
different from that expected
initially.
CASE
II
26 year old male presented with
complaint of pain, redness and
bleeding form the right eye after
injury with an iron chip while he
was working on a drill machine and
the chip entered in the eye.
Patient presented with pain, redness
and diminution of vision. On
examination he had a visual acuity
of 6/18 with sub conjunctival
hemorrhage and a scleral tear at 3
o'clock position. Cornea and the
anterior chamber were clear.
Indirect ophthalmoscopy showed an
IOFB just inferior and nasal to the
disc with retinal hemorrhage and
mild vitreous hemorrhage. After an
informed consent scleral tear repair
with pars plana vitrectomy with
intra ocular foreign body removal
was done. vitreous hemorrhage was
cleared and endolaser applied at the
site of impact of the foreign body.
Post operatively patient was put on
systemic and topical steroids and
antibiotics. Post operative period
was uneventful. Patient had a
visual acuity of 2/60 with a central
scotoma in the field of vision.
Fluorescein angiography revealed a
normal retinal vascular pattern and
a normal macular area. Thus despite
all medical and surgical
interventions the post operative
result was not up to the
expectations.
CASE
III
25 year old male presented with
penetrating ocular injury in the
right eye. On examination he had a
visual acuity of PL+ve and PR
inaccurate. Patient had a
corneoscleral tear about 10 mm long
with vitreous loss, hyphaema and
cilliary body prolapse. The
prognosis was explained to the
patient and an informed consent was
taken. Corneoscleral tear repair
was done the same day. The patient
was put on medical treatment
subsequently in the form of
antibiotics and steroids. Post
operatively the vision of the
patient remained as Pl+ve.
Patient
was diagnosed to have vitreous
hemorrhage. Vitrectomy and scleral
buckling was done and the patient's
vision improved to 6/36. After
correction of aphakia with contact
lenses the vision improved to 6/9.
DISCUSSION
Penetrating ocular trauma remains a
challenging task to an
ophthalmologist. In all cases of
ocular trauma proper assessment of
the patient and accurate
transmission of the clinical data
has to be undertaken. al injuries
should be classified according the
Ocular trauma classification into
open globe and closed globe injuries
and their further subtypes.
All
patients with ocular injuries have
to be assessed according to the four
major parameters: type of injury,
grade of visual acuity,
presence/absence of afferent
pupillary defect, zone of
involvement.
Timely
surgical and medical interventions
should be undertaken in these cases.
Though timely interventions are
undertaken and prognosis assessed
according to the initial
presentation as per the Ocular
trauma score the outcome may be
unpredictable in cases of
penetrating ocular trauma.
Address
for Correspondence
Dr. RK Grewal, Deptt. of
Ophthalmology,
Dayanand Medical College & Hospital,
Ludhiana
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