Vol.14
No. 1, Januray, 2004
Unpredicatele
Outcome in Penterating Ocular Trauma
RK Grewal, Aman Agarwal
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
