Causes Of Perforating Eye Injury

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Perforating ocular injury simply means double laceration (a cut of a tissue or the act of tearing a tissue) of the eye wall due to entrance and exist wound caused by a sharp objects.

Note that perforating eye injury is quite different from penetrating eye injury because in penetrating eye injury, there is only a single laceration as compared to double laceration in perforating eye injury. There are three main causes of perforating ocular injury: foreign bodies, laceration and eye infections.

Foreign bodies

This is the most common type of ocular trauma, accounting for about half of all types of injuries. It generally results from a person not realizing the hazard of the task, for instance when using a hammer and chisel, cutting wire or grinding wheel. The eye's natural defence mechanisms may be penetrated and foreign bodies (FBs) may become embedded in the globe or they may pass through the cornea or sclera to become lodged within the globe. The symptoms can vary from little or no discomfort to severe pain. Common sites of foreign bodies in the eye include: subtarsal, superficial, intra-ocular and retained intra-ocular foreign bodies.

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Recommended: How to Locate and Remove Ocular Foreign Bodies 

Lacerations

In cases where lacerations involve the cornea and sclera, there may be a prolapse of the iris, ciliary body, lens and vitreous, resulting in complete disorganization of the globe. Posterior rupture of the globe is rare and should be suspected when extreme conjunctival oedema and hemorrhage with marked hypotony occur. Unfortunately, useful vision is not often restored, even after prompt surgery. Lacerations may also occur after blunt trauma; for example, two cases of lacerations caused by jets of water from an agricultural sprinkler have been reported.

Infections of the eye

The danger of intra-ocular foreign bodies (IOFBs) is that they may carry infections into the eye, resulting in uveitis; inflammation of the entire uveal tract. Infections may be caused by brucellosis or toxoplasmosis. This is not as serious as a purulent infection, which usually results in the loss of the eye due to panophthalmitis or endopthalmitis.

A very rare and serious complication of perforating lacerations from an IOFB is sympathetic ophthalmitis, a type of uveitis affecting the non-injured eye, and which can lead to blindness.

The second eye usually becomes involved two weeks to two months after injury. According to an old review the only effective therapy is preventive enucleation of the injured eye despite the use of immunosuppressive agents. An individual who has received a perforating injury should be sent for immediate medical attention. The eye should never be padded, as this may cause the ocular contents to prolapse. A cardboard cone can be placed over the eye to protect it from dust, dirt, etc. X-rays should be taken if the presence of an IOFB is suspected, to determine if it is metallic.