Perforation of the eye

Refer urgently to ophthalmology casualty department.

• perforating wounds of the eye often follow a sharp, sudden impact which penetrates the eyelids, for example injury from a splintered windscreen in a car accident
• eyelid wounds require prompt suturing to restore the lid margin. They heal well because of their profuse blood supply
• conjunctival wounds rarely require suturing as they heal well
• perforating wounds of the cornea frequently involve the iris and the lens. The iris may become prolapsed as aqueous escapes through the wound with distortion of the pupil. In a small wound, the prolapse may seal the hole. There may be a hyphaema with reduced vision. Damage to the ciliary body may produce severe haemorrhage. Perforation of the lens capsule results in cataract formation
• an intra-ocular foreign body requires urgent attention. The history is usually suggestive and the patient complains of discomfort in the eye and blurred vision. The foreign body may be visualised directly or may require an orbital X-ray or ultrasound
• vegetable matter may cause infection and require antibiotics. Siderosis from iron causes dark brown staining of the iris, cataract, retinal atrophy and eventually blindness over a period of months. Removal is with a powerful electromagnet. Chalcosis from copper produces an acute inflammatory reaction resulting in rapid loss of vision. Removal is with fine forceps. Many of the newer alloys are more inert and may be tolerated. Glass and porcelain may be tolerated indefinitely and may, in some cases, be best left alone