Eye injury encompasses a wide variety of pathology. Every structure of the eye required for a healthy functioning- eye – lids, cornea, anterior chamber, pupil, iris, lens, posterior chamber, retina, optic nerve, tear ducts, muscles and orbit can be injured. Each of these structures may be injured individually or in combination, even in multiple combinations.
Injury, unlike disease, presents additional challenges to the surgeon. Injury can occur at any level of tissue or combination of tissues in the eye. The extent of the injury may be obscured by swelling of the eyelids, disruption of the clarity of the cornea, or by blood in the front or back interior of the globe blocking the view or all of these factors at once. Retinal detachments, foreign objects, lens displacement and more damage may lie obscured within. No two eyes injuries are identical.
The first obstacle in examining and treating eye injury may be swollen eye lids. Although swollen lids alone are not a serious problem in themselves, swollen lids do not give a clue of what may be behind them – nothing at all or devastating damage – both may be masked by the lids. If we look at the eye from the viewer’s perspective, front to back, most exterior to interior, our first layer of observation will be the cornea framed by the lids. The transparent, shiny, reflective “cap” of the cornea covers the space in front of the iris, the colored part of the eye. Healthy corneas allow for the transmission of light through the pupil opening to the back of the eye where the light, focused by the lens, strikes the retina. As the cornea is one of the most vulnerable exterior tissues, it is frequently injured. The cornea functions as one of the key structures for vision. Damage may be minor, a superficial scratch or foreign body that may quickly heal without any lasting consequence or it may be severe and require replacement by corneal transplant.
The iris, the lens, the “plumbing” of the trabecular meshwork behind the cornea further posteriorly may also be damaged. Damage to the iris, can cause cosmetic disfigurement but more importantly impairment to normal visual functions. Damage to trabecular mesh work can result in inability of fluid to flow normally between front and back of the eye. This “blockage of the plumbing” can lead to threatening pressure rises in the eye. More extensive damage may damage of the ability of the globe of the eye to produce enough of the liquid to maintain adequate pressure causing a softening of the eye.
Next in line, the natural crystalline lens can be dislocated, extruded or may turn opaque from the injury. For many but not all trauma victims the lens can be replaced by a prosthetic intraocular lens implant, similar to the lens that is used to restore vision from cataracts common in older adults. Behind the lens the vitreous cavity the retina and optic nerve lie. A number of sophisticated delicate procedures and techniques may be employed by experienced, skilled retina surgeons to reconstruct the posterior cavity, seal tears, repair retina detachments, remove foreign objects and prevent proliferative scar tissue.
Ocular trauma is perhaps arguably one of the most if not most challenging areas of retinal surgical expertise. From the onset of the practice first established in 1982, ocular trauma has been an area of special interest and focus both in restorative surgery as well as research. With such focus and experience, combined with the deep compassion that understands that in devastating injuries even a small amount of recoverable vision can mean a great deal and for some people, even when vision is not possible, maintaining a normal cosmetic appearance can also be important.
All injuries, even initially minor appearing ones, can potentially have a “hidden” side or may develop problems later. It is important for you to see an eye specialist for all eye injuries. For serious injuries the surgeons here promise to be there for you with their best abilities and support your decisions through out the process.
NOTE: Any serious injury, especially open wounds, burns, explosions or chemical injury or sudden unexplained serious loss of vision requires immediate emergency care.
