_In wounds of the sclerotic_ all portions of the uveal tract and
vitreous which prolapse should be removed, and the wound closed with
sutures passed through the superficial episcleral tissue. Unless the
wound be small the prognosis is not good, as it is liable to be followed
by irido-cyclitis, or, if this does not occur, detachment of the retina
may ensue, following on organization of the exudates in the vitreous.
_Wounds of the cornea_ usually result in prolapse of the iris, which
should be removed in the manner described under iridectomy (see p. 208).
3. _If the lens be injured._ Unless the wound amounts to little more
than a punctured wound of the globe involving the lens, the prognosis is
bad. The wound in the lens capsule and the breaking up of the lens mean
the presence of soft matter in the anterior chamber--a condition which
favours sepsis and is liable to produce increased tension from blocking
the angle of the chamber. In patients under thirty the pupil should be
dilated with atropine and the lens allowed to absorb--assisted at a
later date by needling, when the eye has entirely settled down after the
original injury. If the patient be over thirty it is often extremely
difficult to decide whether extraction of the lens should be undertaken
at the time of the injury or at a later date. The results of both
procedures are very unsatisfactory, and the surgeon should be guided
partly by the position and extent of the wound. Given these in a fairly
favourable position, it is probable that immediate extraction will give
the best result.
4. _If the eye contain a foreign body._ Usually these are pieces of
metal or glass. The following points should be investigated to determine
whether the foreign body be in the eye:--
(i) The history of these accidents is usually the same. The patient is
chipping with a hammer and chisel, and a piece flies off and strikes the
globe. In the case of glass it is usually a mineral-water bottle which
bursts.
(ii) The position and nature of the wound in the cornea and sclerotic.
(iii) The condition of the anterior chamber--whether evacuated or not.
(iv) The tension of the eye, which may be lowered.
(v) The presence of a hole in the iris.
(vi) The presence of traumatic cataract.
(vii) Whether the foreign body is visible with the ophthalmoscope or by
focal illumination.
(viii) The localization of the foreign body by the X-rays. The latter is
the most important factor of all, since the foreign body may pass right
through the globe and be embedded in the orbit.
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