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SEVERE EYEBALL CONTUSIS AND CORNEAL PERFORATION INJURY
(CLINICAL CASE)
Aliyeva R.A.
Ophthalmologist, Department of Emergency Eye Injuries and Eye Microsurgery, Tashkent
City Emergency Medical Care Clinical Hospital
Abstract.
This 39-year-old in the article male in the patient eye of the apple heavy level
contusion and horn curtain piercing past injury with together colorful curtain output status
presented The patient house under the circumstances in the drill while working right iron
wire tattoo on the eye with enter gone. Urgent diagnosis put; primary surgery processing
Done. On time. shown medical help as a result the patient's see ability partially preserved
This is the clinical situation urgent ophthalmological approach and surgery intervention
relevance shows.
Keywords:
Eye injury, contusion, horn
curtain, colorful curtain, surgery intervention,
open globular injury.
Relevance of the study.
Eyeball
piercing past injuries in ophthalmology heavy
complications brought issuer from cases one Especially the horn
curtain through
internal structures out departure with passing injuries the patient's see to the possibility
directly threat solid. This type injuries of sight noticeable loss and injury in the field
infection to increase take arrival possible [1,3,6,8]. Research this shows that such in injuries
temporary delay many in cases endophthalmitis ( internal eye infection ) and traumatic
proliferative the risk of vitreoretinopathy (PVR) increases. 24 hours delayed primary surgery
intervention patients between endophthalmitis the risk almost 2.5 times increases [2,4,5,7].
In time diagnosis put and rush surgery intervention see ability save in staying and recovering
main role plays. Below cited clinical situation this the idea again one there is confirms.
The purpose of the study:
Analysis of the effectiveness of urgent diagnosis and primary
surgical intervention in preserving vision and preventing complications in open eyeball
injuries in a clinical case.
Materials and methods :
This clinical Tashkent city on June 21, 2025 under observation
Urgent fast medical help clinical to the hospital appeal did, right eye of the apple heavy level
contusion and horn curtain piercing past injury diagnosis 39-year-old male patient
participation The patient 's history, physical and ophthalmological examination results, as
well as ultrasound examination (B- scan ) data based on evaluated. Primary surgery
processing was held. From the practice then patient 8 days during stationary under
observation became, dynamic evaluation and conservative treatment continue was carried
out.
Clinical situation Definition:
Patient Age : 39 years old. Gender : male. Occupation :
private businessman. Came Time : June 16, 2025 7:00 PM. Complaint : Right eye redness
packing bleeding to rejuvenate and brighten to see.
Anamnesis : Patient from the word on 16.06.2025 at 11:00 a.m. at home, in the drill a piece
of iron wire while working for nothing right to the eye scattered. From there after in sight
pain, vision of sharpness sharp decline and eye inside of the liquid outside exit felt. Patient
Tashkent city Urgent fast medical help clinical to the hospital appeal as came and rushed
accordingly hospitalization was done.
Status locales : Visus =OD 0.02. Not corrected ; OS 0.9. Intraocular pressure = OD T-1. OS
18.0 mm wire. OD - Pumpkin a little swollen conjunctiva
hyperemia, blepharospasm,
rejuvenation mixture injection, horn curtain para optic in the field 4-5 mm puncture at 16-00
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past injury, wound from the field colorful curtain out, previous camera shallow, fluid dim
hyphaema 2.0mm, pupil wrong in the form reaction slow
OD - eye bottom : front camera dullness because of not visible.
OS - Front parts quiet, horn curtain clear, front camera medium, fluid clear, pupil reaction
3.0 mm saved. gem clear, eye bottom : KND open pink, border clear, veins tuft in the center,
the arteries are narrow, the veins full-fledged, net curtain thinned
Of the eye ultrasound inspection Conclusion OD (B scan ) - vitreous in the div average
homogeneous in character blurs. Back hyaloid curtain separation. Net curtain owns in place,
not moved.
16.06.2025 - year. General blood analysis : blood coagulation time - 3.40-4.00 sec,
Erythrocytes (RBC) - 4.4 10^12/L, Leukocytes (WBC) - 7.1 10^9/L, Hemoglobin (HB) -
138.0 g/l (16.06.2025) - 16.06.2025 - Alcoholic drinks – ABS.
Diagnosis : OD - Eyeball heavy level contusion. Horn curtain piercing past injury. Injury
from the field colorful curtain output with.
Recommendation : OD. Fast horn curtain piercing entered complicated to the injury primary
surgery processing practice transfer
Treatment. OD. Horn curtain piercing entered complicated to the injury primary surgery
processing.
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OD. Pumpkins and its around on the skin processing iodine with given. Anesthesia
retrobulbar Sol. Lidocaine 2% 2 ml. Bleforostat. Horn curtain injury field physiological
solution with diluted with antibiotics solution with washed. From the wound out standing
colorful curtain micro spatula to the front camera using reposition was done. To the injury
step by step step 10/0 thread with 5 stitches with knot was placed. Paracentesis at 09-00
done increased and front camera physiological solution and sterile air with restored,
filtration abs. Under the conjunctiva Sol. Dexamethasone 0.4% 0.5ml was instilled.
Disinfectant, antibiotic solution was instilled. Monocular aseptic bundle was put.
Result. 8 days after surgery passing by the patient's status positive towards changed : Default
based on treatment treatments acceptance did, corneal edema decreased, injury stitches
adapted, filtration abs, infection status not observed. Intraocular pressure stabilized. View
capacity up to 0.04 restored ( later cataract development probability available ). Treatment
plan at the RIKMIATM clinic on the basis of continue delivered
Patient from the station when exiting : General condition satisfactory condition
active,
div temperature normal, conscious in place, skin and visible mucus floors normal.
Peripheral lymph nodes not enlarged. Breast cage cylindrical, Breath in receiving both side
one kind participation It will. In the lungs two one-sided rough vesicular Breathing. Heart
sounds. hoarse, rhythmic. Pathological noises not detected, ABP 120/80 mmHg, Pulse 80
beats per minute. Liver not enlarged, spleen not enlarged, double- sided pasternatsky test
negative. Bone and muscle system unchanged
Status localis : VIS=OD -0.04/OS 0.9 KIB Tn/Tn. OD- Light conjunctival injection, horn
curtain swelling in dynamics ask started, horn curtain paraoptic in the field injury at 4:00
p.m. adapted, filtration abs, sutures in place clean, front camera liquid clear, sterile air, pupil
wrong in the form of, reaction weak, eye bottom details clear not visible. OS Front parts
quiet, horn curtain clear, front camera medium, fluid clear, pupil reaction 3.0 mm saved.
gem clear, eye bottom : KND open pink, border clear, veins tuft in the center, the arteries are
narrow, the veins full-fledged, net curtain thinned.
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Transferred laboratory and instrumental studies and related experts conclusions
General
analysis urine 17.06.2025 Urine yellow Urine transparency-turbid Relative density -
1014mmol/l Reaction-kis Protein - avs g/l Squamous epithelium - 2-3 in p/ zr Leukocytes -
4-5v p/ zr Slime + salt + kris match kis +.
General blood analysis 23.06.25 Hemoglobin (HB)-146 g/l Erythrocytes (RBC)-
4.4*10^12/L Color index -0.89 Erythrocytes average volume (MCV)-90 in 1 erythrocyte
hemoglobin ( MCH ) (MCH)-29.2 Erythrocyte hemoglobin concentration (MCHC)-324 g/l
RBC distribution width (%) (RDW-CV)-13% Hematocrit (HCT)-43.2% Platelets (PLT)-
178*10^9/L Platelets average Platelet volume (MPV) - 8.7μm³ Anisocytosis (RDW)-16.6
Thrombocrit (RST)-0.13% Leukocytes (WBC)-4.5*10^9/L Neutrophils ( Bacillus)
Nucleated )-2 Neutrophils (Segmented Nucleated )-50 Eosinophils (EOS%)-1% Monocytes
(MON%)-9% Lymphocytes (LYM%)-38% ECHT ( erythrocyte drowning speed )- 5 mm/h
16.06.2025 - salt - kris match kis +., Urine Color - yellow, Leukocytes - 4-5 in / ml, Relative
Density - 1014 mmol/l, Urine transparency - cloudy., Reaction - acidic., Protein - avs g/l,
Squamous epithelium - 2-3 v p/ zr, Mucus - +. 06/23/2025 - Color index - 0.89., Monocytes
(MON%) - 9 %, Neutrophils (Segmented Nucleated ) - 50., Neutrophils ( Rod Nucleated ) -
2., Platelets (PLT) - 178 10^9/L, Platelets average volume (MPV) - 8.7 μm³, Platelets
Anisocytosis (RDW) - 16.6., Erythrocytes (RBC) - 4.4 10^12/L, Erythrocyte hemoglobin
concentration (MCHC) - 324 g/l, RBC distribution width (%) (RDW-CV) - 13 %,
Hemoglobin (HB) - 146 g/l, Erythrocytes average volume (MCV) - 90 fL, Hematocrit (HCT)
- 43.2 %, 1 red blood cell hemoglobin (MCH) - 29.2 pg, Thrombocrit (RST) - 0.13 %,
Leukocytes (WBC) - 4.5 10^9/L, Lymphocytes (LYM%) - 38 %, Eosinophils (EOS%) - 1 %,
ECHT ( erythrocyte drowning speed ) - 5 mm/h
Discussion.
Eyeball
open contusions and horns curtain piercing past injuries often see
function sharp decrease, intraocular structures injury, infection to the risk and the next
complications - cataract, traumatic iridodialysis, retinal damage take comes. In the literature
such in cases primary surgery 6 hours after the intervention without delay execution see
ability save while staying important factor as shown ( Kuhn F. et al., 2002; Zhang Y. et al.,
2020). This clinical in case in the patient colorful curtain output, hyphen and prefix camera
blurring to be regardless, on time done washing, repositioning and microsurgical stitches as
a result see ability partially preserved This is the this of the situation diagnostic and
treatment in their approaches relevance shows. News as this highlight this is necessary in
case simple technician under the circumstances heavy level to the injury fast and accurate
approach with minimally invasive, but clear done surgery practice the patient's eye function
to restore service did. Rangdor with a prolapsed diaphragm in cases sometimes to
enucleation take incoming complications to the surface it comes out, but this in the patient
conservative storage approach successful It was. This of the situation from the restrictions
one eye bottom initially assessment possibility It may not have been. Complete analysis and
long long-term monitoring cataracts and other late complications early determination for
necessary.
So, it’s open. in injuries the patient fast delivery, operation delay and microscopic surgery to
the technique compliance to do through even heavy vision even in injuries ability save stay
possible. Clinical in practice such situations doctors for warning experience as service to do,
medical skills to improve encouragement need.
Conclusion.
This clinical situation this proves that : primary surgery 24- hour work inside
( most) preferably — 12–24 hours in ) when performed, especially with uveal prolapse late
heavy globular in injuries, vision function saves stay opportunity noticeable at the level
increases.
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Endophthalmitis danger from 24 hours delayed low in surgery, meta- analysis resulting in
odds ratio = 0.39 organization will reach.
Every 24 hours late final viewing level LogMAR It worsens by 0.37.
This patient in the case of urgent diagnosis insertion, washing, and microsurgical surgery
intervention because of see ability again restored, this practical skills and the world to the
recommendations suitable accordingly successful done increased. This situation in
ophthalmotraumatology speed, accuracy assessment and correct surgery of the technique
importance again one there is proves. From injuries follow-up monitoring, rehabilitation and
follow-up problems in advance determination patient health to keep service does.
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