As soon as the globe of the eye is penetrated there is a serious risk of infection. The vitreous is an excellent culture medium and in the
pre-antibiotic era, eyes were totally lost within two or three days as a result of this. A perforating wound of the eye must, therefore, be considered a surgical emergency. Perforating injuries are seen in children from scissor blades, screwdrivers, darts and other more bizarre objects. In adults, there has been a dramatic fall in the incidence of such injuries since the introduction of compulsory seat belts but "do-it-yourself" accidents and assaults still take their toll. Following such an injury it is important to consider the possibility of an intraocular foreign body, especially when there is a history of using a hammer and chisel.
The outcome of a perforating injury is dependent on the depth of penetration and the care with which the wound is cleaned and sutured. If the cornea alone is damaged, excellent results can be obtained by careful suturing under general anaesthesia using the operating microscope. If the lens has been damaged, early cataract surgery might be needed and deeper penetration can result in the need for retinal detachment surgery.
On admission or in the casualty department, the patient is given tetanus prophylaxis and both systemic and local antibiotics. If early surgery under general anaesthesia is likely to be needed, it is better for the patient not to eat or drink to avoid delays in hospital. If it becomes clear that the injury is a serious one, it is better to warn the patient at an early stage about the possible risk of losing the sight of the eye or even the need to replace it with an artificial one.
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