The injuries to the eye till now remain one of the basic causes of blindness and professional physical inability. Despite the eye-globe is well protected with bone walls of the orbit and appendag­es of the eye, its injuries comprise 5-10% among the total number of traumas in peace time and about 2% — in wartime.

The traumas of the eye make up about 20% of all eye patholo­gy, being the reason of unilateral blindness in 50% and bilateral — in 20% of cases.

The traumas of the eye are predominantly in able-bodied peo­ple (20-40 years of age — 84,6%), and quite often result in limita­tion or full disablement.

Taking into account a huge social value of the eye traumatism, necessity of its preventive measures, duly treatment and prevent­ing of severe outcomes, in Ukraine since 1976 there are created eye traumatological centers supplying the competent help to the patients with damage of the eyes and being now the most perspec­tive form of organization of the specialized ophthalmologic help.

Classification of eye traumatism

According to the conditions and reasons causing injuries of the eye, there are distinguished the following kinds of the eye trau­matism: industrial, agricultural, domestic, children's, military and sporting. Each aspect of the traumatism has its peculiarities.

The industrial traumas, as a rule, are the consequence of dam­age of the eye by drilling breaks of metal, swaft, different buil ding material, in 40.6% of cases refer to severe penetrating inju­ries, quite often with availability of the foreign body.

Agricultural traumas now, in connection with the broad intru­sion of engineering, by nature come nearer to industrial. Howe­ver, there are injuries particular to the countryside trauma (cow's horn, etc.), leading to severe inflammation of the eye.

Every day traumas are extremely miscellaneous: a puncture by the needle, cuts by scissors, the shocks by the fist, and in 53,7% are referred to the high-gravity injuries.

Children's traumas are the result of dangerous games, or non-ob­servance of the accident prevention at home and working skills lessons.

Battle injuries of the eye are characterized by considerable dam­age of tissues of the eye and orbit, multiple intrusion of drilling breaks, quite often non-magnetic, combinated with trauma of the face and other parts of the body.

Of all the eyes damages classifications proposed before, any does not correspond to requirments of the modern ophthalmology: to mirror the diversity of traumas, to be brief (like in glaucoma clas­sification), easily stored and yielding machining. The best classifi­cation was proposed by N. O. Puchkovska with the co-authors in 1985 (Table 5).

Determination of the severely level

Mechanical injuries:

I — mild injuries, which don't cause the loss of the eye functions;

II — middle severity injuries threatening with the decrease of functions of the eye;

ІІI — severe injuries threatening with the loss of the eye func­tions;

IV — high-gravity injuries threatening with loss of the eye.

Burns:

I — mild — hyperemia, erosion, mild oedema of the cornea;

II — middle severity — hemosis, ischemia, surface the oedema, film of the conjunctiva, intensive clouding of surface layers, and erosion of the cornea;

3. — severe — necrosis of the skin, conjunctiva and sclera no more than 1/2 surface, sharp ischemia of the limbus up to 1/2 of circumference, deep clouding of all strata of the cornea;

ІV— high-gravity — necrosis of the skin, conjunctiva and sclera more than 1/2 of surface, "porcelain cornea" or defect of its tis­sue, perforation.

	Table 5. Classification of the eye injuries
Kind of the trauma	Type of injury	Localisation of injury	Degree of severity	Concomitant injuries
Industrial	Mechanical:	Appendages of the eye (a)	I —mild	Iris
Agricultural	— contusion (C)	Orbit (o)	II — middle	Lens
Everyday	— non-penetrating wounds (NPW)	Cornea (c)	III — severe	Vitreous body
Children's	— penetrating wounds (PW)	Limbus (1)	IV — most severe	Retina and choroid
Sport	— perforating wounds (PW)	Sclera (s)		Optic nerve
Military	Burns: — chemical burn — termical burn — termochemical burn — ray burn			Disturbance of the intraocular pressure Foreign bodies Inraocular haemorrhages Intraocular infections
	— thermal-mechanical

The determination of the degree of severity is conditional to a certain extent, as it is difficult to foresee the course of the trau­matic process in the eye and possible posttraumatic complications. So, a mild penetrating wound of the cornea can become compli­cated by endophthalmitis with the full loss of sight.

Wounds of the Organ of Vision

Wounds of the organ of vision are divided into wounds of the orbit, adnexa oculi and eye-ball.

Wounds of the Orbit

Wounds of the orbit and especially gun-shot ones are related to extremely severe traumas by their severity, variability and pecu­liarities. They may be single with or without foreign body in the orbit, combined if there is simultaneous damage of the eye or or bit wound is accompanied by craniocerebral, facial wounds and injuries of the maxillary sinus adnexa.

All patients with orbit traumas are performed roentgenography in two projections.

Depending on the weapon the orbit wounds may be lacerated, incised, stab.

Lacerated wounds are peculiar for prolapse of the fatty tissue, damage of the external eye muscles, injuries of the lacrimal glands, there may be ophthalmoplegia, exophthalm.

Treatment. In lacerated wound first of all a revision should be made (determination of size and depth of the wound, involvement of the os-seal walls of the orbit). The ophthalmologist must solve the question whether the wound canal involves the cranial and paranasal sinus. The initial surgical treatment of the lacerated wounds of the soft orbit tis­sues consists in economic dissection of the soiled wound edges within 0.1-1 mm. The wound canal is washed by hitrofurazone, rivanol or hy­drogen peroxide. When there are indications wound plastics by the ad­jacent tissues is performed, catgut or biological sutures are applied to the injured fascia, ligaments or muscles, and silk ones to the skin.

Distinctive signs of the stab wounds are exophthalmos, ophthal­moplegia, ptosis of the upper eye-lid which are evidence of deep spread of the wound canal and injury of the nerve trunk and ves­sels at the orbit top by the wound object. The severity of the stab wound is determined by impairment of the optic nerve.

Treatment includes thorough revision of the wound's canal and initial surgical treatment. The soft tissues are dissected for 2-2.5 cm; the wound canal is examined carefully, following the princi­pal of maximum spare of the tissues. When there is no penetration of the wound canal into the cranial cavity or paranasal sinus or foreign body in the orbit, the wound is sutured.