System of Ophthalmology Volume XIV Injuries Part 1 Mechanical InjuriesPDF电子书下载

CONTENTS OF PART 1

INTRODUCTION 1

CHAPTER Ⅰ THE NATURE AND INCIDENCE OF OCULAR INJURIES 1

Ⅰ．History 3

Ⅱ．Incidence 5

Ⅲ．The Types of Ocular Injury 7

(a) Intra-uterine Injuries 8

(b) Birth Injuries 9

(c) Non-occupational Domestic Injuries 18

(d) Injuries in Travel and Sport 24

(e) Injuries in Agriculture 31

(f) Industrial Hazards 34

Incidence 36

trade distribution 37

prevention 43

(g) War Injuries 49

Battle casualties 51

aerial bombing 54

(h) Self-inflicted Injuries 56

(i) Iatrogenic Injuries 59

SECTION Ⅰ MECHANICAL INJURIES 61

CHAPTER Ⅱ CONCUSSIONS AND CONTUSIONS 63

A．Concussions and Contusions of the Globe 63

Ⅰ．Concussion Effects on the Cornea 81

(a) CEdematous and Haemorrhagic Changes 81

1．Epithelial Lesions 81

2．Interstitial CEdematous Opacities 82

3．Blood-Staining of the Cornea 83

(b) Folding of the Corneal Tissues 85

(c) Lacerations of the Cornea 86

1．Interstitial Fractures 86

2．Tears in Descemet＇s Membrane 87

3．Complete Rupture of the Cornea 88

Ⅱ．Concussion Effects on the Iris and Ciliary Body 89

(a) Changes in the Pupil and Accommodation 90

1．Traumatic Miosis and Spasm of Accommodation 90

2．Traumatic Iridoplegia and Cycloplegia 90

(b) Vascular Changes 92

1．Reactive Hyperaemia and Exudation 92

2．Haemorrhages into the Iris Tissue 93

3．Traumatic Hyphaema 93

(c) Lacerations of the Iris and Ciliary Body 101

1．Interstitial Tears of the Sphincter 102

2．Tears at the Pupillary Border 102

3．Tears in the Stroma of the Iris 104

4．Dehiscences of the Pigmentary Layer of the Iris 104

5．Iridodialysis 105

6．Irideremia 108

7．Iridoschisis 109

8．Traumatic Cyclodiulysis 110

Recession of the angle of the anterior chamber 111

(d) Retroflexion of the Iris 114

(e) Inflammatory and Atrophic Changes 115

1．Traumatic Iridocyclitis and Endophthahnitis 115

2．Post-traumatic Atrophy 116

3．Pigmentary Changes 118

Ⅲ．Concussion Effects on the Lens and Zonule 121

(a) Posterior Lenticonus 121

(b) Lenticular Opacities and Concussion Cataract 121

1．Vossius＇s Ring Opacity 125

2．Discrete Subepithelial Opacities 127

3．Traumatic Rosette-shaped Opacities 130

Fresh type 130

late opacities 134

4．Traumatic Zonular Cataract 136

5．Post-traumatic Atrophy of the Lens 137

6．Pre-senile and Senile Lens Changes following a Concussion 137

7．Diffuse Concussion Cataract 137

8．Massage Cataract 139

(c) Subluxation and Dislocation of the Lens 142

Ⅳ．Contusion Effects on the Choroid 150

(a) Choroidal Haemorrhage and Detachment 150

(b) Rupture of the Choroid 151

1．Indirect Ruptures 153

2．Direct Ruptures 158

(c) Traumatic Choroiditis 160

Ⅴ．Concussion Effects on the Retina 164

(a) Concussion CEdema of the Retina 165

(b) Concussion Necrosis of the Retina 166

(c) Concussion Changes at the Macula 168

1．Macular CEdema 168

2．Traumatic Macular Cysts and Holes 169

3．Traumatic Macular Atrophy of Haab 172

(d) Peripheral Atrophio Retinal Changes 173

(e) Vascular Changes in the Retina 175

Traumatic Retinal Haemorrhages 175

(f) Retinal Tears 176

(g) Traumatic Retinal Detachment 181

Ⅵ．Concussion Effects at the Optic Disc 187

(a) Papillitis and Optic Atrophy 187

(b) Rupture and Avulsion of the Optic Nerve 187

Ⅶ．Concussion Changes in the Vitreous 194

(a) Vitreous Haemorrhages 194

(b) Detachment of the Vitreous 196

(c) Herniation of the Vitreous into the Anterior Chamber 197

Ⅷ．Ruptures of the Solera 198

(a) Direct Ruptures 198

(b) Indirect Ruptures 199

(e) Incomplete Ruptures 208

Ⅸ．Concussion Effects on the Refraction 210

Ⅹ．The Effects of Concussion on the Ocular Tension 212

B．Concussions and Contusions of the Ocular Adnexa 212

Ⅰ．Contusions of the Lids 212

(a) CEdema and Haemorrhage of the Lids 212

(b) Crush Wounds 214

(c) Supra-orbital Amaurosis and Amblyopia 218

Ⅱ．Fractures of the Orbit 219

(a) Frontal Fractures involving the Orbital Roof 223

(b) Middle Facial Fractures 232

1．Naso-maxillary Fractures 236

2．Malar Fractures 240

(c) Internal Orbital Fractures 243

(d) The Clinical Picture of Orbital Fractures 249

(e) The Diagnosis of Orbital Fractures 259

(f) Indirect Orbital Fractures associated with Head Injury 265

(g) Ocular Injury in Orbital Fractures 268

(h) The Treatment of Orbital Fractures 272

Fractures of the orbital roof and superior orbital rim 274

naso-maxillary fractures 277

zygomatic fractures 277

orbital floor fractures 278

the repair of bony defects 280

ptosis 283

epiphora 283

canthal deformities 284

retraction of the lower lid 284

infra-orbital nerve anaesthesia 284

Ⅲ．Orbital Haemorrhage 285

Orbital granuloma 290

blood cysts 290

Ⅳ．Orbital Emphysema 291

Ⅴ．Contusion Injuries to the Orbital Contents 294

(a) Changes in the Position of the Eyeball 294

1．Luxation of the Globe 295

2．Traumatic Enophthalmos 295

(b) Injuries to the Optic Nerve 297

(c) Concussion Injuries to the Orbital Muscles and Nerves 298

(d) Traumatic Aneurysm of the Ophthalmic Artery 305

(e) Serous Tenonitis 305

Ⅵ．Concussion Injuries to the Lacrimal Apparatus 306

(a) The Lacrimal Gland 306

(b) The Lacrimal Passages 307

CHAPTER Ⅲ INCISED WOUNDS 311

Ⅰ．Introduction 311

Ⅱ．Non-perforating Wounds of the Eye 313

(a) Corneal Abrasions 313

(b) Recurrent Corneal Erosions 315

(c) Deep Non-perforating Corneal Wounds 318

(d) Wounds of the Conjunctiva 321

(e) Wounds of the Sclera 322

Ⅲ．Perforating Wounds of the Eye 323

(a) Perforating Wounds of the Ocular Coats 324

1．Uncomplicated Corneal Wounds 324

2．Complicated Corneal Wounds 327

(ⅰ) Epithelial Ingrowths 327

(ⅱ) Stromal Overgrowth 332

(ⅲ) The Incarceration of Ocular Tissues in the Wound 335

3．Ectasias and Staphylomata 339

4．Cystoid Cicatrix:Corneal Fistula 345

5．Perforating Corneo-scleral Wounds 345

6．Perforating Scleral Wounds 346

(b) Wounds of the Intra-ocular Tissues 350

1．Wounds of the Iris 350

2．Wounds of the Ciliary Body and Choroid 350

3．Wounds of the Retina 351

4．Wounds of the Lens:Perforating Traumatic Cataract 351

Localized stationary cataract 352

rosette cataract 354

total traumatic cataract 356

lacerated cataract 357

(c) The Clinical Picture of Perforating Wounds 360

(d) The Treatment of Perforating Wounds 360

The immediate treatment of a perforated eye 363

the delayed treatment of a perforated eye 373

(e) The Post-traumatic Complications of Perforating Wounds 383

1．Post-traumatic Non-infective Uveitis 383

2．Chronic Haemophthalmitis 390

3．Infected Perforating Wounds 393

(ⅰ) Pyogenic Infections 393

(ⅱ) Infections by Specific Organisms 405

Gas gangrene 405

tetanus 407

4．Sympathetic Ophthalmitis 410

5．Traumatic Cysts 411

(f) The General Prognosis of Perforating Wounds 420

Ⅳ．Perforating Wounds of the Adnexa 424

(a) Perforating Wounds of the Lids 424

Complications 427

treatment 431

(b) Perforating Wounds of the Lacrimal Passages 434

(e) Penetrating Wounds of the Orbit 437

The optic nerve 438

the ocular muscles 441

the orbital nerves 442

intracranial extension 443

complications 445

CHAPTER Ⅳ RETAINED FOREIGN BODIES 451

A．Extra-ocular Foreign Bodies 451

Ⅰ．Mechanical Effects 454

Multiple Foreign Bodies 456

Ⅱ．Specific Effects 459

(a) Unorganized Material 459

Glass and plastics 459

lead 460

copper 461

iron 462

(b) Organized Material 464

Ⅲ．Complications of Extra-ocular Foreign Bodies 467

Infection 467

corneal opacification 469

implantation cysts 469

Ⅳ．Diagnosis of Extra-ocular Foreign Bodies 470

Ⅴ．The Treatment of Extra-ocular Foreign Bodies 471

Superficial foreign bodies 472

foreign bodies embedded in the cornea 473

foreign bodies embedded in the conjunctiva and sclera 476

B．Intra-ocular Foreign Bodies 477

Clinical picture 483

Ⅰ．The Mechanical Effects of Foreign Bodies 485

Ⅱ．Specific Effects of Retained Foreign Bodies 500

(a) Inert Substances 501

Stone,sand,clay and cement 501

coal and carbon 502

gunpowder,cordite 502

glass,quartz,porcelain and plastics 503

india-rubber 505

talc 505

(b) The Irritative Metals 508

1．Lead 508

2．Zinc 510

3．Nickel 510

4．Aluminium 510

5．Mercury 511

6．Copper (Chaleosis) 512

7．Iron (Siderosis) 525

(c) Organized Material 544

1．Vegetable Material 545

2．Animal Matter 551

Cilia 553

Ⅲ．The Complications of Intra-ocular Foreign Bodies 560

Intra-ocular haemorrhage 562

pyogenic infection 562

gas gangrene 563

sympathetic ophthalmitis 563

Ⅳ．The Diagnosis and Localization of Intra-ocular Foreign Bodies 565

(a) Clinical Methods of Investigation 565

(b) Special Methods of Investigation 567

1．Methods depending on Magnetizability 567

2．Methods depending on Electrical Induction 570

3．Radiographic Methods 572

(ⅰ) The Radiological Demonstration of Intra-ocular Foreign Bodies 575

(ⅱ) The Radiological Localization of Intra-ocular Foreign Bodies 579

α．Direct Methods 580

β．Methods depending on Rotation of the Globe 587

γ．Methods depending on Geometrical Construction 592

δ．Stereoscopic Methods 604

ε．Methods depending on the Delineation of the Globe by Contrast Media 605

ζ．Bone-free Methods 606

4．Ultrasonic Localization 611

5．Methods for Determining the Nature of a Foreign Body by Chemical Analysis 613

Ⅴ．The Treatment of Intra-ocular Foreign Bodies 616

(a) The Removal of Magnetic Foreign Bodies 620

(b) The Removal of Non-magnetic Foreign Bodies 637

Ⅵ．The Ultimate Prognosis of Intra-ocular Foreign Bodies 645

C．Foreign Bodies in the Ocular Adnexa 650

Ⅰ．Foreign Bodies in the Lids 650

Ⅱ．Foreign Bodies in the Lacrimal Passages 652

Ⅲ．Foreign Bodies in the Orbit 655

Clinical picture 660

specific effects 661

complications 663

diagnosis 665

treatment 666

CHAPTER Ⅴ EXPLOSION AND GUNSHOT INJURIES 671

Ⅰ．Multiple Explosion Injuries 671

Ⅱ．Gunshot Wounds 676

Types of injury 676

treatment 688

CHAPTER Ⅶ THE INDIRECT OCULAR EFFECTS OF MECHANICAL INJURIES 693

Ⅰ．The Delayed Effects of Ocular Injury 693

(a) The Post-traumatic Development,of Infection 693

Zoster 696

syphilis 697

tuberculosis 698

sarcoidosis 699

(b) The Post-traumatic Incidence of Degenerative Changes 699

(c) The Post-traumatic Development of Neoplasia 700

Simple tumours 701

malignant tumours 702

Ⅱ．The Ophthalmological Implications of Head Injury 705

(a) Injuries to the Visual Pathways 706

(b) Pupillary Changes 707

(c) Ocular Motor Phenomena 709

(d) Vascular Complications 712

(e) Late Effects of Head Injury 715

Ⅲ．The Ophthalmological Implications of Remote Injury 716

(a) Injury to the Sympathetic Nerve 716

The whiplash syndrome 716

cervical migraine 717

(b) Traumatic Retinopathy 717

(c) Multiple Fat Emboli 720

(d) Compression Cyanosis 728

(e) Retinal Ischaemia after Exsanguination 733

(f) The Battered Baby Syndrome 736

(g) Ocular Complications of Diagnostic and Therapeutic Procedures 742