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