Why are ophthalmologists most afraid of the Spring Festival?

Author: Yin Yue, Fudan University Affiliated Eye, Ear, Nose and Throat Hospital

Reviewer: Zhang Ting, deputy chief physician, Eye, Ear, Nose and Throat Hospital, Fudan University

The Spring Festival is a time for family reunions and joy, but it has quietly become the most feared holiday for ophthalmologists. Whenever fireworks illuminate the night sky, the lights in the emergency room seem to be a little more tense and uneasy. Which ophthalmologist has not been worried and nervous in the emergency room during the Spring Festival? Whether it is driving away the Nian beast on New Year's Eve or welcoming the God of Wealth on the fifth day of the first lunar month, under the lively fireworks and firecrackers of the Spring Festival, frequent eye explosion injuries also follow. The most heartbreaking thing is that children's cases are not uncommon. The Spring Festival has become the most feared holiday for ophthalmologists.

Doctors will certainly do their best to rescue patients, but the outcome they face is more determined by the injury itself. And fireworks-induced eyeball explosion injuries are precisely a type of major eye injury that worries doctors and patients.

Figure 1 Copyright image, no permission to reprint

1. Injury and first stage of treatment

In terms of structure and texture, the eyeball is like a jelly ball wrapped in a sugar shell, with a thin shell and soft fillings, and it is juicy. The impact and high temperature generated when setting off fireworks and firecrackers will cause obvious damage to the fragile organ. The huge impact force will cause the outer wall of the eyeball to rupture (eyeball rupture injury). At this time, not only will foreign objects easily enter the eyeball (intraocular foreign bodies), but the fluid in the eyeball will also flow out, and even the contents of the eyeball will be dislocated and stuck, and the integrity of the eyeball shape will be severely damaged. The accompanying high temperature will further burn the eyeball tissue, making surgical repair more difficult. For severe eyeball explosion injuries, emergency repair surgery can take up to several hours. In addition, if not treated in time, the healthy eye on the other side may also induce "sympathetic ophthalmia", resulting in decreased vision or even blindness.

Figure 2 Copyright image, no permission to reprint

The doctor's skillful stitching of the outer wall of the eyeball to restore the basic appearance is only the first step in the long road of reconstruction - the first stage of surgery. At this time, the common goal of the doctor and the patient is to save the eyeball first, and only after it is saved can we talk about vision and the future. Repairing the eyeball is much more complicated than stitching a torn cotton doll. If the cotton is leaking, it can be repaired during the stitching. But for the eyeball, the internal structure damage caused by the explosion injury can only be repaired by a second stage of surgery after the first stage of surgery has recovered relatively stable, and then the lost vision can be restored as much as possible step by step.

2. Subsequent Issues and Second Stage Treatment

From a physiological perspective, the eyeball is like a sophisticated camera. The binocular vision function is achieved from front to back, mainly by the transparent cornea that can transmit light, the lens that can "focus", and the retina that reads the external image and feeds back to the brain. If any of the three functions is affected, even if the outer shell of the eyeball is successfully repaired during the first stage of surgery, the vision of the blast patient will decline or even become blind.

The cornea forms the center of the frontmost part of the outer wall of the eyeball. If the cornea becomes cloudy and the porcelain white is no longer transparent (corneal leukoma) during the recovery process, a corneal transplant is needed to restore vision. Regardless of the time to wait for corneal donation, the surgery itself has the risk of rejection. The lens is located in the front part of the eye. If it is dislocated (lens dislocation) or cloudy (traumatic cataract) during trauma, it needs to be removed and replaced by an artificial lens. The more serious the injury, the more difficult the conditions for later implantation. As the name suggests, the retina is a film-like layer attached to the innermost layer of the outer wall of the middle and posterior segments of the eyeball. Once the retina falls off after trauma (retinal detachment), it needs to be repositioned through retinal repositioning surgery, and the retina is pressed back honestly by injecting gas or silicone oil. The main purpose of the surgery is still to save the eyeball and prevent atrophy. If silicone oil is injected, a third surgery is required to remove it. In terms of the effect of restoring vision, gold and silver are not as good as the original. The doctor tried his best to treat it, and then it was up to time and luck.

3. Difficulties in treatment: Complications

Have you been dizzy and dazed by a series of eye injuries? The above are not all the difficulties you may face after being injured by fireworks. There are also various complications waiting in the wings. The most common complications are endophthalmitis and glaucoma.

Endophthalmitis after trauma is usually infectious endophthalmitis, and bacteria are the most common pathogens. Patients will experience obvious redness, eye pain, and decreased vision. At this time, they need to go to the hospital emergency room as soon as possible and receive anti-infection treatment in time (such as systemic intravenous antibiotics, intraocular injections, and surgery). Endophthalmitis is not the most common complication, but it is the most serious one. Patients with uncontrolled infection will face enucleation.

Glaucoma can also cause red eyes, eye pain, and decreased vision, but the eye pain is mostly distending pain. Ophthalmologists can quickly distinguish between the two through eye B-ultrasound and intraocular pressure examinations, and control them with medication or surgery. If the intraocular structure of trauma patients is damaged and the intraocular fluid cannot be discharged normally, it can cause increased intraocular pressure, which is glaucoma. Long-term high intraocular pressure can cause irreversible damage to the optic nerve, causing blindness and even eye atrophy. Hormone eye drops, which are often used after trauma, can also cause increased intraocular pressure. Therefore, it is very important for trauma patients to regularly check eye B-ultrasound and intraocular pressure after surgery, so that doctors can grasp the condition in time and quickly control it to save the eye.

I hope that everyone can avoid eye explosion injuries while celebrating the festival. Pay special attention to protecting children, do not let them light firecrackers on their own, and keep them away from danger. If an accident occurs, go to a regular hospital for emergency treatment immediately.