The goals of surgery in ocular trauma are to re-establish orbital volume, prevent soft tissue contracture, avoid severe inflammation, infection, scarring and pain, reduce the risk of sympathetic ophthalmia and facilitate long-term recovery. Severe trauma to the right eye and orbit is depicted. Following general resuscitation, clinical and CT evaluation assess orbital integrity and remaining ocular tissue. Under general anesthesia in the operating room, both orbits are vigorously irrigated and inspected.
In the scenario depicted, a fragment of sclera at the limbus is identified and secured with a 6-0 silk traction suture. The conjunctiva is then separated with curved blunt tenotomy scissors from the sclera into the posterior orbit to expose the extent of globe tissue loss.
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The scleral remnants of the globe are secured with 4-0 silk sutures for tissue control. Fragment contamination is carefully debrided. The few intact extra-ocular muscles are cauterized and released. In severe wounds, the muscles are rarely as recognizable as the lateral rectus muscle in this illustration. Muscle release allows debridement of the posterior orbit.
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