Penetrating eye injuries: a histopathological review

This study reports the histological findings in human eyes after severe penetrating trauma. The findings confirm the high incidence of retinal detachment in eyes with severe penetrating injuries. The retina was detached in 32 out of the 34 eyes examined, with 27 having evidence of traction on the retina. These eyes were characterized histologically by intraocular cellular proliferation producing cyclitic, epiretinal, and retroretinal membranes. Intraocular cellular proliferation was discernible or established within 1 week of injury and typically resulted in a cyclitic membrane at about 6 weeks. Epiretinal and retroretinal membranes were found between 1 and 2 weeks after injury in eyes with a detached retina. The results indicate that a damaged lens, the admixture of lens material and vitreous, and the presence of vitreous haemorrhage were all factors promoting intravitreal fibroblastic proliferation. Vitreous surgery may be a rational method of treatment for these severely injured eyes by removing the stimulus and vitreous scaffold for intravitreal fibroblastic proliferation. From this series it would appear that vitrectomy should not be delayed beyond the second week of injury, by which time massive cellular ingrowth may already be under way.