Following gunshot wounds to the globe, the visual prognosis is dependent on a number of important aspects. In these circumstances, the ocular trauma score (OTS), which was developed to assist in predicting visual acuity outcomes following ocular trauma, is helpful but not totally accurate. The location of the exit wound, concomitant optic nerve injury, accompanying retinal detachment (the layer at the back of the eye which gets detached from its normal position), and sub-macular haemorrhages (bleeding beneath the central retinal portion)  are the prognostic factors that have the most impact on visual outcomes following vitrectomy (surgery) for gunshot injuries. Good postoperative visual results are possible even with very poor preoperative visual acuity (light perception). Gunshot wounds frequently result in severe vitreous haemorrhages (blood in the gel that fills up the eye) that impair vision (sometimes resulting in no light perception). If there are no further factors that would indicate a poor prognosis, vision can significantly improve once hemorrhages are removed.

The Birmingham Eye Trauma Terminology System (BETTS) states that gunshot wounds to the eye are typically open-globe wounds and seldom closed-globe wounds. Of the open-globe variety, penetrating injuries, characterised by an entrance wound and an intraocular foreign body (IOFB), or perforating injuries, characterised by both an entrance and an exit wound with the foreign body impacted in the orbital tissue behind the eye, are the most frequently encountered clinical presentations.

There is debate on how to handle gunshot wounds to the eyes at first. In any situation, fast and careful closure of all entrance wounds is crucial. Then, other interventions can be thought about based on the type of injury. Primary vitrectomy (intraocular surgery) is not recommended if the injury is of the perforating type and has both an entrance and an exit hole because the posteriorly placed exit incision will allow the fluid infused into the eye to escape and the likelihood of the globe collapsing during surgery increase.

The first surgical choice must be chosen if the injury is penetrating with an IOFB. However, vitrectomy will be impossible and should be delayed if the cornea is where the pellet entered or if it is extremely swollen, obstructing vision.

It is unknown when a subsequent vitrectomy should be done. Spontaneous, watertight healing, closure of the exit wound, and the return of corneal transparency are all factors that can affect the timing of an intervention. Modern wide-angle viewing technologies, like the Binocular Indirect Ophthalmomicroscope (BIOM), enable surgery to be performed through a cornea that is noticeably opaque as long as a small window of clear cornea is present. The surgeon’s only choice is vitrectomy through a temporary keratoprosthesis (artificial cornea) if that window into the eye is not present. It is advised to wait 1 to 3 weeks before beginning the secondary intervention. This will give the exit incision time to heal and allow for posterior vitreous detachment (PVD), which will make surgery much safer and simpler.

At The Eye Center- Dr. Mahnaz Naveed Shah & Associates our team of eight ophthalmology subspecialists/ eye specialists, eye surgeons who are considered amongst the very best eye specialists in Karachi and in Pakistan, have the diagnostic and treatment capabilities to treat from the simplest to the most complex patients. We work hard to provide our patients with the best possible medical and surgical eye care, in a state of the art purpose built eye care facility. We offer the entire array of medical, laser and surgical treatments to help provide patients the best possible care in the most efficient, safe and ethical manner.

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