The first moment to make the decision for enucleation is immediately or within a day or two following the injury. The globe is ruptured, massive intraocular bleeding is present and there is evidence that repair will not restore visual function. To lower the risk of sympathetic oph-thalmitis, the eye will be enucleated at an early phase. A wide range of foreign bodies can be found in these eyes. The inflammation is usually mild or absent. The most important mission for the pathologist is to confirm the irreparable damage. The lens is often absent or prolapsed through the corneal wound, a retinal tear shows the side of penetration, the vitreous is haemorrhagic, papilloedema is present and the retina can show exudative detachment (Fig. 10.18).

When attempts to repair the eye are made, mild uveitis develops. Within a period of 2-3 weeks the uveitis should diminish. If not, many ophthalmologists will make the decision to enucleate the eye to avoid the risk of sympathetic ophthalmitis. In these eyes, removed within a few weeks after the trauma, reparative changes like fibrous ingrowth of the corneal wound can be found. The blood in the vitreous will show organisation.

Traumatised eyes with residual vision and without inflammatory complications can become hypotonic and atrophic over a period of years. Secondary glaucoma can develop and the eyes are removed because of pain or for cosmetic reasons. Frequently, the secondary changes are very complicated and the primary pathology is not visible anymore. At macroscopic examination, the site of the trauma can be identified by the presence of scars, suture tracks or just by episcleral thickening. Posttraumatic glaucoma is most often caused by secondary angle closure. Furthermore, dislocation of the lens and lens-induced uveitis can be seen. The retina is usually partially or totally detached, and is thickened by reactive gliosis.

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