Showing papers on "Eye injuries published in 1992"

A One--year Prospective Study

Abstract: Purpose: The authors conducted a 1-year prospective study investigating the de­ mographics, causation, and treatment of eye trauma in an urban population at one medical center. Methods: All patients sustaining eye injuries who were evaluated by the ophthal­ mology service over a 1-year interval were included. A formal questionnaire was com­ pleted with demographic data and details of the injury being obtained. An ophthalmologic examination was performed on each patient, and examination findings, diagnostic tests obtained, diagnosis, and treatment were recorded and analyzed. Results: This study included 584 eye injuries. Three hundred seventy-one injuries (70%) occurred in males and 159 (30%) in females. The average age was 30.5 years; 110 (21 %) patients were pediatric. Sixty-two percent of all patients presented within 24 hours of their injury. Thirty-seven percent of all injuries occurred in the street, 31% at home, and only 13% at the workplace. For those older than 65 years of age, 48% of injuries were the result of a fall. Sixty percent of all eye injuries were caused by blunt trauma. Only 42 (8%) patients wore eye wear at the time of their injury. Diagnoses and management were recorded. Conclusions: The inner city population is more likely to sustain eye trauma as the result of an assault and is less likely to be involved in a work- or sports-related injury. Given poor compliance with outpatient management and follow-up, aggressive primary management may be indicated to optimize visual outcome. Ophthalmology 1 993; 100:851-856

Penetration eye injuries in the workplace. The National Eye Trauma System Registry.

Abstract: • Occupational eye injuries are common and preventable. Between 1985 and 1991, there were 635 work-related penetrating eye injuries among the 2939 cases (22%) reported to the National Eye Trauma System Registry by 48 collaborating centers in 28 states and Washington, DC. The median age of the injured workers was 30 years; 75% were younger than 40 years; and 97% were male. The commonest causes of injuries were projectiles (457 cases), sharp objects (166 cases), blunt objects (60 cases), and blasts (22 cases); these terms are not mutually exclusive. Specific objects causing injuries included nails, wire, screwdrivers, and other hand tools. There was evidence of alcohol use by at least 2% of the injured workers. When they were injured, 6% of the workers were wearing safety glasses; 3% were wearing nonsafety eyewear. Posterior segment trauma, which occurred in 63% of the cases, included vitreous hemorrhage (42%), intraocular foreign bodies (35%), and retinal detachment (10%). Hyphema occurred in 35% and traumatic cataract in 32% of the cases. Initial visual acuity after injury was hand motion or worse in 43% of the cases. National Eye Trauma System Registry data are useful to identify strategies to prevent occupational eye injuries such as wider use of safety glasses and improvement in engineerina controls.

Penetrating Eye Injuries Related to Assault: The National Eye Trauma System Registry

Abstract: • From 1985 to 1991, 648 cases of assault-related penetrating ocular injury were reported to the National Eye Trauma System Registry. We examined the circumstances surrounding and initial clinical findings related to this case series of injuries. Eighty-three percent of the patients were male. The median age was 28 years; 77% were younger than age 40 years, and 17% were younger than age 20 years. The ocular injury was part of multiple trauma in 34% of cases. There was evidence of alcohol and illicit drug use by at least 48% and 6% of the injured persons, respectively. Seventeen percent of the injuries involved powder or nonpowder firearms. Fists, glass fragments, metal rods or pipes, knives, and scissors were among the other objects causing injury. Posterior segment trauma, which occurred in 70% of cases, included vitreous hemorrhage (40% of cases), retinal detachment (11%), presence of intraocular foreign bodies (6%), and optic nerve damage (4%). The initial visual acuity after injury was hand motion or worse in 74% of the cases. Strategies to prevent such injuries focus on the origins of violence in general and are more difficult to devise than strategies to prevent eye injuries in other settings. Public health efforts to reduce the use of alcohol, drugs, and firearms may reduce the incidence of these injuries.

Epidemiology of motor vehicle crash-related serious eye injuries

Abstract: The Eye Injury Registry of Alabama has been collecting epidemiologic, treatment, final outcome, and rehabilitation information on serious ocular trauma since 1982. By December 31, 1989, 150 motor vehicle crash-related eye injuries had been registered. This is the largest series of serious motor vehicle crash-related eye injuries reported. The mean age of those injured was 29 years; 61% were between 16-35 years of age, and 73% were males. Ten individuals (7%) suffered bilateral eye injuries. The retina was injured in 47% of eyes. The initial visual acuity was 19/200 or worse in 47% of eyes. Forty percent of eyes with at least 3 months of follow-up remained legally blind, and 12% of eyes required removal.

Predictors of blinding or serious eye injury in blunt trauma

Abstract: Multivariate analysis was used to identify factors predicting injury and visual outcome in 94 blunt trauma patients evaluated for eye injuries among 6700 admissions to a level I trauma center over a 29-month period. Patients with penetrating eye injuries were excluded from this review. Eye injury was detected in 93% or 87 of the patients evaluated. Seven percent of eye injuries resulted in blindness, 22% were serious (visual acuity between 20/40 and 20/200 or eye injury requiring surgery), and 71% were temporary (final visual acuity of 20/40 or better). The presence of an afferent pupillary defect or a nonreactive pupil was the most important factor in predicting the severity of eye injury (p = 0.0023), followed by facial fractures (p = 0.0084), and no eye opening or eye opening to pain within the Glasgow Coma Scale (p = 0.02). Eye injury is an infrequent complication of blunt trauma. Appropriate consultation for evaluation of this problem can be obtained based on findings from the initial history and screening physical examination. Language: en

Eye injuries in Canadian sports and recreational activities.

Abstract: Over 4000 eye injuries, including 449 blind eyes, have been reported in sports and recreational activities in Canada over the past 20 years. This is not only a great personal loss but also a financial loss, both to the injured person and to the community. Statistics should be tabulated on catastrophic injuries that leave the person with a physical or mental deficit, such as a blind eye, and efforts should be directed toward preventing such injuries. Changing and enforcing game rules and providing proper eye protection has proved very beneficial in Canadian hockey, racket sports and war games. Educational programs supported by the media and government that alert players to the need for eye protection are required. Such measures may lead to the prevention of up to 90% of injuries in sports and recreational activities in Canada.

Favourable outcome of traumatic endophthalmitis with associated retinal breaks or detachment.

Abstract: Traumatic endophthalmitis in association with retinal breaks or detachments is reported to have uniformly poor visual and anatomic outcomes. We describe two cases of culture-positive traumatic endophthalmitis with retinal breaks or detachment in which the final visual result was 20/70 in one case and 20/40 in the other. Factors that may improve the prognosis in such cases include attention to the possibility of infection, selective use of broad-spectrum antibiotics, prompt surgical intervention and improvement in vitreous surgical techniques. Modification of intravitreal antibiotic regimens may be indicated in eyes in which the vitreous cavity is partially filled with air or gas.

Ocular injuries caused by magpies.

Abstract: This paper presents a series of six patients with ocular injuries resulting from magpie attacks. Five cases involved children. In two cases the penetration was overlooked initially. In one case the keratitis was caused by Bacillus cereus. Full ophthalmic examination, including indirect ophthalmoscopy and microbiological studies, must be undertaken initially to identify unrecognised eye injuries and to prevent the possible sight-threatening complications of vitreal fibrosis with subsequent retinal detachment or endophthalmitis.

Eye injuries at work: a prospective population-based survey within the chemical industry.

Abstract: A population of 63,000 chemical industry workers was studied prospectively over approximately 10,000,000 man-hours of work A total of 133 eye injuries were reported (84% of all injuries), of which 22% needed medical attention Eye protection was often not worn, some protectors may have been wrongly recommended for a particular task, and some protectors may have failed to perform adequately In this population, an eye injury occurred once every 75,000 man-hours of work on average (injury incidence 23:1000:year) Most injuries were avoidable Revision of protection protocols at work, and improved education of personnel are needed to reduce the incidence of occupational eye injury

Use of a bandage contact lens in perforating injuries of the cornea.

Abstract: Four cases of perforating corneal injuries as a result of work-related injuries are presented. All were managed with a bandage contact lens and surgical intervention was avoided. Topical pilocarpine was used to free incarcerated iris in two cases. All patients received a course of broad-spectrum systemic antibiotics, and also used topical preservative-free chloramphenicol for the duration of contact lens wear. No lens related complications occurred. Final unaided visual acuities were the same or better than at presentation.

An epidemiologic and pathologic study of globes enucleated following trauma.

Abstract: This retrospective study examined demographic, clinical, and histopathologic factors in 24 traumatically ruptured globes that were enucleated at Wills Eye Hospital during a 2-year period. The majority of these injuries occurred in a violent assault setting with a blunt mechanism, during the evening and early morning hours, and in the fall and winter months. Most patients were black males, and 67% were substance abusers. Clinically, the initial visual acuity in 96% of the eyes was light perception or worse. Five of the eyes were enucleated primarily. Gross examination of the globes revealed that 92% of the wounds involved the sclera, 83% of the eyes had hyphema, and 71% of the lacerations were longer than 10 mm. Histopathologic examination demonstrated that the majority of eyes had fragmented or missing lenses, disrupted ciliary bodies, and detached choroids. Ninety-six percent of the retinas were detached. There was one case of acute endophthalmitis.

Accident and emergency medicine--I.

Abstract: Overview of A and E Medicine Investigations in the A and E Department Fractures Specific Features - Upper Limb Specific Fractures - Lower Limb Head Injuries Spinal Injuries Facial Injuries Eye Injuries Management of Wounds Abdominal Pain Chest Pain Paediatric Problems Miscellaneous Conditions.

Civil unrest and ocular trauma.

Abstract: The incidence and causes of ocular trauma among Israeli troops serving in the West Bank and Gaza between 1987 and 1989 was investigated. Of the 985 soldiers who were reported injured, 11.3% (111) were reported to have suffered from injuries to the eye. Although most of the soldiers were supplied with some kind of protective gear, only 27% reported that they received eye protection; none used this protection at the time of injury. Fifty-seven percent of the injuries were caused by stones and 38% by flying glass; 14.6% of soldiers suffered bilateral eye injuries. Only 12.1% of those injured wore corrective lenses. Although only 5% were originally reported to have suffered moderate to severe injuries, 38% complained of residual vision impairment. Better eye protection and enforcement of orders to use such gear would reduce the number and severity of ocular injuries. Language: en

Perforating eye injuries due to intraocular foreign bodies.

Abstract: Summary The results of sixty-four perforating eye injuries with intraocular foreign bodies (lOFB) treated at University Hospital over ten years were reported. Compared to an earlier report we found that the population at risk: was the same and consisted of patients under 35 years (70%), males (95.3%) and work related (86%). The commonest causes ofIOFB were hand hammer (64.1 %) and grass cutting (20.3%). We also noted that while the incidence of cases had increased by 23%, the final visual outcome has improved significantly due to advances in preoperative diagnosis and surgical tech­ niques. Preoperative factors found to have a statistically significant effect on the final visual outcome were the size of the IOFB, poor initial visual acuity, and the presence of the following complications: cataract, iris damage and vitreous haemorrhage. The outcome was also worse in posterior segment IOFBs but this was not statistically significant.

Getting Patients to Protect Their Eyes During Sports.

Abstract: Statistics and especially photographs can prove to patients that serious eye injuries can occur during a leisurely game of racquetball and even tennis. But getting players to actually wear certified polycarbonate eye guards can be challenging. Here are a few strategies to show patients that eye protection is essential to the game.

Pharmacological and neural bases for eye irritation.

Abstract: The ability to perceive a focused image of the immediate physical environment affords a distinct advantage for survival to sighted species. Mammals have elaborated complex defensive systems to avoid trauma to the eye and to provide for rapid recovery with minimum lasting damage in the event of an insult. Rapid reflex movements of the head, a bony socket for the globe, eyelids, and a tough outer collagenous scleral tunic afford a first line of defense against injury. Externally, tear fluid bathing the conjunctiva and exposed ocular surfaces affords some degree of biochemical defense and immune surveillance against environmental irritants, antigenic and microbial pathogens. The composition of tears is complex; it includes a mucous layer, a lipid film, and fluid containing lactoferrin, peroxidase, lysozyme, immunoglobulin A, and other immunoglobulins and complement factors that serve to eliminate offensive materials. These components are produced continuously by cells of the lacrimal glands, tarsus, and conjunctiva, and can be stimulated further by neurogenic reflex. The conjunctiva and limbus also contain mast cells, associated lymphoid tissue and Langerhans cells that detect and, in conjunction with regional lymph nodes, process zenobiotic material and generate humoral and cellular immune responses, depending on the stimulus.

Treatment of posterior eye segment complications after perforating trauma.

Abstract: 168 perforating trauma cases that underwent vitreoretinal surgery in our hospital over a two year period were reviewed. A uniform surgical concept was applied in those severely injured eyes. Showing posterior eye segment complications that required vitreoretinal surgery and having at least light perception were the only two criteria to be eligible for this study. The anatomic and functional results in different trauma groups are discussed as well as indications and duration of silicone oil tamponade.

Retrobulbar block for open-eye injuries: a report of 19 cases.

Abstract: In open-eye injuries, which are often emergency procedures where the patient may have a full stomach or be in precarious health, retrobulbar anesthesia offers definite advantages over general anesthesia. A "low-volume" technique is described which gives adequate anesthesia without dangerously increasing intraocular pressure. A table containing the salient description and outcome of 19 anesthetics given in this manner is included.

Consultation with the Specialist: Eye Injury

Abstract: Optimal management of eye trauma requires a careful history, a controlled examination, protective measures to limit the damage and prevent infection, and swift triage to an ophthalmologist. Personnel in the emergency department or office can accomplish these goals and save the patient permanent visual disability. How Does One Evaluate Trauma to the Eye? A systematic approach emphasizing history, visual acuity, and external examination are essential in the evaluation of eye injuries. The history should be detailed and should note the mechanism of injury, the events following the injury, preexisting eye disorders, systemic disorders, drug allergies, contraindications to anesthesia, when the patient last ate, and prior tetanus immunization. If ocular perforation, laceration, or intraocular foreign body is suspected, treat the patient as if preoperatively, allowing nothing by mouth, and consider intravenous antibiotics to protect against exogenous endophthalmitis. Visual acuity examination must be performed in every case. Measure the visual acuity in each eye separately with corrective lenses in place. A near card may be used for examination at bedside. Picture cards and charts are available for measuring acuity in children age 3 to 6 years. Preverbal children can be tested grossly by allowing them to reach for a small toy with one or the other eye covered.

Pediatric Ocular Injuries

Abstract: Although an ophthalmologist should be consulted for virtually all eye injuries, the first person to see the patient or talk to the parents can be of enormous value in preventing or limiting the sequelae of the injury and subsequent visual loss. This article provides a practical guide to the management of pediatric ocular injuries resulting from trauma and addresses the incidence of ocular trauma in children and the potential for preventing these injuries. Potential Injuries The eye is an anatomically and physiologically complex system that is easily disrupted by sharp or blunt trauma. For this reason, subtle signs of external trauma may indicate serious intraocular injury. The cornea and vitreous are avascular and can be the sites of fulminant infection by even the most indolent of organisms introduced by injury. The crystalline lens is readily dislocated or may opacify after blunt or penetrating trauma. The diaphanous retina is attached to the inner surface of the eye by hydrostatic and osmotic forces. The smallest perforation can lead to total retinal detachment. The highly vascular uvea, which lies beneath the retina, can undergo massive hemorrhage after sharp or blunt trauma. The retinal arteries may occlude after sudden increases in intraocular pressure, which sometimes accompany intraocular or intraorbital hemorrhage.

Stellar corneal rupture and secondary glaucoma after squash trauma in a keratotomized eye.

Abstract: We report an unusual dramatic case of stellar ocular rupture after squash blunt in a recently keratotomized eye through weakened keratotomy scars The early secondary glaucoma, the tension generated by the surgical sutures of the wounds and the use of systemic and topical steroids could explain the reopening of two incisions initially unperforated and the delayed healing procedure We also stress the benefits of wearing protective eye glasses when playing squash, as well as a strict legislation in Belgium in such an eye-threatening sport

Pitfalls in penetrating eye injuries.

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