Showing papers on "Eye injuries published in 1996"

Eye injuries after nonocular surgery. A study of 60,965 anesthetics from 1988 to 1992.

Abstract: BackgroundEye injuries after anesthesia, although infrequent, may result in visual impairment. Previous studies have not defined the risk factors associated with these injuries. To study the cause of these injuries and to determine incidence data, the authors reviewed the records from a 4.5-y period

Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome.

Abstract: AIMS: To provide epidemiological data on the current burden of serious eye injuries utilising the hospital eye service, to inform the planning and provision of eye health care, and health and safety strategies for the prevention of ocular injuries. METHODS: A prospective observational study was carried out of all patients with ocular trauma admitted to hospitals in Scotland, under the care of a consultant ophthalmologist, during a 1 year period. The population of Scotland represented the population at risk of injury. Visual outcome (Snellen visual acuity in the injured eye) was measured at the time of final discharge from ophthalmic care and at follow up. RESULTS: All ophthalmic departments in Scotland participated and a total of 415 residents of Scotland were admitted. The 1 year cumulative incidence of ocular trauma necessitating admission to hospital is estimated to be 8.14 per 100 000 population (95% CI 7.38 to 8.97). Some 13.2% (n = 26/197) of patients discharged from follow up had a poor visual outcome with a visual acuity less than 6/12 in the injured eye. Some 10.7% (21/197) patients at this time had a blinding outcome in the injured eye (visual acuity less than 6/60). No patient was registered blind or partially sighted during the study period. The home was the single most frequent place for blinding injuries to occur (52%, n = 11/21), followed by the workplace 24% (n = 5/21). The 1 year cumulative incidence of blinding outcome from serious ocular trauma is estimated to be 0.41 per 100 000 population per year (95% CI 0.26 to 0.64). CONCLUSION: The current burden of serious ocular trauma presenting to the hospital eye service has been quantified from this population based study, and for the first time, a direct estimate of the incidence of the subsequent blinding outcome from these injuries has been provided. Ocular trauma remains an important cause of avoidable and, predominantly, monocular visual morbidity (visual impairment and blindness), with over half of the blinding injuries now occurring in the home. Health education and safety strategies should now consider targeting the home for the prevention of the serious eye injuries in addition to the traditional work, sports, and leisure environments and their related activities.

Airbag-induced eye injuries : A report of 25 cases

Abstract: Objective : To acquire a better understanding of airbag-induced eye injuries, 25 cases are reviewed and an attempt is made to identify the causal mechanisms associated with each injury. Design and Methods : The National Highway Traffic Safety Administration's National Accident Sampling System for the years 1984-1994 was accessed to identify automobile accidents that included airbag deployment and injury to the ocular region. The search provided 25 such cases with detailed studies of the accident scene and medical records of the injuries. The cases were comprehensively reviewed to determine the causal mechanisms associated with each group of injuries. Results : The study determined that the injuries range from mild corneal abrasions to retinal detachment. Causation for each injury was determined and is detailed. The injuries were grouped according to location within the ocular region, and the distribution is shown. Conclusions : Most of the injuries were induced by impact with the fully deployed airbag, but the more severe ocular trauma resulted from the actively deploying airbag striking the occupant. Thus, ocular trauma from airbags can occur in very minor impacts. Additionally, the left eye seemed more vulnerable to injury than the right. Nontethered airbags have greater inflation distances that tend to increase the probability of injury. External parameters that may also increase the severity of eye injury include an unfastened seat belt, sitting too close to the steering wheel, or wearing glasses.

Ocular and cerebral trauma in non-accidental injury in infancy: underlying mechanisms and implications for paediatric practice.

Abstract: AIMS: To determine the sites, mechanisms, and clinical significance of injuries to the eyes and brains of children with non-accidental injuries in relation to differing levels of trauma. METHODS: A forensic pathological study of injuries in the eyes and brains of 23 consecutive children dying of non-accidental injuries over a 4 year period (1988-92) under the jurisdiction of Yorkshire and Humberside coroners. RESULTS: Sixteen children died from cerebral injuries and seven died from non-cerebral causes. There were high incidences of retinal detachment (63%) and subhyaloid (75%), intraretinal (75%), and perineural (68%) haemorrhages in CNS deaths. Local subhyaloid haemorrhages and retinal detachment were more common at the periphery and optic disc than at the equator. There was a strong correlation between CNS and eye trauma scores in all 23 children (r = 0.7551, p < 0.0001). Ranking of injuries by severity suggests progressively more trauma required for (a) subdural haemorrhage, (b) subhyaloid, intraretinal, perineural haemorrhages, and (c) retinal detachment. At highest trauma levels choroidal and vitreous haemorrhages were associated with additional cerebral lacerations, intracerebral and subarachnoid haemorrhages. CONCLUSIONS: In non-accidental (and probably accidental) infantile head injury the earliest eye injuries (coinciding with subdural haemorrhage) could be missed if indirect ophthalmoscopy is not performed. Retinal detachment and multiple (particularly choroidal/vitreous) haemorrhages may indicate additional cerebral lacerations and/or intracerebral haemorrhage. Vitreous traction is the likely cause of intraocular pathology.

Epidemiology and implications of ocular trauma admitted to hospital in Scotland.

Abstract: OBJECTIVES: To describe the current epidemiology of serious ocular trauma which necessitates admission to hospital so that health and safety strategies for the prevention of ocular injuries and their role within the national health strategy, The Health of the Nation, can be better informed. DESIGN: A prospective observational study of all patients with ocular trauma admitted to hospital under the care of a consultant ophthalmologist between 1 November 1991 and 31 October 1992. SETTING: All ophthalmic department in Scotland. SUBJECTS: All patients with ocular trauma admitted to hospital in Scotland. The population of Scotland represented the population at risk of injury. MEASURES AND MAIN RESULTS: Measures included the type and cause of injury, the place where it occurred, and awareness of risk and safety. All ophthalmic departments in Scotland participated and 428 admissions were reported. The home was the most common place for a serious injury to occur (30.2%), followed by the workplace (19.6%) and a sports or leisure facility (15.8%). The home was the single most frequent place of injury for the 0-15 year and 65 year and over age groups. Tools or machinery, either at home (13.9%) or at work (10.3%), were collectively (24.2%) the most frequent cause of injury, followed by assault (21.8%) and sports-related activities (12.5%). The most frequent type of injury was a blunt injury (54.4%). Six per cent (n = 25) of all injuries were bilateral. Only 13.2% of patients were aware of any risk of injury, with 5.6% aware of any risk at home. When applicable, protective eye wear was only available to 48.6% of patients and only 19.4% of these used it. CONCLUSION: Serious ocular trauma frequently occurs at home and the young and the elderly are particularly at risk. This represents a significant change in the epidemiology of serious ocular trauma and has important implications for prevention. Health and safety strategies specifically aimed at preventing eye injury should now include the home as a high risk environment in addition to the work-place and sports/leisure facilities. The target groups for accident prevention in The Health of the Nation strategy include those at risk of serious ocular trauma with potentially sight threatening sequelae. Those involved in implementing the national accident prevention strategy should be aware of this, for in this process it is possible that some serious eye injuries may also be prevented.

Treatment of traumatic cataracts

Abstract: Purpose: To analyze the postoperative outcome and complication rate following cataract extraction because of post-traumatic lens opacification. Setting: University medical center. Methods: A retrospective analysis was done of 148 eyes with traumatic cataracts operated on between 1978 and 1992. Age, sex, traumatic sequelae, surgical strategies, and postoperative complications were reviewed for all eyes. Results: In 85 eyes, Group A, a history of blunt trauma could be ascertained. In 63 eyes, Group B, there had been a penetrating injury. Secondary glaucoma was observed more frequently in patients with blunt trauma. A posterior chamber intraocular lens was implanted in 85% of Group A eyes and in 67% of Group B eyes. Mild or moderate postoperative complications occurred in 15% of all cases. Postoperatively, the incidence of glaucoma remained unchanged. Visual acuity improved in 90% of eyes. Ten percent of eyes did not benefit from cataract surgery because of severe traumatic involvement of the retina or optic nerve. Conclusions: In this study, a majority of eyes with traumatic cataract were safely rehabilitated with posterior chamber lens implantation. Visual acuity improved in 90% of eyes; complications were seen in 15%.

Eye patch treatment for the pain of corneal abrasion.

Abstract: The traditional use of patching and topical antibiotics in the treatment of corneal abrasion has recently been challenged, particularly after foreign body removal. In a prospective, controlled, randomized study of 33 patients treated in the emergency department for eye pain and corneal abrasion, we attempted to determine whether eye patching affected the pain of simple corneal abrasions. After fluorescein examination with magnification (x 5), a visual analog pain score was recorded and the patient was randomized to either the patched or nonpatched group. A standard analgesic was supplied, and all patients had follow-up at 24 hours, when repeat pain scores and analgesic use were recorded. The groups were compared by using the Wilcoxon's rank sum test, Student's t test, and analysis of covariance as required. There was no significant difference in the mean changes in pain scores between the patched and nonpatched groups. Analgesic use was also similar. We conclude that routine eye patching does not favorably affect the pain associated with the treatment of simple corneal abrasion.

Topical analgesia for superficial corneal injuries.

Abstract: OBJECTIVE--To assess the analgesic effects of a topical non-steroidal anti-inflammatory agent, flurbiprofen 0.03%, during healing after superficial corneal injuries. METHODS--401 patients treated for corneal abrasion in a five month period were randomly allocated to one of four treatment groups: polyvinyl alcohol alone (control), homatropine 2%, flurbiprofen 0.03%, or homatropine 2% followed by flurbiprofen 0.03%. Treatments were given for 48 h. Ocular pain was recorded on a visual analogue scale by the patients over the first 24 h, and use of oral analgesics was also recorded. Usable responses were received from 224 patients (55.8%). RESULTS--Patients treated with flurbiprofen had significantly lower pain scores for the 24 h duration of the study than controls (P < 0.05). CONCLUSIONS--Flurbiprofen eye drops provide more effective pain relief than traditional treatments for superficial corneal injuries.

An analysis of 148 outpatient treated occupational accidents

Abstract: BACKGROUND: The most common eye injuries are non-perforating. Eye injuries in the workplace are a major cause of socioeconomical damage, morbidity and disability, despite well publicised standards for industrial eye protection. This study investigates the epidemiological and clinical aspects of 148 occupational cases. PATIENTS: At the University Eye Clinic of Tubingen, 709 non-perforating eye injuries were registered as occupational accidents between 1995 and 1996. Of these cases, 148 were analysed retrospectively per random. RESULTS: The 5 most common injuries of 148 patients (m/f = 138/10; mean age 33.4 +/- 12 years) were related to corneal foreign body injuries (35%), chemical burns (15.5%), sub-conjunctival foreign bodies (12%), thermal/ultraviolet injuries (11%) and contusions (7.4%). Of these patients, 22.3% were employed as construction workers and 16.2% as metal workers. At the time of examination the visual acuity of the traumatic eye was 0.9 +/- 0.3. The interval between the beginning of work and accident was 6.2 +/- 6.4 hours in average (0.5-13.5 h). Of all accidents, 8.5% were caused during the first hour of work; in contrast 45.5% of all accidents were caused after 6 hours of work. Another 12.4 +/- 14.5 hours (5min.-72 h; median 7 h) passed by until the patients arrived for eye examination at the Eye Clinic of Tubingen. Only 6% of all patients arrived within the first hour, and 29.7% after 12 hours. Of all cases, 30.4% received first-aid treatment in their company by the factory doctor or by the eye doctor before examination at the Eye Clinic. Only 6.8% of all patients had protective spectacles during work. Incapacity was seen in 30.4%; the average in total was 5.5 +/- 10 days. CONCLUSION: Despite the late examination at the Eye Clinic the functional loss was mostly little except after chemical burns. Nevertheless, most occupational accidents can be avoided with better protective devices in order to reduce the incidence of injuries and socioeconomical damage. Therefore an intense campaign about protective devices at the place of employment should be required. We conclude that education about safety glasses in the workplace by tradespeople and trades assistants during tasks for which goggles are recommended could considerably reduce the rate of occupational eye traumata. The data of the University Eye Clinic of Tubingen are useful to identify strategies to prevent eye injuries such as wider and better use of safety glasses and improvement in engineering controls. Language: de

Serious eye injuries associated with fireworks—United states, 1990–1994.

Abstract: Eye injuries caused by fireworks are often severe and can cause permanently reduced visual acuity or blindness. Findings from the National Electronic Injury Surveillance System database maintained by the U.S. Consumer Product Safety Commission (CPSC) indicate that approximately 12,000 persons are treated each year in U.S. emergency departments because of fireworks-related injuries; of these, an estimated 20% are eye injuries. To improve characterization of fireworks-related eye injuries, data were analyzed from the United States Eye Injury Registry (USEIR) for July 1990-December 1994 and from the Eye Injury Registry of Alabama (EIRA) for August 1982-July 1989. This report summarizes the findings of these analyses.

Intralenticular metallic foreign body.

Abstract: Background:Intralenticular metallic foreign bodies may be well tolerated for many years. Case Report:A 24-year-old Caucasian man was referred with an intralenticular metallic foreign body present in the left eye for five days. Following initial treatment with topical steroid and antibiotic, the lens remained clear and visual acuity normal. Two years later the left eye developed an anterior uveitis, with reduced vision. A left phacoemulsification lens extraction with removal of the intralenticular foreign body and insertion of a posterior chamber intraocular lens was performed. Conclusion:Management of intralenticular metallic foreign bodies may be conservative till intraocular inflammation or cataract develops.

Sports-related eye injuries.

Abstract: Sports-related eye injuries have received more and more attention in recent years with the increase of its prevalence. It may cause permanent visual impairment and blindness (Leivo et al., ActaOphthalmol 93(3):224–31, 2015; Lundin et al., WMJ 113(3):99–101, 2014), which places a huge burden on individuals, families, and healthcare systems. Compared with adult group, sports-related eye injuries are more common in pediatric group (Miller et al., WMJ 113(3):99–101, 2014; Podbielski et al., Can J Ophthalmol 44(5):519– 22, 2009; Kadappu et al., ClinExpOphthalmol 41(5):427–34, 2013; Hoskin et al., Acta Ophthalmol 94(6):e407–10, 2016). In addition, eye injuries caused by various sports may result in different consequences, which bring enormous challenges for ophthalmologist. It is noted that 90% of sports-related eye injuries are preventable with adequate protective equipment (Bro and Ghosh, Scand J Med Sci Sports 27(4):430–434, 2017; Goldstein and Wee, Eye Contact Lens 37(3):160–3, 2011). Therefore, knowing the risks and proper protection before the sports activities is the key to prevent sports-related eye injuries.

Penetrating eye injury from a rigid infant pacifier.

Abstract: BACKGROUND: The use of infant pacifiers (dummies) is common in Australasian communities and has been reported to be associated with various injuries, but to date ocular trauma has not been reported. CASE REPORT: A 14-month-old child sustained a penetrating eye injury from the infant pacifier that was in his mouth during a minor fall. Only a lid laceration was detected at the time. One week later he presented with mydriasis, heterochromia and a poor red reflex. Diagnosis of a penetrating eye injury was made by examination under anaesthesia, with B-scan ultrasonography demonstrating hypotony but no retinal detachment or intraocular foreign body. Funduscopy revealed a small inferior vitreous haemorrhage. Exploration of the globe adjacent to the lid wound showed a 6 mm laceration through the sclera plugged with prolapsed vitreous. CONCLUSION: Serious ocular injury may result after a minor fall with some designs of rigid infant pacifiers. Heterochromia and anisocoria noted by the mother heralded more serious ocular injury in this case. The delay in diagnosis of this injury emphasizes the importance of ocular examination to exclude eye trauma when injuries occur around the orbit. Language: en

Mechanical ocular trauma.

Abstract: Mechanical ocular trauma remains a leading cause of visual loss and blindness and often affects young individuals. Approximately 75% of people with trauma-induced visual impairment are monoculary blind. Furthermore, the human, social, and economic consequences of eye injuries are enormous in all parts of the world. Because most eye injuries are preventable, efforts could be spent much more effectively on preventing eye injuries rather than treating them. It is important to make the public aware of the benefits of using protective equipment, which is almost universally available, and was the main concern of most of the authors reporting on ocular trauma in the past year. Of great importance seems to be the introduction of an international standardized classification of ocular trauma.

Perforating eye injuries in children

Abstract: The author studied 140 cases of perforating eye injury in children up to 15 years old admitted at the Clinic Hospital of the Medical College of the University of Sao Paulo (Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo) from January 1989 to December 1993. These cases represent 24.71% of the total of the perforating eye injuries seen during this period, showing a ratio of 76.42% of males, a ratio of 2/1 in the group from 0 to 6 years old, 7/1 in the group from 7 to 11 years old and a ratio of 3/1 in the group from 12 to 15 years old. The most common perforating eye injuries were due to sharp objects (54.71%), contusion (20%), explosions (7.85%) and flying objects (5.71%). The relation between the severity of the injury and the prognosis is emphasized. Safety precautions should be effective in order to reduce frequence and morbidity of these perforating ocular injuries. Language: pt

Differential diagnosis of pediatric conjunctivitis (red eye).

Abstract: Because eye injuries and diseases may potentially result in serious vision impairments, accurate diagnosis and treatment of ophthalmic conditions are imperative. A symptom common to eye impairments is conjunctivitis, or red eye, a commonly seen manifestation in an ambulatory pediatric population. Because conjunctivitis is caused by various etiologies, clinicians must derive a differential diagnosis. This article examines possible causes of conjunctivitis after the neonatal period in this population. Differential diagnosis is dependent on a complete history, distinct physical findings, and use of adjunct diagnostic tests. Treatment, which depends on a sound differential diagnosis, should be targeted according to the cause of the problem.

Ocular and orbital trauma from water balloon slingshots: a clinical, epidemiological, experimental, and theoretical study.

Abstract: PURPOSE: To report the clinical findings of 17 patients with ocular/orbital injuries produced by launched water balloons; to determine water balloon kinetic energies in experimental and theoretical studies. METHODS: Six case histories are presented, 1 case was retrieved from the medical literature, and 10 cases were reported to the National Injury Information Clearinghouse of the United States Consumer Product Safety Commission. The energies were determined by field trials and calculations. RESULTS: Injuries included orbital contusions and hematomas, facial hypesthesia, eyelid lacerations, subconjunctival hemorrhages, corneal edema and abrasion, hyphemas, traumatic iritis, iris sphincter ruptures, iris atrophy, angle recession, iridodialyses, traumatic cataract, vitreous hemorrhages, retinal hemorrhages, macular hole formation, optic atrophy, and bony orbital wall fractures. Epidemiological analysis revealed that children and young adults, more often males, were injured, most commonly in the warm weather months (May through September). In field trials, maximum water balloon velocities ranged from 38 to 41 m/sec (85 to 92 mph) with kinetic energies from 176 to 245 J; by calculation, maximum velocities ranged from 42 to 54 m/sec (95 to 121 mph) with kinetic energies from 141 to 232 J. In a field demonstration a 300-g water balloon launched horizontally from a distance of 20 ft exploded a 12-kg watermelon. Classic physics calculations are presented to explain the complex bio-mechanical interactions between the water balloon and the eye. CONCLUSION: Kinetic energies of launched water balloons are comparable to or greater than kinetic energies experienced with a variety of common objects, including file bullets, which are well known to cause serious ocular and orbital injuries. In addition, these energies are far in excess of those required to perforate a cornea (0.7 to 1.7 J), rupture a globe (1 to 5.3 J), or fracture the bony orbit (1.8 to 14.7 j). Thus, this study demonstrates the serious and potentially vision- and life-threatening injuries inflicted by these "toys."

Eye injuries in the dog caused by cat claws

Abstract: A retrospective study of ocular cat claw injuries in the dog revealed an over-representation of very young dogs in our case material. Puppies up to the age of 12 weeks have no menace response. Thus, an important protective mechanism is missing in early life. This may be one reason for the frequently occurring severe ocular trauma caused by cat claw injuries in puppies. Older dogs are less likely to sustain such an injury. Cat claw injuries cause corneal and lens capsule perforation with ensuing severe phacoclastic uveitis. In our series phthisis bulbi or secondary glaucoma were the result in 50% of the cases. In large lens capsule tears early lens extraction may prevent severe uveitis and may retain functional vision.

Combat eye injury: laser photocoagulation prophylaxis of retinal detachment.

Abstract: Traumatic retinal detachment can occur in combat eye injuries and has numerous complications. We presume that the incidence would be much higher if we omitted to perform argon laser prophylactic treatment in cases of (1) traumatic retinal rupture, (2) retained retinal foreign body (before and after surgery), and (3) vitreoretinal proliferation with or without sector traction detachment. In these cases we performed a modified method of blockade with confluent, two-row laser spots, which proved to be more efficient clinically and formed stronger retina-choroid adhesions in experimental studies. In a total of 78 performed laser coagulations, retinal detachment occurred in three, all of them with already present traction retinal detachment.

Ophthalmic manifestations of laser-induced eye injuries

Abstract: The basis for almost all laser-induced eye injuries is the concentration of the radiation in the visible and near infra red range on the retina. The effect of this concentration is that the energy required to produce a visible retinal lesion is minuscule, about 50 microjoule for a Q- switched 532 nm laser. Even at lower energies the radiation can cause dazzle and flash blindness. At higher energies it can produce lesions which are ophthalmoscopically invisible, and at even higher energies, lesions that are visible and permanent. Higher energies still produce vitreous hemorrhage. The functional results of visible lesions depend not only on the energy impinging on the retina but mostly on the location of the injury. Foveal lesions will cause permanent reduction in visual functions, extrafoveal injuries will cause temporary visual incapacitation, and lesions further away from the macula may cause unnoticeable damage. Temporary incapacitation by intraocular hemorrhage can be engendered by a lesion anywhere in the eye. The latter is usually absorbed spontaneously or can be surgically removed by vitrectomy. An over-threshold injury anywhere on the posterior pole of the eye will lead to severance of the retinal nerve fiber layer, and thus to blind spots in parts of the retina unaffected by the original lesion. A common late, visually devastating, effect of laser lesions is retinal scarring which may lead to retinal holes, retinal detachment and delayed blindness.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The eye and the brain in non-accidental injury involving young children.

Abstract: Intracranial injuries in young children, especially those less than 3 years old, which have no obvious explanation and frequently have no external evidence oftrauma to the skull, should raise the suspicion of whiplash injury. Whiplash injury is caused by forcible shaking of a young child usually by a member of the family or occasionally. by a childminder. The association between this type of injury and subdural haematoma was first noted by the American radiologist, Professor J Caffey.1 There has been much argument since as to whether the various intracranial haemorrhages encountered in non-accidental injury (NAI) in young children are due to shaking or to impact injuries.2 3 The generally held view seems to be that either or both mechanisms may be responsible in an individual case. All the 13 cases described by Hadley et al2 were very young (median age 3 months) but none showed any evidence of skull fracture and the authors concluded that these injuries were the result of shaking. Duhaime et al 3 found skull fractures in all 13 of the fatalities in their series of 48 infants and young children. The matter of cause of non-accidental brain haemorrhage has long bedevilled the expert witness in criminal proceedings involving NAI. A question which is frequently put to the medical expert is that concerning the amount of force which would be required to cause intracranial haemorrhages. To some extent this is unanswerable and attempts by Duhaime et al3 using infant models and accelerometers tended to suggest that the deceleration experienced during impact injury was much greater than that from shaking. The association between ocular haemorrhage and intracranial haemorrhage has long been well known. As with intracranial haemorrhage, the degree of force required to cause the various ocular haemorrhages observed in NAI have been difficult to assess. An important paper in the current issue of the BJ7O (Green et al, p 282) has made a substantial contribution towards answering this question. The authors have examined the eyes taken from 23 children dying of unequivocal NAI and, in addition, performed an extremely detailed forensic necropsy on each. Sixteen of 23 children died as the result of head injury. Of the remaining seven the injuries were to other parts of the body. All but one of the 16 who died ofhead injury had subdural haemorrhages which were solitary in eight of the cases but the remaining seven had more extensive intracranial trauma. The authors have constructed both an eye trauma score and an intracranial trauma score based on the presence of the number of different injuries found in any single individual. It has been possible, using the ocular trauma score, to make some kind of prediction as to the severity of the intracranial injuries likely to be found and of the degree of violence sustained. Eye injuries were found in 81% of those dying ofhead injuries but in only 17% ofthose where death was related to injuries elsewhere in the body. Ten of 16 patients with subdural haematomas had retinal detachment and these patients had a significantly greater number of other intraocular injuries than the six patients who had no retinal detachment. The authors suggest that the same accelerationdeceleration forces that produce subdural haemorrhage also apply to the vitreous, producing subhyaloid and intraretinal haemorrhage and, in may instances, retinal detachment. They observed that these lesions occur at the periphery of the retina where the vitreous is strongly attached and emphasise the need for indirect ophthalmoscopy whenever a young child is suspected ofhaving an intracranial injury, particularly if this is unexplained. Most usefully, they conclude that, with the least severe degree of head trauma, subdural haemorrhage alone may present, but with increasing force subhyaloid and intraretinal haemorrhages, with or without perineural optic nerve sheath haemorrhages, may occur. Greater degrees of violence will frequently produce retinal detachment. The most severe traumas that is, choroid and vitreous haemorrhages, are likely to be associated with subarachnoid and intracerebral haemorrhages in addition to subdural haematoma. From the paediatrician's point of view the authors point out that any intraocular injury may indicate the presence of a subdural haemorrhage and that, furthermore, if not already present, it may develop later. With regard to the controversy over whiplash injuries versus impact injuries, it would have been interesting to know how many of the dead children in this study had sustained skull fractures. One of the authors' cases was found to have cerebral oedema as the only intracranial finding following shaking. This child had retinal detachment, indicating considerable force had been applied. The authors were unable to judge the presence of cerebral oedema in their other cases but this has been a prominent feature in at least one other study by Munger et al,4 where 83% were found to have cerebral oedema. This is a not infrequent finding in shaking injuries and may be attributed to a primary hypoxic event, such as aspiration of stomach contents, by a defence counsel. This is an important paper for any paediatrician or ophthalmologist who has to give evidence in court in relation to child abuse. It will draw attention to the need for enlisting the early help of an ophthalmologist for any child suspected of sustaining injury to the brain. Similarly, it will remind forensic pathologists to remove the eyes from those dying of intracranial trauma for further examination where criminal proceedings are contemplated and the degree of force used may become an issue. GJ A I SNODGRASS The Royal Hospitals NHS Trust, Garden House Children's Unit, The Royal London Hospital, Whitechapel, London El 1BB

[Perforating eye injuries caused by motor vehicle accidents: cases assisted during the year 1994].

Abstract: A prospective study of 32 patients with perforating eye injuries caused by motor vehicle accidents, 24.32% of the 131 cases of perforating injuries admitted at the University of Sao Paulo Medical School Hospital from January to december, 1994 was performed. Most of the accidents occurred at night (68.75%), and in urban areas (65.63%). There were more male victims (65.63%), mostly under 25 years of age (53.13%). None of the victims were using seat belts and those in the front seats were more vulnerable. Safety precautions should be effectively in use in order to reduce frequency and morbidity of these injuries.