Showing papers on "Eye injuries published in 1997"

Serious and Fatal Air Gun Injuries: More Than Meets the Eye

Abstract: Objective. To describe the epidemiology of air gun injuries to children that required hospitalization. Design. A consecutive series of children with air gun injuries. Setting. Urban pediatric teaching hospitals in Cincinnati, OH; Kansas City, MO; and Seattle, WA. Methods. A retrospective chart review. Results. A total of 101 children were studied: 81% were male; 80% were white, 18% were black, and 2% were other races. The median age was 10.9 years (range, 0.5 to 18.8). Victims were most commonly shot by a friend (30%) or sibling (21%). A total of 34% occurred at the victim9s home, and 36% occurred at the home of a friend or relative. Although 71% of shootings were unintentional, 5% were assaults, and 1% were suicides. The median hospital stay was 3 days (range, 1 to 17 days). Fifteen children (15%) required treatment in intensive care. A total of 56% required at least one surgical procedure. Forty-nine had injuries to the head, including 38 with injuries to the eye, 10 with intracranial injuries, and 1 with a skull injury. Fourteen children were shot in the neck; 15 were shot in the chest, with 2 patients sustaining lacerations of the pericardium and 1 having a right ventricular foreign body. Another child had a laceration of the innominate artery. Nineteen had abdominal injuries, including laceration of the stomach (N = 3), small bowel (N = 4), colon (N = 2), and liver (N = 3). Three of 10 children with intracranial injuries died. Two had long-term neurologic deficits. Of children with eye injuries, 25 (66%) had permanent visual loss and 15 (39%) of these were blind. Conclusion. Air guns are associated with serious and fatal injuries. Families should be counseled that air guns may cause serious injuries and even death. Furthermore, pediatric care givers should advocate for increased regulation of air guns and expansion of safety standards.

Endophthalmitis after penetrating ocular trauma.

Abstract: Endophthalmitis following penetrating eye injuries has a relatively poor prognosis due to the underlying eye trauma and the frequency of more virulent organisms such as Bacillus species. Risk factors for infection include 1) retained intraocular foreign body, 2) a rural injury setting, 3) delay in primary wound closure, and 4) disruption of the crystalline lens. Although endophthalmitis is difficult to distinguish from traumatic changes, recognition of early clinical signs of endophthalmitis, such as hypopyon, vitritis, or retinal periphlebitis, is important and early treatment is recommended. Comprehensive prophylactic antibiotic treatment at the time of injury repair combined with timely diagnostic vitrectomy and injection of intravitreal antibiotics when infection is suspected may significantly improve visual acuity outcomes following penetrating injuries. Treatment includes intravitreal, periocular, and systemic antibiotics. Intravitreal and periocular corticosteroids are also recommended. Recent and past literature supporting these recommendations, as well as the authors' specific prevention and treatment protocols for post-traumatic endophthalmitis, is included in this review.

Causes and visual outcome of childhood eye injuries in Nigeria.

Abstract: Two hundred and twenty-eight children of both sexes (152 males and 76 females) aged between 1 and 15 years treated for eye injuries at the University of Nigeria Teaching Hospital, Enugu, Nigeria were studied. The injuries were commonly sustained during domestic activities (29.8%), at play or sports (23.7%), in the schoolroom (16.7%) and during farm work (10.1%). Causative agents were mostly sticks, followed by stone missiles and other flying objects. There was a general delay in reporting to hospital in all types and degrees of severity of injuries, with only 28.5% reporting in the first 24 hours and as many as 10.5% after 1 month. How quickly the patient came to hospital was determined more by social and economic factors than by sex, age and type of injury. Visual outcome was best in patients with mild non-penetrating injuries and worst in those with severe penetrating injuries. Amongst the latter the outcome was worse when the posterior segment was involved than when the injury involved only the anterior segment. Our study showed that there has been a change in the causation of childhood eye injuries in the country compared with reports of 25 years ago. The visual outcome in our patients was worse than in reports from developed countries. This was due mainly to delay in seeking specialist treatment and lack of sophistication of the treatment, especially in severe cases.

Management of traumatic cataract in children

Abstract: Purpose: To evaluate the presentation, mode of management, and clinical outcome of traumatic cataract in children. Setting: L.V. Prasad Eye Institute, Hyderabad, India. Methods: One hundred thirty-seven children ( Results: The study group comprised 110 boys and 27 girls. Average follow-up was 11.7 months (range 1 week to 60 months). Most injuries (54.7%) were caused by a stick or a bow and arrow. Most (53.2%) of the cataracts were total. Corneal scarring (60.5%) and iris-related problems (49.6%) were the most common associated findings. Extracapsular cataract extraction with intraocular lens (IOL) implantation was performed in 65.67% of patients. Visual acuity improved from 20/200 or worse in 97.7% of patients preoperatively to 20/60 or better in 74.1 % of patients postoperatively. Seventeen patients had associated posterior segment insult; most failed to recover satisfactory vision. Posterior capsule opacification (PCO) was noted in 42.9% of patients. Conclusions: Extracapsular cataract extraction with IOL implantation provides satisfactory results in children with traumatic cataract. Associated posterior segment complications and development of PCO are the major obstacles to visual rehabilitation.

Severe ocular trauma managed with primary pars plana vitrectomy and silicone oil.

Abstract: PURPOSE This study evaluated the outcome of severely injured eyes treated with early primary vitrectomy with silicone oil filling. METHODS A total of 435 eye injuries, which required surgical intervention, were reviewed retrospectively. In 13 eyes (3%) pars plana vitrectomy and silicone oil filling were performed as primary surgical repair. Silicone oil filling was restricted to cases with laceration of the retina larger than 4 disc diameters (nine eyes), primary retinal detachment larger than two quadrants (two eyes) and/or persistent intrasurgical hemorrhage (12 eyes). All patients underwent surgery within 24 hours. RESULTS After a mean follow-up period of 28.7 months (range, 9-70 months), 11 eyes achieved a visual acuity ranging from 20/25 to 20/200. Silicone oil was removed in 11 of 13 eyes after 5.8 +/- 4.6 months. Recurrent proliferative vitreoretinopathy developed in two eyes. CONCLUSIONS Silicone oil tamponade after early primary pars plana vitrectomy may be an alternative for primary repair after trauma, especially in severely injured eyes with retinal lacerations larger than 4 disc diameters, persistent intrasurgical bleeding, and/or primary retinal detachments.

Retinal Perforation in strabismus surgery

Abstract: Purpose: Perforation of the retina is a major complication of strabismus surgery. The reported incidence of perforation varies from 0.13% to 12%. This study was undertaken to determine, from a large collaborative database, the incidence of suspected and unsuspected retinal and choroidal injury in pediatric horizontal muscle surgery. Method: All children with horizontal strabismus surgery seen between September 1992 and October 1995 were examined with indirect ophthalmoscopy immediately following their procedure. Surgery was performed by both resident and attending physicians. Cases involving muscle reoperation, high myopia, or patients with connective tissue disorders were excluded. Results: Strabismus surgery was performed on 765 patients, who underwent 1 129 muscle recessions and 349 muscle resections. These children also had 161 vertical or oblique muscle procedures performed. Intraocular trauma resulting from horizontal muscle surgery was noted in 14 patients, including three retinal perforations. One of these patients was treated with cryotherapy; the other two received no therapy other than intraoperative and postoperative antibiotics. Discussion: The incidence of retinal perforation was 0.4% and the incidence of choroidal injury without perforation was 1.4% in this large series of children undergoing horizontal strabismus surgery. Retinal detachment or endophthalmitis did not develop during the 6-week follow-up period.

Ocular siderosis. Diagnosis and management.

Abstract: Purpose To assist clinicians in the diagnosis and management of ocular siderosis. Methods The diagnosis and management of three cases of ocular siderosis secondary to a retained iron-containing intraocular foreign body are described. Results Noteworthy features included: 1) the characteristic features of a tonic or Adies pupil (one case) and 2) the failure of high-resolution computed tomography scanning and plain film radiography to detect the intraocular foreign body (two of three cases). In contrast, ultrasonography demonstrated the intraocular foreign bodies in all cases and accurately localized them to the inferior retinal quadrants. A third noteworthy finding was that a preoperative electroretinogram reduction in amplitudes of as much as 40% compared with that of the uninvolved eye was compatible with excellent vision, and that the electroretinogram returned to normal after the intraocular foreign body was removed. Conclusions Ocular siderosis should be considered in the differential diagnosis of a tonic or Adies pupil. To detect an occult intraocular foreign body, clinicians should not rely exclusively on computed tomography scanning or plain film radiography, but should also use B-mode echography with careful study of the inferior quadrants. In ocular siderosis a preoperative electroretinogram reduction in amplitudes of as much as 40% may be reversible after intraocular foreign body removal.

Ocular superglue injury.

Abstract: OBJECTIVE: To determine the incidence of ocular injuries associated with superglue. METHODS: A retrospective review of patients attending an accident and emergency department over a 12 month period with ocular superglue injuries. RESULTS: 14 patients who suffered ocular injuries due to superglue were identified. No patients had long term complications from their injury. Management is discussed. CONCLUSIONS: Superglue eye injuries do not appear to cause long term morbidity.

Transscleral diode laser therapy for traumatic cyclodialysis cleft

Abstract: This case report describes a new surgical approach for the treatment of cyclodialysis. The treatment of cyclodialysis cleft associated with hypotony is in a period of evolution. In this report, a patient with traumatic cyclodialysis associated with hypotony maculopathy was treated with contact transscleral diode laser therapy to the cleft areas. The contact diode laser therapy resulted in closure of the clefts, reversal of hypotony, and resolution of maculopathy with improvement in vision. The results of this study show that this technique can be less invasive than other surgical options.

Penetrating eye injuries in rural New South Wales.

Abstract: Purpose: To determine the epidemiology and outcomes of penetrating eye injuries in a rural Australian setting. Methods: A retrospective study of an 11 year period to identify 77 cases of penetrating eye injury in Lismore, New South Wales. Results: The commonest cause of penetrating eye injury was fencing wire followed by hammering metal. The average age was 32.6 years, and males were involved in 88% of cases. A final visual acuity of 6/12 or better was achieved in 61% of cases. Enucleation was performed in 14%. Visual outcome was best for wounds involving the cornea only. Conclusions: Penetrating eye injuries are potentially devastating to vision, but with modern surgical techniques patients are likely to achieve reasonable vision. Prevention requires education to ensure adequate protective measures are taken in potentially hazardous settings.

Inadvertent globe perforation during retrobulbar injection in high myopes

Abstract: Purpose: To report ocular perforation that occurred duringretrobulbar injection in 7 highly myopic eyes.Methods: Seven patients with a diagnosis of globe injuryduring retrobulbar injection for ocular anesthesia beforecataract surgery were managed by vitreoretinal surgery. Allinjections were performed by ophthalmologists. The surgeonrecognized the perforation in 4 cases at the time of injection.The preoperative vision was hand motion perception in 4 eyes andlight perception in 3 eyes. All patients underwent vitreoretinalsurgery because of the presence of vitreous hemorrhage and/orretinal detachment diagnosed by funduscopy or ultrasonography. Atthe time of surgery, all eyes had vitreous hemorrhage and 4 eyeshad rhegmatogenous retinal detachment. The number ofvitreoretinal procedures performed was: 1 procedure in 4patients, 2 procedures in 2 patients, and 3 procedures in 1patient. The period of follow-up ranged from 4 months to 4 years,averaging 20 months.Results: At the end of the follow-up period, the retinawas attached in 6 patients. The postoperative vision was 20/400in 3 eyes, finger counting in 3 eyes, and light perception in 1eye.Conclusion: Special care should be taken in retrobulbarinjection of highly myopic globes, which have an increased riskof perforation. The functional outcome of surgical repair ofthese eyes was poor.

Profile of ocular trauma in Papua New Guinea

Abstract: BACKGROUND: Ocular trauma is a significant cause of blindness in Papua New Guinea (PNG). This study was done to determine the pattern and rates of ocular and adnexal injuries so as to determine the size and extent of the problem. METHODS: A retrospective study of 4157 cases presenting with ocular trauma in three regions of PNG was carried out. The data were analysed with respect to the age, sex, province, type and cause of injury, time interval between injury and presentation to the hospital and the final visual outcome after treatment. RESULTS: Ocular trauma rates in PNG were alarmingly high (39.1 per 100,000). The commonest cause of injury in the younger age group was due to lime. Alcohol-related violence and fights resulted in injuries in the adult age group. Most of the injuries were grievous and 60.7% of patients were left with a visual acuity of less than 6/60 in the injured eye. In addition, 78.7% of the patients were under 30 years of age. CONCLUSIONS: Ocular injuries in PNG are an important cause of visual disability. Some specific injuries, such as those due to lime in children, can easily be prevented by health education. Language: en

Surgical management of ophthalmic trauma due to the Palestinian Intifada

Abstract: Purpose: The purpose of the study was to determine the causes, morbidity and visual outcome of 567 Intifada eye injuries which occurred during a 6 year period from December 1987 to December 1993. Methods: A prospective study was undertaken of Intifada eye injuries from December 1987 to December 1993 which were treated at the St John Ophthalmic Hospital, Jerusalem, or in private clinics in East Jerusalem, the West Bank and Gaza. Results: Seventy-five per cent of those injured came from East Jerusalem or the West Bank. The average age of a person injured was 17 years. Male preponderance was 84.7%. The study demonstrates both the high morbidity and the poor visual outcome which characterise Intifada eye injuries. There were 567 eyes in the series, of which 143 (25.2%) lost perception of light and 72 (12.6%) had vision less than or equal to 6/60. Eighty-six eyes (15.1%) required enucleation. In total 43.1% of the series had severe ocular injuries. Rubber or plastic bullets caused 154 injuries. They were the commonest indication for the enucleation of an eye (90.6% of 86 enucleations). There were 3 cases of severe Gram-negative endophthalmitis in the group of patients who presented late to the hospital (0.52%). Conclusions: Intifada injuries are associated with far greater morbidity than non-military eye injuries. Rubber or plastic bullet injuries are the leading cause of visual loss and of eye enucleation. Military curfews exacerbate the morbidity of Intifada injuries by prolonging evacuation time.

Intravitreal cilia in phakic penetrating eye injury

Abstract: Background: Intraocular cilia present clinical perplexity due to their radiolucency, the extremely variable ocular response to such cilia, and the inadvisability of using MRI in cases of suspected metallic intraocular foreign bodies (IOFB). Methods: Two cases of intravitreal cilia associated with phakic penetrating eye injury are described where preoperative CT scan revealed no retained IOFB. Results: B-scan ultrasonography detected intravitreal cilia in one patient and raised this suspicion in the other. One patient presented with endophthalmitis unresponsive to intravitreal antibiotics, the other with culture-negative anterior uveitis. Both underwent vitrectomy and removal of cilia. Conclusions: Intravitreal cilia should be considered in penetrating eye injuries even in phakic eyes with no radiological evidence of IOFB, especially if associated with endophthalmitis. B-scan ultrasonography may aid detection of intravitreal cilia and thus alter clinical management.

Ocular and cerebral trauma in non-accidental injury in infancy

Abstract: Editor,—We read with interest the paper by Green et al .1 We agree with the authors about the importance of ophthalmoscopic examination in the ‘battered child syndrome’. However, we feel that some considerations on the pathogenesis should be discussed. Firstly, we believe, based on personal clinical and not autoptical cases, that there is a possible association between subdural and intraocular haemorrhages. Nevertheless, we want to underline that intraocular haemorrhages could be isolated manifestations in battered child syndrome; sometimes not due to a direct bulbar trauma.2 Traumas of various types, even not ocular, may involve the retinal vascular system, as previously described by Purtscher at the beginning of this century.3 Several unilateral or bilateral retinopathies similar to those observed by Purtscher have been reported after compressive thoracic injuries (for example, seat belt injuries), head trauma, and violent deceleration.4-6 Various pathogenetic mechanisms of these retinal vascular alterations have been reported—sudden rise in intrathoracic venous pressure,4 arterial angiospasms, retinal vessel occlusion by gas, and lipid embolisms or aggregates of granulocytes. In the case of shaking, the pathogenesis of retinochoroidal haemorrhage basically can be caused by: (1) transient blood flow arrest due to rapid bending of the neck or rapid movement of the head, both resulting in direct trauma of the carotid-ophthalmic vascular system and/or retinal vasospasm. This mechanism is the same as the one that occurs in some cases of whiplash lesions; (2) acute thoracic compression probably due to a rapid muscular contraction with closed glottis, resembling a Valsalva’s manoeuvre. Such compression would give rise to a venous pressure wave transmitted to the eye, as a result of the lack of antireflux valves between the caval vein and the eye. The unilaterality or bilaterality of the symptoms may be explained by the anatomical distribution of the …

Airbag-induced eye injuries: experiments with in situ cadaver eyes.

Abstract: In an attempt to investigate eye injuries from airbags, a set of experiments was performed that involved the deployment of several types of airbags onto thirteen unembalmed, previously frozen cadaver heads. The airbags differed in the material, coating, presence of a tether, and folding pattern, and were deployed via a pneumatic deployment system. The eyes were impacted in situ after being repressureized with saline injected through a 30-gauge needle. Injury determination was achieved by ophthalmic ultrasound imaging, staining with fluorescein dye, and dissection. All twenty-six eyes revealed detached retinas, as shown by the ultrasound, before impact as a result of decaying tissue and the freezing process. High speed video and film were used to capture the events. The impact velocities of the airbags were recorded from the digitized film at the first contact location with the eye and ranged from 30 m/s to 66 m/s. Eyeglasses were placed on four of the specimens, and the presence of eyeglasses seemed to provide protection to the eye because of the lack of contact between the airbag and ocular region. Minimal ocular damage was recorded for all experiments.

Eye injury and sport: sport-related eye injuries presenting to an eye casualty department throughout 1995.

Abstract: A survey was undertaken of all patients attending the Eye Casualty Department at Waterford Regional Hospital with sports injuries in the twelve-month period 1st January 1995 to 31st December 1995. Ninety eight patients had problems associated with sport. Hurling was responsible for the largest group (30%) and football of different codes accounted for 29%. The next largest group was the racquet sports (13%). The most common injuries were to the anterior chamber (hyphaema and microhyphaema: 36%). There were three orbital fractures. 26 patients (27%) were admitted. 83 patients (85%) were male. The median age was 20 years. Sport is a significant cause of eye injury, which is often serious, and affects mostly young healthy males. Language: en

Dissection along the optic nerve axis by a BB.

Abstract: A 13-year-old Hispanic boy suffered a perforating injury to his right eye from a BB. The clinical examination and computed tomographic scan revealed questionable light perception and a dense foreign body, consistent with a BB, situated behind the globe. A vitrectomy was performed that was unsuccessful. Six months later the eye was enucleated, and the BB was found to be within the optic nerve sheath. Foreign bodies within the optic nerve are uncommon. The foreign body in this case, a BB, entered the optic nerve through the nerve head after traversing the globe. The histopathologic findings in this unusual case are presented herein.

A study of perforating eye injuries at the Ophthalmology Department, National University of Malaysia.

Abstract: One hundred and sixty seven (167) perforating eye injuries involving 159 patients were analyzed in a retrospective study over a three-year period. The degree of blindness and their associated factors were determined. Most patients were in the first three decades of life and were males. One hundred and seven (64%) eyes had vision of 3/60 or worse at initial assessment. Of these only 45% of eyes had improved vision to 6/36 or better at six months of follow-up. Fifty-five per cent of eyes were blind. The only significant associated factor identified was the extent of injury. Age, time interval and mechanism of injury were not significant factors. Language: en

Prompt treatment for chemical eye injuries.

Abstract: A chemical injury to the eye requires prompt and effective treatment to minimise permanent damage. This article describes the types of chemical injury and discusses the treatments available.