Bilateral Eye Injuries Research Articles

Enhancing Ophthalmic Triage: identification of new clinical features to support healthcare professionals in triage.

To investigate which features from a patient's history are either high or low risk that could support healthcare professionals in ophthalmic emergency triage. Prospective, 12,584 visits from 11,733 adult patients attending an Accident and Emergency department at a single tertiary centre were analysed. Data were collected by ophthalmic nurses working in triage, using an online form from August 2021 to April 2022. Multivariate analysis (MVA) was conducted to identify which features from the patients' history would be associated with emergency care. This study found that 45.5% (5731 patient visits (PV)) required a same day eye emergency examination (SDEE), 11.3% (1416 PV) needed urgent care, and 43.2% (5437 PV) were appropriate for elective consultations with a GP or optometrist. The MVA top ten features that were statistically significant (p < 0.05) that would warrant SDEE with odds ratio (95% CI) were: bilateral eye injury 36.5 [15.6-85.5], unilateral eye injury 25.8 [20.9-31.7], vision loss 4.8 [2.9-7.8], post-operative ophthalmic ( < 4 weeks) 4.6 [3.8-5.7], contact lens wearer 3.9 [3.3-4.7], history of uveitis 3.9 [3.3-4.7], photophobia 2.9 [2.4-3.6], unilateral dark shadow/curtain in vision 2.4 [1.8-3.0], unilateral injected red eye 2.0 [1.8-2.2] and rapid change in visual acuity 1.8 [1.5-2.2]. This study characterises presenting features covering almost 100 ophthalmic acute presentations that are commonly seen in emergency and elective care. This information could supplement current red flag indicators and support healthcare professionals in ophthalmic triage. Further research is required to evaluate the cost effectivity and safety of our findings for triaging acute presentations.

Case Report: Accidental Ocular Blast Injury To A Farmer’s Eye by Gandhak Potash

Ocular exposure to chemical explosions constitute true emergency that can be associated with injuries leading to significant visual morbidities. Herein, we report a case of bilateral eye injury in a 54 year old male farmer due to a chemical explosion while preparing a Gandhak Potash mixture. He presented with multiple charred wounds around his face and embedded particulate matter over the eyelids, conjunctiva and cornea. He underwent superficial debridement of the particulate matter along with conservative management using topical antibiotics, cycloplegics and steroids with good visual outcome. Gandhak potash explosions can be potentially visually devastating. Ophthalmologists, especially those working in agricultural surroundings, should be aware of this mode of injury. Good visual outcome is possible with urgent, appropriate medical intervention.

Proliferative Vitreoretinopathy After Combat Ocular Trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001-2011.

To determine the risk factors associated with developing proliferative vitreoretinopathy (PVR) from combat ocular injuries in U.S. service members. Retrospective review of associated risk factors and outcomes of PVR within the Walter Reed Ocular Trauma Database. Ocular injuries in U.S. service members wounded during Operation Enduring Freedom and Operation Iraqi Freedom from 2001 to 2011 were assessed, and of these all cases of PVR were studied. Principal outcome measures were the risk factors associated with PVR development and rate of final visual acuity (VA) less than 20/200. Eight hundred ninety eyes of 651 U.S. service members were evaluated. A total of 76 eyes (8.5%) of 66 patients developed PVR. Five patients had bilateral PVR. Nineteen patients had bilateral eye injuries. Sixty-one eyes (80.2%) had a final VA less than 20/200. PVR was found to be a significant risk factor for a poor final VA (P < .001). Retinal detachment (RD) was found in 52 eyes (68.4%) of patients. In patients with a RD, intraocular foreign bodies (IOFBs) (P < .001), unsuccessful repair (P = .002), and macular hemorrhage (P = .04) were significant risk factors for the development of PVR. Time to initial retina surgery was not found to be a risk factor for PVR development (P = .5). Time to initial retina surgery was available in 41 patients and the time to surgery on average was 22.56 days (range: 3 to 87 days). PVR occurs frequently in combat trauma and is a significant cause of poor final VA. In patients with PVR and RD, injuries caused by an IOFB, macular hemorrhage, or unsuccessful repair were significant risk factors for the development of PVR. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:556-563.].

Plasma fibroblast skin tightening treatment resulting in bilateral chemical eye injury secondary to EMLA cream: a case report

BackgroundPlasma fibroblast skin tightening treatment is a relatively novel and growing minimally invasive aesthetic skin procedure. The treatment claims to rejuvenate skin by improving facial lines, wrinkles and skin pigmentation associated with photo-ageing. The skin is often anaesthetised prior to the procedure with topical creams such as EMLA (Eutectic mixture of local anaesthetics). We present the first case of bilateral chemical eye injury following plasma fibroblast skin tightening treatment secondary to EMLA cream. EMLA cream was inadvertently administered to both eyes in preparation for the treatment.Case presentationA patient was referred from the emergency department to a tertiary ophthalmology centre with bilateral exquisite eye pain, inability to open the eyes, photosensitivity and reduced vision. She underwent cosmetic plasma fibroblast skin tightening treatment at her local salon four hours earlier. She was found to have bilateral alkali chemical eye injuries with significant diffuse corneal epithelial loss. The injury was thought to be caused by inadvertent ocular exposure to EMLA cream, which was used in preparation for the plasma fibroblast skin tightening treatment. She was treated with topical antibiotics and achieved satisfactory recovery.ConclusionThis case report highlights a possible complication following plasma fibroblast skin tightening treatment. We lay emphasis on the importance identifying chemical injury and recommend that medication attention should be sought if there is any concern.

Spectrum of Ocular Injuries and Visual Outcome Following Firework Injury to the Eye.

Background:Ocular injury due to fireworks requires urgent ophthalmic assessment and management to preserve vision.Methods:Spectrum of injury, type of intervention, visual outcome, and reasons for visual loss were assessed in consecutive patients presenting over 2 years with firework-related eye injury. The final visual outcome was recorded as best-corrected visual acuity.Results:In the 96 patients (75 males) enrolled, 122 eyes were involved. Twenty-six patients had bilateral eye injury. The median (interquartile) age was 14 (8, 28.5) years. Injuries occurred during Diwali festival (59.4%) and funeral processions (20.8%); over half (53.8%) were bystanders. Injury was due to negligence (78%), device malfunction (12.5%), and attempts to reignite (5.2%) or recover failed device (4.2%). Presenting symptoms were redness (100%), pain (97%), watering (86%), and reduced vision (77%). Facial laceration, contusion, or hematoma occurred in 13 patients. The most frequent adnexal and ocular surface injuries were lid burns (57.3%), edema (44.2%), charred eyelashes (24.6%), and laceration (13.9%). Open-globe injury occurred in 8 eyes. Common anterior segment injuries were corneal epithelial defect (51.6%) and hyphema (20.5%). Posterior segment injuries included commotio retinae (13.1%) and Berlin's edema (7.4%). Surgical treatment was required in 15 eyes; 107 (88%) were managed conservatively. At study completion, of the 99 eyes evaluated, 21 had reduced visual acuity (<6/6) including 7 with monocular blindness. Factors associated with poor vision were open-globe injury (P < 0.001) and poor initial visual acuity (P = 0.05).Conclusions:Open-globe injury and poor visual acuity at presentation predict the final visual outcome. Monocular blindness following firecracker injury is common.

Suriye İç Savaşı?ndaki Açık Göz Küresi Yaralanmaları

Objective: To analyze the incidence and severity of open globe injuries among the Syrian anti-regime forces and Syrian civilians in Syrian Civil War. Material and Methods: Open globe injuries were retrospectively analyzed on 39 patients (43 eyes) hospitalized at Kilis State Hospital in Turkey, Department of Ophthalmology, between August 2012 and May 2013. Informed patient consents were obtained preoperatively. We reported the causes and localization of ocular injury, presence of the intraocular foreign body and the microsurgical treatment applied. Results: A total of 43 eyes of 39 patients were included in the study. The average age was 24.8 years, ranging from 4 to 50. Ten patients (25.6%) were <18 years old, and 29 patients (74.4%) were ≥ 18 years old. Four patients (10.2%) had bilateral eye injuries. While fragments of explosive devices (rockets, grenades) were responsible for 26 eye injuries (60.5%), gunshots were the cause of the 17 eye injuries (39.5%). Primary evisceration was performed on 4 eyes (9.3%), because of the destruction of the eye. Conclusion: Extraordinary presentations and subversive visual results are common in war-related open-globe injuries, and ocular injuries are much more severe than those held in civilian life. We think that surgical treatment urgently needs to be done in war-related open globe injuries and these patients can refer to advanced centers after surgical repairment. We consider that because the severity of ocular injuries was very high in our study, most of our patients had unfavorable visual outcomes in the remaining part of their lives, despite of immediate surgical treatment. Our study is the first clinical practice on open globe eye injuries during Syrian Civil War. In conclusion, we believe that we can draw attention to the tragedy that is going on in Syria as a result of the violent civil war.

Occupational disability due to an eye injury (case report)

We report a long service driver with late onset bilateral cataract and unilateral retinal detachment following bilateral eye injury. The causal relationship between these pathological conditions and occupational injury has been convincingly established. The degree of patient's occupational disability has been determined by expert decision.

Bilateral eye irrigation

Bilateral chemical eye injuries are a common and important problem in the Emergency Department. Irrigation of both eyes can be time-consuming, so we present a novel, simple and cost-effective technique for hands-free bilateral eye irrigation. Modifications of a generic dual-lumen cannula adapter and fixation about the glabella allow sterile irrigation fluid to be delivered directly to the medial canthi of the contaminated eyes in a hands-free fashion. Our customized rig frees both the clinician(s) and patient, thus conferring benefits to both. Patients regain autonomy of movement to reposition themselves for comfort or to manipulate the eyelids for more effective irrigation. Clinicians are freed to tend to other tasks. By sharing this technique we hope to stimulate discussion on the safest and most effective method of irrigating chemically injured eyes and prompt the generation of comparable outcome data for the benefit of patients.

Determination of visual prognosis in children with open globe injuries

To determine the predictive factors of visual outcomes in children with open globe injury and to give guidance to reduce the incidence of open globe injury. One hundred and forty eyes of 137 consecutive open globe injury patients, who were treated at the Eye Center of Second Bethune Hospital affiliated with Jilin University between August 2005 and August 2012, were retrospectively analyzed. Data recorded included demographic characteristics, causes of injury, location and extent of injury, presenting visual acuity, detailed ocular anterior and posterior segment evaluations, details of primary and subsequent surgeries, and postoperative complications and outcomes. The follow-up data included the most recent best-corrected visual acuity, complications, and the duration of follow-up. Of the 137 patients, there were 116 (84.7%) boys and 21 (15.3%) girls. Their ages ranged between 3 and 17 years old (mean=11.57±4.19 years old). Sixty (43.8%) children had a right eye injury, whereas 74 (54.0%) had a left eye injury. Only three (2.2%) children suffered bilateral eye injury. Living utensils, industrial tools, and fireworks contributed to the most common causes of open globe injury. Eighty-one (59.1%) had sharp force injuries, 23 (16.8%) had blunt injuries, and 33 (24.1%) had missile injuries. Unfavorable visual outcomes were related to a younger age at presentation, poor presenting visual acuity, injuries caused by blunt or missile objects, posterior wound location, hyphema, vitreous hemorrhage, and surgical intervention of pars plana vitrectomy.

Bilateral chemical eye injury resulting from airbag deployment

A case report highlighting an unusual cause of a chemical injury and an explanation of the basic initial management of chemical eye injuries: relevant to all Armed Forces medical personnel.

Ulcerative Keratitis Following Particulate Elemental Gold Deposition

To describe a case of 68-year-old male industrial chemist who received a chemical injury after a gold/amine compound exploded causing bilateral eye injuries. No apparent long-term problems were anticipated. After cataract extraction 40 years later, he developed a localized ulcerative keratitis adjacent to embedded gold in the cornea. To describe the clinical features, management, and outcomes. Successful treatment with topical hydrocortisone was achieved. Subsequently, 3 further episodes of ulcerative keratitis were treated with topical steroid therapy without need for systemic immunosuppression. A systemic vasculitic/autoimmune screen was normal. Ocular chrysiasis is well recognized after systemic gold administration and is normally considered inert, but in this case exogenous gold deposition might have been a contributing factor to very localized and repeated episodes of stromal erosion in this man, many years after the original injury. To the best of our knowledge this is the first such reported case.

Simultaneous injuries to both eyes in traffic accidents

In traffic accidents, eye injuries occur as isolated or with polytrauma. They may involve just one eye, but simultaneous injuries to both eyes do happen occasionally. The aim of our paper was to reveal the risk factors, in an effort to reduce the number of such accidents and to prevent bilateral ocular damage. All patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, due to traffic accidents with bilateral eye injuries in a period of 9 years from the beginning of 2000 to the end of 2008 were analyzed. In this 9-year period, a total of 36 patients were hospitalized and treated for bilateral ocular injury (72 eyes). There were 23 males among them, the male-female ratio being 1.8:1. Mean age was 33.9 years. The occupations of injured persons were the following: the most common were workers--15, followed by clerks--seven, while less common were pupils, students, pensioners and housewives-three of each of them, and farmers--two. Front-seat passengers were the most common among the injured--20 (55.6%), then drivers--15 (41.7%), with only one passenger from the back seat on the right side (2.7%). As many as 33 (91.7%) of them failed to fasten their seat belts, while 18 (50.0%) were drunk. Penetrating bulbar injuries or eyeball ruptures were predominant--66.7%, while blunt injuries were found in only two (2.8%) eyes in one single person; but in 22 cases (30.5%) there was adnexal damage, too. Visual acuity at discharge and subsequent controls was as follows: amaurosis in 21 (29.2%), less than 0.3 in nine (5.6%), 0.4 and better in 42 (58.1%), and normal visual acuity of 1.0 in 28 patients (38.3%). The major risk factors for getting bilateral eye injuries in traffic accidents proved to be: sitting in the front car seats, not fastening the seat belt and alcohol intoxication. Prevention of these risk factors would result in a decrease in such a large number of bilateral eye injuries.

Airbag-induced chemical eye injury

Chemical injuries of the eye are a rare complication of airbag deployment and result from seepage of the chemical, causing inflation through vents in the airbag. We describe a severe case of bilateral alkali eye injury upon airbag contact in a road traffic accident. Delayed recognition and irrigation of the eyes exacerbated the injury with a resultant poor healing response of the left eye. Consequently, a left amniotic membrane graft was performed to promote corneal epithelial healing. The use of an amniotic membrane graft in the acute period after a chemical keratitis is unusual and reflects the severity of the corneal injuries sustained by this patient. This case illustrates the vision-threatening risk of alkali keratitis secondary to airbag deployment and highlights the importance of early recognition and management.

Eye Injury – Conditioning

0406 HISTORY: A 19-year-old African American female lacrosse college player sustained a bilateral eye injury while involved in resistance training. She was exercising with an elastic band that snapped and struck her across the face, hitting both eyes. Symptoms were more pronounced in the left eye and included intense bilateral pain, tearing, photophobia and blurring. PHYSICAL EXAMINATION: Examination in the training room revealed 1–2+ edema in the superior and inferior eyelids bilaterally; 1+ conjunctivae injection bilaterally; normal motility bilaterally; pupils 5mm irregular and non reactive bilaterally; and presence of coagulated blood in the anterior chamber at 9 o'clock bilaterally. Patient experienced difficulty in performing visual field and visual acuity testing due to pain and photophobia. She was immediately brought to the emergency room for an ophthalmologic examination. DIFFERENTIAL DIAGNOSIS: *Bilateral Traumatic Hyphema *Corneal Injury (abrasion; laceration) *Retinal Hemorrhage/Detachment/Commotio *Orbital Fracture TEST AND RESULTS: Visual Acuity/Refraction: OD: 20/25+3; OS: 20/80 Visual Fields: Normal bilaterally Intraocular Pressure (mm Hg) (Tonopen): OD: 18; OS: 28 Cornea: Epithelial defects: OD: 1–5 o'clock, peripherally; OS: 3–5 o'clock, peripherally Anterior Chamber: Deep with 4+ cell and flare; Clots at 9 o'clock bilaterally Iris: Multiple sphincter tears bilaterally Lens: Clear bilaterally Ophthalmoscopy: OD: Commotio retinae and preretinal hemorrhage inferotemporally OS: Commotio retinae and preretinal hemorrhage approaching the macula; Retinal hemorrhage and preretinal hemorrhage inferonasally Optic Nerve: Pink and flat bilaterally Sickle Cell Screen: Negative FINAL/WORKING DIAGNOSIS: *Bilateral Traumatic Hyphema *Bilateral Iris Sphincter Tear *Bilateral Corneal Epithelial Defects *Bilateral Commotio with Preretinal hemorrhage *Probable Bilateral Angle Recession *Unilateral Choroidal Rupture (OS) *Unilateral Transient Elevation in Intracocular Pressure (OS) TREATMENT AND OUTCOMES: *Topical steroid, scopolamine and erythromycin *Bilateral eye shields, bed rest and sleeping in the upright position *Daily intraocular pressure measurements *Developed acute increase in intraocular pressure in the left eye 9 days after trauma that resolved with the use of acetazolamide, brimonide and dorzamide plus timolol *Patient discontinued all medications and resumed physical activity 6 weeks after the incident

Indirect traumatic optic neuropathy complicated with periorbital facial bone fracture.

This study evaluated the outcome for 45 consecutive, nonrandomized patients whose indirect type traumatic optic neuropathy and periorbital facial bone fracture were treated at the Chang Gung Memorial Hospital in Kaohsiung between June of 1996 and June of 2001. There were a total of 48 eye injuries in 45 patients (3 patients sustained bilateral eye injuries). Data related to megadose steroid treatment, timing of open reduction and internal fixation for periorbital facial fractures, and pretreatment and post-treatment of visual acuities were collected from the medical records. Measurements of visual improvement in terms of degree and percentage were calculated after the visual acuities were converted into the log of the minimum angle of resolution units. Visual acuities were significantly improved according to mechanism of injury, gender, or associated periorbital skin laceration wound. However, no light perception for eight patients at initial presentation and gradually deteriorating vision in four injured eyes of three patients were identified as poor prognostic factors. Therefore, repeated visual measurements are recommended to detect any gradually deteriorating vision, which although uncommon, has a poor prognosis. No significantly improved vision was found after treatment with megadose steroids. However, if improvement in vision did occur, treatment with megadose steroids resulted in a much greater visual improvement in terms of degree (p = 0.001) and percentage (p = 0.02). Thus treatment with megadose steroid is recommended. No significant differences were found in the visual improvement between those who received and those who did not receive periorbital open reduction and internal fixation operations, and between those who received early repair within 48 hours and those who received late repair after more than 48 hours. However, it seems medicolegally prudent to delay the procedure because some patients may experience gradually deteriorating vision, which has a poor prognosis, and because postoperative visual loss after facial fracture repair did happen.

Airbags and bilateral eye injury: Five case reports and a review of the literature

We report five cases of bilateral eye injuries from airbag deployment in motor vehicle crashes and review the world’s literature on ocular injuries associated with airbags. The cases in the literature were identified by cross-referencing Medline searches from airbags and ocular injuries. Additional cases were identified after review of references from each article in the search. An additional 89 cases from the literature were identified and are included for discussion. Patients were treated individually in a noncontrolled, nonrandomized fashion according to the nature of each injury with regular follow-up examinations in clinic. Of the 94 cases studied, 24 (27%) were bilateral eye injuries, and 15 (16%) patients were wearing spectacles at the time of the accident. The most common injuries included corneal abrasions, eyelid trauma, and hyphemas. Outcomes ranged from complete resolution of symptoms and return of normal visual acuity to primary enucleation. This report describes the wide spectrum of eye injuries that may occur after airbag deployment. We suggest a management plan for the evaluation and treatment of the ocular complications of airbag-related trauma.

War-wounded refugees: the types of injury and influence of disability on well-being and social integration.

The aim of this study is to describe the war injuries and investigate the influence of physical disability on well-being and social integration in a group of war-wounded refugees after two years in Sweden. A culturally heterogenous sample of 54 war-wounded refugees was investigated during hospitalization shortly after arrival, and after two years. Quantitative data were covered by physical examinations, interviews and questionnaires. In addition, qualitative data were collected within semi-structured interviews on both occasions. The major types of war injuries were: fractures (22%), traumatic amputations (17%), spinal cord injuries (17%), nerve injuries (11%), combinations of fractures and nerve injuries (9%), bilateral eye injuries (9%), brain injuries (7%), other injuries (7%). Regarding the type of injuries and medical complications, the group studied was representative of small unit operations of war with low access to early medical care. The degree of physical disability was not a salient factor for well-being and social integration after two years in Sweden. The losses and desires to be repatriated were apparent from the qualitative findings, as exemplified by three case reports. The findings of this study are in accordance with previous research on refugees and war-injured ex-combatants, but further multidisciplinary research is needed. The results also imply that resettlement countries should pay continuous attention to the broad needs of their war-wounded refugees.

High-Pressure Directed Water Jets as a Cause of Severe Bilateral Intraocular Injuries

To draw attention to the characteristic features of eye injuries caused by high-pressure water jets. We examined three patients with bilateral eye injuries caused by directed high-pressure water jets. All three patients had reduced visual acuity bilaterally, extensive eyelid ecchymosis, subconjunctival hemorrhages, hyphema, iris sphincter rupture, transient increase in intraocular pressure, and inferior commotio retinae. These injuries were confined primarily to the lower parts of the eyes. High-pressure water jets may cause bilateral eye injuries affecting primarily the anterior and inferior parts of the eyes. Because of concern about late effects of injuries, long-term follow-up is recommended.

Epidemiology of motor vehicle crash-related serious eye injuries

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 motor vehicle crash-related serious eye injuries reported. The mean age of those injured was 29 years; 61% were between 16 and 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 (legal blindness) in 47% of eyes. Of eyes with at least 3 months of follow-up, 63% had worse than 20/200 initial visual acuity and 41% remained legally blind. Twelve percent of eyes required removal. Possibly due to the large number of blunt ruptures, motor vehicle crash-related eye trauma carries a particularly unfavorable treatment prognosis. Prevention of these injuries is therefore of extraordinary importance.

Civil Unrest and Ocular Trauma

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.