Blunt Eye Trauma Research Articles

A CLINICAL CASE OF SUCCESSFUL SURGICAL TREATMENT OF A LATE-PRESENTING PATIENT WITH TRAUMATIC FLAP DISLOCATION AFTER FEMTOLASIK

FemtoLASIK is a frequently performed refractive surgery, one of the complications of which is flap dislocation. Most often, this condition is accompanied by decreased vision, pain, lacrimation, which makes patients immediately visit ophthalmologist. This article describes a case of a patient who came to the clinic only on the fourth day after the flap displacement due to blunt eye trauma. By this time, the patient’s corneal flap had significant edema, was folded and displaced with exposure of the stromal bed, which was epithelialized over 2/3 of the area. The surgical treatment of this patient with restoration of anatomical structures, as well as visual functions exceeding the maximum-corrected at the preoperative stage is presented. The treatment provided a stable result for 15 months after the performed reposition.

Retinal hemorrhages and damages from tractional forces associated with infantile abusive head trauma evaluated by wide-field fundus photography

We evaluated the distribution and types of retinal hemorrhages (RHs) and other damages in eyes with abusive head trauma (AHT). This retrospective, consecutive case series of AHT and non-AHT conditions involved 54 children with AHT, 43 children with head bruises, and 49 children with blunt eye trauma, each of non-AHT supported by reliable witness accounts. RHs and other damage were evaluated using ophthalmoscopy and wide-field fundus photography. A variety of RH types and other damage were identified in the AHT group but not in the non-AHT group. RHs in AHT extended from the posterior pole to the far periphery in 77% of eyes and on/near the veins in 86% and arteries in 85%, most of which were in the far periphery. Retinoschisis, white-dot lesions, and retinal folds were seen even in the far periphery. RHs on/near the veins and arteries, retinoschisis, and retinal folds suggest a traumatic mechanism of the tractional force of the vitreous that is attached to the entire retinal surface. Identifying the distribution and arterio and venous origins of RHs is a key factor in determining the association with trauma. Thus, wide-field fundus photography is useful to record and evaluate the origin of the RHs and other retinal damage.

ANGLE RECESSION, THE SEQUELA OF EIGHT-BALL HYPHEMA AFTER SPRAYED BY FIRE HYDRANT: A CASE REPORT

Introduction : Hyphema results from damage to the blood vessels of the iris or anterior ciliary body after blunt trauma, and in 56–100% of cases can occur angle recession.
 Case Illustration : A 40-year-old man complaints of pain and blurred left eye after being sprayed by a high-pressure fire hydrant five hours before coming to the emergency room. Visual acuity was 20/20 and hand movement in right and left eye, IOP is 13 mmHg and 18 mmHg in both eyes. Subconjunctival bleeding, conjunctival and pericorneal injections were found with punctate fluorescein test in the left eye. The cornea was edema and the anterior chamber was full of hyphema. Five days after being hospitalized and treated with topical atropine, antibiotics, and steroid in combination with oral tranexamic acid, the visual acuity was 5/6.5 and the hyphema was resolved. The IOP elevated after 1-6 weeks of follow-up in the outpatient clinic then timolol eyedrops were given. Gonioscopy showed widening of CBB, torn iris processus 2 clock hours in the inferior quadrant. The antiglaucoma medication was stopped due to the controlled IOP in the end episode of the treatment.
 Discussion : Angle recession involves a tear between the longitudinal and circular muscle fibres of the ciliary body. Medication is needed to control the IOP, while surgical management only indicated in cases where medical treatment fails to control the IOP and risk of progressive visual loss.
 Conclusion : Angle recession can occur after blunt eye trauma with hyphema and IOP control is needed to prevent the development of secondary glaucoma.

Clinical Aspects of Transient Myopia after Blunt Eye Trauma

Purpose: To investigate the clinical aspects of transient myopia after blunt eye trauma.Methods: The medical records of 32 patients treated at our hospital for from 2020 to 2022 traumatic microhyphema were analyzed retrospectively. The visual acuity, intraocular pressure, anterior chamber cells, anterior chamber depth, axial length, lens thickness, and refractive index were analyzed immediately after injury and after treatment. Patients with additional diseases such as vitreous and retinal hemorrhage, traumatic retinal detachment, iridodialysis, or orbital fracture were excluded. Correlations between the myopic changes and the amount of myopic refractive change caused by trauma were analyzed.Results: The 32 patients included 24 (75%) males and 8 (25%) females. The average myopic change was -3.03 ± 0.92 (range -1.00 to -5.25) diopters (D). The average change in anterior chamber depth due to trauma was -0.22 ± 0.11 mm, the change in lens diameter was 0.20 ± 0.09 mm, and the change in axial length was -0.07 ± 0.05 mm. The average change in refractive index due to ciliary spasm was -1.63 ± 0.65 D. The correlations between the change in refractive index and anterior chamber depth (r = 0.475, <i>p</i> = 0.008), traumatic ciliary spasm (r = 0.649, <i>p</i> < 0.001), and lens thickness (r = -0.184, <i>p</i> = 0.330) were determined.Conclusions: Factors such as ciliary spasm, change in the anterior chamber depth, anterior shift of the lens-iris diaphragm, and increased lens thickness affect the myopic changes caused by trauma. Of these, a shallower anterior chamber depth and ciliary spasm are highly correlated with the transient myopic changes.

Bilateral Angle Recession and Chronic Post-Traumatic Glaucoma: A Review of the Literature and a Case Report.

Ocular trauma affects millions of people worldwide and is a leading cause of secondary glaucoma. Angle recession is the main cause of post-traumatic glaucoma after blunt eye trauma, and it is usually unilateral. The aim of this paper is to investigate the possible causes of angle recession with a bilateral presentation. Airbag activation during traffic accidents is a likely cause to be ruled out, along with repeated head or eye trauma, due to contact sports or a history of physical abuse. These aspects can aid in early detection, appropriate management, and improved outcomes for patients with ocular trauma. Finally, we report the case of a 75-year-old Caucasian man who developed a bilateral angle recession after an airbag impact, with advanced glaucoma in the right eye and ocular hypertension in the left eye. To our knowledge, this is the first case in the literature of chronic post-traumatic glaucoma probably caused by an airbag.

Maculopathies Secondary to Mechanical and Blunt Trauma

Blunt eye trauma includes the mechanical deformation of the globe with foreign bodies or the damage that occurs by the direct penetration of the energy to the tissues. It is estimated that it accounts for more than 2% of 2,5 million eye injuries per year only in the United States. Retinal or macular damage due to blunt injury includes the following well-known conditions such as commotio retinae (Berlin’s Edema), choroidal rupture, retinal tears, retinal detachment, retinal dialyzes, and macular hole. Although the clinical presentations of retinal and choroidal lesions are well defined, the pathogenesis of them is not clear yet. Besides the most accepted theory which supposes that the main cause of the retinal injury is vitreous traction, alternative comments suggest differential globe layer deformation and increased inner limiting membrane rigidity. Today, by the available advanced vitreoretinal surgery technics, the chance of the patient for functional recovery is higher than before. However, the pharmacological methods for preventing/ treating retinal or macular damage are still in their infancy.

Blunt Eye Trauma: Epidemiology, Prognostic Factors and Visual Outcome-A 10-Year Retrospective Study.

The aim of this study is to define the accompanying prognostic factors and evaluate the final visual acuity of patients presenting with blunt eye trauma. The data of this study included the demographic characteristics of the patients, the mechanism of injury, initial and final visual acuities and accompanying pathologies. A total of 259 eyes of 259 patients who presented with blunt eye trauma were included. Eighty-three percent of the patients were male. The most common mechanisms are beaten, accidents, and falls. The visual acuity of the patient at admission was no perception of light, and the final visual acuity was also no perception of light. The incidence of blunt eye trauma was more common in males and in advanced age. A higher final visual acuity level is achieved with successful management of concomitant pathologies.

Suprachoroidal Hemorrhage and Choroidal Rupture

Suprachoroidal hemorrhage (SCH) is a rare but potentially vision-threatening, feared complication of intraocular surgery. It is defined as the accumulation of blood in the potential space between the choroid and sclera by the rupture of the long or short posterior ciliary arteries or vortex veins due to sudden low intraocular pressure (IOP). Choroidal rupture is the rupture of the inner choroid, the overlying Bruchs membrane, and the RPE due to blunt eye trauma. After blunt trauma that causes anterior-posterior compression, the globe suddenly expands in the horizontal direction and crescent-shaped cracks are formed centered on the optic disc. In this section, suprachoroidal hemorrhage (SCH) and choroidal rupture will be mentioned.

A rare orbital cyst due to traumatic lens dislocation

Lens dislocation into the subconjunctival or subtenon's space is a rare but known complication of blunt eye trauma. However, lens dislocation into the orbital space has never been reported. Here, we describe a case of orbital cyst caused by traumatic lens dislocation. A 55-year-old man complained of persistent orbital edema and pain in the right eye after ocular evisceration and orbital implant surgery for severe scleral rupture. Computed tomography showed increased soft-tissue density in the infero-temporal orbital space. An orbitotomy and histological examination confirmed that the mass in the orbit was a cyst that formed from the dislocated lens.

Axial length of cataract eyes: a comparison of two cohorts over a span of 10 years apart

BackgroundTo assess the associations of axial length with age-related cataract within a span of 10 years in an Asian population in southern Taiwan.MethodsA retrospective cohort study examined 960 adults who underwent cataract surgery at the Kaohsiung Chang Gung Memorial Hospital in year 2008 and year 2018. Axial length was assessed with the ultrasound biometry and/or the Zeiss IOLMaster. Eyes with prior blunt eye trauma or had underwent vitrectomy operations were excluded. The significance of the changes in axial length between the two cohorts was determined after performing age-matched analyses. Due to utilization of ultrasound biometry and/or Zeiss IOLMaster, axial length corrections with our mean difference in measurement results, which were similar to previous studies on comparison between the two measurement tools, were carried out.ResultsAxial length showed an age-related elongation in 10-year cross-sectional data, from a mean of 23.65 ± 1.80 mm in year 2008 to a mean of 24.30 ± 1.90 in year 2018 (p = 0.003). Patients with high myopia (axial length > 26 mm) increased significantly over the 10-year period from 8.1 to 16 % (p < 0.001). A birth cohort effect on axial length was evident as the axial lengths of year 2008 cohort were shorter than the 2018 cohort when they were in the same operation age group. In particular, persons born after the 1960s demonstrated a predominant increase in axial length in both cohorts.ConclusionsOur study confirms a trend in increase of axial myopia, especially high myopias, over the 10-year period. A novel finding of this study was discovering a birth cohort effect on axial length, especially in persons born after the 1960s in southern Taiwan.

A reappraisal of indirect choroidal rupture using swept-source optical coherence tomography in-vivo pathology images in patients with blunt eye trauma.

Purpose:To describe the in-vivo pathology of indirect choroidal rupture (ICR) in patients with recent ocular trauma using swept-source optical coherence tomography (SSOCT).Methods:Retrospective observational study of the presenting and follow-up OCT images of four consecutive Asian patients with blunt trauma presenting over a period of 6 months and review of OCT descriptions in the literature.Results:The three patients who presented within 2 weeks of injury showed a gap in the Bruch's membrane (BM)/retinal pigment epithelial complex at the site of the ICR. The distance of the gap ranged from 103 to 465 μm. Blood from associated tear in the choriocapillary layer dissected under the photoreceptor layer to lift it off the retinal pigment epithelium (RPE) layer. The Sattler's and Haller's layers of the choroid were not affected. Fibro-vascular proliferation occurring in the reparative phase bridges the gap in the BM, RPE complex. Late fibrous tissue proliferation extends into the Sattler's layer in the choroid and goes up to the outer nuclear layer in the retina disrupting its architecture.Conclusion:SSOCT is a useful tool to study the pathology of recent onset ICR as it is capable of imaging through blood. The primary injury in ICR seems to be a break in the Bruch's membrane. The RPE layer and choriocapillaries get disrupted secondary to the break in the BM as their basement membranes are part of the BM. Scarring during the reparative phase disrupts the adjacent layers of the choroid and retina.

Bacillary layer detachment: a novel optical coherence tomography finding as part of blunt eye trauma

Blunt eye trauma causes a sudden decrement in anteroposterior diameter of the eye and a simultaneous expansion at the equatorial plane associated with a short live increment in intraocular pressure...

DRAINING AUTO VALVE LIMBOSCLERECTOMY IN POSTTRAUMATIC GLAUCOMA TREATMENT

The aim of the current article is to report the case of a patient with posttraumatic glaucoma who underwent a successful a draining auto valve limbosclerectomy (DALS) 6 months ago. A 65-year-old patient admitted on April 2017 with history of blunt left eye trauma. The diagnosis of severe eye contusion, Ectopia lentis and ocular hypertension was made. A subtotal vitrectomy, lensectomy and iris fixation of posterior chamber intraocular lense were performed the next day. A laser trabeculoplasty was performed 10 days after surgery for lowering IOP. During a follow-up examination, the patient was found high IOP in the left eye despite maximum IOP-lowering topical treatment. A draining auto valve limbosclerectomy (DALS) was performed in the left eye. The reduction in IOP has subsequently been maintained over six months of follow-up. This patient’s experience is a single case, yet it contributes to the evidence that a draining auto valve limbosclerectomy (DALS) may be high efficient in posttraumatic glaucoma treatment.

Особенности тупой травмы глазного яблока в детском возрасте

Особенности тупой травмы глазного яблока в детском возрасте

Severe blunt eye trauma causes a decrease in central macular thickness within first 48 hours of trauma

Abstract Background Blunt eye trauma is an important emergency in ophthalmology practice, and may alter the structure of the macula. Objectives To evaluate the optic coherence tomography (OCT) measurements of central macular thickness (CMT) among patients admitted to the hospital within 48 hours of blunt eye trauma. Methods Prospective cross-sectional study to evaluate patients who were admitted to hospital with blunt eye trauma within 48 hours trauma. Spectral domain OCT was used to measure macular thickness. CMT measurements of 24 healthy and 26 traumatized eyes of same patients were analyzed as control and case groups, respectively. Results The mean CMT measurements were 230.04 ± 18.64 μm in control and 226.50 ± 18.89 μm in traumatized groups. The difference between two groups was not statistically significant (P = 0.412). However, when the patients were classified according to the severity of trauma, CMT measurements of severely injured patients were found significantly lower than both healthy and mildly traumatized eyes (P = 0.008, P = 0.004, respectively). Conclusions Early stage macular OCT findings at blunt eye trauma may change with the severity of trauma. We have determined an insignificant increase in the mildly traumatized group in CMT compared with the healthy group within the first 48 hours of blunt trauma as a sign of macular trauma. However, in the severely traumatized group in CMT values significantly decreased, which may be a sign of cellular loss. Further prospective studies with long follow-up periods are warranted to elucidate the effects of this decrease in thickness.

Cataract secondary to self-inflicted blunt trauma in children with autism spectrum disorder

We report 3 cases of bilateral cataract secondary to self-inflicted blunt eye trauma in children with autism spectrum disorder (ASD). All 3 children hit their foreheads, orbits, or globes repeatedly for long periods of time and developed cataracts. Clinicians must be aware of this phenomenon to diagnose ocular pathology early and to provide adequate education, counseling, and services to affected patients and their families and to put appropriate postoperative care mechanisms in place to prevent permanent ocular damage.

Neurodegeneration and Vision Loss after Mild Blunt Trauma in the C57Bl/6 and DBA/2J Mouse.

Damage to the eye from blast exposure can occur as a result of the overpressure air-wave (primary injury), flying debris (secondary injury), blunt force trauma (tertiary injury), and/or chemical/thermal burns (quaternary injury). In this study, we investigated damage in the contralateral eye after a blast directed at the ipsilateral eye in the C57Bl/6J and DBA/2J mouse. Assessments of ocular health (gross pathology, electroretinogram recordings, optokinetic tracking, optical coherence tomography and histology) were performed at 3, 7, 14 and 28 days post-trauma. Olfactory epithelium and optic nerves were also examined. Anterior pathologies were more common in the DBA/2J than in the C57Bl/6 and could be prevented with non-medicated viscous eye drops. Visual acuity decreased over time in both strains, but was more rapid and severe in the DBA/2J. Retinal cell death was present in approximately 10% of the retina at 7 and 28 days post-blast in both strains. Approximately 60% of the cell death occurred in photoreceptors. Increased oxidative stress and microglial reactivity was detected in both strains, beginning at 3 days post-injury. However, there was no sign of injury to the olfactory epithelium or optic nerve in either strain. Although our model directs an overpressure air-wave at the left eye in a restrained and otherwise protected mouse, retinal damage was detected in the contralateral eye. The lack of damage to the olfactory epithelium and optic nerve, as well as the different timing of cell death as compared to the blast-exposed eye, suggests that the injuries were due to physical contact between the contralateral eye and the housing chamber of the blast device and not propagation of the blast wave through the head. Thus we describe a model of mild blunt eye trauma.

Ocular injuries - a review

No abstract available

Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India

We studied the demographic profile and outcome of traumatic cataract after penetrating and blunt ocular trauma in children in northern India. We reviewed the medical records of children with penetrating and blunt ocular trauma associated with traumatic cataract who underwent cataract surgery with posterior chamber intraocular lens implantation and having more than 1 year follow up. We evaluated the demographic characteristics and visual outcome in the affected eye. Of the 100 children (100 eyes), 65 were penetrating trauma and 35 were blunt trauma. The common modes of injury in the penetrating group were wooden splinters in 30.8% and bow and arrow in 15.4%. Fire crackers and trauma during play with ball were seen in 34% and 11.4% of blunt eye trauma, respectively. The age ranged from 1 to 14 years (mean, 7.8 years) in the penetrating trauma and 2 to 15 years (mean, 8.3 years) in the blunt trauma group. The best corrected visual acuity of 20/40 or better was achieved in 57.6% eyes in penetrating group compared with 71.4% in the blunt trauma group. Visually significant posterior capsular opacification developed in 32.3% eyes in penetrating group and 28.6% eyes in blunt trauma group. Glaucoma was diagnosed in 4.6% eyes in penetrating group and 8.6% in blunt trauma group. Eye injuries with traumatic cataract are associated with significant visual impairment. There were more children with penetrating eye injuries as compared with blunt trauma. Cataract surgery with intraocular lens implantation is a preferred method for visual rehabilitation in these children. Epidemiologic study, level IV.

A case of transient myopia after blunt eye trauma

A case of transient myopia after blunt eye trauma