Blunt Eye Trauma Research Articles

Orbital Blow-Out Fracture In Benin City, Nigeria: An 11-Year Review

The incidence of orbital blow-out fracture as seen in University of Benin Teaching Hospital (UBTH) Benin City is on the increase. This is due to the increasing rate of violence and road traffic accidents in our society. Whereas early recognition and management is associated with good outcome, delayed diagnosis and poor management invariably leads to poor prognosis. The aim of this article is to review the cases of orbital blow-out fractures seen/managed in UBTH, Benin City and to analyze the treatment of the cases and out-come of surgery. A total of eight patients who had orbital blow-out fracture over an eleven year period (1985-1989, 1997-2004), were retrospectively evaluated for age and sex distribution, clinical features at presentation, investigation, surgical procedure employed and outcome of surgery. There were equal number of males and females. Seventy-five percent (75%) of the patients had left eye involvement, with trauma from physical assault as the main mechanism of injury, while diplopia, enophathalmos and limitation of vertical eye movement were common clinical presentation. Surgical intervention carried out in all cases had satisfactory outcome. Early patient presentation, a high index of suspicion for diagnosis and good pre-operative assessment are needed for good surgical outcome. Keywords: Orbital Blow-Out Fracture, Diplopia, Enophthalmos, Blunt Eye Trauma, Sub-Labial Antrostomy Annals of Biomedical Science Vol. 4 (1) 2005: pp. 1-6

Optical Coherence Tomographic Documentation of the Formation of a Traumatic Macular Hole

To assess how optical coherent tomography 3 (OCT3) images help explain the mechanism of traumatic macular hole formation. Observational case report. A patient presented with an altered foveal depression after a unilateral blunt eye trauma. After four days, the injury developed into an impending macular hole. Follow-up was done by ophthalmic examination, fundus photography, and OCT3. Fundus examination showed a macular edema at first presentation, with a dot hemorrhage next to the fovea and a perifoveal little yellow ring. Minimal macular edema and a small foveal depression were seen on OCT3. After four days, an impending hole had formed. The foveal cyst closed after one month, but subretinal fluid persisted for months. After six months, full recovery was observed. Subclinical foveal changes occurred directly after the trauma, preceding macular hole formation. OCT3 allows detection of small lesions, which helps explain the pathogenesis of traumatic macular hole formation.

Acute retrobulbar haemorrhage: An ophthalmic emergency

Acute retrobulbar haemorrhage is a rare complication of blunt eye trauma. It can be sight-threatening but is reversible when recognized and treated promptly. We presented a case of acute retrobulbar haemorrhage with profound reduction of vision. Emergency surgical decompression was performed to preserve the vision. Clinical features and management are discussed.

Stumpfes Augentrauma

Blunt ocular traumas include contusions and ruptures of the globe--open and closed globe injuries. Characteristic damage results in anterior and posterior segment trauma. Typical patterns of injuries are combinations of (1) hyphema grade II-IV, iris-lens injury, vitreal bleeding--choroidal rupture and increased risk of rebleeding, (2) angle recession >180 degrees--secondary open-angle glaucoma, and (3) vitreal prolapse and lens dislocation-retinal detachment. Patients with blunt eye trauma should be under steady observation by an ophthalmologist to handle late complications.

Indirect traumatic rupture of the globe without conjunctival injury

Blunt injuries are frequent causes of ocular trauma. Rupture of the globe without conjunctival injury following ocular contusions may be as dangerous as ruptures with opened conjunctiva, but is much more difficult to diagnose. Retrospective analysis of 13 inpatients of the University Ophthalmological Hospital in 1991-1995 with rupture of the globe but without conjunctival injury following ocular contusion. These were 5 % of all the patients with through-through injuries of the eye wall. The characteristic finding in all 13 patients has been hyposphagma, hyphema, vitreal haemorrhage and loss of visual acuity to "finger counting" or less. At the time of the first examination, in 6 of the 13 patients intraocular pressure was between 3 mm Hg and 16 mm Hg. One patient had had an initial pressure of 3 mm Hg, but at the time of surgery, the eye had a stable normalized pressure. Postoperatively three of the 13 patients attained final visual acuities between 80/200 and 140/200 after at least 6 months, the remaining patients achieved not more than 5/200. In patients after blunt eye trauma rupture of the globe may occur in patients without damaging the conjunctiva and with normalised intraocular pressure. In such cases with intraocular bleeding and loss of vision it may be essential to open the conjunctiva and explore the sclera in order to be sure that there has not been a rupture of the sclera and to have the opportunity to perform pars-plana vitrectomy in time.

Pathogenesis of transient high myopia after blunt eye trauma

ObjectiveTo determine the pathogenesis of transient high myopia after blunt eye trauma. DesignTwo observational case reports and literature review. MethodsRefraction was measured in two patients with an autorefractometer in the acute and convalescent stages after a blunt eye injury. The anterior chamber angle, the ciliary body, and the choroid were examined by ultrasound biomicroscopy (UBM) in the acute and convalescent stages. In one patient, the anterior chamber depth, lens thickness, and axial length were measured by A-scan ultrasonography in the acute and convalescent stages. Main outcome measuresComparison of the refraction, anterior chamber depth, lens thickness, axial length, and the UBM-determined appearance of the choroid and ciliary body during the acute stage with the values during the convalescent stages. ResultsThe first patient showed a myopic shift of −9.75 diopters (D) and an anterior chamber shallowing of 0.94 mm measured 3 days after trauma by an air bag inflation compared with the measurements at the convalescent phase. UBM showed an annular ciliochoroidal effusion with ciliary body edema, anterior rotation of the ciliary processes, and disappearance of the ciliary sulcus. Eleven days after the injury, these UBM findings normalized, and the myopia decreased to −0.75 D, 27 days after trauma. The second patient had a myopic shift of −8.9 D compared with the convalescent phase, immediately after blunt trauma by a firework. Seven days after the injury, UBM revealed a partial cyclodialysis in addition to findings similar to those in the first patient. Ten days after injury, a myopic shift (−4.75 D), anterior chamber shallowing (by 1.1 mm), and thickening of the crystalline lens (by 0.27 mm) were observed compared with the convalescent phase. Associated UBM findings confirmed the anterior shift of the lens-iris diaphragm. Seventeen days after trauma, the UBM findings, including the cyclodialysis, were normalized, and the myopia had decreased to −1.0 D. ConclusionsTransient high myopia after blunt trauma is caused by anatomic changes in the ciliary body and crystalline lens. The anterior shift of the lens-iris diaphragm caused by ciliochoroidal effusion with ciliary body edema and thickening of the crystalline lens from blunt eye trauma are involved in traumatic high myopia.

Intravenous methylprednisolone in treatment of traumatic optic neuropathy.

Traumatic optic neuropathy is one of true ophthalmic emergencies and there is no proven form of treatment for traumatic optic neuropathy. Here we were presented with 30 cases of sudden visual loss following blunt eye trauma seen in Kaohsiung Medical College Hospital, Taiwan from April 1994 to March 1997. We analyze the treatment style, visual acuity, elapsed time since injury and orbit computed tomography retrospectively. Among them, 21 cases received intravenous methylprednisolone treatment, 2 cases received oral prednisolone, 2 cases underwent optic canal decompression in addition to intravenous methylprednisolone and 5 cases were carefully monitored without any kind of treatment. Thirteen of the 21 cases (62%) in intravenous methylprednisolone group got visual improvement. Patients with initial vision better than light perception benefitted more from treatment than did the patients who with no light perception in medical treatment group (85% VS 20%) (p < 0.05). Thirteen of the 30 cases (53.3%) had orbit fracture and 2 of the 30 cases (6.7%) had a fracture of the optic canal. These two cases also received optic canal decompression surgery in addition to intravenous steroid treatment but the prognosis was poor. In conclusion, intravenous methylprednisolone does offer help in traumatic optic neuropathy. Whether or not initial visual acuity was better than light perception was a key risk factor in the outcome. In this article, we also compare our results with other series in the literature and found that the value of different treatment in traumatic optic neuropathy still needs to be prospectively judged in the future.

Sickle Cell Trait as a Risk Factor for Secondary Hemorrhage in Children With Traumatic Hyphema

To determine risk factors for secondary hemorrhage and poor visual outcome in children with traumatic hyphemas. We reviewed 99 eyes of 97 children younger than 18 years who had been hospitalized for hyphema within 48 hours of blunt eye trauma. Inpatient records were examined for race, age, sickle cell trait status, size of hyphema and intraocular pressure at admission, secondary hemorrhage (rebleed of hyphema), and medications while hospitalized. Fifty-five eyes of 53 children had at least 1 month of follow-up or attained best-corrected visual acuity of 20/50 or better at their last outpatient visit. Among 99 eyes of 97 children with traumatic hyphema, secondary hemorrhage occurred in nine eyes (9%). Among 72 eyes of 70 African-American children, secondary hemorrhage occurred in nine eyes (14%), whereas in 27 eyes of 27 white children, there were no secondary hemorrhages. However, when the 14 eyes of 13 sickle cell trait-positive children were excluded from the African-American group, the 57 eyes of sickle cell trait-negative African-American and white children did not have any secondary hemorrhages. The sickle cell trait-positive group had secondary hemorrhages in nine of 14 eyes (64%), significantly (P < .005) different from the 0% rate in the 57 eyes of African-American sickle cell trait-negative and white children. The sickle cell trait-positive group also had higher intraocular pressure and permanent visual impairment. Sickle cell trait is a significant risk factor for secondary hemorrhage, increased intraocular pressure, and permanent visual impairment in children who have traumatic hyphemas following blunt trauma.

Radial Keratotomy in the Soldier-Aviator

Radial keratotomy (RK) is an ophthalmological procedure that alters the shape of the cornea, making it "flatter," causing the desired shift to farsightedness. Complications can be minor and "normal" in the immediate post-operative period, or can include problems that occur in many eyes, that persist but do not decrease best corrected visual acuity, or may include events that potentially or actually threaten vision and may produce blindness. At best, only 50% of patients can expect to have 20/20 uncorrected vision 2-3 years after surgery. Diurnal fluctuations in vision (two-five Snellen lines) can persist years after RK. Perhaps 1% of patients may have a two-three Snellen line loss of best corrected vision or ghost images that interfere with clear vision. Disabling glare can disrupt daily activities. Eyes that have undergone RK are at increased risk of corneal rupture after blunt eye trauma. The visual demands of the active duty military, and more dramatically the military aviator, are incompatible with RK. Therefore, RK should not be performed on active duty soldiers, nor should enlistees be accepted if they have undergone the procedure.