Cause Of Unilateral Blindness Research Articles

Clinical Profile of Ocular Trauma at a Tertiary Care Hospital

Background: Ocular trauma is preventable and one of the leading causes of ocular morbidity and blindness. Approximately 6 million people are blind from eye injuries, 2.3 million with bilateral visual impairment and 19 million with unilateral visual loss worldwide. In developing countries like ours the incidence of eye injuries is very high. This study has been conducted in the view of public health importance to provide information on magnitude, clinical and epidemiological profile of ocular injuries. Methods: A hospital based, cross sectional observational study, conducted during September 2014 - March 2016 in tertiary care center in Jharkhand, all cases of ocular trauma were included in the study. Demographic profile (age, sex, locality, occupation), nature and cause of injury was recorded. Detailed ophthalmological examination including visual acuity, slit lamp examination, indirect ophthalmoscopy, B-scan, intraocular pressure measurement, gonioscopy, computed tomography brain with orbit, Magnetic Resonance Imaging, X-Ray were done in relevant cases. Results: Total of 948 patients of ocular trauma were included. Most patients belong to the age group 21-40 years (60.87%), with mean age of 29.79 + 16.47 years. Males were affected more (73.52%) than females (26.47%). Closed globe injuries were more (75%) than open globe injuries (25%). Anterior segment was involved in (94.30%) and posterior segment in (8.86%). Work-related ocular injuries formed the commonest mode of injury (41.8%) followed by road traffic accident (30.37%). Conclusion: Ocular trauma is one of the most common causes of unilateral blindness. Targeting groups most at risk with health education, providing effective eye protection and strict implementation of traffic rules may decrease the occurrence of ocular injuries.

Neglected Spheno-orbital Meningioma Presenting with Unilateral Blindness

Sphenoorbital meningiomas (SOM) constitutes 9% of all intracranial meningiomas and are originated from sphenoid wing dura. They are also called en plaque meningioma. They cause hyperostosis of involved bone and their soft tissue growth may spread the orbit, the infratemporal fossa, and the temporal fossa. Most patients with SOM are middle- aged women and most commonly presents with unilateral, nonpulsating, progressive proptosis. Recently a woman with unilateral progressive proptosis from a remote area of Bangladesh presented to us with blindness of her left eye due to diagnostic delay. After thorough evaluation and imaging studies, she was diagnosed with a large spheno-orbital meningioma with extensive bony involvement of skull base and orbit. Objective: This report highlights the necessity of creating awareness among optometrists, undergraduate medical students as well as and ophthalmologists who are practicing in remote areas of Bangladesh about clinical presentation of sphenoorbital meningiomas which is a benign lesion but may be a cause of unilateral blindness if remain undiagnosed for long Bang. J Neurosurgery 2023; 13(1): 51-54

Unilateral visual impairment and blindness in school children - prevalence and aetiology in Saki-East LGA of Oyo State, Nigeria.

This study determined the prevalence and aetiology of unilateral visual impairment (VI) and blindness and its associated factors in school children. We conducted a multistage, cross-sectional study in primary and secondary schools of Saki-East Local Government Area of Oyo State, Nigeria. Unilateral VI was defined as presenting visual acuity (PVA) worse than +0.3 LogMAR (6/12) and unilateral blindness as PVA worse than +1.3 LogMAR (3/60) in the worse eye. Detailed ocular examinations were performed for students with unilateral VI, and Logistic regression analysis was performed to explore associations with independent variables. The mean age of participants was 11 ± 3.2 years. Thirty-six (0.98%) of 3671 children had unilateral VI, and fifteen children had unilateral blindness (0.41%), giving a combined prevalence of 1.39 ± 0.5%. History of ocular trauma was reported by 14 (27.5%) participants with unilateral VI and blindness. In addition, those with a history of ocular trauma were 6.5 times more likely to be blind or have a severe VI (95% CI 1.5-2.8) than those without a history of ocular trauma. Uncorrected refractive error was the major cause of unilateral VI in 26 (51%) participants, while traumatic cataract was the main cause of unilateral blindness seen in 5 (9.8%) participants, none of whom had a previous eye examination. Fourteen per thousand school children had unilateral VI in this study; the major causes were refractive error and cataract, which are treatable. Ocular trauma was a significant risk factor for unilateral VI and blindness.

Ophthalmologic Emergencies: Assessment and Management.

There are an estimated 2-3 million emergency department (ED) visits in the United States for eye complaints. Although most patients who present to the ED have nontraumatic eye complaints, many seek treatment for eye trauma, which is a leading cause of unilateral blindness and vison impairment. Given the prevalence of eye-related emergencies, it is imperative that emergency care providers understand how to recognize and treat eye complaints to prevent permanent vision loss and disability. This article covers basic eye anatomy and physiology, discusses a systematic approach to the eye examination, and presents the evidence-based treatment of selected, common nonemergent and emergent eye complaints. For each complaint, essential history questions, examination techniques, differentials, and emergency management have been presented.

Characteristics, Etiological Factors, and Visual Outcomes of Pediatric Open Globe Injuries in Central Saudi Arabia: A 22-Year Retrospective Study.

To discuss the characteristics, etiological factors, and visual outcomes of open globe injuries (OGIs) in children at a tertiary eye hospital in Riyadh, Central Saudi Arabia. This was a hospital-based cohort study conducted in 2021. Children aged ≤16 years with OGI based on the Birmingham Eye Trauma Terminology classification were included. The age, gender, type, cause of OGI, and vision were recorded, as well as uncorrected and best corrected visual acuity (UCVA and BCVA, respectively). There was a change in the UCVA and BCVA one year after management. BCVA following management was linked to a variety of factors. There were 664 eyes with OGI. [median age 5.1, 461 (69.6%) boys]. UCVA at presentation was <20/400 in 525 (79%) of eyes with OGI. Injuries were mainly due to metallic objects in 195 (29.4%), glass in 102 (15.4%), and fireworks in 62 (9.4%). The Change in visual impairment grade in UCVA and BCVA after management compared to the initial presentation was significant (p < 0.001). Improvement of two lines of BCVA was noted in 345 (52%), no change in (<± 2 lines) 299 (45%) and deteriorated in 10 (1.5%). OGI was identified as a leading cause of unilateral blindness. Children with OGIs who receive standard treatment have better outcomes. Many children could not achieve normal, functional vision despite the intervention of skilled care providers.

Mikrobiyal keratitli hastaların demografik, laboratuvar ve klinik özelliklerinin analitik olarak incelenmesi

Purpose: In this study, we investigated epidemiological properties, clinical findings, risk factors, direct microscopy and culture results in the patients diagnosed with microbial keratitis. &#x0D; &#x0D; Materials and Methods: We examined the hospital records of patients with microbial keratitis between March 2016 and March 2021, retrospectively. Also, clinical findings, risk factors, microbiological results, empirical treatment and treatment responses were evaluated.&#x0D; &#x0D; Results:42 eyes of 42 patients whose mean age was 57.8 (range 18-70 years) included in the study. In 12 (28.5%) patients, a gram positive and gram negative bacterial finding was found in the stained microscopic examination. In total, microbial growth was detected in culture of 7 patients (16.6%), while growth was not detected in 35 patients (83.4%). No etiological factor was detected in 27 patients (64.4%). The complaints at admission were pain in 24 patients (57.6%), redness in 12 patients (28.8%), and both redness and pain in 6 patients (14.1%).While the visual acuity of 18 cases were preserved after the treatment, 24 cases (88.8%) achieved 1 or more line with the treatment. While the mean visual acuity was 0.69 ± 1.1 (0-3.1) logMAR before treatment, it increased to 0.79 ± 1.1 (0-3.1) logMAR after treatment (p=0.006).&#x0D; &#x0D; Conclusion: The keratitis is a common cause of unilateral blindness. Early diagnosis and treatment of the keratitis is a significant role on the prognosis. The success of the therapy can be provided starting empirical antimicrobial therapy by taking into consideration of the regional risk factors and common pathogens.

Factors associated with ocular injuries among adult road traffic accident patients presenting at Mulago National Referral Hospital, Uganda.

Ocular trauma is the leading cause of unilateral blindness globally. Road traffic accidents are among the top risk factors for ocular trauma. This study aimed to evaluate factors associated with ocular injuries among adult road traffic accident patients at Mulago Hospital, Uganda. A cross-sectional study was conducted among adult road traffic accident patients. History taking and ophthalmological examination were performed on consenting participants. Data was analysed using STATA version 14.0. Overall, 428 road traffic accident cases were enrolled, of which majority (84.3%) were male. Age 30-39years (aOR = 0.58, 0.36 - 0.94, p = 0.027), being male (aOR = 2.64, 1.21 - 5.13, p = 0.004) and being a passenger of motor vehicle/cycle (aOR = 3.85, 1.49 - 9.93, p = 0.005) were the factors associated with ocular injuries among the participants. Age 30-39 years, male gender and being a passenger of motor vehicle/cycle were the factors associated with ocular injuries among the adult road traffic accident patients. Ocular injuries were more common among the road users who did not use safety measures. Use of safety measure by passengers of motor vehicles and cycles is recommended.

Penetrating Facial Trauma Resulting in Loss of Sense

Introduction. Clinical forensic medicine interacts between the law, the judiciary and the police involving living and dead people with the issuance of a visum et repertum. A wound is damage to a part of the body in the form of a break in the integrity of the tissue that can occur due to mechanical violence. The eye organ is particularly vulnerable to injury, which can be fatal and lead to blindness. Trauma is the leading cause of unilateral blindness. Approximately 3 million cases of ocular and orbital trauma occur in the United States each year. An estimated 20,000 to 68,000 of these cases are visually impairing and approximately 40,000 have significant vision loss. Objective. To review forensic and medicolegal cases of sharp facial trauma to sensory loss. Case Illustration. Reported a case of stabbing a woman who was riding a motorcycle with the intention of the perpetrator to seize the victim's motorcycle. Discussion. the results of the examination, the victim is a woman, 54 years old, the patient's general condition is good, cooperative compos mentis consciousness, and examination of vital signs within normal limits. On examination, there were stab wounds on the face covering the forehead, nose and right cheek to the right eyeball due to sharp trauma. It was confirmed that the condition of the victim's left eye was categorized as blind, the eye could not see anymore because the eyeball had been cut and bleeding occurred so that the removal of the eyeball organ had to be done to avoid complications from the injury, but in this case the victim refused to take this action. Conclusion. Based on this injury, the victim suffered a loss of vision. This case constitutes serious injury pursuant to Article 90 of the Penal Code and the suspect is charged under Article 355 of the Penal Code.&#x0D; Key Point: Forensic and Medicolegal, Loss of Sense, Penetrating Facial Trauma

Visual Outcomes and Prognostic Factors for Pediatric Open Globe Injuries.

Open globe injuries (OGIs) in children can be visually devastating traumas and are a common cause of unilateral blindness in children. Three commonly used ocular trauma scores (Ocular Trauma Score [OTS], Pediatric Penetrating Ocular Trauma Score [POTS], and Toddler/Infant Ocular Trauma Score [TOTS]) can be used to help predict visual outcomes in ocular injuries. Each has strengths and weaknesses, but these scores have not been studied extensively in the pediatric population. The medical records of all pediatric patients presenting at a single institution with OGIs from 2011 to 2016 were retrospectively reviewed. Initial clinical presentation and subsequent examinations were reviewed. The 3 trauma scoring systems were applied to patient data to determine the effectiveness at predicting final visual acuity (VA). A total of 15 patients met inclusion criteria. The mean age at presentation was 6.97 years. Seven of 15 (47%) of the patients had a final VA of 20/40 or better. The OTS was applied to 8 of 15 patients, as the OTS requires initial VA, which could not be obtained in 7 patients. The POTS and TOTS were applied to all 15 patients. The POTS, TOTS, and OTS were all significantly correlated to final VA. Incidence of relative afferent pupillary defect and more posterior zone of injury were correlated with poorer visual outcomes. All 3 available ocular trauma scores were effective at predicting final VA in our cohort of pediatric patients with OGIs even outside of the age ranges for which they have been created. Of all the factors included in the scores, relative afferent pupillary defect and zone of injury were most closely correlated with poor final VA.

Traumatic Blindness—A Clinical Study

Background: As a cause of blindness, ocular injury constitutes 1.5% of all causes of blindness. In the developed world, trauma is also the leading cause of unilateral blindness and is preceded only by the cataract as a cause for vision impairment. Males are much more likely than females to sustain ocular trauma. The ocular effects of trauma can be far-reaching, so timely intervention is of prime importance to improve the visual outcome. General Objective: To evaluate the visual outcome after ocular injury. Methods: This study was conducted at Nagri Eye Hospital, Ahmadabad. In total, 68 eyes of 68 patients with eye injury were included in this study. Detail history was taken from the entire patient and a detailed ocular examination was done. Results: The mean age of incidence of the patients was 25.39 ± 16.89. The commonest age group presented with ocular trauma was nd decade, i.e., 11 - 20 yrs. A great majority of patients were male with the mean age of 25.89 ± 16.55 accounting for 83.82%. The majority of the patients have visited the hospital in between the time period of 24 hrs - 1 wk (57.35%), followed by 23.52% within the time period of st visit to the final visit (p-value < 0.005). Conclusions: The majority of cases were youth males with the age group of 25 yrs. All the cases with ocular trauma were unilateral. The trauma was common in industrial workers with the majority of the cases of blunt type. There was satisfactory visual improvement in patients who followed-up well.

Pars Plana Capsulectomy with Scissors and Micro Forceps: A Case Report of an Alternative Approach for Membranous Posterior Capsule Opacity

Pediatric eye injuries are the leading cause of unilateral blindness in childhood. Post-traumatic cataract development is common, and the risk of posterior capsule opacity occurrence is seen at a high rate. Nd-YAG laser capsulotomy or anterior vitrectomy may useful, but some patients develop thick posterior membranous capsule opacity and mentioned techniques may not be performed. A 6-year-old girl who had a corneal tear repair, traumatic cataract and thick posterior capsule membrane, which could not be cleared by Nd-YAG laser or vitrectomy, was removed with scissors and micro forceps through the pars plana vitrector entrances. Here, we present a case report as an alternative method of posterior capsulectomy.

Jednostranná slepota v souvislosti s mukokélou klínové dutiny – kazuistika

Mucocele of the paranasal sinuses are benign cystic lesions filled with mucus. They occur in the sphenoid sinus in 1–2% of all paranasal sinuses, most often in the fourth decade of life. Clinical manifestations are non-specific, caused by pressure expansion into anatomical structures immediately adjacent to the sphenoid sinus. They are manifested by headaches, dropped eyelids, impaired movement of the globe, and impaired vision. In the differential dia­gnosis, it is necessary to distinguish them from tumour processes and processes propagating from the intracranium. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in the dia­gnosis, the definitive dia­gnosis is determined by perioperative findings and histological examination. Curative surgical options include endoscopic transnasal sphenoidotomy with marsupialization. In this article, we present a case of a patient with a mucocele of the sphenoid sinus, which was the cause of unilateral blindness. Keywords: marsupialization – mucocele – sphenoid sinus – endoscopic transnasal sphenoidotomy

Integration of ophthalmology in ocular trauma to improve patient care: A narrative review

Introduction Ocular trauma can cause significant morbidity and is a leading cause of unilateral blindness. In multi-trauma, life- and sight-threatening injuries can co-occur causing increased complexity in the assessment and management of ocular injuries as the competing priorities in the severely injured must be balanced. We conducted a narrative review to determine how ophthalmology may be further integrated into a trauma service and/or the organisation of an ocular trauma service. Methods The literature was reviewed via EMBASE, MEDLINE, CINAHL and Google Scholar utilising comprehensive search strategies and keyword searches. Our review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results The search yielded 437 articles, 30 studies met selection criteria and were included in the review. The included literature comprised guidelines, observational studies and reviews of registry data from Australia, England, the United States, Singapore, Iran and Israel. Conclusion The Australian Trauma Model has clear guidelines for referral of trauma patients to ensure appropriate care of the severely injured. However, there are no clear guidelines for the integration of ophthalmology into trauma. Therefore, early referral to ophthalmology and streamlining of referral pathways of specialist care would improve the care of patients with ocular trauma.

English

BACKGROUND Ocular injuries due to road traffic accidents (RTA) is one of the important causes of ophthalmological morbidity and cause of unilateral blindness. Some of the injuries also result in cosmetic disfigurement. Increased usage of vehicles for transport in recent times has increased the incidence of cases. The primary objective of this study was to understand the epidemiology and pattern of ocular trauma in RTA cases and their visual outcome. METHODS A total of 75 cases was included in the study following the inclusion and exclusion criteria. A detailed history was taken which included information regarding time, location, type and mechanism of injury, use of spectacles, car safety belts, and helmets. The time interval between injury and reporting was recorded. Test of visual acuity was done, ophthalmic examination included the examination of all patients with the slit lamp, 90 D examination, and indirect ophthalmoscopy were done. Ultrasound B scan was done in cases where unclear media prevented fundus examination. RESULTS Ecchymosis of the lids was the commonest type of ocular injury. Out of 15 eyelid laceration cases, 10 cases were with mild partial-thickness tears present and 5 had severe lid tears which required suturing. Most of the patients recovered with good vision in 6 months post-treatment and a few fair results. Analysis of variance (ANOVA) comparison between conservative management and surgical management at the end of 4 months post treatment was done. The P-values were &gt; 0.05 hence, not significant. It indicated that the outcomes were independent of the method of management adopted. CONCLUSIONS The incidence of RTAs is increasing due to an increase in the number of vehicles used by the public. Ocular injuries are more often seen in young men especially those driving two-wheelers without safety devices like helmets. Open globe injuries and cases with previous ocular problems have poor outcomes. KEYWORDS Ocular Trauma, Road Traffic Accidents [RTA], Visual Outcome

Antimicrobial peptides in human corneal tissue of patients with fungal keratitis

BackgroundFungal keratitis (FK) is the leading cause of unilateral blindness in the developing world. Antimicrobial peptides (AMPs) have been shown to play an important role on human ocular surface (OS)...

Adoption of Innovation in Herpes Simplex Virus Keratitis.

:Herpes simplex keratitis, caused primarily by human herpes simplex virus type 1 (HSV-1), remains the most common infectious cause of unilateral blindness and vision impairment in the industrialized world. Major advances in the care of HSV keratitis have been driven in large part by the landmark Herpetic Eye Disease Study randomized clinical trials, which were among the first in ophthalmology to reflect emerging trial conventions, including multicenter subject enrollment, double-masking, placebo controls, and a priori sample size determinations. The results of these trials now form much of the evidence basis for the management of this disease. However, management patterns in clinical practice often deviate from evidence-based care. These perceived quality gaps have given rise to the evolving field of implementation science, which is concerned with the methods of promoting the application of evidence-based medicine within routine care. To overcome variations in the quality and consistency of care for HSV keratitis, a range of clinical- and technology-based innovations are proposed. The most pressing needs include the following: a rational and tractable disease classification scheme that provides an immediate link between the anatomical localization of disease (corneal epithelial, stromal, or endothelial) and the appropriate treatment, and the actualization of an electronic medical record system capable of providing evidence-based treatment algorithms at relevant points of care. The latter would also input data to population-wide disease registries to identify implementation-rich targets for quality improvement, education, and research. These innovations may allow us to reduce the human and economic burdens of this highly morbid, and often blinding, disease.

Cataract following electric shock - Case report

Ocular trauma is the under-recognized cause of unilateral blindness particularly in developing nations.The growing demand on generated electricity has also led to increase in electricity related occupational trauma. We report a case of bilateral cataract in a 22 years professional electrician. He survived a high voltage electric shock and sustained burn injury on the right side of his head. Ocular examination revealed typical anterior as well as posterior subcapsular cataract in right eye and visually insignificant early anterior subcapsular vacuoles in the left eye. There was a significant difference in lenticular opacification density in between these two eyes. Uneventful phacoemulsification and foldable posterior chamber intraocular lens implantation was performed in the right eye and the sufferer was rehabilitated with normal best corrected visual acuity. The possibility of ocular complications and importance of ocular screening is emphasized in the survivors of electrical injury. The lenticular opacities can be successfully managed with surgery, however the final visual acuity depends on damage to other vital ocular structures. The clinical features, pathogenic mechanism of these opacities and review of the literatures are discussed.

Fish hook injury to the eye and its management

The most common cause of unilateral blindness in paediatric age groups, especially in developing countries, is ocular trauma. Trauma to the eye is very debilitating to the patient; hence, managing various types of penetrating and blunt injury to the eye provide a challenge to the ophthalmologist. It is simply preventable by the supervisionof the parents and caregivers. We will be discussing one such case and our experience in dealing with a fish hook injury to the eye in a 12-year-old boy—the challenges we faced and the precautions we took to give a good visual outcome.

Mikrobiyal keratit olgularının demografik, laboratuvar ve klinik bulguları

Purpose: In this study, we investigated epidemiological properties, clinical findings, risk factors, direct microscopy and culture results in the inpatients diagnosed with microbial keratitis. Our objective is to revise our empirical treatment procedure after evaluating causative microorganisms in our region and risk factors. Materials and Methods: We examined the hospital records of inpatients with microbial keratitis between June 2017 and June 2018, retrospectively. Also, clinical findings, risk factors, microbiological results, empirical treatment and treatment response were evaluated. Results: Eighteen eyes of 18 patients were examined, 9 female and 9 male, mean age was 67.8. The 27.8 percentage of the eyes had microbiologic finding. The risk factors found in 27.9% of patients. The vision acuities (VA) before the treatment were : light perception (LP) negative 11.1 %; LP positive 16.7 %; hand motion (HM) 38.9 %; counting fingers 16.7 %, 0.05 and above 16.7 %. The empirical treatment was started for all of the patients. The clinical response of empirical antimicrobial therapy was detected in 72.2 % of the patients. The vision acuities (VA) after the treatment were: light perception (LP) negative 11.1 %; LP positive 5.6 %; hand motion (HM) 33.3 % ; counting fingers 27.8 %, 0.05 and above 22.2 %. The highest vision acuity was 0.1. Conclusion: The keratitis is a common cause of unilateral blindness. Early diagnosis and treatment of the keratitis is a significant role on the prognosis. The success of the therapy can be provided starting empirical antimicrobial therapy by taking into consideration of the regional risk factors and common pathogens. On the other hand, direct microscopy and culture-antibiogram provide serious support in cases where the treatment response is not available.

An Unusual Case of Penetrating Ocular Trauma with a Pressure Cooker Whistle

Worldwide blindness in 1.6 million people is due to ocular trauma. Trauma is the most common cause of unilateral loss of vision in developing countries and about 5 % of all bilateral blindness is directly due to trauma. In Nepal, ocular trauma is considered a major cause of unilateral blindness and caused 7.9 % of all blindness in Nepal. It is the second leading cause of blindness after cataract. Pressure cooker is a cooking utensil that works with high pressure and heat, consuming less time and fuel but as seemingly easy, the trouble handling with it could be horrible. It may cause serious injury to someone nearby. Here by, we would like to report a case that could rarely happen in kitchen as a worst accident.