Eye Injury Registry Research Articles

Work-Related Eye Injury: The Main Cause of Ocular Trauma in Iran

Occupational eye injuries are among the major causes of ocular trauma and can cause severe visual impairment, with even minor injuries incurring considerable financial costs due to work absenteeism. This study was designed to evaluate the epidemiology of eye trauma and the role of occupational injuries at Farabi Eye Hospital, which is the largest eye hospital in Iran. In this prospective, cross-sectional study, 822 eyes from 768 trauma patients presenting to Farabi Eye Hospital were enrolled in the study. The Birmingham Eye Trauma Terminology System and the United States Eye Injury Registry model were adopted as the basis for the study questionnaire. The questionnaires were completed through in-person interviews and comprehensive ocular examinations. The mean age of ocular trauma patients was 31.11 years, and 685 (89.2%) patients were male. Of all eye injuries, 73.7% were work-related. Only 2.2% of the patients were wearing safety goggles at the time of injury. History of previous eye trauma was positive in 44.3% of cases. An Ocular Trauma Score 3 or more was present in 4% of patients. Work-related eye trauma is the major cause of eye injury in Iran and most often occurs as a result of the lack of proper eye protection. Most work-related eye injury patients are young men.

Ocular injuries in survivors of improvised explosive devices (IED) in commuter trains

BackgroundOcular injuries are common in survivors of terror incidents that involve the use of explosive materials. These explosives are commonly of a High Explosive type (HE) and may be fashioned into improvised explosive devices (IED) that incorporate additional materials to maximise trauma and injuries. Serial IED explosions have occurred in commuter trains in several cities including London and Madrid but data on ocular injuries is limited. We report the ocular injuries of the survivors of a series of IED explosions in crowded commuter trains.Methods28 patients (56 eyes, 28 male, ages ranging from 22 to 52 years (mean 35.27 years) were screened in the triage area or the Intensive Care Unit (ICU). Testing included bedside visual acuity testing, torchlight examination of the anterior segment and dilated (or if necessary, undilated) fundus examination. Selected patients underwent B-scan examination, magnetic resonance imaging of the brain, orbits and the optic nerves or visual evoked potential assessment. The injuries, investigations and procedures were entered into the patient's case sheet as well as into a standardised format suggested by the Indian eye injury registry (IER).Results16 of 28 patients (57.1%) had ocular injuries whereas 12 (42.8%) were found to be normal. Injuries were seen unilaterally in 10 patients and bilaterally in six yielding a total of 22 injured eyes. The common injuries were periorbital haemorrhages (09 eyes, 40%); first or second degree burns to the upper or lower lids (seen in 07 eyes, 31.8 %) and corneal injuries (seen in 08 eyes, 36.3%). Open globe injuries were seen in two eyes of two patients (09%). One patient (4.5%) had a traumatic optic neuropathy.ConclusionOphthalmologists and traumatologists should be aware of these patterns of ocular injuries. Protocols need to include the screening of large numbers of patients in a short time, diagnostic tests (B scan, visual evoked potential (VEP) etc) and early surgery preferably at the initial triage itself as most of the serious injuries in our studies had been missed or not treated at an initial assessment.

Epidemiology of Blinding Trauma in the United States Eye Injury Registry

Purpose: To analyze the epidemiology and clinical characteristics of serious eye injuries leading to legal blindness. Methods: Analysis of information on 11,320 eyes in the United States Eye Injury Registry (USEIR) database. Legal blindness in this study was defined as visual acuity of worse than 20/200. Results: No less than 27% of eyes with serious injury had < 20/200 final vision, although the rate varied greatly with injury type. Several risk factors were found to statistically significantly increase the chance of eye trauma resulting in blindness: age over 60 years, injury by assault, sustained on street/highway, or occurring during fall or by gunshot. Trauma to the left eye carried a statistically significantly poor prognosis as did two injury types, rupture and perforating. Involvement of the posterior segment was another factor indicating poor outcome; in particular, vitreous hemorrhage, retinal detachment, choroidal rupture, and endophthalmitis were found to increase the risk of blindness. Conversely, young age, contusion and intraocular foreign body injuries, among others, signaled a better than average chance of good outcome. Overall, 60.5% of injured eyes showed visual improvement after treatment. Conclusions: This large study identified multiple risk factors whose presence significantly increases the chance of the injured eye becoming “legally blind.” Continued efforts to improve treatment and develop/implement prevention measures based on risk analysis should reduce the incidence of blinding trauma.

Glaucoma After Ocular Contusion

This cohort study was designed to evaluate risk factors for the development of posttraumatic glaucoma after ocular contusion. Data from the United States Eye Injury Registry (USEIR) were obtained from a total of 6021 patients who experienced blunt ocular contusion. Logistic regression was used to evaluate the association between these baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals were obtained. The 6-month incidence of developing posttraumatic glaucoma was 3.39%. The development of glaucoma was independently associated with: advancing age (OR = 1.02; 95% CI = 1.02, 1.03), visual acuity worse than 20/200 (OR = 1.92; 95% CI = 1.19, 3.10), iris injury (OR = 1.60; 95% CI = 1.05, 2.44), lens injury (OR = 1.86; 95% CI = 1.11, 3.11), hyphema (OR = 2.23; 95% CI = 1.40, 3.54), or angle recession (OR = 1.71; 95% CI = 1.00, 2.90). This study provides an estimate for the risk of developing glaucoma after ocular contusion in a large cohort of patients and has determined several independently predictive factors that were significantly associated with the development of posttraumatic glaucoma including poor initial visual acuity, advancing age, lens injury, angle recession, and hyphema.

Fishing-related ocular trauma

To evaluate the characteristics of fishing-related ocular injuries. Retrospective observational analysis of a computerized databank. The United States Eye Injury Registry was used to analyze 143 patients with fishing-related ocular injury. Epidemiologic and clinical information was evaluated including the age and gender of the subjects, classification of ocular trauma, surgical management, and final visual acuity. Of the 732 cases of sport-related ocular trauma, 143 (19.54%) occurred while fishing; of these, 79% were male patients who ranged in age from 6 to 68 years (mean, 37 years). Corneal laceration, globe rupture, and hyphema were the most common diagnoses at presentation and were caused by fishing hooks, lures, and weights. Thirty-five bystanders are included in the study. Thirty-eight percent of patients had visual acuity less than 20/50, and 21% had a visual acuity of less than 20/200. Open globe injuries portended a poor visual outcome compared with closed globe injuries. Fishing-related ocular injuries represent a large percent of sports-related trauma, often resulting in significant visual loss. Preventive measures such as the use of protective eyewear should be advised in this activity.

Glaucoma following penetrating ocular trauma: A cohort study of the United States Eye Injury Registry

To evaluate associations between baseline structural and functional ocular characteristics and the risk of developing posttraumatic glaucoma after penetrating ocular injury. Prospective cohort study. Data from the United States Eye Injury Registry (USEIR) were obtained from a total of 3,627 patients who experienced penetrating ocular injury. The risk of posttraumatic glaucoma and associated structural and functional ocular risk factors was estimated. The risk of developing posttraumatic glaucoma was 2.67%. The development of glaucoma was independently associated with several baseline characteristics including advancing age (relative risk 1.02/yr 95% confidence interval [1.00, 1.03]), lens injury (1.56 [1.03, 2.35]), poor baseline visual acuity (2.59 [1.62, 4.14]), and inflammation (3.02 [1.52, 6.02]). This study provides an estimate for the risk of developing glaucoma after penetrating ocular injury in a large cohort of patients and determined several factors that are significantly associated with the development of post-traumatic glaucoma, including advancing age, lens injury, poor visual acuity, and intraocular inflammation.

Economic antecedents of temporal variation in the incidence of ocular trauma

PURPOSE To test the reciprocal risk hypothesis that the monthly number of unemployed persons in Alabama predicts: 1) the odds that a worker will suffer an ocular injury; and 2) the incidence of ocular injuries at home. METHODS Data from the United States Eye Injury Registry and from the Bureau of Labor Statistics are analyzed with time series methods to test the hypotheses. RESULTS As implied by the reciprocal risk hypothesis, the monthly odds of a worker reporting a job-related ocular injury decrease as the number of unemployed persons increases. The incidence of ocular injuries in the home, however, increases when the number of unemployed persons increases. CONCLUSIONS Consistent with theory and earlier research, the incidence of ocular injuries appears related to the performance of the economy. Unlike earlier research, however, we find a reciprocal risk between injuries at work and home. The findings suggest that public health efforts to prevent injuries could be made more effective by strategically shifting the focus from home to work and vice versa depending on changes in the local economy.

EYE TRAUMA. OPEN GLOBE INJURY MANAGEMENT

Background. Ocular trauma is important cause of blindness. Birmingham Eye Trauma Terminology allows us to use a standardized eye injury terminology which permits an unambigous interpretation. The Eye Injury Registry enables the analysis of medical, epidemyologic and social data. The most frequent ocular injury ocular contusion has a relatively good prognosis. An adequate primary ocular repair and correct timing of pars plana vitrectomy are very important in open globe injury management. There still exist some controversial issues concerning the role of posterior segment surgery in open globe injuries. These include timing of surgery, prophylactic scleral buckle placement and a proper use of systemic and intravitreal antibiotics. Conclusions. With adequate primary ocular repair, the use of systemic, intravitreal antibiotics, scleral buckling and proper timing for pars plana vitrectomy the prognosis for ocular trauma cases can be better.

Soccer-Related Ocular Injuries

To outline the severity and long-term sequelae of eye injuries in soccer. Prospective observational study of 163 patients who sustained soccer-related ocular injuries between April 1, 1992, and March 31, 2000 (8 years). Patients were observed at a sports ophthalmology unit located in the largest university hospital of the northern region of the country and central to all major soccer fields in town. The data were recorded using the United States Eye Injury Registry report forms for initial and follow-up observation. (1) Self-reported history surrounding the ocular trauma, initial visual acuity, diagnosis, and operations and (2) final visual acuity, late diagnosis, and additional operations. Injuries occurred predominantly in young men (mean +/- SD age, 23.2 +/- 8.8 years) practicing indoor soccer (50.9%) or outdoor soccer (47.2%), and most resulted from a kicked ball (79.1%) near the goal post (60.1%). Angle recession and peripheral vitreoretinal lesions were more likely to occur in the superotemporal quadrant (54.7%; 95% confidence interval, 44.2%-65.0%; and 57.6%; 95% confidence interval, 48.4%-66.4%; respectively). Vitreoretinal lesions were present in 42.2% (95% confidence interval, 33.1%-51.8%) of patients with "normal" visual acuity (> or =20/40) and in 50.0% (95% confidence interval, 38.1%-61.8%) of patients without hyphema. No significant association was found between severity of injury and age, sex, type of soccer, level of athletic expertise, or player position. Severe ocular lesions can occur in soccer players without symptoms and at all skill levels. The development of laboratory models will be essential to explain the tendency for lesions to be in the superotemporal quadrant. The data support the need for protective eyewear designed specifically for soccer.

Internal Limiting Membrane Removal for Traumatic Macular Holes

To evaluate a new surgical technique for traumatic macular holes and to provide epidemiological information for such holes. Vitrectomy with internal limiting membrane (ILM) removal but without adjuvant use on 17 consecutive eyes. The hole closed in 100% of eyes. Vision improved > or = 2 Snellen lines in 16 eyes (94%). The macula showed additional trauma-related damage in 10 eyes (59%). No permanent complication related to ILM removal was seen. Among 4440 eyes with contusion trauma in the United States Eye Injury Registry, the risk of macular hole formation is 9 times higher in eyes closed than with open globe injury (1.4% versus 0.15%). Without introducing special risks, removal of the macular ILM appears to be a highly successful surgical option in improving vision in eyes with traumatic macular holes. The majority of eyes benefit from ILM removal, even when additional traumatic macular pathology is present.

Eye Injuries in the U.S. Armed Forces

To develop prevention and treatment modalities for eye injuries, ophthalmologists require epidemiological data on the various types of eye injuries. This study sought to define eye injury patterns in the U.S. armed forces. Data on patterns of eye injury in the armed forces were obtained through voluntary reporting by U.S. military ophthalmologists throughout the world. The reporting format was standardized with the U.S. Eye Injury Registry initial and follow-up report forms. The data were analyzed for significant injury patterns. Data on 112 patients were submitted, representing a broad range of the military population. Data on a total of 96 patients with a 6-month follow-up were analyzed in this study. Immediately after injury, 43% of the patients were noted to have poor vision (worse than 20/200). After treatment, only 20% were noted to have poor vision. Patients lost an average of 21.6 days of work after a severe eye injury. An eye injury is a traumatic and potentially debilitating event. The loss of visual acuity can be drastic, resulting in an extensive recovery period.

The epidemiology of serious eye injuries from the United States Eye Injury Registry

Trauma remains a major problem throughout the world. The prognosis of severe eye injuries is commonly bleak. This paper focuses on the epidemiology of eye trauma, the role of ocular epidemiology, and identification and reduction of risk factors. An analysis of the first 8,952 patients reported with severe eye injuries, defined as those eye injuries resulting in permanent and significant (measurable and observable on routine eye examination) structural and/or functional changes to the eye, from the United States Eye Injury Registry as of 31 July 1998. The age of patients entered was from the 1st year of life to 103 years. Fifty-eight percent of those injured were less than 30 years of age. The male to female ratio was 4.6:1, reaching 7.4:1 in the fourth decade of life. Almost half of the injuries involved the retina, and 77% of the injured eyes required one or more surgical procedures, including a large proportion which have undergone vitreoretinal surgical procedures. Injuries remain the most serious public health problem facing developed nations. Yet, a persistent inadequacy exists both in the standardized documentation of eye injuries and in their treatment. With appropriate surgical and medical intervention, a majority of the reported injured eyes recovered functional levels of visual acuity. It appears that glasses, including prescription glasses and even non-prescription sunglasses, can offer measurable protection which results in a lower incidence of severe eye injuries to those wearing glasses.

Serious fireworks-related eye injuries

OBJECTIVE. To analyze and compare epidemiological and clinical information on serious fireworks-related eye injuries from two affiliates of the United States Eye Injury Registry. METHOD. Retrospective review. RESULTS. In the Eye Injury Registry of Alabama (EIRA) database, 185 of the 4150 injuries (4.4%) were caused by fireworks. In the Hungarian Eye Injury Registry database, only two of the 1245 cases (0.1%, p=0.000001) were fireworks-related. In the EIRA, 79% of patients were males and 87% were under 31 years. A bystander was injured in 67% of the cases, being an average of 23 feet away; 39% of bystanders had a final vision =19/200. No injured person wore eye protection. Bottle rockets caused 80% of the 185 injuries. Overall, 20% of eyes had <5/200 final visual acuity. Twenty-five percent of bottle rocket-injured eyes, compared to 64% of those injured by other devices, had =20/40 final vision (p=0.000004). CONCLUSIONS. The rate of fireworks-related serious eye injuries has not decreased in Alabama in the last 16 years; most patients are young males. Since bystanders are at a measurable risk even at a distance of 100 feet, wearing eye protection is recommended to both bystanders and operators. Bottle rockets cause most of the injuries and the more severe ones, and should be the prime target for prevention. The benefit of a strict and enforced legislative ban on private fireworks displays is demonstrated by the much lower incidence figure in Hungary. Such a ban should be considered in other countries where fireworks-related eye injuries are common.

Increasing paintball related eye trauma reported to a state eye injury registry

Objectives—To evaluate an apparent increase in documented trauma from paintball related eye injuries reported to the Eye Injury Registry of Indiana. Methods—A retrospective review of cases reported to the database...

The global impact of eye injuries

Using data compiled from the ophthalmic literature and WHO's Blindness Data Bank, the available information on eye injuries from an epidemiological and public health perspective has been extensively reviewed. This collection of data has allowed an analysis of risk factors, incidence, prevalence, and impact of eye injuries in terms of visual outcome. However, most of the estimates are based on information from More Developed Countries (MDCs). The severity of eye injuries can be assessed through proxy indicators such as: (i) potentially blinding bilateral injuries; (ii) open-globe injuries; (iii) endophthalmitis; (iv) enucleation or (v) defined visual impairment. Major risk factors for ocular injuries include age, gender, socioeconomic status and lifestyle. The site where the injury occurs is also related to a risk situation. Available information indicates a very significant impact of eye injuries in terms of medical care, needs for vocational rehabilitation and great socioeconomic costs. The global pattern of eye injuries and their consequences emerging from the present review, undertaken for planning purposes in the WHO Programme for the Prevention of Blindness, suggests that: – some 55 million eye injuries restricting activities more than one day occur each year; – 750,000 cases will require hospitalization each year, including some 200,000 open-globe injuries; – there are approximately 1.6 million blind from injuries, an additional 2.3 million people with bilateral low vision from this cause, and almost 19 million with unilateral blindness or low vision. Further epidemiological studies are needed to permit more accurate planning of prevention and management measures; a standardized international template for reporting on eye injuries might be useful to this effect, along the lines of the reporting occurring through the US Eye Injury Registry.

Sports-related Ocular Injuries: A Three-year Follow-up Study

Purpose: The authors performed a sports-related ocular injuries evaluation with periodic patient observation and follow-up, to outline the severity and long-term sequelae of eye injuries in sports.Methods: A prospective study was conducted of 84 consecutive patients (85 injured eyes) with sports-related eye injuries examined at the Eye Emergency Department of Porto S. João Hospital, between April 1992 and March 1995. The ophthalmologic examination was recorded using the United States Eye Injury Registry report forms, and the follow-up ranged from 3 months to 3 years.Results: Injuries occurred predominantly in young males (mean age, 24.8 ± 9.6 years). The type of sport and the mechanism most frequently responsible for injuries were, respectively, outdoor and indoor soccer (72.6%) and ball trauma (64.3%). Of 45 patients presenting with hyphema, 24 (53.3%) had vitreous and/or retina (V/R) lesions (95% confidence interval [Cl], 38.8-67.5) compared with 13 of 39 (33.3%) patients with no hyphema (95% Cl, 20.0–49.1). Angle recession was significantly more common in the presence of hyphema (55.6%; 95% Cl, 41.0–69.5 vs. 10.3%; 95% Cl, 3.3–22.9; P < 0.00005), and retinal tears were more common in the presence of vitreous hemorrhage (P = 0.004). Nineteen of 58 (32.8%) patients with "normal" visual acuity (≥ 20/40) presented with VIR lesions. Hyphemas were significantly more frequent in soccer players (38/61 vs. 7/23, P = 0.018).Conclusion: These results highlighted the serious nature of outdoor and indoor soccer injuries. The severity of the anterior segment injury was not a good predictor of posterior segment damage. Ophthalmologists can help prevent delayed consequences by including regular gonioscopy and peripheral retinal examination in all cases of blunt trauma. The United States Eye Injury Registry report forms adapted to sports proved to be a useful tool for collecting detailed information and sharing a common database.

A standardized classification of ocular trauma.

No internationally standardized classification of ocular trauma terminology has existed heretofore. Despite a growing interest in eye injuries, the absence of a common language continues to impede both clinical care and research. A classification was initially developed based on the authors' extensive personal experience. It then under-went repeated reviews over a 3-year period by international ophthalmic specialists. Written and oral suggestions from respondents in 19 countries and from selected ocular trauma experts were considered and incorporated. By always using the entire globe as the tissue of reference, the new classification is unambiguous, consistent, simple, and comprehensive. It provides definitions for the terms commonly used in eye trauma and creates a logical system of injury types. In addition to widespread international acceptance by professionals, the new classification has been endorsed by the International Society of Ocular Trauma, the United States Eye Injury Registry, the American Academy of Ophthalmology, the Hungarian Eye injury Registry, the Vetreous Society, and the Retina Society. It can be reasonably expected that the system will ultimately become the standardized international language of ocular trauma.

A Standardized Classification of Ocular Trauma

No internationally standardized classification of ocular trauma terminology has existed previously. Despite a growing interest in eye injuries, the absence of a common language continues to impede both clinical care and research. A classification has been developed initially based on the authors' extensive personal experience. It then has undergone repeated reviews over a 3-year period by international ophthalmic audiences, incorporating suggestions from respondents in 13 countries and selected ocular trauma experts. By always using the entire globe as the tissue of reference, the new classification is unambiguous, consistent, and simple. It provides definitions for the commonly used eye trauma terms within the framework of a comprehensive system. The new classification has been endorse by the Board of Directors of the International Society of Ocular Trauma, the United States Eye Injury Registry, the Hungarian Eye Injury Registry, the Vitreous Society, the Retina Society, and the American Academy of Ophthalmology. It can be reasonable expected that the system eventually will become the standardized international language of ocular trauma. The authors urge ophthalmologists to begin using this terminology in both clinical practice and research.

Serious Eye Injuries Associated With Fireworks—United States, 1990-1994

Eye injuries caused by fireworks are often severe and can cause permanently reduced visual acuity or blindness. Findings from the National Electronic Injury Surveillance System database maintained by the U.S. Consumer Product Safety Commission (CPSC) indicate that approximately 12,000 persons are treated each year in U.S. emergency departments because of fireworks-related injuries; of these, an estimated 20% are eye injuries. To improve characterization of fireworks-related eye injuries, data were analyzed from the United States Eye Injury Registry (USEIR) for July 1990-December 1994 and from the Eye Injury Registry of Alabama (EIRA) for August 1982-July 1989. This report summarizes the findings of these analyses.

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.