Globe Perforation Research Articles

Update on Factors Contributing to Traumatic Glaucoma Following Ocular Contusion and Globe Perforation

Update on Factors Contributing to Traumatic Glaucoma Following Ocular Contusion and Globe Perforation

Intrabulbar, Intraorbital and Intracranial Perforating Eye Injury with Foreign Body: A Case Report

Ocular trauma is a significant cause of preventable blindness and visual impairment worldwide. Eye globe perforation can happen due to work with sharp tools or different particles that are spread during work with metals, wood, and other solid substances.We present the case of a 14-year-old male patient admitted as an urgent case at the Ophthalmology Department in 2014 due to a perforating eye injury with a foreign body – a 7 cm rusty metallic nail in the right eye. The X-ray of the orbit revealed that the foreign body had penetrated the eyelid, the eye eyeball, and through the orbit and its posterior wall, penetrated the skull and 2 cm in the brain. Under general anesthesia, we performed the anterior chamber lavage, excision of the prolapsed iris, and pupilloplasty. The anterior chamber was reconstructed using a saline solution (0.9% NaCl) and air. The patient was treated conservatively with antibiotics and steroids for 10 days; there were no signs of wound filtration, hypotonia, or endophthalmitis. Due to the limited resources for the posterior segment surgery, the patient was referred to another center for pars plana vitrectomy (PPV) after 10 days of hospitalization in the Department of Ophthalmology at the University Clinical Center of Kosovo. After PPV with silicon oil and cataract surgery, the patient could see the light and its projections (BCVA = L+P+). We followed up on the patient until September 2022, there were no signs of bulbus atrophy, and the visual acuity remained the same, BCVA = L+P+. The correct diagnosis and treatment at the right time play a leading role in achieving one of the main goals of surgical treatment of perforating eye injuries, which is the preservation of the anatomical structure and the physiology of the eye.

Surgical Outcome of Inferior Oblique Myectomy versus Recession-Anteriorization in the Treatment of Inferior Oblique Overaction.

This study aimed to compare the surgical outcome of inferior oblique myectomy, IOM versus inferior oblique recession-anteriorization, IORA in the treatment of inferior oblique overaction, IOOA. A retrospective chart review was performed over a 12-year period, from 2009 to 2021. Eighty-nine patients diagnosed with IOOA who underwent IOM or IORA were included. The primary outcome was postoperative residual IOOA (grade 0 to +4) and percentage favorable outcome, defined as IOOA grade ≤1+ at 6 months post operation, in each group. The outcomes were compared between the two surgical procedures (IOM and IORA). The secondary outcome was the percentage of postoperative anti-elevation syndrome cases for each surgical procedure. The median age at the time of surgery was 10.50 years (interquartile range, IQR: 2.83 to 28.33) in the IOM group and 5.08 years (IQR: 2.75 to 29.42) in the IORA group. The favorable outcome at 6 months was 90.91% in the IOM group, which was lower than the 95.74% in the IORA group but the difference was not statistically significant (P-value = 0.390, 95% CI: 0.07-2.82). The only surgical complication, anti-elevation syndrome, was detected in 3.77% of IOM cases and 5.80% of IORA cases, with an odds ratio of 0.64 on comparing the IOM group to the IORA group (P-value = 0.611, 95% CI: 0.11-3.62). These two weakening procedures are effective for treating IOOA. Although IORA seemed slightly superior to IOM in terms of favorable outcomes, the difference was not statistically significant. Moreover, the myectomy procedure was easier, was less time-consuming, had a lower risk of globe perforation and presented fewer complications such as anti-elevation syndrome.

Retrobulbar haemorrhage and globe perforation after botulinum toxin injection into the medial rectus

Aims/Purpose: The aim of this communication is to show a recent case of both retrobulbar haemorrhage (RH) and probable globe perforation (GP) after botulinum toxin (BT) injection in the medial rectus of the right eye.Methods: We selected a recent case seen at our hospital. A 5u BT injection was performed under topical anaesthesia and guiding electromiography into the medial rectus due to a VI cranial nerve palsy. 2 min later the patient claimed intense pain and we evidenced a sudden growing periocular oedema and progressing exophthalmos. Retrobulbar haemorrhage was diagnosed and immediate canthotomy and cantholisys were performed, with consequent haemorrhage drainage. In the 24 h follow‐up visit, our patient claimed blurry vision and floaters. VA RE was 0.3 (before BT 0.7). Important corneal oedema and 3–4 + tyndall was observed. In the funduscopic exploration severe hemovitreous was observed; and an ocular ecography was performed, which showed no signs of retinal disruption. As vitreous started clearing and VA and floaters improved, observational treatment was decided. When we became able to see the retina with detail a possible perforation hole was seen in the infero‐medial quadrant, with no signs of traction or retinal elevation.Results: 3 months later, VA was 0.8 e° 1. Funduscopy showed an applied retina, with only a few persistent fibrine remainders in the inferior quadrant. Good‐coloured optic disc, with physiologic excavation and no signs of atrophy.Conclusions: Eventhough RH and GP are quite rare complications after BT infection, we should always take them into consideration. We also wanted to highlight these complications treatment. RH: Immediate canthotomy and cantholysis must be performed GP: close observation must be followed in order not to miss a retinal detachment. Plus, to avoid them we should be careful to perform the right technique and to use the electromiograph to guide us into the muscle.

Development and evaluation of a point-of-care ocular ultrasound curriculum for medical students - a proof-of-concept study

BackgroundPoint-of-care Ocular Ultrasound (POCOUS) has gained importance in emergency medicine and intensive care in recent years. This work aimed to establish and evaluate a dedicated ultrasound education program for learning POCOUS-specific skills during medical studies at a university hospital.MethodsThe blended learning-based program (6 teaching units) based on recent scientific publications and recommendations was developed for students in the clinical part of their medical studies. Experts and trainers consisted of physicians from the Ear-Nose-Throat, radiology, ophthalmology and neurology specialties as well as university educational specialists. Lecture notes containing digital video links for preparation was produced as teaching material. In total, 33 students participated in the study. The education program, including the teaching materials, motivation and subjective gain in competency, was evaluated with the aid of a questionnaire (7-point Likert response format). Objective learning success was assessed on the basis of pre- and post-tests. These covered the skill areas: “anatomical basics”, “ultrasound basics”, “understanding of cross-sectional images”, “normal findings” and “pathology recognition”.ResultsIn the objective assessment of image interpretation, the participants improved significantly (p < 0.001) from pre- to post-test with a large effect size (Cohen’s d = 1.78, effect size r = 0.66). The evaluations revealed a high level of satisfaction with the course concept, teaching materials and the tutors. In addition, a high level of motivation was recorded in relation to continuing to study “ultrasound diagnostics” and “ophthalmologic diseases”. A significant (p < 0.01) positive gain was also achieved in terms of the subjective assessment of competency. This covers areas such as expertise, sonographic anatomy and performing a POCOUS examination as well as recognizing retinal detachment, globe perforation and increased optic nerve sheath diameter.ConclusionThe results of this feasibility study show that medical students accept and support a POCOUS-specific education program and are able to develop a higher objective and subjective level of competency. Future transfer to other sites and larger groups of participants seems feasible.

–Inadvertent intravitreal injection of microdroplet of sclerosant during lower lid inclusion cyst management

Globe perforation during oculoplastic procedures is uncommon. Inclusion cysts of the conjunctiva are amenable to complete excision but tend to recur if a part of the cyst wall remains. Sclerosant injections have been tried successfully to collapse inclusion cysts of the conjunctiva. Our case presented with signs of globe perforation two days after the second cyst aspiration and sclerosant injection procedure. The case was managed with a laser barrage of the suspected perforation site, systemic antibiotics, and steroids, resulting in complete visual and functional recovery at the 1-month follow-up. This is the first such case reported in the literature.

Stifling the sneeze in ACHOO syndrome-What the anesthesiologist should know.

Dear Editor, A 32-year-old male, a known patient of ocular amyloidosis, was posted for superficial keratectomy (removal of the corneal epithelium up to Bowman membrane) of the right eye under topical anesthesia. This patient had a history of photic sneeze reflex (PSR) since 12 years of age and was a diagnosed case of autosomal dominant compelling helio-ophthalmic outburst (ACHOO) syndrome. This condition is characterized by uncontrollable sneezing episodes on exposure to bright light or periocular injection including peribulbar block or eyelid infiltration. He suffered from continuous sneezing episodes lasting around 5 min even in response to slit-lamp examination. This was usually followed by a refractory period during which the ophthalmic examination was conducted. He had no other systemic illness. On the day of the procedure, he developed an irrepressible sneezing reflex after cleaning and draping of the right eye in the operating room. The ambient light had stimulated the PSR. The anesthesiologist was called for help. On clinical examination, the patient’s vitals were stable with a heart rate of 62/min, SpO2 98%, and blood pressure 100/70 mmHg. His sneezing fit had ceased but the patient was extremely anxious. An intravenous line was secured and he was administered midazolam 1 mg and fentanyl 50 μg intravenously. He became calm and allowed the gentle insertion of a wire speculum but still could not look at the light of the operating microscope though there were no more sneezing episodes. He was given another 50 μg fentanyl intravenously and reassured. The procedure was completed smoothly in 10 min. No further drugs were administered nor were there any sneezing episodes. A syringe filled with injection pheniramine maleate 22.75 mg was kept ready but was not required. Five days later, he was posted for superficial keratectomy of the other eye under monitored anesthesia care. The same anesthetic technique was followed and he was administered midazolam 1 mg and fentanyl 100 μg in small aliquots even before skin preparation. The procedure was completed uneventfully under topical anesthesia without a single sneezing episode. Sneezing fit after exposure to bright light or “sun sneezing” has been reported in about 25% of the population. These patients are also prone to a sternutatory reflex after local anesthetic injection under sedation.[1] Unexpected or sudden head movement during peribulbar block or eye surgery can cause globe perforation or vascular injury and retrobulbar hemorrhage.[2] PSR is a primitive brainstem reflex, sometimes considered a variant of the trigemino-cardiac reflex with the center in the trigeminal nucleus and adjacent reticular formation. The afferent arc is from the first (ophthalmic) and second (maxillary) division of the trigeminal nerve (VN) and the efferent is the vagus nerve. A cross-talk between the optic nerve (IIN) and VN has also been hypothesized.[3] No known treatment exists except avoidance. Few authors have found deep sedation, eyelid infiltration, midazolam, and propofol to increase the risk while opioids, dexmedetomidine, and antihistamines have been found to reduce the risk.[2,4] Some have even suggested PSR as an indication for general anesthesia in ophthalmic surgery.[5] It is important for anesthesiologists routinely caring for patients for ophthalmic surgery to be aware of this reflex as it can have severe sight-threatening consequences. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Commentary: Scleral penetration or perforation during strabismus surgery.

Commentary: Scleral penetration or perforation during strabismus surgery.

Open Globe Injury in a Tertiary Hospital of Northern Thailand: No Vision Survival and Ocular Trauma Score.

To determine characteristics and factors associated with no vision survival (included no light perception, enucleation, and evisceration) following open globe injury (OGI) and to correlate the proportion of final vision to predictive values of ocular trauma score (OTS). The medical records of consecutive patients diagnosed as OGI between January 2015 and December 2020 were retrospectively reviewed. Data collected included demographics, mechanisms and modes of injuries, ophthalmic presentations, managements, and visual outcomes at the final visit. Three hundred and seventy-one patients with a mean (standard deviation, SD) age of 44.0 (17.4) years were included. Male with workplace injury was the most frequent scenario. High-velocity metallic objects were the predominant causative materials. Following treatments, fifty-six eyes (14.9%) obtained no vision survival. Factors associated with no vision survival following OGI were low presenting vision, globe perforation, larger wound, presence of relative afferent pupillary defect, retinal detachment, and vitreous hemorrhage. Compared to OTS predictive values, eyes in OTS categories 1 and 2 had a lower proportion of no vision survival. This study identified the importance of workplace injuries. Overall, there were comparable final visions between OTS and this study. However, a reduced proportion of no vision survival among severely injured eyes signifies the challenges of OGI management.

Outcomes of planned versus emergent enucleation procedures with primary orbital implants

ObjectifNotre étude avait pour objectif principal d'examiner les résultats de la pose d'un implant intraorbitaire primaire au décours d'une énucléation prévue ou réalisée en urgence. MéthodesOn a procédé à un examen rétrospectif des dossiers médicaux portant sur 128 énucléations pour lesquelles on disposait d'un suivi postopératoire d'au moins 1 an (entre novembre 2008 et mai 2019). La pose de l'implant a été réalisée par un seul chirurgien oculoplasticien au Albany Medical Center. Les cas urgents étaient définis comme suit : perforation non refermée du globe oculaire secondaire à un traumatisme aigu, à une déhiscence ou à l’échec du rapprochement des berges d'une plaie, ou encore à l'exposition d'une plaie chirurgicale s'accompagnant d'une déhiscence de la sclère sous-jacente. Ont été enregistrées les données démographiques, cliniques et postopératoires de chaque patient. L'incidence d'exposition de l'implant a servi d'indicateur des résultats cliniques, et les données ont par la suite été analysées à l'aide du test t. RésultatsParmi les 128 énucléations examinées, 32 (25 %) avaient été réalisées en urgence; dans 2 de ces cas (6,25 %), il y a eu exposition de l'implant. En revanche, sur les 96 énucléations qui avaient été planifiées, on a dénombré seulement 3 cas (3,1 %) d'exposition de l'implant. On n'a pas relevé de lien significatif entre le taux d'exposition de l'implant et le moment où a eu lieu l’énucléation (prévue ou réalisée en urgence; p = 0,4047). ConclusionsEn dépit des effets d'une perforation du globe oculaire, notre analyse a permis de constater qu'il n'existe pas de corrélation significative entre le moment de la pose d'un implant intraorbitaire primaire (en situation d'urgence ou planifiée) et l'exposition de l'implant. De ce fait, les médecins ne devraient pas hésiter à insérer un implant intraorbitaire primaire au moment même de l’énucléation chez les 2 types de patients et peuvent s'en remettre aux présentes données pour conseiller leurs patients en ce qui a trait au risque de complications postopératoires.

Prompt Detection and Management of Globe Perforation due to Retrobulbar Anaesthesia.

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Computed tomography scan measurements of the globe and orbit to assess the risks of traumatic complications from medial peribulbar anaesthesia

Complications of peribulbar anaesthesia include retrobulbar haemorrhage, globe perforation and brainstem anaesthesia. Therefore, this study took measurements relating the proximity of medial canthus to the optic nerve and also the safe angle between orbit and globe using 200 multiplanar reconstructed computed tomography (CT) images of the orbit. The principal results show that in 1.5% of the sample, the optic nerve is within 20 mm of the medial canthus, with a minimum distance of 15 mm. One% have a safe angle of 10 degrees or less between bone and globe. None of the demographic data, nor axial length were predictive of these results. We have shown that there are a minority of patients with unusual orbital anatomy. This places them at a theoretical higher risk of complications. These cases are not currently predicted by measured data.

Efficacy of Retrobulbar versus Topical Anesthesia in Cataract Surgery

Aim: To monitor the effect of retrobulbar versus topical anesthesia in cataract surgery patients by comparing different parameters such as: intraocular pressure akinesia and analgesia parameters. Study type: Interventional case series. Place and duration of study: Department of Ophthalmology, Niazi Medical &amp; Dental College Sargodha from 1st October 2020 to 31st October 2021. Methodology: One hundred patients who underwent cataract surgery were enrolled. Study participants were divided into two groups and each group contain fifty 50 participants. Group one give retrobulbar block and group two treated by topical anesthesia. Complete ocular and systematic examinations and relevant examinations like clotting time, blood pressure, blood sugar, complete blood examination and bleeding time were done before starting the surgery. Results: 80% were males and 20% were females. During topical local anesthesia, 47(94%) patients experienced pain free surgery whereas in retrobulbar anesthesia, only 38(76%) patients experienced pain free surgery. In retrobulbar anesthesia group, complete akinesia was observed in 25(50%) patients. In retrobulbar group, significant increase in intraocular pressure was noted 41(82%) upto 30 mmHg after the administration of local anesthesia as compared to topical anesthesia group. Conclusion: Topical anesthesia is more safe and effective approach for cataract patients in contrast to retrobulbar group. It prevents many life and sight threatening implications like globe perforation and brain stem anesthesia. Key words: Efficacy, Retrobulbar, Topical anesthesia, Surgery

A Comparative Evaluation of Globe Trauma Features in a Tertiary Care Hospital Before and During the COVID-19 Pandemic

Objectives:To compare the clinical features, preoperative evaluation, and surgical approaches of globe trauma patients presenting to the emergency department before and during the coronavirus disease 2019 (COVID-19) pandemic.Materials and Methods:We retrospectively analyzed 54 eyes of 54 patients with traumatic globe perforation who underwent primary globe repair. The patients were divided into two groups according to the official start of the COVID-19 pandemic in Turkey: Group 1, 1 May 2019-11 March 2020 and Group 2, 11 March 2020-1 January 2021. The demographic features, trauma history, time from trauma to admission and from admission to surgery, COVID-19 serology (polymerase chain reaction [PCR]) result, ophthalmological examination findings at admission, surgical interventions, and postoperative clinical features were obtained from the patients’ records.Results:The mean ages of the patients in Group 1 (n=21) and Group 2 (n=33) were 42.76±20.72 and 37.78±23.47 years, respectively (p=0.431). During the pandemic, garden/farm injuries increased while workplace injuries decreased. In Groups 1 and 2 respectively, time from trauma to admission was 461.4±1228.6 and 935.4±2039.6 min (p=0.342), time from admission to surgery was 604.2±679.8 and 392.7±306.9 min (p=0.125), and length of hospital stay was 7.23±4.96, and 3.78±2.28 days (p<0.005). All patients had a COVID-19 PCR test and all resulted negative. There was no significant difference between the groups in terms of the clinical features of the ocular and adnexal injuries, surgical interventions, or postoperative complications (p>0.05). Preoperative visual acuity was found to be an important prognostic factor associated with postoperative visual acuity.Conclusion:Globe injuries require urgent intervention in terms of visual morbidity. Patterns of injury differ during the pandemic due to both restrictions and lifestyle changes. During the pandemic, patients were discharged as soon as possible after emergency treatment to minimize the time spent in the hospital.

A Rare Case of Hyphema in Fuchs Heterochromic Iridocyclitis After Peri-bulbar Block for Cataract Surgery

We report a case of 47 year old male patient with Fuchs heterochromic iridocyclitis and cataract in left eye who developed hyphema after peri-bulbar block for cataract surgery. The patient developed Amsler like Sign. It appeared few minutes after Peri-bulbar block following digital massage before any instrumentation of the globe. Surgery was post-poned to rule out globe perforation or any other pathology for Anterior Chamber bleed. All possible causes were ruled out and patient was eventually taken up for Cataract Surgery which was uneventful without any intra-op or post-op complications.

Inadvertent ocular perforation with hypodermic needle during saline irrigation

We present a case of globe perforation with hypodermic needle during saline irrigation. A 24-year-old presented with sudden onset defective vision during saline wash in his left eye. Patient on examination had hypotony and mild lid edema. Scleral wound was only apparent after staining; rest of the anterior segment was within normal limits. Posterior segment showed vitreous hemorrhage with retinal tear nasal to disc and adjacent commotio retinae. Patient was given tapering topical antibiotic steroid eye drops and kept under close observation. On his final follow-up 6 weeks after the initial injury, vitreous hemorrhage was resolving; the retinal tear had scarred with a choroidal rupture. Hypodermic-needle injuries are often complicated by the development of endophthalmitis. Our patient did not develop endophthalmitis, possibly due to the needle being sterile. He regained good vision and was saved from devastating consequences as the needle had missed the disc by a few millimeters.

Albumin in Tears Modulates Bacterial Susceptibility to Topical Antibiotics in Ophthalmology.

Bacterial keratitis is a serious and vision-threatening condition in veterinary and human patients, one that often requires culture and susceptibility testing to adjust therapy and improve clinical outcomes. The present study challenges the antimicrobial susceptibility testing (AST) paradigm in ophthalmology, enabling more accurate in vitro-to-in vivo translation by incorporating factors normally present during host-pathogen interactions in clinical patients. Thirty bacteria (10 Staphylococcus pseudintermedius, 10 Streptococcus canis, 10 Pseudomonas aeruginosa) were isolated from canine patients with infectious keratitis. For each isolate, commercial plates (Sensititre™ JOEYE2) were used to assess the minimal inhibitory concentration (MIC) of 17 different antibiotics in the absence (0% albumin, control) or presence of canine albumin (0.01–2%). For Staphylococcus pseudintermedius, the experiment was repeated with actual tear fluid collected from canine eyes with ocular surface inflammation. Kruskal-Wallis, Wilcoxon signed rank test and Spearman's correlation tests were used for statistical analysis. Clinical outcomes were unfavorable in selected canine patients with bacterial keratitis (e.g., globe perforation, graft dehiscence) despite standard AST (i.e., 0% albumin in test medium) confirming that most corneal infections (93%) were susceptible to ≥1 topical antibiotics used at the initial visit. Albumin levels ≥0.05% increased MICs in a dose-dependent, bacteria-specific, and antibiotic-specific manner. No significant differences (P = 1.000) were noted in MICs of any antibiotic whether albumin or tear fluid was added to the Mueller-Hinton broth. Percent protein binding inherent to each antibiotic was associated with clinical interpretations (Spearman's rho = −0.53, P = 0.034) but not changes in MICs. Albumin in tears impacted the efficacy of selected ophthalmic antibiotics as only the unbound portion of an antibiotic is microbiologically active. The present findings could improve decision making of clinicians managing bacterial keratitis, reduce development of antimicrobial resistance, influence current guidelines set by the Clinical and Laboratory Standards Institute, and serve as a reference for bacteriological evaluations across medical fields and across species.

Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series.

PurposeTo evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforation during peribulbar or retrobulbar block.MethodsThis retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesia from 2012 to 2020. The patients were divided into three groups: group 1, Clear media with no rhegmatogenous retinal detachment (RRD); group 2, significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and group 3, RRD with/without VH.ResultsTwenty-five patients were included in the study. The mean axial length (AL) was 24.7 ± 2.7 mm (range, 20.9–31.2 mm). The most common presenting feature was VH (n = 14). The treatment included retinal laser barrage (n = 7) and vitrectomy (n = 17). Retinal breaks were identified in all the eyes (total breaks = 37). The mean presenting best-corrected visual acuity in groups 1, 2, and 3 were logarithm of the minimum angle of resolution 0.79 ± 0.73, 1.82 ± 0.78, and 2.13 ± 0.59 respectively. All the treated patients had an attached retina at the last follow-up. The mean final best-corrected visual acuity for each group was logarithm of the minimum angle of resolution 0.59 ± 0.79, 0.48 ± 0.26, and 1.25 ± 0.64, respectively (p = 0.006). The development of RRD was associated with a larger AL (p = 0.015); while the development of significant VH associated with the superior location of the perforation (p = 0.015), late recognition of the perforation (p = 0.004), and multiple perforations (p = 0.015).ConclusionsEarly recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complications like RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.

Epidemiology, Etiologies, and Complications of Playtime Open Globe Injuries in Children.

To study the epidemiology, etiologies, and complications of playtime open globe injuries in children at the Assiut University Hospital, Egypt. This prospective cross-sectional study enrolled children with open globe injury who were admitted to Assiut University Hospital during a 6-month period (January to July 2016). All causes of trauma that occurred during playtime (at home, outside home, at the club, or at school) were recorded and analyzed. Eighty-one children (age = 18 years and younger; mean ± standard deviation age = 8.35 ± 4.84 years) were admitted with open globe injury, and 32 of them (39.51%) sustained ocular trauma during playtime. The majority of children were boys (n = 23, 71.88%). The causes of trauma during playtime were: playing with sharp objects (n = 11; 34.38%), playing with a wooden stick (n = 7; 21.88%), falling on the ground (n = 5; 15.63%), trauma by a stone (n = 2; 6.25%), trauma during running (n = 1; 3.13%), playing with a plastic toy (n = 1; 3.13%), and unknown causes (n = 5; 15.63%). The sites of globe perforation were corneal (n = 23; 71.88%), corneoscleral (n = 8; 25%), and scleral (n = 1; 3.13%). Playtime trauma that causes open globe injury and visual disability is avoidable and constituted approximately half of the open globe injuries in this study population. Corneal involvement occurred in almost all open globe injuries. Parental supervision for children during playtime is crucial to injury prevention. Children should avoid playing with sharp, dangerous objects and desist from playing or running on unsafe ground. [J Pediatr Ophthalmol Strabismus. 2021;58(6):385-389.].

Full thickness posterior globe perforation managed with laser photocoagulation

Full thickness posterior globe perforation managed with laser photocoagulation