Ocular Contusion Research Articles

Evaluation and classification of pediatric ocular trauma

To offer to the pediatric emergency physician consistent and unambiguous terms for the description of pediatric ocular trauma, based upon an adapted version of a standardized classification system. To show the potential effect of this reclassification system in a tertiary care emergency department. The authors reviewed a new classification system of ocular trauma and adapted it for use by pediatric emergency physicians. In addition, a retrospective analysis of the records of pediatric patients presenting over a 2-year period to a tertiary emergency department with ocular complaints was performed. The diagnoses related to ocular trauma were reclassified according to the new classification system. Over a 2-year period, 117 pediatric patients were evaluated for ophthalmic complaints. Sixty-seven (57%) of these cases involved an ocular contusion or ruptured globe; however, six disparate diagnoses were given. The cases were reclassified into an adapted, unambiguous, classification system. In some cases, the reclassification altered the indication for immediate ophthalmologic referral. There is currently no standardized system of terminology to describe pediatric ocular trauma. This may lead to confusion in communication among the pediatric emergency physician, the pediatrician, and the ophthalmologist. Consistent, unambiguous, terminology will assist in this communication, facilitate the writing of peer-reviewed articles and case reports, and increase the level of accurate documentation in the medical record.

Comparison of retinal breaks between patients with atopic dermatitis and mentally retarded patients with self-inflicted ocular injury

We compared the distribution of retinal breaks in retinal detachment between patients with atopic dermatitis (AD) and mentally retarded patients who had self-inflicted ocular injury (MR). The cases of AD were 16 eyes in 14 patients (six males and eight females, ranging in age from 15 to 52 years, mean 24.5) and the cases of MR were 6 eyes in 5 patients (5 males, ranging in age from 14 to 25 years, mean 20.2). There was no corneoscleral laceration in either group. In the patients with AD, 14 (87.5%) of 16 eyes had retinal breaks at the vitreous base, and 21 (87.5%) of 24 retinal breaks in 16 eyes were at the vitreous base. In the patients with MR, five (83.3%) of 6 eyes had retinal breaks at the vitreous base and 6(66.7%) of 9 retinal breaks in 6 eyes were at the vitreous base. In both groups, ciliary epithelial breaks and peripheral retinal tears were frequently observed, suggesting that retinal detachment in AD has a pathophysiology similar to traumatic retinal detachment with repeated ocular contusion (self-inflicted injury).

Shotgun pellets in the cavernous sinus

We present two cases of ocular shotgun injury where pellets entered the cavernous sinus. Both injuries occurred accidently while shooting pheasants. The first patient developed a third nerve palsy, while the second developed a third and a sixth nerve palsy. In each case, CT scanning showed a pellet in the cavernous sinus. Both recovered completely within four months. In both cases, only one pellet had lodged in the orbital area and had entered medial to the globe causing only minor ocular contusions before entering the cavernous sinus. Shooting is well recognised as a dangerous pastime and reports of associated ocular injuries abound in the literature. In both our cases, the entry wound was in the medial canthal area; we postulate that pellets at this location are funnelled along the medial orbital wall, through the superior orbital fissure and into the cavernous sinus. We could find only one other reference describing a pellet in the cavernous sinus.

Ocular Conditions Associated With Posterior Vitreous Detachment in Young Patients

To investigate the ocular conditions associated with posterior vitreous detachment (PVD) in young patients. The vitreous conditions of 861 patients younger than 30 years were studied retrospectively and examined biomicroscopically. In the first and second decades of life, retinitis pigmentosa, nondiabetic retinal vascular disorders, and a history of ocular contusion were most commonly associated with PVD. In the third decade of life, proliferative diabetic retinopathy was overwhelmingly the condition most commonly associated with PVD. This study delineated the ocular pathologic conditions associated with PVD in young patients. These findings may be useful in the management of PVD in patients younger than 30 years.

P 329 An experimental study of hemodynamic changes and treatment on ocular contusion in rabbits

P 329 An experimental study of hemodynamic changes and treatment on ocular contusion in rabbits

An experimental study of hemodynamic changes and treatment on ocular contusion in rabbits

An experimental study of hemodynamic changes and treatment on ocular contusion in rabbits

Sectoranopia After Head Trauma

Sectoranopia is a homonymous, horizontally oriented, wedge-shaped visual field defect typically associated with lateral geniculate body (LGB) lesions, [1-3] but recent reports challenge the diagnostic location specificity of sectoranopia by demonstrating causal retrogeniculate lesions [4-6]. Due to its size and location, neuroradiologic demonstration of the LGB was difficult until the development of MRI [7]. We followed a patient with sectoranopia as a consequence of severe head trauma. MRI revealed an isolated contralateral LGB lesion. Case report. On July 22, 1993, a previously healthy 25-year-old man was involved in a car accident and suffered frontal and facial traumatism. He presented with multiple facial fractures (Le Fort II and left hemi-Le Fort I fracture types) necessitating hospitalization and multiple maxillofacial surgeries. Left ocular contusion …

Optic disc hemorrhages after ocular contusion.

Optic disc hemorrhages after ocular contusion.

Retinal Detachment with Atopic Dermatitis Similar to Traumatic Retinal Detachment

The cause of retinal detachment (RD) with atopic dermatitis remains uncertain. The purpose of this study is to show that the probable cause of RD with atopic dermatitis is ocular contusion. The authors retrospectively compared the fundus findings of 24 eyes (16 patients) that had RD and atopic dermatitis with 36 eyes (36 patients) that had traumatic RD. The authors found similar characteristics. Retinal breaks at vitreous base borders characterized by ocular contusion occurred in 79.2% of eyes with RD and atopic dermatitis and in 75.0% of eyes with traumatic RD. Irregular retinal traumatic breaks in the equatorial zone occurred in 20.8% of eyes with RD and atopic dermatitis and in 47.2% of eyes with traumatic RD. Objective signs of ocular contusion outside the retina appeared in 54.2% of eyes with RD and atopic dermatitis. The authors' data support the conclusion that self-inflected ocular contusion by tapping the eyes can cause RD with atopic dermatitis.

Reattachment of the Detached Ciliary Body With Suturing for Treatment of Contusional Ocular Hypotension

Ocular hypotension resulting from a detached ciliary body after ocular contusion usually is best treated surgically. We report a simple, safe, and relatively effective procedure used to suture the ciliary body onto the inner surface of the sclera in eight such cases. Intraocular pressure (IOP) rose from unmeasurable levels to 10 to 12 mm Hg in five of these cases. Although in the three other cases IOP did not increase immediately after the operation, in one case it rose to 10 to 12 mm Hg 1 month postoperatively, and in the other two cases it rose to a normal level after additional laser therapy.

Traumatic retinal detachment.

Seventy-seven patients developed retinal breaks following an episode of ocular contusion, and 65 (84.4%) of these developed rhegmatogenous retinal detachment. Surgical treatment successfully restored or maintained retinal apposition in 74 (96.1%) of the eyes. Thirty-six (46.8%) eyes recovered visual acuity of 6/9 or better. Of the retinal breaks recognised dialysis at the ora serrata was observed in 49 eyes, of which 28 were situated at the lower temporal quadrant. Seventeen eyes had irregular breaks arising within necrotic retina at the site of scleral impact. Twenty-four (31.2%) patients had retinal break or retinal detachment diagnosed within 24 hours of injury and 49 (63.6%) within six weeks. Immediate retinal detachment was a feature of necrotic retinal breaks, while inferior oral dialyses led to a slow accumulation of subretinal fluid. Delayed diagnosis of retinal detachment was due either to opaque media or to failure to examine the retina after injury. Visual prognosis was good when retinal break or detachment were diagnosed within six weeks of injury. However, those patients who escaped initial retinal examination and were lost to follow-up had a less favourable visual outcome.

Gonioskopische Veränderungen durch stumpfe Augapfelverletzungen beim Sport

In the course of the last five years 32 patients were hospitalized in Maribor because of ocular contusions sustained while participating in sports. The most frequent were injuries occurring in ball games. In 56.2% of the patients, clinically manifest changes in the angle were found, most frequently in the form of angle recession with hyphema. The importance of routine gonioscopy and of examining the periphery of the posterior segment in all ocular contusions is stressed. The possibility of a late post-contusion glaucoma developing must also be kept in mind.

Changes in the chamber angle following ocular contusions (author's transl)

In a retrospective study, 87 patients were reexamined after hospital treatment of ocular contusion. The relationships between intraocular pressure, outflow facility, and lesions of the anterior chamber angle were analyzed. In 52% of the cases, lesions were demonstrated in the anterior chamber angle; about half of these patients showed extension of 180 degrees or more. There was no statistical correlation between intraocular pressure and outflow facility or the extent of anterior chamber angle lesions, although clinical findings clearly indicated such correlations. Blunt ocular injuries evidently lead to higher intraocular pressure in elderly patients. The latency period also appears to play a role: the longer the period between trauma and examination, the higher the pressure measured in the injured eyes. We found secondary glaucoma in two cases (about 2%). Glaucoma was suspected in six patients (6.5%). There was an apparent risk of glaucoma in four patients (4.3%).

Whiplash Injury as One Cause of the Foveolar Splinter and Macular Wisps-Reply

<h3>In Reply.</h3> —We are glad to acknowledge Dr Daily's important contributions to this area of macular pathology. It was our intention to describe a small subgroup of patients that form a part of the larger group Dr Daily has described. Among all patients with foveal tufts, pits, and wisps are a small number whose symptoms and signs are temporally related to a whiplash injury. The foveal changes can certainly occur in a variety of other settings. Intentional ocular contusion would, in our experience, produce other associated ocular changes in most cases. Anterior chamber angle recession, choroidal rupture, or Berlin's edema would indicate direct trauma rather than flexion extension spinal injury.

Changes in anterior chamber depth and angle-recession, late complications to ocular contusion.

Of 46 patients consecutively admitted to hospital for ocular contusion with hyphaema in 1964 and 1965, 30 patients were followed-up somewhat more than 10 years later in order to assess late complications. Angle-recession was observed in 17 (57%), while none had developed glaucoma. An average increase in depth of the anterior chamber of 0.06 mm in the affected eye was observed; this differences is highly significant with P less than 0.005. However, as these changes are small in individual patients, measurement of the increase in anterior chamber depth can only be a supplement to gonioscopy.

Injuries in Preadolescent Wrestlers.

Is wrestling safe for children? Injury of an unfused epiphysis may worry some physicians, but muscle strains, ocular contusions, and laryngitic contusions are more common.

Injuries in Preadolescent Wrestlers

Is wrestling safe for children? Injury of an unfused epiphysis may worry some physicians, but muscle strains, ocular contusions, and laryngitic contusions are more common.

Late Macular Complications of Choroidal Ruptures

Late complications of ocular contusion have been widely studied. Attention is fre­ quently directed to the anterior segment, to late onset glaucoma and its relation to angle recession. Posteriorly, late onset of retinal detachment is well recognized. Recently de­ layed damage to the macula related to ad­ jacent choroidal ruptures causing late visual symptoms has been recognized by Gass' and Fuller and Gitter. Choroidal rupture is a common complica­ tion of contusion injuries of the eye. Such rents in the choroid (and in Bruch's mem­ brane) usually occur temporal to the disk in a concentric fashion and are often associ­ ated with intrachoroidal, subretinal, and intraretinal hemorrhage. The usual course of such injuries is one of gradual clearing of localized hemorrhage and retinal or choroidal edema with formation of a gliotic scar and pigment epithelial alterations in the area of the choroid tear. If the macula has not been directly involved, good visual acuity is to be expected. Usually the area remains essentially unchanged. Gass and others,' however, have observed hemorrhagic detachment of the pigment epi­ thelium as a late complication of choroidal rupture. Fuller and Gitter described a case in which subretinal neovascularization and serous detachment of the macula occurred six months after choroidal rupture. Patients with choroidal rupture should be followed with the potential complication in mind. Fluorescein angiography is useful in detecting and observing the changes in the choroidal rupture. Our report concerns three additional cases

Angle recession and secondary glaucoma.

In a previous article (Mooney, I972), the incidence and extent of angle tears was reported in a series of 53 cases of traumatic hyphaema examined within 3 years of the date of injury, and it was suggested that those cases with angle tears involving I8o° or more of the anterior chamber angle should have annual tonometry in order to detect the development of glaucoma in the injured eye at as early a stage as possible. The purpose of this paper is to report the findings in a series of cases examined between I I and I4 years after hyphaema due to non-perforating injury. The late development of glaucoma after traumatic hyphaema has been described by several authors. D'Ombrain (1944) drew attention to the association of ocular trauma and chronic glaucoma and described four patients with chronic unilateral glaucoma who had suffered ocular or periorbital injury i8, i6, 20, and 4 years previously. D'Ombrain substantiated his observations with further cases described in articles published in 1945, I946, and I949. He suggested that the glaucoma may be due to a process of fibrosis or cuticular proliferation in the region of the trabecular meshwork as described by Reese (I944). Wolff and Zimmerman (I962) described the early and late histopathological changes of angle recession in a series of eyes enucleated after ocular contusion and confirmed D'Ombrain's theory of the underlying cause. In early cases they noted lacerations into the face of the ciliary body with damage to the ciliary muscle. Those lacerations that passed between the circular and longitudinal muscles of the ciliary body resulted in posterior displacement of the former along with the iris root and pars plicata. They also noted disruption of the trabecular meshwork. In late cases they noted atrophy of the circular muscle fibres that had been separated from the longitudinal fibres and advanced degenerative changes of the trabecular meshwork consisting of atrophy, fibrosis, and hyalinization ofthe trabeculae and obliteration ofthe intertrabecular spaces and Schlemm's canal. In many cases there was a newly formed hyaline membrane covering the inner surface of the trabeculae continuous with Descemet's membrane and often extending into the recessed angle covering the longitudinal muscle. D'Ombrain made no comment about the gonioscopic findings in his cases, but Alper (i963) described the gonioscopic changes in a selected series of 27 non-perforating eye injuries; he noted deepening of the anterior chamber, widening of the ciliary body band and posterior displacement ofthe iris root. Fourteen of his 27 cases had chronic uniocular glaucoma in the injured eye. Pettit and Keates (I963) described eight cases of angle recession after blunt ocular trauma, one of which had chronic uniocular glaucoma 8 years after trauma. Blanton (i964) found I30 cases of angle recession in a series of I82 cases of traumatic hyphaema; four of these patients had chronic uniocular glaucoma diagnosed more than IO years after the injury and all four had angle recession involving more than 1800 of the anterior chamber angle.

Optic Atrophy After Ocular Contusion

Case 1—A 10-year-old black boy was struck in the left eye with a rock. Two days later the visual acuity in that eye had decreased to light perception without projection. The eyelids and the globe were intact. A small hyphema was present, the intraocu­ lar pressure was 53 mm Hg, and the cornea was edematous. The left optic disk appeared normal with spontaneous venous pulsations. Roentgenograms of the orbit and optic foramen were normal. He was treated with absolute bedrest, sedation, top­ ical corticosteroids, and dichlorphenamide (Daranide). Seven days after the injury, the intraocular pressure was 7 mm Hg, the hyphema had cleared, and the fundus showed early pallor of the optic disk with slight dilatation of the retinal veins. Definite optic atrophy with a vision of counting fingers at one foot was present one month after the injury.