Ocular Trauma Research Articles

Scleral sutured aniridia intraocular lens (Morcher®): indications and long-term outcomes.

To evaluate the outcomes of trans-scleral sutured posterior chamber black diaphragm intraocular lens (BDIOL) (Morcher®) implantations over 11 years. Retrospective case-series of patients, who underwent BDIOL implantation, identified from electronic patient records system from 2006 to 2016, Moorfields Eye Hospital. Demographics, pre/post-operative, final best-corrected visual acuity (BCVA), diagnosis, symptomatic improvement, intraoperative and postoperative complications immediate or late were collected and analysed to relate outcomes to surgical indication. Forty eyes of 38 patients (F:M 1:2.8) underwent BDIOL implantation with a mean surgical age of 46.6 years and follow-up of 44.5 months (range of 8-132 months). Indications included 23(57%) ocular trauma, 7(17%) congenital aniridia, 7(17%) iatrogenic lens and/or iris loss, and 3(7%) infectious keratitis. Mean preoperative BCVA was 1.64 logMAR and mean final postoperative BCVA was 0.94 logMAR with an average improvement in BCVA of 0.23 logMAR, equivalent to 1.5 lines of Snellen visual acuity. Visual results varied according to indications. Infectious cause patients had the greatest vision improvement (-0.7 logMAR), followed by trauma (-0.3 logMAR), and 25% of these achieved vision of 0.3 logMAR (6/12 in Snellen acuity) or better. Conversely, the aniridia group had the least improvement (worsened vision of 0.01 logMAR), 17 patients (42%) reported subjective improvement. BDIOLs achieve reasonably good visual outcomes in eyes with complex vision threatening pathology. No significant intra-operative complications are documented and most post-operative complications are related to the pre-existing pathology. Post - trauma and iatrogenic aniridia have better outcomes compared to congenital aniridia.

Ocular trauma from Lawn mower accidents: Clinical insights, visual outcomes and microbial profiles

AimsTo characterize the clinical features of ocular trauma resulting from lawn mower, identify determinants of unfavorable final visual acuity (FVA), and assess the spectrum of microbial in posttraumatic endophthalmitis. MethodsThis retrospective study enrolled patients who experienced ocular trauma due to lawn mower at Zhongshan Ophthalmic Center from January 2013 to August 2021. Demographics, clinical features, isolated microorganisms, risk factors influencing reduced visual acuity, treatment regimens, and utilization of eyewear were collected. ResultsThe study included 140 participants (140 eyes) (49.47 ± 12.03 years, 95% male). The predominant injury manifestations were penetrating globe injuries (75.7%) and intraocular foreign bodies (51.4%). Endophthalmitis occurred in 35 cases (25%) and Bacillus cereus (23.5%) was the primary pathogen, followed by Staphylococcus epidermidis (11.8%) and Streptococcus species (11.8%). Following the initial assessment, where 77.9% of patients had initial visual acuity (IVA) at grade IV (ranging from light perception to 4/200) and only 0.7% attained grade I (better than 20/40), post-treatment results revealed that 5.7% achieved FVA at grade I, with a concurrent decrease in patients with grade IV vision to 64.3%. Multivariate logistic regression revealed that injury protection (p < 0.001, OR = 0.237, 95% CI = 0.126–0.446), IVA (p = 0.001, OR = 4.102, 95% CI = 1.730–9.729), and retinal detachment (p = 0.042, OR = 8.105, 95% CI = 1.075–61.111) were significant independent risk factors impacting FVA. ConclusionLawn mower often cause severe ocular injuries, with high-velocity metal foreign bodies that can lead to infections, most commonly caused by Bacillus cereus. Correct use of protective gear, initial vision assessment, and detecting retinal detachment are crucial for visual prognosis.

Incidence and Outcomes of Eye Trauma Associated With Recreative Use of Nonpowder Toy Guns: A 12-Year Retrospective Study

Nonpowder toy guns (NPTGs) are responsible for many ocular traumas. This study aims to detail the outcomes of these injuries depending on the causative NPTG. Retrospective, observational case series. Cases of NPTG-associated ocular trauma managed in a Parisian eye emergency department between August 1, 2010, and January 1, 2023, were reviewed. The date of trauma, causative NPTG, patient demographics, initial and follow-up eye examinations, any surgical procedure, and visual outcomes for each ocular trauma were analyzed. Over 12 years, NPTGs were responsible for 324 eye injuries and 980 visits. Patients were mostly male (77.5%), and mean age at trauma was 16.2 years. Foam bullets or foam dart blasters accounted for 54.9% of traumas and were mainly responsible for corneal injuries and hyphema (30.9% and 27%, respectively). BB guns and airsoft guns were frequently responsible for anterior segment lesions, as well as intravitreal hemorrhages (14.7%) and commotio retinae (21.1%). Paintball guns accounted for the largest proportion of posterior segment lesions (eg, intraretinal or subretinal hemorrhages leading to macular atrophy/contusion maculopathy), and one-third of casualties had undergone ocular surgery. Among all traumas, final visual acuity was lower than 20/200 in 6.5% of cases. Phthisis occurred in 8 cases: Two were related to foam bullets or foam dart blaster injuries (1 contusion and 1 rupture), 2 other cases followed a rupture due to BB guns/airsoft guns, 1 case occurred after a rupture related to a paintball gunshot, and 3 others were due to other types of compressed air guns (1 rupture, 1 intraocular foreign body, and 1 total retinal detachment). NPTG-related ocular trauma outcomes differ according to the causative toy. Paintball guns and BB guns/airsoft gun-related traumas were more likely to be associated with severe lesions, but an increasing number of ocular injuries related to the use of foam bullets or foam dart blasters are reported in younger and younger children. Public health policies should promote the use of protective eyewear.

Blink of innocence: A study of paediatric ocular trauma at a tertiary eye care centre in South India

To assess the prevalence of ocular trauma and extent of visual loss in paediatric patients at a tertiary care eye hospital in South India.A retrospective study was conducted on all children of age group 15 years and younger, of both genders, sustaining ocular injuries and seeking care within the ophthalmology outpatient department of a tertiary eye care hospital. The study spanned for a duration of six months. The demographic profile of the participants was recorded, detailed history was taken, followed by standardised ocular evaluation. Orbital imaging was done where deemed necessary. An eye was considered blind due to trauma if best corrected visual acuity for distance was worse than 3/60 due to trauma. Patients with pre-existing low vision in the affected eye were excluded in the study.50 children were included in the study. The mean age upon initial presentation manifested was 9.8 years. The demographic distribution revealed a predilection for children within the age group of 11 to 15 years, constituting 38% of the sampled populace, with the subsequent demographic tier of 5-10 years encompassing 36%. Noteworthy differentials emerged between rural and urban cohorts, with rural representation at 64% and urban at 36%. The predominant ocular injuries were categorized as 72% closed globe injuries and 18% open globe injuries. Operative interventions were administered to 54% of the cases, while the remaining 46% were subject to conservative therapeutic modalities. Within the subset of closed globe injuries necessitating surgical intervention (36%), specific pathologies included lid tear, canalicular tear, and traumatic cataract.Ocular trauma in paediatric population can lead to permanent blindness and visual handicap. It also affects the social, emotional and psychological development of the child. Most of these injuries can be prevented by supervision of children during play, educating the children, family members and teachers regarding ocular health and hygiene.

Descemet’s membrane tears following forceps delivery

: To report a case series on corneal trauma induced by forceps assisted vaginal delivery.: Case records of six patients who had clinical features suggestive of corneal trauma induced by forceps delivery were retrospectively reviewed and analysed. Vertical to oblique corneal Descemet’s membrane (DM) tears were noted in all 6 patients which included 2 males and 4 females. Right eye was involved in all patients and one patient had bilateral involvement. The age of presentation ranged from 5 to 39 years. Three patients had visual acuity better than 6/18 and three had worse than 6/18 in their affected eyes. All patients had corneal astigmatism in the range of 1.75 to 8 diopters. : A complicated vaginal delivery should be anticipated at the earliest by the obstetrician and an apt decision on the mode of delivery has to be attempted in order to prevent avoidable ocular trauma, especially in forceps assisted vaginal deliveries. All neonates who are born by forceps assisted vaginal delivery require mandatory referral to an ophthalmologist to rule out any ocular trauma. Early intervention can prevent irreversible vision loss due to amblyopia.

A case of iridoschisis with partial lens dislocation in both eyes

BackgroundIridoschisis is a rare condition that primarily affects individuals aged 60–70 years. The predominant characteristics of iridoschisis involve the tissue splitting and separation of the iris stromal layers, often resulting in two distinct layers and the presence of floating fibers in the anterior chamber. This article reports the case of a 48-year-old male with iridoschisis with partial lens dislocation in both eyes.Case presentationTrauma is the leading factor in the development of iridoschisis. However, there is no documented case of ocular trauma in the patient’s medical history. Visible white atrophic fibers were observed bilaterally in the anterior iris stroma of both eyes of the individual, accompanied by a small quantity of iris tissue within the anterior chamber. In this instance, the magnitude of the iridoschisis corresponded with the degree of lens dislocation. We were apprised that the patient had regularly used a cervical massager for a prolonged period of time, positioning it upon the ocular region. Frequent stimulation of both eyes with excessive force resulted in the development of iridoschisis and the partial dislocation of the lens.During the initial surgical procedure, phacoemulsification (Phaco) was carried out on the left eye without the placement of an intraocular lens (IOL). Following a two-month interval, we proceeded with the IOL suspension. Subsequently, the right eye underwent Phaco, accompanied by the implantation of an IOL. After closely monitoring the patient’s progress for two months, it was evident that their vision had significantly improved, substantiating the success of the surgical interventions.ConclusionsThis finding posits that the recurrent friction applied to both eyes may induce iridoschisis and various ocular complications. In the event of ocular intricacies manifesting, expeditious medical intervention becomes imperative.

Visual-functional impact of people affected by severe ocular trauma during social protests in Chile in 2019.

To determine the impact on the functionality associated with visual loss (VFIP) in people with severe ocular trauma (SOT) caused by kinetic impact projectiles used in police crowd control through a prioritization tool in people admitted to a rehabilitation program in Santiago de Chile from December 02, 2019, to November 13, 2020. Across-sectional descriptive study of SOT victims (N = 85), average age 31.4 ± 11.9. The data were recorded through a new 9-item screening instrument for assessment and prioritization of rehabilitation created for this emergency scenario. The impact of the use of kinetic weapons resulted in monocular blindness in the majority of those affected (n = 68; 80.0%). The highest VFIP observed was among young men from lower social strata. There were extreme difficulties in the performance of productive tasks (occupational and/or educational) (n = 42; 49.4%) and the pursuit of hobbies and pastimes (n = 23; 27.1%), as well as a high difficulty in adapting to changes in brightness (n = 29; 34.1%) and handling objects accurately (n = 22; 25.9%). The use of kinetic weapons for crowd control resulted in high and extreme VFIP and, in most cases, monocular blindness, causing major difficulties in work, study, and development of hobbies and pastimes in the affected population, highlighting the urgent need for effective rehabilitative care, which requires special attention in order to generate an adequate rehabilitation program. The use of kinetic weapons for crowd control contravenes international goals, policies, and plans set by the WHO and the International Agency for the Prevention of Blindness on strategies to prevent avoidable blindness worldwide until 2020. It is essential to ban the use of these weapons in Chile and worldwide, as well as to revise police protocols for crowd control.

EYEBALL SAVING ON UNILATERAL OCULAR TRAUMA AFTER MOTOR VEHICLE ACCIDENT: AN EMERGENCY ROOM CASE REPORT

Introduction : One of the main causes of reduced or lost vision is ocular trauma. The second common cause of ocular trauma, particularly among younger people, was motor vehicle accidents (MVA).&#x0D; Case Illustration : A 16-year-old female with a history of MVA was brought to the emergency room. She complained of pain with her left eye. Visual acuity was no light perception. Linear wound was found from limbus to limbus and 0.5cm beyond the limbus to medial. The lens cannot be assessed because of the prolapse of the iris and choroid, abnormal corneal and iris structures, and active hemorrhage. CT Scan showed collapsed and deformed on the left bulbi.&#x0D; Discussion : In this case, initial surgery was performed by exploration and reposition of the eyeball then close the wound through primary hecting on the cornea. Following surgery, 8 days later, patient went for an eye ultrasonography checked and showed that the left globe was ruptured, along with a subcutaneous hematoma and emphysema. Even though, patient’s visual acuity improved into the stage of light perception. The left eye's follow-up examination revealed hyperemic conjunctiva, a hazy cornea with a horizontal scar-forming, and securely closed sutures. Iris seems superior, however, it was impossible to see the pupil.&#x0D; Conclusion : Ocular trauma causes tremendous morbidity as well as psychological and social distress, and an economic burden. Thus, proper diagnosis and therapy are related to the prognosis of visual acuity, eye anatomy, and future complications.

Management of Open Globe Injury Followed by Cataract Traumatic and Corneal Laceration in a 37-year-old Man. A Case Report

Introduction : Ocular trauma is the most common cause of visual impairment and unilateral vision loss. According to the Birmingham Eye Trauma Terminology, ocular trauma consists of Open Globe Injury and Closed Globe Injury. Open globe injury is a full-thickness eyewall wound due to a laceration or occult rupture. Damage to the cornea and lens are among the most common types of ocular trauma.&#x0D; Case Illustration : This case report involves a 37 year-old-man who presented with complaints of pain and visual impairment in the left eye for the past month. The symptoms appeared after accidentally getting hit by a bamboo branch. Upon examination, the patient had a visual acuity of 1/300 in the left eye, ciliary injection (+), non-spherical pupil, and normal intraocular pressure on palpation. On slit lamp examination, a 7mm corneal laceration with a scar formation and a lens mass in the eye's anterior chamber.&#x0D; Discussion : In this case, the open globe injury resulted in visual impairment due to corneal laceration and traumatic cataracts. The trauma occurred one month before the examination, and the corneal laceration had already formed a leukoma. The patient underwent corneal repair and vitrectomy, extracapsular cataract extraction using the ECCE technique, and intraocular lens implantation.&#x0D; Conclusion : The prognosis of ocular trauma depends on the severity of the injury to the eye structures, the time between the injury and surgery, the preoperative visual acuity, the mode of injury, and the patient's age. The OTS scoring system can predict the final visual acuity outcome in such cases.

Ocular Penetration Trauma due to Bamboo Resulting in Evisceration: A Case Report

Introduction : Penetrating ocular trauma includes open-eye trauma, which leads to the time and a precision of eye- penetrating trauma’s management determine the advanced vision prognosis. In this case a male experience penetration trauma of the right eye due to exposure to the bamboo, delaying and inadequate management resulted in evisceration of the right eye. A 42-year-old male came to ER RSUD Prof. Soekandar mojokerto with bloody right eye and pain from getting a piece of bamboo from two days before entering the hospital. The patient also complained that the right eye is swollen so that it is unable to open the eyes. vision examination revealed LP (-) in the right eye, visual acuity in the left eye was 6/6, soft palpation in the right eye, normal palpation in the left eye, examination of the right anterior segment of the eye revealed that part of the eyeball content had prolapsed and for the left eye within the normal range. During laboratory tests, 15.280 white blood cells were found, which confirmed the infection of the right eye.&#x0D; Case Illustration : Descriptive Study&#x0D; Discussion : The observations on these patients include covered the right eye, antibiotic, steroids, and analgesic by intravenous injection. Based on the condition of the patient's right eye, it is advisable to do evisceration of the right eyeball under general anesthesia.&#x0D; Conclusion : Penetrating ocular trauma resulting in extensive intra ocular tissue damage and poor vision prognosis, considered for evisceration, in order to prevent the development of the sympatetic ophthalmia.

Disaster of Retrobulbar Hemorrhage

Introduction : Retrobulbar hemorrhage is a rare case, 3.6% of which are caused by ocular trauma. However, this case is an ophthalmic emergency and must be treated quickly and accurately. We present a case of neglected traumatic retrobulbar hemorrhage with compartment-syndrome and opportunistic bacterial infection which underwent dilemmatic exenteration and orbitectomy.&#x0D; Case Illustration : A 39-year-old man was referred with a history of being beaten, 11 days before admission. He felt a dark vision, pain and swelling in his left eye. The visual acuity was no light perception. Eyelid necrosis with proptosis and periorbital edema. We found severe chemosis and cloudy cornea. Negative-light reflex with increase intraocular pressure and limited eye movement in all directions. We did three surgeries due to serious complication. First, evacuation of retrobulbar bleeding. The second was total exenteration. The last was left orbitectomy, necrotomy and reconstruction performed together with plastic-surgeon and neuro-surgeon. Patient was hospitalized for 1.5 months.&#x0D; Discussion : Accumulation of blood in retrobulbar space leads to increased orbital pressure, which can stretch the optic nerve and impair blood flow in the eye which can lead to orbital compartment-syndrome. Unwanted complications can be prevented with prompt treatment within the first-two hours. Orbital decompression with lateral canthotomy and inferior cantholysis is considered as an emergency procedure. In this case, our patient had chronic compartment-syndrome and had no previous orbital decompression.&#x0D; Conclusion : Retrobulbar hemorrhage is an ophthalmic emergency. Early diagnosis and treatment are critical to ensure the best clinical outcome. Delayed treatment causes blindness and opportunistic infections can destroy the surrounding structure, a disaster.

Ocular Penetration Trauma due to Bamboo Resulting in Evisceration: A Case Report

Introduction : Penetrating ocular trauma includes open-eye trauma, which leads to the time and a precision of eye- penetrating trauma’s management determine the advanced vision prognosis. In this case a male experience penetration trauma of the right eye due to exposure to the bamboo, delaying and inadequate management resulted in evisceration of the right eye. A 42-year-old male came to ER RSUD Prof. Soekandar mojokerto with bloody right eye and pain from getting a piece of bamboo from two days before entering the hospital. The patient also complained that the right eye is swollen so that it is unable to open the eyes. vision examination revealed LP (-) in the right eye, visual acuity in the left eye was 6/6, soft palpation in the right eye, normal palpation in the left eye, examination of the right anterior segment of the eye revealed that part of the eyeball content had prolapsed and for the left eye within the normal range. During laboratory tests, 15.280 white blood cells were found, which confirmed the infection of the right eye.&#x0D; Case Illustration : Descriptive Study&#x0D; Discussion : The observations on these patients include covered the right eye, antibiotic, steroids, and analgesic by intravenous injection. Based on the condition of the patient's right eye, it is advisable to do evisceration of the right eyeball under general anesthesia.&#x0D; Conclusion : Penetrating ocular trauma resulting in extensive intra ocular tissue damage and poor vision prognosis, considered for evisceration, in order to prevent the development of the sympatetic ophthalmia.

Perforating Ocular Sickle Knife Trauma: a Case report

Introduction : Perforating ocular injury can lead to disability or even mortality. Most individuals sustaining eye injuries are male in young age. This is a report of an extreme case when a sickle knife stabbed in the right eye of a young male cause perforating of the eyeball.&#x0D; Case Illustration : Seventeen years old young male presented to Emergency Room of Sukabumi Regional Public Hospital with pain and bleeding in his right eye an hour before. He had been hacked during a brawls. There was a wound in the right supraorbita area and a big sickle knife stuck in the head and tear the eye ball. Visual acuity was no light perception in his right eye. Anterior segment examination of the right eye revealed perforated sclera and cornea. X-ray examination showed fracture of the roof of the right orbit and a metal object had stuck into the Orbits. The sickle knife extraction, enucleation and superior orbit reconstruction of the right eye was done.&#x0D; Discussion : Identification of wounds caused by sharp metal foreign body is very important for the subsequent treatment of injuries. If the eyeball cannot be preserved, then enucleation can't be avoided. In this case, hard impact of sharp object around of the eye are also cause fracture of superior orbital rim. Reconstruction of the orbital roof using titanium and micro screws given the most stable and effective results.&#x0D; Conclusion : Removing a metal foreign body and anatomical defect management is important for a good outcome.

EARLY DIAGNOSIS AND TREATMENT OF VOGT-KOYANAGI-HARADA SYNDROME WITH OPTIC DISC SWELLING : A CASE REPORT

Introduction : Vogt-Koyanagi-Harada (VKH) syndrome is characterized as a multisystem autoimmune disease that affects the pigmented tissues of the eye, auditory system, skin, and central nervous system. Optic disc swelling is a common finding during the prodromal and acute uveitis stage and must be considered seriously.&#x0D; Case Illustration : A 41-year-old woman presented with blurred vision in both eyes in the last month, accompanied by headache, nausea, and vomiting. There is no history of penetrating ocular trauma or surgery. Examination findings for visual acuity were light perception, bilateral posterior synechia, optic disc swelling, and serous retinal detachment. A steroid injection was given due to swelling of the optic disc, and four months later, the visual acuity improved to 20/120 and 20/60, respectively, and optic disc swelling and serous retinal detachment decreased.&#x0D; Discussion : In the acute uveitic stage, VKH can be presented with bilateral optic disc edema and various degrees of serous retinal detachment. The key to the management of VKH is early diagnosis and systemic corticosteroid in the acute uveitis stage, otherwise, improper and inadequate treatment can lead to chronic recurrent VKH disease. Our patient presented with acute uveitis and was treated promptly and adequately.&#x0D; Conclusion : Optic disc swelling may occur in VKH and worsen the visual prognosis, early diagnosis and treatment of VKH syndrome focused on optic disc swelling can improve the visual prognosis.

A Mystery Unsolved: A Spontaneous Lens and Uveal Prolapse in a New-born

Introduction : Corneal rupture in new-born, especially during the first week of life is rare. Some of these cases occur because of ocular trauma during deliveries, systemic infection, and congenital anomalies. We aim to deliver a rare case of spontaneous lens and uveal prolapse in new-born and management in treating the case.&#x0D; Case Illustration : A-2-day-old full-term-baby was referred due to bleeding of the right eye 6 hours post-partum by spontaneous vaginal delivery with no trauma. The mother, a 23-year-old, having the second born with no history of medical illness or vaginal discharged during pregnancy. Measurements of birth weight and length were normal. Eye examination of the right eye (RE) was uveal and lens prolapse and left eye (LE) cloudy cornea with leukoma and prominent neovascularization. Orbital CT-Scan revealed bilateral vitreous bleeding of both eyes. Laboratory examination showed reactive IgM for herpes simplex virus, reactive IgG for both toxoplasma and rubella. Corneal swab culture was sterile. Systemic and topical antibiotics were administered then switched to systemic antivirus. The 12-day-old-patient showed partial epithelization of cornea, less uveal volume with it partially shrank. Close observation was conducted and evisceration was postponed.&#x0D; Discussion : Although etiologic work-up has been addressed, exact etiology remains unknown with the possibility of congenital cause. It has been postulated that structurally malformed eyes are more prone to corneal perforations. Management should be personalized based on the patient’s need.&#x0D; Conclusion : Thorough examination is vital a rare case with undisclosed aetiology especially new-born. Patient monitoring is sufficient if no infections and bleedings found.

A Case of Pediatric Eyelid Laceration ec Unusual Foreign Body

Introduction : Eyelid lacerations refer to partial or full-thickness defects in the eyelid and constitute a significant subset of facial trauma which is often accompanied by other injuries including foreign bodies.&#x0D; Case Illustration : A 16-year-old boy was brought to the emergency department with a laceration and penetrating orbital injury in his right upper eyelid. On examination, there was a 4 cm x 0,5 cm upper eyelid laceration caused by tooth penetrating, CT scan revealed a high density foreign body measuring 1,5 cm x 0,5 cm in the right upper eyelid as deep as levator muscle and no globe injury. The patient underwent an emergency operation under general anesthesia, the foreign body was removed completely and the size of the foreign body was 2,6cm x 0,5cm. After the removal of the foreign body, debridement was performed and then sutured layer by layer. After surgery, he was treated with Tetanus prophylaxis, antibiotic, and analgetic.&#x0D; Discussion : Eyelid laceration is one of the most encountered ocular trauma, but needed to be evaluated and treated carefully. Although the rate of ocular foreign bodies found was low, it can lead to devastating ocular morbidities. After surgery and treatment, there is no other complaint from the patient. Visual acuity and ophthalmology examination are all in normal condition.&#x0D; ConclusionEyelid trauma with foreign bodies must undergo a complete examination. A good prognosis and outcomes can be achieved when appropriate medical and surgical treatment is performed.

MANAGEMENT OF CORNEAL ULCER PRESENTED WITH RARE PATHOGEN : STREPTOCOCCUS MITIS

Introduction : Corneal ulcers can arise from various corneal diseases, including infections, inflammation, and autoimmune disease. Staphylococcus aureus is the most common bacterial pathogen, but lesser- known bacteria like Streptococcus mitis can also cause corneal ulcers. Accurate diagnosis and treatment are essential to prevent vision loss and complications.&#x0D; Case Illustration : A 19-year-old female patient presented with a chief complaint of white spots on her right eye for three months. Previously, her right eye was hit by a foreign object and subsequently, the patient experienced redness and pain in the affected eye. One week later, white spot appeared in the patient's eye and reported to enlarge in the last month. The patient also complained of pain, blurry vision with visual acuity of 1/300, redness, glare, and a foreign body sensation. Corneal swab culture discovered Streptococcus mitis to be the causative agent. The patients was given hourly drop of topical levofloxacin. One month after initial treatment, patient’s symptoms was improving with visual acuity of 6/60 on her affected eye and the ulcer was healed.&#x0D; Discussion : Streptococcus mitis is a commensal pathogen in oral cavity and not normally cause infection of ocular tissue. It may cause ulcer due to prolonged use of topical steroid and previous ocular trauma, since Streptococcus mitis had low virulence rate.&#x0D; Conclusion : Corneal scraping culture should be carried out before treatment of infectious corneal ulcer. Streptococcus mitis is considered rare for corneal ulcer pathogen. Topical quinolones are the first- line drug for bacterial corneal ulcer and worked exceptional for wide range of bacteria.

PANOPHTHALMITIS SECONDARY TO RETAINED INTRAOCULAR FOREIGN BODY , SETTING IN RURAL AREA

Introduction : IOFB can be serious and result in vison threatening complication. We report IOFB presenting with panophtalmitis secondary to delay in seeking medical attention and misdiagnosed in emergency ward by general practitioner.&#x0D; Case Illustration : A 40-years-old male presented with pain and outward bulging of his right eye with no light perception after trauma to his right eye by a small metallic object while working as electric grasscutter. He presented to our department 3 days following the incident. Systemically, he had a fever, headache and nausea. 2 days after incident, he visited to emergency ward but he was given eye drop only. On Slit lamp examination, corneal melting with keratinization and lacerated wound in cornea at 12 o'clock about 3 mm. Non-contrast CT showing a linear hyperdense foreign body in the right globe likely metal, measuring 3 mm x 4 mm was found. The patient was admitted ceftriaxone intravenous, twice daily. No light perception of visual acuity, ocular penetrating, persistence of the active inflammation, and risk of spread, a decision was made to eviscerate the eye. A metallic foreign body was found in eviscerated tissue.&#x0D; Discussion : &#x0D; Conclusion : Important to suspect foreign body in all cases ocular trauma. Detailed examination and imaging should be performed. Delay treatment from the time of injury, result in poor prognosis. Surgical treatment such as evisceration, should be informed to patient about the visual prognosis.

PANOPHTHALMITIS SECONDARY TO RETAINED INTRAOCULAR FOREIGN BODY , SETTING IN RURAL AREA

Introduction : IOFB can be serious and result in vison threatening complication. We report IOFB presenting with panophtalmitis secondary to delay in seeking medical attention and misdiagnosed in emergency ward by general practitioner.&#x0D; Case Illustration : A 40-years-old male presented with pain and outward bulging of his right eye with no light perception after trauma to his right eye by a small metallic object while working as electric grasscutter. He presented to our department 3 days following the incident. Systemically, he had a fever, headache and nausea. 2 days after incident, he visited to emergency ward but he was given eye drop only. On Slit lamp examination, corneal melting with keratinization and lacerated wound in cornea at 12 o'clock about 3 mm. Non-contrast CT showing a linear hyperdense foreign body in the right globe likely metal, measuring 3 mm x 4 mm was found. The patient was admitted ceftriaxone intravenous, twice daily. No light perception of visual acuity, ocular penetrating, persistence of the active inflammation, and risk of spread, a decision was made to eviscerate the eye. A metallic foreign body was found in eviscerated tissue.&#x0D; Discussion : &#x0D; Conclusion : Important to suspect foreign body in all cases ocular trauma. Detailed examination and imaging should be performed. Delay treatment from the time of injury, result in poor prognosis. Surgical treatment such as evisceration, should be informed to patient about the visual prognosis.

One-Step Surgical Approach for Treating Lens-Induced Glaucoma with Iridodialysis Following Blunt Trauma

Introduction : Traumatic glaucoma is one of secondary glaucoma that can be challenging to treat. Blunt trauma to the eye may result in iritis, hyphema, lens subluxation, or dislocation leading to increased intraocular pressure (IOP). Every complication needs to be addressed promptly. Here we present about one-step surgical approach to treat lens indued glaucoma with iridodialysis following blunt trauma.&#x0D; Case Illustration : A 65-year-old man presented with a chief complaint of blurred vision and pain in his right eye for a month following blunt ocular trauma where he was hit with piece of wood while operating a chainsaw. Ophthalmologic examination revealed RE VA of 2/60 with IOP 32 mmHg. Anterior examination revealed a shallow anterior chamber, iridodialysis 90 degrees, cloudy lens with phacodonesis (Fig 1). Patient was diagnosed with lens-induced glaucoma, lens subluxation, iridodialysis and traumatic cataract. Patient was treated with antiglaucoma agents prior to surgery. One-step surgical approach: trabeculectomy, phacoemulsification with capsular tension ring, and iridodialysis repair become the treatment of choice (Fig 2). After one month of surgery, IOP decreased to 16 mmHg without anti-glaucoma medication, final VA RE achieved 0.2 (Fig 3).DiscussionManagement of traumatic glaucoma depends on the underlying cause of increased IOP. Trabeculectomy combined with lens extraction should be considered with degree of subluxation that may cause pupillary block. Repair iridodialysis can be done using various techniques.&#x0D; Conclusion : Management of traumatic glaucoma can be done with trabeculectomy, lens extraction and repair iridodialysis in one-step surgery. Surgical technique should be considered depending on the patient’s eye condition.