Ophthalmic Injury Research Articles

Hydrogel dressings on neurotrophic keratitis in an experimental animal model.

To investigate the therapeutic effects of hydrogel dressings on neurotrophic keratitis in rats. Male Wistar rats, aged 42-56d, were randomly divided into control, experimental, and treatment groups, each consisting of five rats. The experimental and treatment groups underwent neurotrophic keratitis modeling in both eyes. After successful modeling, biomedical hydrogels formed with polyvinyl alcohol and polyvinyl pyrrolidone were used in treatment group for 7d. Ocular irritation response and keratitis index scores, Schirmer's test, tear film break-up time (BUT), sodium fluorescein staining, and hematoxylin and eosin (HE) staining were used to evaluate the effectiveness of the treatment. The neurotrophic keratitis model was successfully established in rats with severe ophthalmic nerve injury, characterized by keratitis, ocular irritation, reduced tear secretion measured by decreased BUT and Schirmer test values, corneal epithelial loss, and disorganized collagen fibers in the stromal layer. Following treatment with hydrogel dressings, significant improvements were observed in keratitis scores and ocular irritation symptoms in model eyes. Although the recovery of tear secretion, as measured by the Schirmer's test, did not show statistical differences, BUT was significantly prolonged. Fluorescein staining confirmed a reduction in the extent of corneal epithelial loss after treatment. HE staining revealed the restoration of the structural disorder in both the epithelial and stromal layers to a certain extent. Hydrogel dressing reduces ocular surface irritation, improves tear film stability, and promotes the repair and restoration of damaged epithelial cells by maintaining a moist and clean environment on the ocular surface in the rat model.

Ophthalmic implications of biological threat agents according to the chemical, biological, radiological, nuclear, and explosives framework.

As technology continues to evolve, the possibility for a wide range of dangers to people, organizations, and countries escalate globally. The United States federal government classifies types of threats with the capability of inflicting mass casualties and societal disruption as Chemical, Biological, Radiological, Nuclear, and Energetics/Explosives (CBRNE). Such incidents encompass accidental and intentional events ranging from weapons of mass destruction and bioterrorism to fires or spills involving hazardous or radiologic material. All of these have the capacity to inflict death or severe physical, neurological, and/or sensorial disabilities if injuries are not diagnosed and treated in a timely manner. Ophthalmic injury can provide important insight into understanding and treating patients impacted by CBRNE agents; however, improper ophthalmic management can result in suboptimal patient outcomes. This review specifically addresses the biological agents the Center for Disease Control and Prevention (CDC) deems to have the greatest capacity for bioterrorism. CBRNE biological agents, encompassing pathogens and organic toxins, are further subdivided into categories A, B, and C according to their national security threat level. In our compendium of these biological agents, we address their respective CDC category, systemic and ophthalmic manifestations, route of transmission and personal protective equipment considerations as well as pertinent vaccination and treatment guidelines.

IDENTIFICATION OF NEW BIOMARKERS AND PROMISING NEURO IMAGING OF DIFFUSE AXONAL INJURY: AN OBSERVATIONAL STUDY

Objective: To determine the clinical patterns of the newly identified novel biomarkers of prognosis among adult patients with traumatic brain injury (TBI), diffuse axonal injury (DAI) and ophthalmic injury (OI) and micro bleeds in the Brain. Methods: According to the online search engine from the databases of PubMed, Embase, Ovid Science Direct, and the way of sciences of the original contribution articles which are providing with the essential information about outcome in patients with DAI in general, DAI vs. non-DAI, related to magnetic resonance imaging (MRI) classification , related to lesion and their specific , Specific location/load and their future outcomes. We have gone through the major references and checked their quality control (QC) assessments performed through International standard protocol/guidelines and our own experiences. Results: A total of 585 articles were included. TBI patients with DAI patients favorable outcomes are (75-90 %). The risk associated unfavorable outcome (RAUO) is in TBI with DAI was three to four times higher than in TBI without DAI in our Asian Indian patients.The Odds ratio (OR) for their unfavorable outcome was 2.7 as per increase of DAI grade on the MRI findings. Lesions are located in the area of the corpus callosum (CC) associated with an unfavorable outcomes reported frequently (85-95%). Conclusions: DAI patients management through MRI and patients with with TBI results unfavorable outcome are increasing in larger in numbers day by day in trauma care. MRI grading, locations, pattern of diffuse (POD) and axonal injury rates (AIR) are increasing in their three to four fold with every grade. Associated Lesions in the corpus callosum (CC) are associated with an unfavorable outcomes are those frequently associated with the DAI patients in TBI. Need appropriate diagnosis and management for DAI. Our newly developed biomarkers are quite useful for DAI patients associated within the TBI patients management and follow-up.

Ashes to eye: A skilled snake handler's experience with ophthalmic envenomation.

With the continued growth of human populations, rural urbanisation and habitat degradation are on the rise, resulting in the displacement of native wildlife and an increase in human-wildlife conflicts. The presence of human habitation and waste often attracts rodents and thereby, snakes, leading to increased snake sightings in homes. To address this problem, snake handlers, who are volunteers that remove and relocate snakes away from human development areas, are called upon. However, snake removal is a high-risk task that poses a risk of envenomation, particularly when dealing with spitting snakes. Several cobra species have the ability to spit venom. If the venom enters a person's eye, it can result in ophthalmic envenomation, which can have serious consequences for their eyesight. Therefore, snake handlers should take precautions, wear suitable eye protection, and use appropriate tools to ensure their safety and that of the snake. In this case, an experienced snake handler was called to remove a spitting cobra, but they were ill-equipped. During the removal, the venom was sprayed across the handler's face, and some of it entered their eye, resulting in ophthalmic envenomation. The handler promptly irrigated their eye, but medical treatment was still necessary. This report highlights the risks and consequences of ophthalmic injury and the importance of wearing appropriate eye protection and taking due care when dealing with venomous species, particularly those that can spit venom. It serves as a reminder that accidents can happen at any time and experienced snake handlers are not exempt from the risks.

Utilization of Ophthalmic Management in Patients with Head-and-Neck Trauma Secondary to Firearms.

This retrospective cohort study presents the epidemiology of severe firearm-related ophthalmic injury and the level of ophthalmology involvement in the multidisciplinary management of head-and-neck gunshot injuries. A retrospective study identified 207 patients with firearm-related injuries involving the head and neck treated at an Academic Tertiary Care Institution from 2010 to 2020. Ophthalmology consulted on 29% of patients with head-and-neck firearm injuries. At least one of the services managing facial trauma (plastic surgery and otolaryngology) consulted on 71.5% of cases (P < 0.001). Of patients evaluated by ophthalmology, 93.3% survived to discharge; 78.2% of patients who were not evaluated survived to discharge (P = 0.009). Ophthalmology consulted on all patients with open globe injury (10.6%) (P < 0.001), all of which were evaluated by the facial trauma service (P = 0.002), 77.3% by otolaryngology (P = 0.42), 50% by neurosurgery, 36.4% by plastic surgery, 13.6% by orthopedic surgery, and 4.5% by vascular surgery. Ophthalmology consulted on 76.5% of patients with orbital fracture (32.9%) (P < 0.001); 83.8% were evaluated by the facial trauma service (P = 0.006), 69.1% by otolaryngology (P = 0.014), 54.4% by neurosurgery, 27.9% by plastic surgery, 10.3% by orthopedic surgery, and 2.9% by vascular surgery. For patients with orbital fractures, 92.3% survived when ophthalmology was consulted (P = 0.698); 43.8% survived when not consulted (P = 0.001). Firearm-related injuries of the head and neck frequently involve ocular and orbital structures, often causing serious vision-threatening injuries. Multispecialty management is common and early ophthalmology specialist evaluation and co-management are indicated to best identify ophthalmic injuries.

Community-level awareness of proper immediate steps regarding ocular chemical injury in Asir Region

Background: Although the eyes represent 0.1% of the total human body, such organs are exposed to multiple injuries, some of which possibly lead to permanent loss of vision. Chemical injuries occurring on the eyes is deemed to be a major ophthalmic emergency, requiring immediate clinical assessment and initiation of treatment. Concerning the awareness of the Saudi population regarding the risks of chemical-based ophthalmic injuries and the permanent repercussions brought about by such incidents, together with the proper steps and actions that should be taken in such cases, this has unfortunately still a degree of paucity within the state. In addition, it is of great importance to recognize areas of shortcomings by health care workers, in order to provide accurate and non-complex medical facts regarding chemical-based ophthalmic injuries Aims: This study focused on evaluating the general population’s awareness of the immediate responses that are required, following ophthalmic chemical injury incidents within the Asir province of Saudi Arabia. Methodology: This study contained a questionnaire that was randomly distributed across all segments of population in the Asir province of the Kingdom of Saudi Arabia (KSA), through various social media, entitled ‘The eyes are arguably the most important sensory organ of the human body’. This investigation lasted a total time span of six months (May – October 2021) and its design was classified as a descriptive cross-sectional survey of the local Asir community. Results: In relation to overall population awareness regarding chemical eye injury within the Asir region, KSA, among this cohort, 288 (48%) had good awareness level regarding chemical eye injury and its management, while 312 (52%) had poor awareness. Through our research we found out that individuals in the Asir population require greater awareness regarding the immediate steps of management in cases of ocular chemical eye injuries. Furthermore, there is a need to establish that the only solution required to irrigate the eye is water, with a mechanism of eye washing from the middle part of the face to the tip of the eye. Conclusions: These results should be evaluated by the Ministry of Health and the appropriate actions should be made, such as health awareness campaigns, regarding ocular chemical injuries and immediate corrective actions, in order to improve knowledge and to create a healthier society. Key words: ocular chemical injury, community awareness, Abha

“AN ANALYSIS OF OPHTHALMIC INJURIES IN PATIENTS WITH MAXILLOFACIAL TRAUMA”

PURPOSE OFTHE STUDY: To estimate the proportion and types of ophthalmic injuries in patients with maxillofacial fractures PATIENTS AND METHODS: All patients with maxillofacial trauma, who came to the Department of Oral and Maxillofacial surgery Government Dental college Thiruvananthapuram from November 2020 to June 2021were included in this study. The information and data collected included age, sex, mechanism of injury, type of maxillofacial fracture and type of ophthalmic injury. RESULTS: Ocular injury was sustained by 209 patients out of which 180 (86.1%) were males and 29(13.9%)were females. The largest age group of patients associated with ophthalmic injuries were 30-39 years. The etiology of facial fractures or ocular injuries showed that road trafc accidents more frequently resulted in ocular injuries 66.5% followed by assault 18.7% and self fall 14.8%. Ophthalmic injuries occurred mostly in association with orbital fractures 33.5% followed by Zygomatico maxillary complex fracture 26.8%and Maxillary sinus fractures 24.4%. Periorbital oedema was the most common ophthalmic injury accounting for 46.4%of cases followed by Periorbital ecchymosis 35.4% and Subconjuntival haemorrhage 17.2%. CONCLUSION: Mid facial trauma commonly causes ophthalmic injuries of varying degrees. Prompt ophthalmic examination of all patients with mid facial trauma is mandatory to prevent any blinding complications

Characteristics of Ophthalmic Trauma in Fall-Related Hospitalizations in the United States from 2000 to 2017

ABSTRACT Purpose: Falls is a leading cause of injuries nationally and can lead to serious ophthalmic injuries. The purpose of this study is to examine the incidence and characteristics of ophthalmic trauma in patients with fall-related hospitalizations in the United States. Methods: Retrospective, cross-sectional study. National Inpatient Sample (NIS) was queried to identify all ophthalmic trauma associated with fall-related hospitalizations from 2000 to 2017. Patients were identified using relevant International Classification of Diseases (ICD) codes. National estimates, annual incidences and characteristics were produced from trend weights provided by the NIS sampling frame and population data from the US Census Bureau. Results: There were 21,415,120 fall-related hospitalizations of which 425,725 (2.0%) had ophthalmic trauma. Ophthalmic injury incidence increased from 4.26 to 14.31 per 100,000 population (P < .01) from 2000 to 2017. Mean (±SEM) age was 69.2 ± 20.1 years and 56.9% were females. Of the patients with specified fall mechanism, the most common mechanisms were tripping or stumbling (48.0%), falls related to furniture (18.3%), and falls related to stairs (16.3%). The most common ophthalmic injuries were contusions of the eye and adnexa including hyphema and commotio retinae (50.1%), orbital fractures (20.7%), and eyelid lacerations (14.9%). Conclusions: Incidence of ophthalmic trauma in patients with fall-related hospitalizations has increased and our study provides valuable information for targeting preventive measures particularly for the elderly and falls due to tripping, stairs, and furniture related accidents. The most common associated ophthalmic injuries are contusions, orbital fractures and eyelid lacerations.

Patient Care Guidelines of Ophthalmic Injuries During COVID-19: A Systematic Review

Background: Coronavirus disease 2019 pandemic and lockdown have changed human behaviors and physician practice patterns. Trauma centers reported decreased numbers of injuries during the lockdown. Ophthalmic injuries are urgent conditions and may introduce risks to the health personnel during patient care. Objective: To study the epidemiological trends and to review the guidelines of patient care regarding ophthalmic injuries during the present study period. Materials and Methods: A systematic search was performed in PubMed, Scopus, Cochrane library, and all Web of Science databases. Duplicated and non-relevant articles were excluded. Thirty-eight articles were independently reviewed by all authors, conflicts resolved by consensus. Guidelines retrieved from ophthalmic associations were summarized. Results: The pooled incidence of eye injury was 17.8% (95% CI 10.2% to 29.2%). Eight articles were included in the meta-analysis for changes in numbers of ophthalmic injury cases, which showed no statistically significant change of percentage of cases during the lockdown comparing with the pre-lockdown, Odds Ratio 1.653 (95% CI 0.826 to 3.309), p=0.155). Causes of trauma were mainly from gardening and home improvement projects. Corneal and external eye injury were the main diagnoses. Guidelines of ophthalmic injury patient care stated about the risk stratification, coronavirus disease screening, and the preventive measures to limit virus spread during the caregiving. Conclusion: There was no significant reduction of the incidence of ophthalmic injury during the Coronavirus disease 2019 pandemic and lockdown period. The causes of injury were mainly from the stay-at-home activities. Therefore, the authors suggest that eye protection when doing home maintenance should be advocated to the public for preventive measures even when they are less exposed to the outside environment. When the injuries occur, the primary care at the emergency department should include risk stratification, screening, and prevention of virus spreading as the key roles in the ophthalmic injury patient care. Keywords: Ocular trauma, Ophthalmic injury, Epidemiology, COVID-19, Coronavirus

Consensus of experts on diagnosis and treatment of neurotrophic keratitis in China (2021)

Neurotrophic keratitis is a degenerative disease of the cornea caused by impairment in the trigeminal nerve, which can lead to dry eyes, corneal epithelial defects and corneal ulcers. The common causes include herpes virus infection, craniocerebral and ophthalmic surgery injury, and diabetes. Due to the reduced or lack of corneal sensitivity, patients' symptoms are mild, while severe corneal stroma melting or even perforation may occur. And the conventional symptomatic treatment is not effective. In view of the current lack of clinical understanding of this disease, there are a large number of problems of misdiagnosis and mistreatment. To improve the level of diagnosis and treatment, the consensus of experts on diagnosis and treatment of neurotrophic keratitis, which can be used as a reference for ophthalmologists in clinical work, is formulated by the Cornea Group of Chinese Ophthalmological Society. (Chin J Ophthalmol, 2021, 57:90-94).

EFEITO ADVERSO OFTALMOLÓGICO PELO USO DE HIDROXICLOROQUINA E SEUS ANÁLOGOS

A cloroquina (CQ) e a hidroxicloroquina (HCQ), devido a seus efeitos benéficos, têm sido amplamente utilizados em diversos cenários de terapêutica médica. No entanto, deve-se levar em consideração os importantes efeitos adversos associados à essas drogas, sendo o mais temido o potencial dano oftalmológico, especificamente ao nível da retina. Inicialmente, a CQ foi desenvolvida para o tratamento da malária falciparum, no entanto, no cenário atual é amplamente utilizada em diversas áreas médicas. O risco de toxicidade dessa droga depende da dose diária e da duração do uso, sendo que suas reações adversas podem atingir o trato gastrointestinal, sistema hematológico, neurológico, neuromuscular, dermatológico e cardiológico, sendo, no entanto, os feitos oculares os mais preocupantes, sendo a característica clínica mais conhecida da retinopatia por HCQ a maculopatia bilateral em olho de boi. A fim de minimizar seus efeitos adversos, é preciso que seja feita uma triagem dos pacientes antes do início da terapia com HCQ ou CQ, onde deve ser realizado um exame inicial para avaliar quaisquer condições oculares complicadas, o grau de risco e estabelecer um registro da aparência do fundo e campo visual. Até o momento, nenhuma terapia medicamentosa testada apresentou-se eficaz na prevenção ou no tratamento da retinopatia induzida por HCQ ou CQ. É imprescindível a importância de um acompanhamento dos pacientes em uso dessas medicações. Apesar do risco relativamente baixo esses danos podem ser irreversíveis, mas quando detectados precocemente, maiores serão as chances de que se tenha a preservação da capacidade visual ao suspender o tratamento.

A Clinical Study of the Evaluation and Assessment of the Etiology and Patterns of Ocular Injuries in Midfacial Trauma in a Tertiary Care Hospital.

AimsThe aim is to study the pattern of ocular injuries in midfacial trauma and to evaluate the overall incidence of ophthalmic injury of any severity following maxillofacial trauma.Methods and MaterialsThe maxillofacial surgeon conducted routine facial examination of patients with midfacial fractures, which also included a detailed ophthalmologic examination of patients, at the time of initial presentation. These patients were then further evaluated by an ophthalmologist for thorough examination of the eye.ResultsThe total number of recorded midface maxillofacial trauma cases was 181. Out of 181 patients, 161 had ocular injuries. Among 181 cases, 161 (88.95%) cases were due to road traffic accidents, which was the prime etiologic factor. Out of total 181 patients, 172 (95.03%) were males and 9 (4.97%) were females. The maximum number of cases were of zygomaticomaxillary complex fractures (44.75%) followed by nasal bone fractures (21.5%). Periorbital ecchymosis accounted for the maximum number of cases, amounting to 61.88%. Loss of vision or blindness was seen in eight (4.42%) patients.ConclusionsThe study stresses further on the importance of long-term and continuous data collection and record management of trauma patients, which may help health care providers with necessary information to develop treatment protocols and device measures for the prevention of complications.

Retinal photoreceptor damage produced in guinea pigs by tunicamycin.

Corynetoxins, members of the tunicamycin group of antibiotics, produce a severe and frequently fatal neurological disorder in ruminant livestock, and guinea pigs are a useful model to study the pathology and pathogenesis of this disease. The aim of this study was to determine whether tunicamycin produced ocular damage in this species, which could have pharmacotherapeutic and diagnostic value. Four 8-week-old guinea pigs were treated with tunicamycin, and two control animals were given the drug vehicle only. Guinea pigs were injected subcutaneously with 400 μg/kg of tunicamycin, in dimethyl sulphoxide, and killed 48 h post-injection. The eyes were then examined by light microscopy. Immunohistochemistry for rhodopsin was also performed. The principal pathological finding was marked retinal photoreceptor damage, which was characterised by disruption and disorganisation of rods, sometimes progressing to necrosis and separation of the outer segment. The cytoplasm of some rods was focally distended by accumulated, proteinaceous material. Rhodopsin immunopositivity in injured rods was markedly diminished and associated with shrinkage and shortening of the injured rod's outer segment. Ocular pathology, in the form of reproducible and extensive retinal photoreceptor damage, was found in guinea pigs given tunicamycin, extending the range of species found to be susceptible to this toxic injury. The guinea pig could prove to be a good animal model to test potential therapeutic interventions, and as brain lesions are often minimal and liver pathology non-specific in intoxicated ruminants, any spontaneously arising ophthalmic injury found in these species could be diagnostically useful.

Outcomes and Complications with Topical Epinephrine in Endoscopic Sinus Surgery: A Systematic Review and Meta‐analysis

To assess the safety and efficacy of topical epinephrine in adults undergoing endoscopic sinus surgery (ESS). PubMed, Embase, and Ovid MEDLINE online databases. Non-case report English articles studying the effects of topical epinephrine as the topical vasoconstrictor used in adult ESS were found from the online databases through January 2019. The PRISMA literature selection process was used (Preferred Reporting Items for Systematic Reviews and Meta-analyses). An overall 2216 articles were identified, with 9 meeting inclusion criteria involving a total of 5043 patients. All 9 studies assessed the safety of topical epinephrine, while 5 examined efficacy. Intraoperative average blood loss (ABL) ranged from 60 to 426 mL. Topical epinephrine concentrations varied from 1:1000 to 1:100,000, and 3 major complications were found for a rate of 0.06%. There were no reports of ophthalmic, orbital, or skull base injury, nor were there reports of cerebrospinal fluid leaks. A meta-analysis was performed on the 4 studies examining ABL. Estimated mean (95% CI) ABL was 119.4 mL (39.1-199.6) in the higher-concentration cohort (>1:10,000) and 372.2 mL (296.8-447.5) in the lower-concentration cohort (≤1:10,000) (P = .001). Topical epinephrine is generally safe and provides acceptable hemostasis during ESS, with higher concentrations (>1:10,000) providing improved hemostasis. Caution is advised for its use in patients with preexisting cardiovascular disease or in combination with other topical or injected vasoconstrictive agents. More prospective comparative studies are necessary to determine the ideal hemostatic concentration of epinephrine in ESS.

Management of Mid-Facial Fracture with Ophthalmic Injury

Background: Trauma affecting mid-face often leads to lesions of soft tissues, teeth and bone, damaging the integrity of the orbital skeletons, and is frequently complicated by ophthalmic injury. Careful injury assessment and its complications are important to make optimal treatment decision. The aim of this paper is to present a case of mid-facial fracture with a brief review of the risk of ophthalmic injury and its surgical management preferred by the authors. Case Report: A 19 year-old man was brought to the emergency room with swelling and multiple wounds at facial region after he was involved in a motorcycle accident 30 minutes earlier. Primary survey performed according to Advanced Trauma Live Support (ATLS) showed no live threatening condition. There was asymmetrical face with edema at left cheek and eye. We found no wound intra-orally and teeth occlusion was not possible. After careful physical examinations, we assessed his condition with the following injuries: mid-facial fracture with suspect muscle entrapment of his left eyeball. Laboratory and radiographic imaging were taken to support the diagnostic. The surgical reposition and fixation of the fracture were performed under general anesthesia by an oral maxillofacial surgeon and an ophthalmologist. Reduction using interdental wiring and fixation using plate and screw at facial buttress successfully returned the patient facial contour to its former condition and occlusion was achieved. A catheter balloon was inserted to his left maxillary sinus to obtain normal sinus volume and hold his eyeball to its position. Then the patient was followed up at 1 day, 1 week, and 1 month. Discussion: Treatment of mid-facial fracture focuses on reductions to achieve exact orbital rim alignment, preserve ophthalmic function and normal dental occlusion. Immobilization of fracture requires various combinations of interdental wiring, inter-maxillary fixation, and open reduction with internal fixation. Conclusion: Dealing with mid-facial fracture needs a sharp investigation to produce proper diagnosis. Ophthalmic injury is one of the common injuries accompanying mid-facial injury. Early surgical treatment is preferred to reduce risk of irreversible globe injury and maximizes the functional and cosmetic results.

CLO19-032: Skin Cancer of the Nose: Outcome in 405 Cases Treated With Accelerated High Dose Rate Radiation Therapy

Overview: Between 2013 and 2016, we treated 1,500 cases of nonmelanoma skin cancer using high-dose radiation therapy. In this series, 405 cases involved the nose. Patient selection was limited to age &gt;35 years, tumor size &lt;40 mm in diameter and &lt;5 mm thick. Demographics included 86.7% basal, 12.8% squamous, 1 lymphoma, 1 melanoma. Size by treatment field: 66.9% 10mm, 28.1% 20mm, 4.7% 35mm, and &lt;1% 50mm. Age: 76.8 years median (37.3–99.7 years) Methods: Radiation therapy was administered following guidelines suggested by ASTRO and AAPM using either a 6MeV LINAC electron beam or 50kV x-ray source. The majority of patients received 4,000 cGy in 500 cGy fractions given twice weekly. Prescribed treatment depth was zero (0) mm for non-bulky disease. Bolus was used for all electron treatments. Wax-coated nasal shields were used for lateralized or large midline lesions. Devitalized tumor was debrided and/or treatment depth modified during treatment as needed. Treatment interruptions were rare, usually due to infection, and limited to less than 2 weeks. Results: 99% of patients maintained a complete response at 2 years (0.2–3.7 years) median follow-up, with 1 edge-of-field progression and 1 in-field recurrence. Side effects seen included transient nasal mucositis (10%) limited to lateralized or large midline lesions, superficial infection (&lt;1%) limited to patients with a history of moderate to severe acne and/or patients applying cosmetic concealers during treatment. No chronic nasal dryness, cartilage necrosis, ophthalmic injury, nasolacrimal disruption, or dental complications occurred. Patient satisfaction/cosmesis: patient-scored functional and cosmetic outcomes ranged from very good to excellent in 100% of patients. Conclusion: Accelerated high dose rate radiation therapy using either LINAC electron beam or electronic brachytherapy is an effective and well-tolerated treatment option for carefully selected patients with basal and squamous cell skin cancer of the nose. Response rates for electron beam or low-energy x-rays with this dose schedule were similar. When compared to surgery, radiation therapy results in high patient satisfaction and excellent cosmesis without the need for lengthy postoperative care or reconstruction. When compared to conventional radiation therapy, the high response rates, smaller field sizes, shorter treatment times, and reduced radiation dose to adjacent critical tissues makes electronic brachytherapy a useful addition to standard techniques.

Modeling Microdebrider-Mediated Ophthalmic Damage: A Word of Caution in Endoscopic Sinus Surgery.

The microdebrider has become nearly universal in the treatment of sinonasal pathology; however, recent case reports have demonstrated the potential for major ophthalmic complications. The goal of this study was twofold: 1) determine the anatomical proximity of ophthalmic structures to the paranasal sinuses, and 2) assess the timeframe at which ophthalmic injury may occur with the use of a microdebrider during FESS utilizing a cadaveric model. Computed tomography scans from 50 patients were accessed retrospectively. The distances between the lamina papyracea (LP) and orbital structures were determined at varying depths. Seven cadavers (14 sides) were studied using three microdebrider systems operated by otolaryngology residents. Following removal of a window of LP, the time from activation of the microdebrider on the periorbita until transection of the medial rectus (MR), optic nerve (ON), and to aspiration of the globe were measured. The mean distance between the LP and MR at the level of the anterior aspect of the anterior ethmoid and basal lamella were 3.59 ±1.2mm and 1.5 ±0.8mm, respectively. The mean distance between the LP and ON at the level of the basal lamella was 8.1 ±2.1mm. Mean transection times for the MR and ON were 13.4 ± 7.3 seconds and 37.3 ± 9.2 seconds, respectively, with minimum times of 4 seconds and 26 seconds. The proximity of orbital structures to the paranasal sinuses and the rapidity of ophthalmic damage following violation of the periorbita reaffirms the need for cautious use of the microdebrider during FESS.

Association of Midfacial Fractures with Ophthalmic Injury.

The aim of this study is to evaluate the incidence of ophthalmic complications following midfacial fractures and investigate its relation to surgical or nonsurgical treatment. This article is a retrospective study, describing the spectrum and incidence of ophthalmic injury in 106 patients presenting with midfacial fractures at the Department of Oral and Maxillofacial Surgery of the University Hospitals Leuven over a period of 16 months (January 2013 to April 2014). The mean age of the patients was 45.6 years with a gender distribution of 68 men and 38 women. The main cause of trauma was road traffic accidents. Forty-one patients suffered an ophthalmic injury following the fracture. Twelve of them had a persistent ophthalmic problem. Ophthalmic examination is necessary during the initial management. The time window for preservation of sight is small and treatment should be started immediately. Development of an emergency trauma scale that includes fractures, symptoms of visual impairment, and patient history is recommended and should stimulate a multidisciplinary approach of complex cases.

Imagerie de la maltraitance chez l’enfant

The diagnosis of abuse is often supported by the findings of skeletal and brain imaging. On skeletal radiographs, the main diagnostic argument is the presence of fractures of different ages and/or specific locations (epiphysometaphyseal, posterior arches of the ribs, etc.). Bone scintigraphy is useful for detecting recent infra-radiological lesions. Prognosis depends mainly on damage inflicted on the brain. Brain trauma is often serious, and is the leading cause of death. Brain damage is caused by violent shaking, sometimes associated with a final impact. The brain may be injured despite the absence of any detectable skeletal, dermal, or ophthalmic injury. If abuse is suspected, brain imaging (computed tomography scan in the emergency setting, often supplemented with magnetic resonance imaging in the subacute phase) should be systematic in children younger than 2 years. Lesions may include diffuse bilateral subdural hematomas and deep injury (inter hemispherical tentorium) or intra parenchymal injury (contusion, swelling, anoxic-ischemia or shear damage). Organ damage is rare and non-specific, but must be carefully searched, at least with ultrasound, in young children in this context. Image appropriateness and quality together with the accuracy of interpretation are fundamental for the diagnosis of child abuse that always has very serious consequences. The presence of lesions of different ages is an important but inconstant diagnostic feature to recognize.

Patient Survival after a Very Deep Penetrating Orbitocranial Injury.

Patient Survival after a Very Deep Penetrating Orbitocranial Injury.