Penetrating Eye Injury Research Articles

Observation of successful treatment of acute subdural hematoma in the posterior cranial fossa due to penetrating eye injury

Observation of successful treatment of acute subdural hematoma in the posterior cranial fossa due to penetrating eye injury

Appearance and location of retinal haemorrhages in critically ill children

BackgroundThere are few high-quality studies describing the appearance and location of retinal haemorrhages in critically ill children not due to birth or abusive head trauma.MethodsProspective study from February 2008 to...

Uniocular blindness in a six-year-old boy following penetrating eye injury from a domestic hen peck

Domestic hen pecking eye trauma causes avoidable blindness and the public should guard against it, especially among children.

Polytrauma patient - Ophthalmologist perspective

Ocular trauma is the leading cause of monocular blindness accounting for up to 40%. It can occur in all age groups, most frequent being young males. The incidence of penetrating eye injuries is 3.6 per lakh, while those requiring hospitalization is 15.2 per lakh. Common sources of injury include blunt objects, sports, and road traffic accidents. The current article deals with the examination and management of an ocular emergency in a polytrauma patient.

Pattern of paediatric corneal laceration injuries in the University of port Harcourt teaching hospital, Rivers state, Nigeria

BackgroundCorneal lacerations mostly affect younger children, commonly males, who will constitute the majority of the workforce. Clinical outcomes are reviewed and compared so that measures to reduce their occurrence and improve outcome can be proffered.MethodsRecords of all children between the ages of 1-18 yrs, who presented with penetrating eye injuries at the eye clinic of the University of Port Harcourt teaching Hospital, Rivers state, Nigeria between January 2002 and December 2009 were included. Information retrieved -patient’s Bio data, presenting symptoms, presenting visual acuity (VA), source of injury, surgical intervention and outcome using VA. All data analysed with EPI Info version 6 with the aid of a statistician.ResultsFolders of thirty-six children (36 eyes) between the ages of 0–18 years diagnosed with corneal laceration over a period of 8 years out of 65 cases managed within that period available. Other folders reported as missing. Male female ratio 3:1, the mean age is 8.7 years (SD ± 3.67). Only one presented within 24 hours. Objects causing injury mainly missiles with stones/catapult injuries (n = 8, 22.2%). Presenting VAs in those that could be measured, ranged from 6/24 to 6/60 (n = 4, 11%) to no light perception (NLP) (n = 5, 13.9%). Associated injuries include lid laceration, cataract, vitreous haemorrhage and retinal detachment. Twenty one patients had primary corneal repair (58.3%) carried out within 7 days of presentation. Four had endophthalmitis. After 3 months follow up, VA of 6/60 and better was achieved in 11 of 18 eyes left in follow up (6/60-6/24 in 8 eyes (22.2%), 6/18 and better in 3 eyes (8.3%).ConclusionMost eye injuries in children are preventable. In this study, the prognosis was better in those whose injuries were confined to a peripheral part of the cornea, with no other associated injury, who presented within 5 days and who did not have any intraocular infection at the time of presentation. The importance of health education, adult supervision of play and application of appropriate measures that is necessary for reducing the incidence and severity of trauma is emphasized.

Proliferative Response of Lymphocyte to Pokeweed Mitogen Depends on the Concentration of Endogenous Cortisol in the Early Post-Traumatic Period in Patients with Penetrating Eye Injury

The intensity of lymphocyte proliferation in response to pokeweed mitogen depends on cortisol level in the peripheral blood in the early post-traumatic period of penetrating eye injury. Lymphocyte proliferation in 72- and 96-h cultures from patients with high levels of endogenous hormone was suppressed. In 120-h cultures, the intensity of proliferation remains unchanged. Lymphocyte blast transformation was increased in 120-h cultures from patients with normal cortisol concentration and remained unchanged in case of low cortisol level.

Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India

We studied the demographic profile and outcome of traumatic cataract after penetrating and blunt ocular trauma in children in northern India. We reviewed the medical records of children with penetrating and blunt ocular trauma associated with traumatic cataract who underwent cataract surgery with posterior chamber intraocular lens implantation and having more than 1 year follow up. We evaluated the demographic characteristics and visual outcome in the affected eye. Of the 100 children (100 eyes), 65 were penetrating trauma and 35 were blunt trauma. The common modes of injury in the penetrating group were wooden splinters in 30.8% and bow and arrow in 15.4%. Fire crackers and trauma during play with ball were seen in 34% and 11.4% of blunt eye trauma, respectively. The age ranged from 1 to 14 years (mean, 7.8 years) in the penetrating trauma and 2 to 15 years (mean, 8.3 years) in the blunt trauma group. The best corrected visual acuity of 20/40 or better was achieved in 57.6% eyes in penetrating group compared with 71.4% in the blunt trauma group. Visually significant posterior capsular opacification developed in 32.3% eyes in penetrating group and 28.6% eyes in blunt trauma group. Glaucoma was diagnosed in 4.6% eyes in penetrating group and 8.6% in blunt trauma group. Eye injuries with traumatic cataract are associated with significant visual impairment. There were more children with penetrating eye injuries as compared with blunt trauma. Cataract surgery with intraocular lens implantation is a preferred method for visual rehabilitation in these children. Epidemiologic study, level IV.

Comparison of EyeCam and anterior segment optical coherence tomography in detecting angle closure

To compare the diagnostic performance of EyeCam (Clarity Medical Systems, Pleasanton, CA, USA) and anterior segment optical coherence tomography (ASOCT, Visante; Carl Zeiss Meditec, Dublin, CA, USA) in detecting angle closure, using gonioscopy as the reference standard. Ninety-eight phakic patients, recruited from a glaucoma clinic, underwent gonioscopy by a single examiner, and EyeCam and ASOCT imaging by another examiner. Another observer, masked to gonioscopy findings, graded EyeCam and ASOCT images. For both gonioscopy and EyeCam, a closed angle in a particular quadrant was defined if the posterior trabecular meshwork was not visible. For ASOCT, angle closure was defined by any contact between the iris and angle anterior to the scleral spur. An eye was diagnosed as having angle closure if ≥2 quadrants were closed. Agreement and area under the receiver operating characteristic curves (AUC) were evaluated. The majority of subjects were Chinese (69/98, 70.4%) with a mean age of 60.6 years. Angle closure was diagnosed in 39/98 (39.8%) eyes with gonioscopy, 40/98 (40.8%) with EyeCam and 56/97 (57.7%) with ASOCT. The agreement (kappa statistic) for angle closure diagnosis for gonioscopy versus EyeCam was 0.89; gonioscopy versus ASOCT and EyeCam versus ASOCT were both 0.56. The AUC for detecting eyes with gonioscopic angle closure with EyeCam was 0.978 (95% CI: 0.93-1.0) and 0.847 (95% CI: 0.76-0.92, p < 0.01) for ASOCT. The diagnostic performance of EyeCam was better than ASOCT in detecting angle closure when gonioscopic grading was used as the reference standard. The agreement between the two imaging modalities was moderate.

SUTURELESS 23-GAUGE VERSUS 20-GAUGE VITRECTOMY WITH SILICONE OIL INJECTION IN RHEGMATOGENOUS RETINAL DETACHMENT

To report the efficacy of 23-gauge (G) pars plana vitrectomy with silicone oil injection in rhegmatogenous retinal detachment. Retrospective chart review of consecutive patients with retinal detachment who underwent pars plana vitrectomy by one of two surgeons using distinct and consistent methods. All patients undergoing 23-G pars plana vitrectomy did not have scleral buckling, whereas all patients undergoing surgery by 20-G pars plana vitrectomy had additional 240-band encircling scleral buckle. All patients received silicone oil tamponade. Patients with proliferative vitreoretinopathy Grade D, previous retinal detachment surgery, and penetrating eye injury were excluded. The main outcome measure was the final anatomical reattachment rate. The secondary outcome measures were the improvement in visual acuity and recurrence rate of retinal detachment after primary surgery. Eighteen patients in the 23-G group and 21 patients in the 20-G group were analyzed. The mean age of the patients was 48.05 ± 10.37 years and 42.57 ± 17.84 years in the 23-G and 20-G groups, respectively. The mean follow-up duration was 5.9 months (range, 2-12 months) and 6.2 months (range, 4-9 months) in the 23-G and 20-G groups, respectively. The primary reattachment rate was 83.3% (95% confidence interval, 66.11%-100%) in the 23-G group and 86.8% (95% confidence interval, 67.81%-100%); P = 1.00) in 20-G group. The mean preoperative logarithm of the minimum angle of resolution visual acuity was 1.30 ± 0.57 (Snellen equivalent 20/400) in the 23-G group and 1.27 ± 0.70 (Snellen equivalent 20/400) in the 20-G group (P = 0.80). The mean logarithm of the minimum angle of resolution visual acuity at 1 month after the surgery was 0.66 ± 0.25 (Snellen equivalent 20/100) in the 23-G group and 0.77 ± 0.50 (Snellen equivalent 20/120; P = 0.46) in the 20-G group. The visual acuity at the last visit was 0.80 ± 0.52 (20/125) versus 0.65 ± 0.44 (20/100) in the 23-G and 20-G, respectively (P = 0.32). Silicone oil injection with 23-G system is possible and is associated with favorable anatomical success in cases of rhegmatogenous retinal detachment.

The effect of polyoxidonium on immune response and morphological parameters of inflammation after experimental penetrating eye injury

The effect of polyoxidonium on immune response and morphological parameters of inflammation after experimental penetrating eye injury

Intraocular Femtosecond Laser Use in Traumatic Cataracts Following Penetrating and Blunt Trauma

To investigate the use of femtosecond laser cataract surgery in traumatic cataracts of different origin. The first case developed acute traumatic cataract due to penetrating injury of the cornea and the anterior lens capsule; the second developed traumatic cataract 11 years after a penetrating corneal injury; and the third developed a "white" cataract 12 months after blunt ocular trauma. In all cases, 4.5-mm capsulorrhexis and corneal incisions were performed using a femtosecond laser system (Alcon LenSx Inc), and nucleus liquefaction with the laser was performed additionally in the second case. In all patients, a capsulorrhexis could be created with the femtosecond laser. Preexisting radial tears were present in the first case, but the remaining anterior capsule could be cut with the laser. The second and third cases showed an intact 4.5-mm capsulorrhexis. Corneal incisions were stable in all cases, and nucleus liquefaction was possible in the second case (grade 1-2 nuclear density). Results indicate that a femtosecond laser can be used successfully in certain instances of traumatic cataract after penetrating eye injury, even if an anterior capsule laceration is present, and also after blunt trauma resulting in "white" cataracts.

CT Severity Spectrum of Penetrating Eye Injuries From Blasts

Penetrating eye trauma from blasts can result in a vast spectrum of ocular injuries. Several cases of orbital trauma are reviewed, all of which occurred during combat operations and treated in an Air Force Theater Hospital. Computed tomography was used as the primary imaging modality and proved crucial in determining the extent of ocular injury. This report focuses on factors we believe affect globe salvageability, reviews imaging modalities in theater, and briefly discusses management in theater and aeromedical evacuation after initial injury.

The factors affecting the development of phthisis bulbi after penetrating eye injuries

We aimed to investigate the factors affecting the development of phthisis bulbi after penetrating eye injuries. The medical records of 132 patients admitted to our clinic between 2000-2006 with the diagnosis of penetrating eye injury were collected. The records of the eight patients who developed phthisis bulbi were evaluated retrospectively. The aspects of anatomic localization, type of trauma, associated events, and development of phthisis bulbi were also investigated. The mean age of the eight patients (5 males, 3 females) was 7.12±4.70 years (range: 2-16 years) and the mean follow-up time was 2.06±1.47 years (range: 6 months-5 years). Three of eight patients developed post-perforation endophthalmitis. Three patients had zone 2-3 scleral perforation and associated retinal detachment and the remaining two patients had proliferative vitreoretinopathy according to the trauma; all eight patients eventually developed phthisis bulbi. The mean time for the development of phthisis bulbi was 5.5±2.13 months (range: 3-10 months). After penetrating eye injuries, visual prognosis and development of phthisis bulbi were affected significantly by the factors including anatomic localization, size of the injury, associated anterior or posterior segment pathologies, and endophthalmitis secondary to the trauma.

Juxtapontine abscess around a retained wooden fragment following a penetrating eye injury: surgical management via a transtentorial approach

Penetrating injury through the orbit with a retained intracranial wooden foreign body is rare. The authors report the case of a child with a juxtapontine brain abscess secondary to a retained foreign body. The pitfalls in diagnosis and the surgical management for removal of the wooden fragment and drainage of the abscess are discussed.

Presumed occult globe rupture resulting in sympathetic ophthalmia

IntroductionSympathetic ophthalmia (SO) is an uncommon bilateral granulomatous panuveitis following uveal trauma to one eye. We present an unusual case of SO which resulted from presumed occult globe rupture following blunt trauma; and highlight the association of trauma and acquired external ocular pigmentation as a possible predictor for SO.Case reportFive weeks following blunt trauma to the left eye (OS), a 30-year-old patient presented complaining of spontaneous blurred vision (4/60) in the right eye (OD). In the OD, there was anterior chamber and vitreous inflammation (3+), multiple areas of serous retinal detachments, Dalen Fuchs spots, and optic disk swelling. In the OS, there was iridodialysis, post-traumatic acquired external ocular pigmentation suggestive of occult globe rupture.This was diagnosed as SO and treated with systemic steroids and a steroid sparing agent; which resulted in resolution of the inflammation with improvement in the visual acuity.ConclusionSympathetic ophthalmia has been reported to occur following penetrating eye injury secondary to trauma and surgery, and also secondary to non-penetrating eye trauma. This case reports SO occurring after presumed occult globe rupture; and reinforces the association between acquired external ocular pigmentation and SO in the context of trauma.

Kosten- und Leistungsheterogenität bei penetrierenden Augenverletzungen und Amnionmembranaufnähungen unter DRG-Bedingungen

Patients with penetrating eye injuries are a very heterogeneous group both medically and economically. Since 2009, treatment involving sutures for open eye injuries and cases requiring amniotic membrane transplantation (AMT) were allocated to DRG C01B of the German diagnosis-related group system. However, given the significant clinical differences between these treatments, an inhomogeneity of costs to performance is postulated. This analysis describes case allocation problems within the G-DRG C01B category and presents solutions.A retrospective analysis was conducted from the standardized G-DRG data of 277 patients with open eye injuries and AMT between 2007 and 2008, grouped under the 2008 G-DRG system version to the G-DRG C01Z category. This data was provided by the Department of Ophthalmology at the University Hospital Regensburg. Additionally case-based data of the following were supplemented: length of surgery, time of anesthesia and intensity of patient care. Fixed and variable costs were determined for surgery and other inpatient treatment. Finally, an analysis of the heterogeneity of costs within the G-DRG C01B of the G-DRG system 2009 was implemented.Inhomogeneity was evident within the G-DRG C01B of the G-DRG system 2009 for the two groups suture of open eye injuries and AMT concerning the parameters length of stay, proportion of high outliers and cost per case. Multiple surgeries during an inpatient stay lead to an extended length of stay and increasing costs, especially within the AMT group. Intensity of patient care and the consideration of patient comorbidity did not yield relevant differences.The quality of the G-DRG system is measured by its ability to obtain adequate funding for highly complex and heterogeneous cases. Specific modifications of the G-DRG structures could increase the appropriateness of case allocation for patients with open eye injuries within the G-DRG C01B of the German DRG system 2009. As a result of the present study, cases with amniotic membrane transplantation should not be allocated to the G-DRG C01B. A petition has been presented by the German Association of Ophthalmology (DOG) to the German DRG Institute to restructure the G-DRG C01B. Data-based analysis is an essential prerequisite for a constructive development of the G-DRG system and a necessary tool for the active participation of medical societies in this process.

Penetrating eye injury from a crayfish antenna

This is the first reported case of eye injury caused by a crayfish antenna. A 20-year-old male crayfish diver sustained a scleral penetrating injury that led to a subconjunctival abscess. The foreign body was histologically similar to a crayfish antenna.

Penetrating eye injuries from writing instruments

PurposeTo consider the potential for ocular injury from writing implements by presenting four such cases, and to consider the incidence of such eye injuries from analysis of a national trauma database.MethodsThe Home and Leisure Accident Surveillance System was searched for records of eye injuries from writing instruments to provide UK estimates of such injuries. Four patients with ocular penetrating injury from pens or pencils (especially when caused by children), and examined by the authors, are described which illustrate mechanisms of injury.ResultsIt is estimated that around 748 ocular pen injuries and 892 ocular pencil injuries of undetermined severity occurred annually in the UK during the database surveillance period 2000–2002. No eye injuries from swords, including toy swords and fencing foils, were reported.ConclusionOcular perforation sometimes occur from writing instruments that are thrown in the community, especially by children. Implications for policy and prevention are discussed. Non-specialists should have a low threshold for referring patients with eye injuries if suspicious of ocular penetration, even where caused by everyday objects, such as writing instruments.

Wii eye injury: Self-inflicted globe rupture and vision loss in a 7-year-old boy from a video game accident

The Nintendo Wii is a home video game console released in November 2006. It is distinguished by its Wii Remote, a wireless controller that can be used as a handheld pointing device. We report a self-inflicted penetrating eye injury, late retinal detachment, and vision loss in a 7-year-old boy resulting from the use of a Wii Remote. To our knowledge, this is the first reported case of severe ocular trauma from use of a wireless game controller.

OUTCOMES OF DELAYED VITRECTOMY IN OPEN-GLOBE INJURIES IN YOUNG PATIENTS

The timing of vitrectomy for severe penetrating eye injury to the posterior segment remains controversial; this is particularly pertinent if patients are children and young adults. We present our results of the surgical procedure in young patients after penetrating eye injury using a delayed approach. Noncomparative interventional study of patients up to 29 years of age who had vitreoretinal surgery for penetrating eye injury. Surgical procedure was performed in seven eyes of six patients. Posterior vitrectomy was performed because of hemophthalmos after waiting for a mean of 49 days (range, 17-90 days) after posterior vitreous detachment was confirmed on ultrasound examination. The mean postoperative follow-up period was 22 months (range, 9-35 months). Of the 7 patients, 6 (85.7%) achieved visual acuity (Snellen acuity) of 6/12 or better and 4 eyes (57.1%) reached 6/6. At the last follow-up, all patients were pseudophakic, 2 required secondary lens implants, and retinal detachment developed in 1 patient. This consecutive case series underlines the fact that a delayed approach is compatible with good visual prognosis in relatively young patients.