Severe Eye Injuries Research Articles

Eye Injury Incidence in Germany from 2008 to 2022: An Analysis of Hospital Quality Reports.

Eye injuries range from minor to severe and may lead to permanent visual impairment. There is still little in the way of epidemiological data on eye injuries in Germany. The aim of this study was to obtain an objective record of minor and severe eye injuries in Germany by evaluating hospital quality reports. We also investigated the relevance of injuries from fireworks in relation to the total number of eye injuries and the general population. This retrospective routine data study entailed analysing hospital quality reports from 2008 to 2022 in XML format. The R programming language was used for data processing and statistical analysis. The number of ICD-coded eye injuries was exported and analysed together with location data. We also included data from a prospective survey study on fireworks-related eye injuries from 2016 to 2023. Eyeball and/or orbital contusions are the most common eye injuries treated in Germany at up to 2,500 cases per year. The most severe injuries comprise traumatic globe rupture with loss of intraocular tissue at up to 990 cases per year. Numbers of eye injuries of any type have been declining since 2020. As a percentage of population, Mecklenburg-Western Pomerania treats the most eye injuries at up to 0.017%; in absolute numbers, North Rhine-Westphalia leads the country at up to 1,600 injuries. Private firework displays are probably responsible for 1.4% of annual globe ruptures and 8.3% of eyeball contusions. Our analysis of hospital quality reports has provided the first comprehensive epidemiological record on eye injuries in Germany. Firework-related injuries account for a relevant proportion of total injuries. These results could serve as a basis for preventive measures and health policy decisions.

Association between paediatric eye injuries, later aca-demic success and social performance

<p><strong>Aim</strong> <br />To investigate an association between eye injury and later academic and social performance.<br /><strong>Methods</strong> <br />A retrospective longitudinal study of taking measurements multiple times was conducted including all severe eye injuries admitted during 2011-2017 at the main regional clinic to investigate changes in academic success and social inclusion before and after an injury. Parents/caregivers were surveyed asking questions on academic performance, and community/social involvement. In 2023 data on employment status were obtained. Kappa (ĸ) and non-parametric Wilcox-on signed-rank test for multiple comparisons were used. For association of employment status and post-injury visual acuity Fisher score was tested.<br /><strong>Results</strong> <br />The total sample for assessing social inclusion and academic success was 36 and 25 children, respectively. In the following academic year ĸ agreements decreased from 0.88 (p<0.001) comparing pre-injury with a one-year post to 0.5106 (p<.0001) in the second year and 0.4750 (p=0.003) in the third, suggesting a deteriorating trend. A comparison of academic success before injury to two and three years after injury showed the trend significantly worsening with time (p=0.005, and 0.003, respectively). No association between an eye injury and social inclusion, as well as between employment and final visual acuity was noticed. <br /><strong>Conclusion</strong> <br />Our findings suggest no association between social inclusion, employment, and eye trauma, while in later years academic success may be more impacted by the eye injury. Due to eye injury unpredictability in childhood age, both an informed and supportive climate environment at home and school is essential to minimize deleterious responses to eye trauma.</p>

Artificial intelligence, adversarial attacks, and ocular warfare

PurposeWe explore the potential misuse of artificial intelligence (AI), specifically large language models (LLMs), in generating harmful content related to ocular warfare. By examining the vulnerabilities of AI systems to adversarial attacks, we aim to highlight the urgent need for robust safety measures, enforceable regulation, and proactive ethics. DesignA viewpoint paper discussing the ethical challenges posed by AI, using ophthalmology as a case study. It examines the susceptibility of AI systems to adversarial attacks and the potential for their misuse in creating harmful content. MethodsThe study involved crafting adversarial prompts to test the safeguards of a well-known LLM, OpenAI's ChatGPT-4.0. The focus was on evaluating the model's responses to hypothetical scenarios aimed at causing ocular damage through biological, chemical, and physical means. ResultsThe AI provided detailed responses on using Onchocerca volvulus for mass infection, methanol for optic nerve damage, mustard gas for severe eye injuries, and high-powered lasers for inducing blindness. Despite significant safeguards, the study revealed that with enough effort, it was possible to bypass these constraints and obtain harmful information, underscoring the vulnerabilities in AI systems. ConclusionAI holds the potential for both positive transformative change and malevolent exploitation. The susceptibility of LLMs to adversarial attacks and the possibility of purposefully trained unethical AI systems present significant risks. This paper calls for improved robustness of AI systems, global legal and ethical frameworks, and proactive measures to ensure AI technologies benefit humanity and do not pose threats.

Principal and Secondary Diagnoses Related to Eye Injury: Characteristics from a tertiary center in Northern Thailand

OBJECTIVE This study aimed to explore the epidemiological characteris-tics of primary and secondary diagnoses of eye injuries requiring hospitali-zation in a tertiary referral center. METHODS The medical records of 726 patients with diagnoses of eye injury who were admitted between January 2016 and December 2019 were reviewed. RESULTS Four hundred and thirty-six of the patients (60.1%) were hospitalized with a principal diagnosis related to eye injury, while 290 patients (39.9%) were admitted with secondary diagnoses. Over the four-year period of study, the proportion of admissions with a principal diagnosis stayed consistently in the range of 54.0% to 63.9%. Most of the patients in the principal diagnosis group were age between 41 and 60 years. Patients in the secondary diagnosis group, however, were mostly between the age of 21 and 40 years. The majority of patients in the principal diagnosis group (267 patients, 61.2%) had eye injuries which had occurred at work, whereas in the secondary diagnosis group most (230 patients, 79.3%) had eye injuries resulting from traffic accidents. CONCLUSIONS Work-related accidents and traffic accidents were the two main types of at-risk behaviors in both the primary and secondary diagnosis categories. Initiatives for public health education related to eye injuries should pay more special attention to these two primary causes of severe eye injuries. KEYWORDS principal diagnosis, secondary diagnosis, eye injury, hos- pitalization

The Importance of Initial Management in Ocular Chemical Burn: A Case Series

Introduction : Ocular chemical injuries are true emergency which requires immediate intervention. Delayed management may result in severe eye injuries. This report aims to describe the effectivity of initial management and medical treatment of ocular chemical burns.
 Case Illustration : We reported four cases of ocular chemical injuries due to alkaline, acidic, and unspecified chemical compound. All subjects were men, aged 30 to 50 years old. They had injuries at work and none of them used eyewear protector. Each was brought to emergency unit in less than 2 hours. They were given initial timely irrigation until pH neutralized. Ocular damages were evaluated using Roper-Hall Classification, three cases were Roper-Hall 2 and other was Roper-Hall 3. After initial management, all cases were treated with medical treatment and showed significant improvement. After 6 months follow up, there weren’t any long-term sequelae in all subjects.
 Discussion : Serious eye damage results from strongly alkaline or acidic compounds. Most critical factor is timely delivery of irrigating fluid. Irrigation should ideally be performed with isotonic saline or lactate ringer solution and continued until the pH neutralized to a physiological level. Any method of irrigating the eye is preferable than delay in elimination of the destructive chemical. Medical treatments in acute management of severe ocular chemical burns are anti-inflammatory therapy, halting epithelial and stromal breakdown, promoting re-epithelialization and promoting corneal stromal healing.
 Conclusion : Timely irrigation of the eye effectively reduces severity of chemical burns, reduces need for surgical intervention, and improves final visual acuity if combined with medical treatment in golden period.

Epidemiology of older adult patients with ocular and periocular injuries and risk factors for severe injuries: a multicenter, observational study

In an aging society, the annual frequency of older adult patients with ocular and periocular injuries has consistently increased. We aimed to identify the epidemiological characteristics and factors associated with severe ocular and periocular injuries in older adult patients. This retrospective, multicenter study was conducted using the regional eye injury registry of four tertiary teaching hospitals at a single metropolitan city in the Republic of Korea from August 2016 to December 2020. We enrolled adult patients aged ≥65 years and classified them as having severe or mild eye injuries. Next, we compared the epidemiological characteristics of the two study groups and determined the risk factors associated with severe eye injury through logistic regression analyses. Of the 1185 older adult patients, 279 (23.5%) had severe eye injuries. Males comprised most (823, 69.5%) of the study population. The most common location wherein the injury occurred was the street/highway for men and the home for women. Fall was the most common causative activity; however, farm work or mowing predominated as reasons for men and home activity for women. Multivariable logistic regression analysis revealed that male sex (adjusted odds ratio (aOR): 1.91, 95% confidence interval (95% CI): 1.34–2.77), 70–74 years (aOR: 1.49, 95% CI: 1.05–2.11), hammering/nailing (aOR: 5.84, 95%CI: 1.71–21.75), and mowing (aOR: 2.51, 95% CI: 1.04–6.60) acted as risk factors for severe eye injury. In conclusion, older adult patients with ocular and periocular injuries occurred more commonly among men, and the most common causative activity of injury was a fall. Severe eye injury tended to occur in men aged 70–74 years while performing hammering/nailing and mowing activities.

Prospects for predicting long-term treatment outcomes in patients with combat ocular trauma

Introduction. The analysis of experience in changing approaches to organizing medical care for combat eye injuries, changing treatment tactics for such patients during armed conflicts in the 20th and 21st centuries, domestic experience in providing medical care for eye and its adnexal injuries, highlights the search for informative methods of predicting long-term outcomes of the applied treatment methods. The aim of the study was to determine the informativeness of constructing a forecast of functional changes of the visual analyzer based on the results of treatment of patients with eye injuries during dynamic retrospective observation. Materials and Methods: The primary material for the study was medical documentation of combat eye injury patients (data from medical histories, outpatient cards, and discharge summaries) for the period of 2014-2015, who were treated at the National Military Medical Clinical Center "Main Military Clinical Hospital" (NMMCC "MMCH"). Indicators of the functional state of the visual analyzer were evaluated upon admission to the NMMCC "MMCH" and after 180 days following the injury. The study used the proposed F. Kuhn and colleagues' scale for evaluating long-term treatment outcomes (OTS-Ocular Trauma Score). Results. It was found that overall, the results of treatment for combat eye injuries and their adnexa at the NMMCC "MMCH" during the study period of 2014-2015 showed a high correlation with the calculated values of the probability of preserving visual functions according to the OTS scale. Almost all patients with a case of blindness remained blind in the injured eye six months later. In the group with light projection and movement of the hand near the face, an improvement in visual function in most cases (65%) was noted, while, according to the OTS scale, these patients in most cases remain in this group or move to the group with blindness. Cases with visual acuity of 0.005-0.1 after 6 months improve visual acuity with the transition in most cases to 0.1 and above. The same trend, but, as expected, with a higher probability in groups with visual acuity of 0.1-0.4 and above 0.5. The identified discrepancies justify the need for adaptation of the OTS scale for predicting functional changes in combat eye injuries, as it has been developed for use in eye injuries during peacetime. Conclusion: Considering the large number of wounded soldiers with severe eye injuries during the war with rf, scientific research on the implementation of a system for predicting long-term functional outcomes of the treatment of combat eye trauma based on clinical data at the time of initial examination remains relevant. The results obtained with the OTS (Ocular Trauma Score) assessment scale in most cases correspond to the results of the treatment of injured patients in the ophthalmology clinic of the NMMCC "MMCH" in 2014-2015. Further development of the existing OTS system and its adaptation to domestic conditions and the realities of providing ophthalmic care for combat eye trauma is promising for further study.

Анализ причин удаления глазного яблока на современном этапе

Retrospective analysis of the case histories of 243 patients (111 men and 132 women) aged 6 months to 96 years who underwent eye removal operations (22 eviscerations and 221 enucleations) was conducted. In the structure of clinical indications for enucleation and evisceration of the eye dominated severe pyo-inflammatory processes (infectious ulcer with corneal perforation, endophthalmitis, panophthalmitis, chronic sluggish uveitis with the threat of sympathetic ophthalmia) – 46.5 %. The percentage of malignant neoplasm (melanoma and retinoblastoma) is 27.9 %. Painful absolute glaucoma was the cause of enucleation in 18.9 %, severe eye injury in 6.5 % of patients. Radical surgeries were more often performed in women of the older age group with inflammatory pathology and oncopathology, men were more often operated on for painful absolute glaucoma and eye injury. Keywords: еnucleation; еvisceration; аnophthalmia

Material risk: vitreoretinal surgery, evisceration, enucleation and sympathetic ophthalmia-where are we currently?

Sympathetic ophthalmia (SO) is known to occur after severe penetrating eye injury, evisceration and even enucleation surgery. Recent evidence suggests that a greater risk lies after multiple vitreoretinal procedures. The risk of SO following evisceration is only minimally greater than that following enucleation surgery. This review evaluates literature on SO to date and provides figures for the risk of developing SO for the purposes of the consent process. The issue of SO and Material Risk following vitreoretinal surgery is reviewed and figures for the purposes of consent are outlined. This is of particular relevance for patients in whom the contralateral eye is and will likely remain the better seeing eye. Sympathetic ophthalmitis is known to occur after severe penetrating eye injury, after evisceration and enucleation. More recently, sympathetic ophthalmitis has been recognised to occur after vitreoretinal surgery. This article reviews the evidence on material risk when consenting patients for elective and emergency eye procedures after ocular trauma or surgery. When a globe needs to be removed because of irreparable ocular injury, previous publications dictated the procedure to be an enucleation because of the fear of an increased risk of SO after an evisceration. Perhaps the issue of material risk of sympathetic ophthalmia (SO) remains over-emphasised by ophthalmic plastic surgeons and under-recognised by vitreoretinal surgeons during the consent process for evisceration, enucleation and vitreoretinal surgery. Antecedent trauma and number of previous surgeries may actually be a more significant risk factor than the type of eye removal. Recent medicolegal cases also help us understand the importance of the discussion of this risk. We present our current understanding of the risk of SO after different procedures and suggest how this information may be included in a patient consent.

Ocular trauma, visual acuity related to time of referral and psychosocial determinants, during COVID‑19 pandemic: A prospective study.

The aim of the present study was to explore the associations between visual outcomes of ocular injury patients in a tertiary hospital unit with clinical and demographic variables and to evaluate the psychosocial impact of the injury on the patients. An 18-month prospective study of 30 eye-injured adult patients was conducted in the General University Hospital of Heraklion, Crete, a tertiary referral hospital. All severe eye injury case information was prospectively collected between February 1, 2020 and August 31, 2021. Best corrected visual acuity (BCVA) was labelled not poor (>0.5/10 or >20/400 on the Snellen scale, <1.3 in LogMAR scale) and poor (≤0.5/10 or ≤20/400 on the Snellen scale, ≥1.3 on the LogMAR equivalent). Data regarding participants' perceived stress levels, by using Perceived Stress Scale 14 (PSS-14), were collected prospectively, one year after study end. Out of 30 ocular injury patients selected, 76.7% were men and most of them were self-employed and private or public sector workers (36.7%). Not poor final BCVA was related to not poor initial BCVA [odds ratio (OR) 1.714; P=0.006]. No statistical associations were found between visual outcome and demographic or clinical factors, but not poor final BCVA was associated with improved self-reported psychological condition of the sufferers, as examined by a questionnaire sheet developed to collect information for study purpose (8.36/10 vs. 6.40/10; P=0.011). No patient reported job loss or changed work status following the injury. Not poor initial BCVA was a significant predictor for not poor final visual outcomes (OR 1.714; P=0.006). Patients with not poor final BCVA expressed higher levels of positive psychology (8.36/10 vs. 6.40/10; P=0.011) and less fear of eye injury repetition (64.0 vs. 100.0%; P=0.286). Not poor final BCVA was associated with low PSS-14 scores one year after study end (77.3 vs. 0.0%, P=0.003). Collaboration between ophthalmologists, mental health professionals and primary care team may be important in order to help patients to cope with the psychosocial burden sequel to eye trauma.

Severe chemical eye injuries - clinical outcomes and associated socio-economic factors.

To describe clinical outcomes, management, and socio-economic impact of severe acute chemical eye injuries in a tertiary hospital. 37 patients required emergency admission to the Royal Victoria Infirmary eye ward between April 2013 and September 2015. Demographics, best corrected distance visual acuity (BCDVA), causative agent, degree of limbal stem cell deficiency (LSCD), management and socio-economic data were evaluated. Mean age on admission was 34.5 years (SD 16.3; range 16-82); 30 males (81.1%); 22 bilateral (59.5%). Causative agent: alkali in 30 cases (81.1%); acid in three cases (8.1%); and unknown in four cases (10.8%). Fifteen cases (40.5%) were assaults, 12 (32.5%) work-related accidents, nine (24.3%) domestic accidents and one (2.7%) undetermined. Eleven patients (29.7%) were unemployed, 18 (48.6%) were labourers, three (8.1%) were students, three (8.1%) were retired and two (5.4%) were professionals. Mean admission time was five days (SD 3.2; range 1-12). Mean follow-up time was 170.5 days (range 1-946). Mean cost of admission was £2478 (range £274-5785). Five patients (13%; seven eyes) developed total or partial limbal stem cell deficiency, all being assaults. Main causative agent in our study was alkali, with young men in the working age being most frequently involved. Many patients required prolonged hospital admission and costly follow-up. The majority of cases were assaults, mostly occurring in unemployed patients. All the limbal stem cell deficiency cases were due to assaults. We believe that socio-economic factors play an important role in the cause, severity and cost of chemical eye injuries. Acute chemical eye injuries have a significant and extensive impact on patients' visual function outcomes and vision-related quality of life, with consequent enormous burden to affected individuals, their families and society. We believe that by understanding the socio-economic environment, we may not only be able to enforce safety measures to tackle the increasing rate of severe chemical eye injuries in our community, but also to develop collaborative programmes with the community, educating the population on the seriousness of chemical eye injuries, and with the local authorities, trying to understand the clustering of assaults in areas and tackling the associated socio-economic risk factors, such as unemployment. Given the increasing rate of assaults using chemicals in recent times, it is also important to assess availability of adequate victim support programmes and develop good interaction with relevant local, regional and national authorities to ensure all aspects of community security service are in place to be able to address any potential deficiencies in line with police and home office guidelines. Keeping in mind that the best action plan is always prevention. However, when an ocular injury does occur it is evident that significant morbidity and visual sequelae can result and affect the socio-economic status of the victims despite our best current medical and surgical care.

Расширенный подход к первичной микрохирургической обработке обширных проникающих ранений склеры с одномоментной витрэктомией и герметизацией хориоретинального дефекта

Background: the current strategy for managing extensive zone 3 scleral lacerations implies delayed subtotal vitrectomy. A high rate of poor treatment outcomes requires novel approaches to surgical debridement of lacerations given anatomical and pathogenic specifics. Aim: to assess the treatment results of extensive zone 3 scleral laceration surgery by simultaneous vitrectomy and chorioretinal wound debridement. Patients and Methods: 14 patients (14 eyes) diagnosed with extensive penetrating scleral/corneoscleral laceration and polymorphic intraocular lesions associated with grade 4–5 visual impairment were enrolled. All patients underwent primary microsurgical debridement using a technique that involved external debridement and suturing of scleral laceration, single-step subtotal vitrectomy, and internal debridement of the chorioretinal wound. The chorioretinal wound was filled with pure platelet-rich plasma (P-PRP). Endotamponade was performed using silicone oil (n=9) or air-gas mixture (n=5). Results: after 6 months, visual acuity (VA) was estimated to be 0.02–0.5 in 12 patients and light perception in 2 patients. During the follow- up, no phthisis bulbi was reported. The progression of proliferative vitreoretinopathy (formation of intraretinal adhesions or subretinal bands involving healthy retina) was reported in 3 patients (21.4%). Chorioretinal scars were characterized by local nonaggressive proliferation, no prominence in the vitreous cavity, or proliferation of tissue beyond the scars. Conclusion: our approach to severe eye injury management has demonstrated positive outcomes by providing a stable anatomical result, significant improvement in early and late postoperative VA. KEYWORDS: open globe injury, primary microsurgical debridement, proliferative vitreoretinopathy, scleral lacerations, vitrectomy, platelet- rich plasma. FOR CITATION: Shamkin S.S., Subbotina S.N., Stepanyants A.B., Salov D.V. Advanced approach to primary microsurgical debridement of extensive scleral lacerations involving simultaneous vitrectomy and chorioretinal wound closure. Russian Journal of Clinical Ophthalmology. 2023;23(3):124–128 (in Russ.). DOI: 10.32364/2311-7729-2023-23-3-3.

Pandemic-related sales ban of fireworks in Germany leads to asignificant reduction of firework-related eye injuries

The continuous recording of eye injuries caused by fireworks around New Year's Eve over 6 years allows us to investigate injury numbers, injury patterns, and accident histories in ayear to year comparison. In order to relieve the burden on hospitals during the COVID-19 pandemic, aban on the sale of firework articles was implemented in Germany for 2020/2021 and 2021/2022. We investigate the impact of these measures on the number of fireworks-related eye injuries and analyze whether this led to an increase in serious injuries and an association with increased use of homemade pyrotechnics or pyrotechnics potentially not approved in Germany. We used our online questionnaire to collect anonymized data on patients, accident history, and, since 2017/2018 information on the acquisition of firework articles. Our analysis included data from 2151 affected individuals. While data of about 500 injured were entered per year before the pandemic, this number decreased to 79in 2020/2021 and 193 in 2021/2022. The proportion of severe eye injuries requiring inpatient care ranged from 21% to 26% in the years before the pandemic but ranged from 27% to 34% in the pandemic years. At the same time, under the sales ban the proportion of fireworks that were homemade or unofficially purchased increased from 3% to nearly 10%. In terms of absolute numbers, however, there were 67accidents involving unofficially purchased pyrotechnics compared with 1675 incidents involving officially purchased or unidentified fireworks, which can be explained by the high proportion (about 50%) of injured bystanders. The absolute number of patients with eye injuries caused by pyrotechnics decreased under the pandemic conditions from about 500 to 79or 193. The use of fireworks designated as unofficially purchased was proportionally low even under the sales ban, and plays aminor role compared to injuries with officially purchased fireworks articles.

Changing trends in ocular trauma during the COVID-19 pandemic in the USA

Background/aimsThe COVID-19 pandemic has been associated with a decline in emergency department (ED) presentations for trauma. The purpose of this study is to compare the estimated number and characteristics of...

Клинический случай обширного субконъюнктивального разрыва склеры с благоприятным исходом

Aim. To present a clinical case of severe open injury of the eyeball of a con-tusion nature with the presence of intraocular complications and to show that de-spite the significant severity of the injury, good results can be achieved. Material and methods. Patient injured his right eye at home with a metal tip on a rubber band, after which his vision sharply decreased, pain and lacrimation of the right eye appeared. Objectively: vision of the right eye pr. l. certae, intraocular pressure (palpation) - hypotension. No foreign body was found on the survey radi-ograph of the orbits. An ultrasound B-scan revealed hemophthalmus, and subse-quently (after 7 days) retinal detachment appeared. The patient underwent vitrec-tomy, tamponade of the vitreous cavity with silicone oil, endolaser coagulation of the retina. Results. On the 1st day after the operation, the visual acuity increased to 0.4 with correction (shp +8.0). 3 months after discharge from the hospital, the patient had complete safety of the eyeball and stable functional results were achieved, where the visual functions of the injured eye were 0.5 with correction (shp + 8.0). Conclusions. A clinical case of severe open eye injury with extensive sub-conjunctival rupture of the sclera, hemophthalmos and retinal detachment demon-strates that, despite the severity of the injury, with timely provision of high-tech surgical care, there is a real chance of saving the eyeball and get high visual func-tions. Key words: Traumatic vitreous haemorrhage; vitrectomy; subconjunctival rupture of the sclera; retinal detachment.

Epidemiology and visual outcome of severe eye injuries in a tertiary center of Gandaki Province of Nepal

Introduction: Ocular trauma is an important worldwide preventable public health problem which may lead to permanent visual impairment. This study aims to determine the demographics, clinical profile and visual outcome of severe eye injuries.&#x0D; Methods: This study was conducted at a tertiary centre from January 2013 to August 2014. Cases of severe eye injuries hospitalized at or presenting to emergency/OPD were included in the study. All cases underwent detailed examination and necessary intervention. Cases were followed upto 3 months and final visual outcome was evaluated.&#x0D; Results: The study comprised of 60 individuals (65 eyes); 76.7% males and 23.3% females. Out of 60 cases, the age group 1-9 years had the highest occurrence with 23.33% followed by 20-29 years with 20% and majority were students 45%. Impact with stone was the commonest cause of injury reported on 21.7% followed by road traffic accident (RTA) 20%. Closed-globe injuries accounted for 36.6% and open-globe injuries for 33.3%. At the time of presentation, visual acuity of less than 6/18 was seen in 71.6% and at follow up was seen in 45%. Among total cases, 63.3% eyes were managed conservatively, 30% eyes underwent surgery and 6.7% were referred to higher centre for vitreoretinal surgeries.&#x0D; Conclusions: Severe eye injuries were seen in 0.13% of total eye injuries. Paediatric and young adult males formed the majority of victims. Stone and road traffic accidents were the common causes. One fourth of the eyes were blind. Primary prevention and management of the affected cases is the clear need.

Penetrating eye injury by dart

Darts are constantly gaining in popularity. However, their risk of injury is often underestimated. This report is about a juvenile who suffered from a severe eye injury including the opening of the eye bulb. The attending ophthalmologists ruled out the possibility that this kind of injury could be caused by a dart with a plastic point. However, by reconstructing the course of action and throwing darts at porcine eyes, the forensic medical advisory opinion was able to state that darts with damaged plastic points may cause the exact same form of injury. This casuistic illustrates the essential significance of forensic-traumatological knowledge and, especially in the case of rare injury patterns, case-related practical experiments.

Silicone oil: physical properties and clinical use (a literature review)

Introduction. In modern vitreoretinal surgery, silicone oil is used for replacing the vitreous body during vitrectomy. This surgery is performed to treat retinal detachment, proliferative retinopathy, giant retinal tears and severe eye injuries. In this regard, it seems especially relevant to provide a description of the physical characteristics of silicone oils that determine the choice of surgeons.Purpose. To study indications for the use of silicone oil tamponade as well as possible complications associated with its use based on a literature review and own research.Materials and methods. We analyzed literature on PubMed, eLibrary, and Medline over the past 30 years. Overall, 34 sources of literature were reviewed, including results of our own clinical studies.Results. Literature review has shown that silicone oils are very useful as a permanent tamponade. Although gas tamponade can be used for giant retinal tear management, silicone oils are used for minimizing the risk of post-surgical bleeding and reattach detached retinas in case of severe eye injuries. One of the main issues related to the use of silicone oils is the post-surgical increase in IOP. To reduce the risk of such complication, we have proposed methods of infusion and optimal schedule of silicone oil removal.Conclusion. Silicone oil is the optimal choice for treating most retinal diseases and improving their prognosis. An important criterion for choice of silicone oil is the time that is required for tamponade.

Long-term Health Outcomes Among Survivors Exposed to Sulfur Mustard in Iran

The prevalence and severity of long-term health complications after exposure to sulfur mustard are unknown. To investigate the long-term health outcomes among survivors exposed to sulfur mustard during the Iran-Iraq War. In this retrospective cohort study, late-onset health complications of 64 190 Iranian survivors exposed to sulfur mustard during the Iran-Iraq War from 1980 to 1988 were investigated using descriptive statistics. Data involving affected organs and symptom severity were extracted from the Veterans and Martyr Affair Foundation (VMAF) database from 1980 to 2019. Assessments were conducted across 3 groups depending on whether survivors were (1) evacuated and admitted (EA) to a hospital; (2) not evacuated or admitted (NEA) to a hospital; or (3) evacuation or admission status was not documented. Analysis of chronic symptom severity following exposure to sulfur mustard. Mild, moderate, or severe rankings of symptoms in lungs, eyes, and skin of survivors exposed to sulfur mustard using data from the VMAF database. Of 64 190 chemical survivors registered in the VMAF database, 60 861 met the inclusion criteria. Of the included survivors, 98.0% were male, and the mean (SD) age was 23.5 (7.7) years. Most survivors (53 675 [88.2%]) had no symptoms or mild lesions, and 7186 survivors (11.8%) had moderate or severe complications. Moderate to severe lung (6540 [10.7%]), eye (335 [0.6%]), or skin (725 [1.2%]) injuries were documented in the exposed population. The proportion of moderate plus severe late complications in eyes was 3 times as high in male survivors compared with female survivors (0.6% [95% CI, 0.53%-0.65%] vs 0.2% [95% CI, 0.09%-0.73%]; P < .001), whereas dermal complications were significantly more common in female survivors (3.9% [95% CI, 2.92%-5.11%] vs 1.14% [95% CI, 1.06%-1.23%]; P < .001). Mild lung lesions were more prevalent in the NEA group than in the EA group (73.9% [95% CI, 73.4%-74.4%] vs 11.0% [95% CI, 10.6%-11.3%]; P < .001). In the NEA group, 83.2% (n = 23 866) developed lung injuries that were mostly mild or moderate, whereas 77% (n = 24 766) of the EA group did not develop lung injuries (P < .001). The present study found sex differences in the frequencies of eye and skin complications following sulfur mustard exposure, and lung complications were more prevalent years after sulfur mustard exposure than soon after exposure. Mild lung lesions were observed more frequently among sulfur mustard-exposed survivors who had not been evacuated or hospitalized than among those who had been evacuated or hospitalized. These differences may be due to physiological response or dose of exposure. Close monitoring over an extended period may be required for detection of late pulmonary complications in individuals exposed to sulfur mustard.

Risk Factors of Severe Eye Injury in Work-related Eye Injuries: A Registry-based Multi-Center Study

Risk Factors of Severe Eye Injury in Work-related Eye Injuries: A Registry-based Multi-Center Study