Severe Ocular Injury Research Articles

Ocular Injury Reduction From Ocular Protection Use in Current Combat Operations

The mechanisms of modern warfare unfortunately have lead to many ocular injuries. This study attempts to quantify the effect of military combat eye protection on the incidence of ocular injury among US service members engaged in current combat operations. We retrospectively gathered data from the Joint Theater Trauma Registry from patients entering level III hospital facilities in Operations Iraqi and Enduring Freedom from March 2003 to September 2006. The presence of ocular injury was the primary outcome measure; whereas severity of injury and the effect of eye protection education on compliance with wearing this protection were secondary outcome measurements. Ocular protection status at the time of injury was documented in 3,276 casualties during the collection period. Of these, 451 of 2,671 (17%) casualties who reported wearing ocular protection sustained an ocular injury and 155 of 605 (26%) casualties who reported not wearing eye protection suffered an eye injury (p < 0.01). After an intense ocular protection education program, there was a 16% increase in compliance of eye protection use in combat. Finally, when the severity of eye injuries are compared using an abbreviated injury scale, casualties with eye protection had decreased injury severity in addition to incidence (p < 005). This study suggests that the military combat eye protection used by military personnel during current combat operations has resulted in significantly fewer and less severe ocular injuries. Further, results from this study may also suggest that Department of Defense educational programs may have been successful in increasing eye protection compliance.

Ocular trauma resulting from paintball injury

Paintball-related ocular injuries result in severe damage and loss of vision. Despite efforts to increase public awareness and improve safety features, the incidence of eye injuries has increased over time. We examined the characteristics and ocular effects of paintball injury at our tertiary referral center. Retrospective review of charts of patients with paintball injury between 1998-2005. Fourteen patients were evaluated for paintball injury; 13 (93%) were male and one (7%) was female. Average age was 17 years (range from 9 to 30). Thirteen patients (95%) did not wear eye protection; one is unknown. Injuries occurred while playing paintball in three patients (21%); ten (71%) were injured in either accidental (four patients) or intentional (six patients) shootings not associated with play. Minimum follow-up was 6 weeks, except for one patient who was lost to follow-up. Seven patients (50%) had final visual acuity (VA) better than 20/200, six patients (43%) were 20/200 or worse, and information on one patient was not available. VA, except in one case, improved with treatment. Decreased VA in this case was due to proliferative vitreoretinopathy (PVR). Hyphema was noted in ten patients (71%), vitreous hemorrhage in eight (57%), retinal hemorrhage in six (43%), retinal tear or detachment in six (43%), commotio retinae in six (43%), iris injury in five (36%), keratopathy in four (29%), lens injury in two (14%), subluxation of lens in two (14%), secondary glaucoma in two (14%), open globe/intraocular foreign body (IOFB) in one (7%), choroidal rupture in one (7%), and proliferative vitreoretinopathy (PVR) in one (7%). Ten patients (71%) required intervention (surgery, laser retinopexy or cryotherapy). Paintball trauma results in significant ocular injury and loss of vision. Most injuries occur in unsupervised settings without proper eye protection. Ten patients (71%) were injured in accidental or intentional shootings. Lack of supervision and use of paintball materials as assault weapons make the risk for ocular injury more significant. Improved safety features of paintball equipment, along with continued education of proper eye protection, may reduce the incidence of severe ocular injuries.

Corneal Injury Due to a Calcium Hydroxide Containing Food Preparation Product ("Cal")

Alkaline chemicals can cause severe ocular injury, leaving the victim with significant visual impairment. Calcium hydroxide is a strong alkali present in some household products. We report a case of corneal alkali burns in a 5-year-old boy due to calcium hydroxide powder ("cal") used in preparation of corn masa. Prompt recognition of "cal" as calcium hydroxide will allow the practitioner to appropriately render effective treatment.

Safety goggles: are they adequate to prevent eye injuries caused by rotating wire brushes?

Rotating wire brushes can cause severe ocular injuries. Wearing safety goggles has been recommended to prevent injury. A case is described of a superficial penetrating eye injury secondary to the...

Multiple facial and scalp injuries from petrol explosion: a case report and literature review.

Background: Severe injuries if not fatal may follow explosive accidents during welding of petrol containers if adequate protective or precautionary measures are not taken. Materials and Methods: This paper describes two non fatal cases of multiple severe maxillofacial and scalp injuries from an explosion during roadside welding of containers used to store petrol. Results: Two male roadside welders aged 38 years, and 40 years sustained multiple severe maxillofacial, scalp, ocular, auricular and finger injuries in an explosion of petrol containers being repaired by them. They received early intensive resuscitation, and meticulous soft tissue repair, and reduction and immobilisation of fractured facial skeleton within three hours of the injury with satisfactory results. Conclusion: Since severe and or fatal injuries are associated with explosions of petrol con tainers during welding, adequate safety measures are suggested that could prevent such accidents from occurring in future. Keywords: petrol container, welding, explosion, facial and scalp injuries.Nigerian Journal of Plastic Surgery Vol. 4 (1) 2008: pp. 20-25

184: Ocular Injury Reduction from Ocular Protection Use in Current Combat Operations

Ocular injuries in soldiers have become common war injuries since the advent of modern warfare. Many injuries, especially ocular, occur on today’s battlefield through explosive and high velocity fragment mechanisms. The purpose of this study is to determine the effect of ocular protection on incidence of severe traumatic ocular injury in soldiers during current combat operations.

Severe surfing-related ocular injuries: the Stanford Northern Californian experience

There is a growing body of literature describing severe surfing-related ocular injuries that result in permanent vision loss. We describe three severe surfing-related ocular injuries that occurred on beaches in...

Traumatic Transection of the Optic Nerve and Evulsion of the Eye Globe: Case Report and Review of Literature

Purpose: To report a case of traumatic transection of the optic nerve (ON) and evulsion of the eye globe in an adult farm worker caused by cow horn and review of literature. Methods: A 50-year-old male farm worker was attacked by an unprovoked cow. In addition to the subdural hematoma, the cow horn transected the ON and evulsed the patient's left eye resulting in total loss of vision. Results: Patient required evacuation of subdural hematoma and the left eye globe was severed from the remaining attached lateral rectus muscle. Conclusion: Unprovoked severe ocular injuries caused by cow horn are rare. To the best of our knowledge, cow horn caused traumatic transaction of the ON and evulsion of the eye globe has never been reported in ophthalmic literature.

Severe Eye Injuries in the War in Iraq, 2003–2005

To document the incidence and treatment of patients with severe ocular and ocular adnexal injuries during Operation Iraqi Freedom. Retrospective hospital-based observational analysis of injuries. All coalition forces, enemy prisoners of war, and civilians with severe ocular and ocular adnexal injuries. The authors retrospectively examined severe ocular and ocular adnexal injuries that were treated by United States Army ophthalmologists during the war in Iraq from March 2003 through December 2005. Incidence, causes, and treatment of severe ocular and ocular adnexal injuries. During the time data were gathered, 797 severe eye injuries were treated. The most common cause of the eye injuries was explosions with fragmentation injury. Among those injured, there were 438 open globe injuries, of which 49 were bilateral. A total of 116 eyes were removed (enucleation, evisceration, or exenteration), of which 6 patients required bilateral enucleation. Injuries to other body systems were common. Severe eye injuries represent a significant form of trauma encountered in Operation Iraqi Freedom. These injuries were most commonly caused by explosion trauma.

Potential Impact of Seatbelt Use on the Spectrum of Ocular Injuries and Visual Acuity Outcomes after Motor Vehicle Accidents with Airbag Deployment

To investigate the association between seatbelt use and (1) the spectrum of ocular injuries and (2) visual acuity outcomes after motor vehicle accidents (MVAs) with airbag deployment. Single-center retrospective observational case series. Forty-seven patients involved in MVAs with airbag deployment. Medical record review of all patients evaluated after an MVA with airbag deployment between January, 1997, and August, 2005, at a single level 1 trauma center. Type of ocular injury and visual acuity at 3 months after an MVA. Seventy-one percent of patients who did not wear seatbelts experienced type III ocular injuries compared with 31% who wore seatbelts (P<0.0002). Posterior segment injuries occurred only in patients who did not wear seatbelts. At the 3-month follow-up, 76% of patients who did not wear seatbelts achieved a visual acuity of 20/40 or better compared with 96% of patients who wore seatbelts (P>0.10); a visual acuity worse than 20/200 was measured in 14% and 0% of patients in the 2 groups, respectively (P<0.03). In the current study, the use of seatbelts was associated with less severe ocular injuries and better visual outcomes.

Severe open-globe eye injuries: socio-demographic aspects and risk factors

To evaluate sociodemographic aspects and risk factors of severe open-globe ocular injuries. We present data from prospective study of 315 patients with severe open-globe ocular injuries, meeting inclusion criteria. The patients in our series were predominantly male (92.70%). The male to female ratio was 12.7:1. Almost 27% of the patients were from the age group of 30-39 years. Home (53.65%), streets and highways (19.05%) were the most common place of injury, followed by industrial premises (11.11%), agricultural activities (8.25%), recreation and sports (5.40%); 15.56% of cases were work-related. Sharp objects (43.17%) and hammering on metal (24.44%) were the two major causes of injury. Alcohol intoxication was observed in 13.65% of cases. Severe open-globe eye injuries were classified into four categories: penetrating injuries (56.83%), perforating injuries (2.54%), globe ruptures (12.38 %), and IOFB injuries (28.25%). Males suffered significantly more often than females in the age of 20-29 (OR=1.39+/-95% CI 1.10-1.75, P<0.01) and 30-39-year (OR=1.75+/-95% PI 1.45-2.22, P<0.01). Risk factors of severe open-globe eye injuries for male gender were living in urban setting (P=0.001), alcohol use (P=0.001), occupation--unemployed (P=0.001) and retired persons (P=0.011). Risk factors for male gender to sustain severe open-globe eye injury were living in urban setting, alcohol use, and occupation (unemployed and retired persons).

Review of 1375 enucleations in the TongRen Eye Centre, Beijing

To review clinical causes for ocular enucleations and the histopathological features of the enucleated globes in a large third-referral centre in China. The retrospective study included 1375 globes enucleated in the Beijing TongRen Hospital between January 2003 and November 2006. The medical records were reviewed, and the clinical indications for enucleation and histopathological findings were evaluated. The enucleated eyes accounted for 0.97% of all operated patients registered in the hospital and for 29.5% of all surgical specimens received in the pathological department. The age distribution showed two peaks at an age group of 0-10 years (main enucleation cause: retinoblastoma) and at an age group of 30-40 years (main cause: trauma). In the whole study group, trauma was the most common clinical diagnosis (62.5%) leading to enucleation, followed by tumours (28.5%), surgically treated or untreated ocular diseases (5.7%), and infectious or inflammatory diseases (1.7%). With respect to the histopathological findings, phthisis bulbi (36.4%) was the most frequent finding followed by ocular malignant tumours (28.5%), and acute severe ocular injury (19.9%). Uveal metastases were the second most common intraocular malignant tumour in adults, in the majority of globes secondary to a primary lung cancer. The rate of 1% of enucleations per patient operated and the relatively high rate of ocular traumata as primary cause for enucleation suggest to improve further safety conditions and primary surgical care. The relatively high rate of ocular tumours as cause for enucleations suggests to promote the wide-spread clinical introduction of chemoradioactive tumour therapy.

Vitrectomy for severe ocular injury

目的 探讨玻璃体手术在治疗严重眼外伤中的应用.方法 对52例(52眼)严重眼外伤施玻璃体手术进行治疗.结果 术后视力较术前提高者37例.28例眼内异物均成功摘出.视网膜脱离25眼有21眼复位.结论 玻璃体切除术有效治疗严重眼外伤,掌握手术适应症和时机,能最大限度挽救视力和眼球。

Full-thickness lamellar keratoplasty and amniotic membrane transplantation for severe ocular surface injury

目的 观察带角膜缘的全板层角膜移植联合新鲜羊膜移植,治疗严重眼表损伤的临床效果.方法 12例(13眼)严重眼表损伤行带角膜缘的余板层角膜移植联合新鲜羊膜移植的回顾性分析.其中,碱烧伤4例(5眼)、酸烧伤5例(5眼)、热烧伤3例(3眼).术后均予以抗感染、抗炎、抗排斥等治疗.术后随访12～24月.结果 所有患眼治疗后均形成了稳定的眼表,保住了眼球,视力均有不同程度的提高.3例(3眼)因严重的眼干燥症,需长期滴用人工泪液.结论 带角膜缘的全板层角膜移植联合新鲜羊膜移植,能有效地修复严重的眼表损伤,具有较好的疗效。

Penetrating ocular injuries in the home

We studied the prevalence and aetiology of penetrating ocular injuries, in particular ones that were sustained whilst undertaking Do It Yourself (DIY) or gardening in the domestic environment. We also examined the extent of eye safety promotion in DIY stores and garden centres and on their websites. We conducted a case note review of patients who underwent surgery for penetrating ocular trauma between January 2000 and June 2004. Eight DIY stores and garden centres and 10 websites were visited and evaluated using standardized questions. Of the 85 patients identified, 35 (41.2%) patients had injuries that occurred in the home with 10 patients having visual acuities of <6/60 at final follow up. Accidents from DIY or gardening were the cause in 17 of 33 (51.5%) patients, with a failure to wear eye protection in all cases. Overall, DIY stores and garden centres were poor at promoting eye safety both in their stores and on their websites. The home is a frequent place for severe penetrating ocular injury, with highly popular pastimes such as DIY and gardening as common causes. As many of these injuries are preventable, additional safety information is essential to educate the public on the potential dangers of these pastimes.

Lipopolysaccharide from Escherichia coli induces the expression of vascular endothelial growth factor via toll-like receptor 4 in human limbal fibroblasts

Corneal neovascularization can be induced by a severe ocular infection, injury or immunological diseases. The vascular endothelial growth factor (VEGF) is the main cytokine involved in this phenomenon, inducing angiogenesis from the vascularized ocular tissues. As the limbal tissue is located between conjunctival and corneal tissues, we suggest that the limbal cells are participating in the production of VEGF induced by bacterial components as LPS. In this work, RT-PCRs and immunoblots were used to investigate the expression of VEGF and other pro-angiogenic genes in primary cultures of human limbal fibroblasts (PCHLF) treated with lipopolysaccharide (LPS) from Escherichia coli. We found that the expression of VEGF was initiated at 6 h and reaches its highest expression at 72 h after stimulation with LPS. Up-regulation of toll-like receptor 4 (TLR4) after 3 h of treatment was also observed. LPS-induced the expression of VEGF in a dose-dependent manner, and the blocking of TLR4 with an anti-TLR4 antibody prevented VEGF expression. We also analyzed the molecules that modulate VEGF expression. LPS did not induce the up-regulation of LL-37 nor the hypoxia induced factor 1 alpha (HIF-1α) mRNA expression, however, an up-regulation of interleukin 13 receptor alpha 1 (IL-13Rα1) and interleukin 4 receptor alpha (IL-4Rα) were observed after 3 and 12 h of stimulation, respectively. The expression of interleukin 13 did not change throughout the treatment. These results suggest that TLR4, IL-13Rα1 and IL-4Rα induced by LPS in PCHLF could be playing an important role in the corneal neovascularization.

O.314 Midfacial fractures: primary treatment and treatment of sequelae

Ocular injuries commonly in patients with facial fractures. This prospective study was set up to determine the incidence of ocular injuries, as assessed by an ophthalmologist, in patients who had sustained midfacial fractures. Over a 2-year period, a study of 363 patients who had sustained midfacial trauma sufficient to lead to a facial bone fracture (438 fractures) was undertaken and patients received a comprehensive examination by an ophthalmologist and an orthoptist within 1 week of injury. The characteristics of the eye injuries sustained were related to the aetiology of the fracture, the type of fracture, and the sex and age of each patient. Ninety percent of patients sustained ocular injuries of various severities. Sixty three percent of patients sustained only minor or transient ocular injuries, 16% suffered moderately severe ocular injury and 12% experienced severe eye injuries. Road traffic accident was associated with the highest incidence of severe ocular disorder (945=20%) whilst assaults had the second highest incidence at 11% (20181). One third of all patients with comminuted malar fracture suffered a severe ocular disorder (927) whilst blow-out fracture came second at 16·7% (636). Fifty six patients (15·4%) had a decrease in their visual acuity and 9 patients (2·5%) had significant traumatic optic neuropathy.Decrease in visual acuity was the main clinical finding accompanying the majority of significant eye injuries. When ocular injuries were related to aetiology, it was apparent that road traffic accidents and assaults associated with alcohol abuse showed the highest incidence of major ocular dysfunction. It is suggested that all patients sustaining midfacial fracture associated with a significant decrease in visual acuity either pre- or postoperatively should have an early ophthalmological review.

Facial Fractures – Association with Ocular Injuries: A 13-Year Review of One Practice in a Tertiary Care Centre

The incidence of ocular injury associated with facial fractures has been reported to be between 0.8% and 30%. Because of this wide range of incidences, a system to stratify the risk of ocular injury by type of facial fracture was sought. The present study reviewed 266 patients with facial fractures to determine the risk factors for ocular injury. The anatomy of each facial fracture was classified using an orbit-centred approach according to the number of orbital walls fractured. Patients were then grouped using this classification system. Charts documenting follow-up for each patient over a minimum of one year were examined and initial emergency room presentations of patients with subsequent visual impairment were recorded. The incidence of severe visual impairment and blindness was 4.5% overall. Although all facial fractures (including isolated fractures of the mandible) had a notable incidence of ocular injury, an increased number of orbital wall fractures were correlated with an increased incidence of permanent visual disability. One of 147 (0.68%) patients without an orbital wall fracture sustained permanent severe ocular injury or blindness, while 13.5% (five of 37) of three-wall orbital fracture patients and 25% (four of 16) of four-wall orbital fracture patients sustained the same injury. The risk of ocular injury in complex facial fractures can be stratified by the degree of orbital wall involvement. However, because all patients with persistent visual impairment had ocular findings on initial examination, it is proposed that oculovisual testing is a more sensitive indicator of lasting ocular injuries than the type of facial fracture.

Penetrating Keratoplasty Combined with Vitreoretinal Surgery for Severe Ocular Injury with Blood-Stained Cornea and No Light Perception

Objective: To evaluate the effects of treatment of severe ocular injury with blood-stained cornea and no light perception by combined penetrating keratoplasty and vitreoretinal surgery, and to analyze the relevant factors. Methods: Records of 7 severely injured eyes of 7 patients with blood-stained cornea and no light perception who underwent penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis were evaluated retrospectively. The preoperative visual acuity was no light perception in all injured eyes with a mean intraocular pressure of 3 mm Hg and a range from 2 to 5 mm Hg. The average interval from emergency wound closure to vitrectomy was 18 days with a range from 12 to 21 days. The mean follow-up was 28 months with a range from 26 to 30 months. Results: The postoperative visual acuity was better than light perception in 5 eyes with the best corrected visual acuity from light perception to 0.06. The retina was attached in 5 eyes. The postoperative intraocular pressure ranged from 5 to 15 mm Hg with a mean of 12 mm Hg; it was significantly higher than the preoperative one (p < 0.05). The postoperative complications mainly included temporary intraocular elevation (1 eye), corneal neovascularization (4 eyes), corneal rejection (4 eyes), retinal detachment (2 eyes) and ocular atrophy (2 eyes). Conclusion: Penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis is a safe and effective method in treating severe ocular injury with blood-stained cornea and no light perception.

Severe Ocular Injury Resulting from Chuna Packets

To describe a mechanism of severe ocular alkali burns occurring as a result of bursting of chuna packets (edible calcium hydroxide paste), a popular additive to chewing tobacco in India. Retrospective case series. Twenty-one patients (25 eyes) who experienced ocular burns as a result of bursting of chuna packets. Patients were treated medically or with 1 or more of the following surgeries: symblepharon release, amniotic membrane grafting, allograft or autograft stem cell transplantation, or both, and large diameter lamellar keratoplasty. The main outcome measures were time interval between the injury and presentation, presenting visual acuity, grade of injury, management (medical therapy or surgical intervention), and final visual outcome at the last follow-up. The average age at time of injury was 8.4+/-5.5 years. The median visual acuity at presentation was light perception with projection. The ocular burns were grade 4 in 23 eyes. Eight of 25 eyes were treated medically, and the rest underwent 1 or more surgeries in the form of symblepharon release (n = 6), amniotic membrane grafting (n = 3), allograft or autograft stem cell transplantation (n = 6), and large diameter lamellar keratoplasty (n = 6). At the final follow-up (mean, 637+/-592 days), median visual acuity was 1/60. Bursting of chuna packets can cause severe ocular alkali burns in children. These patients carry a poor visual prognosis with both medical and surgical therapy.