Traumatic Eye Injury Research Articles

Mixed Gangliocytoma-Pituitary Adenoma: Incidental Discovery During Eye Injury Evaluation: A Case Study

Abstract Introduction/Objective Mixed gangliocytoma-adenoma is exceedingly rare, representing less than 0.5% of sellar tumors. We present a unique case of mixed gangliocytoma-pituitary adenoma incidentally diagnosed during the evaluation of traumatic eye injury. We aim to clarify the diagnostic process using real clinical data, stressing how such cases might be missed without careful histopathological examination Methods/Case Report A 32-year-old male presented for elective transsphenoidal resection (TSR) due to a suspected growth hormone (GH) secreting pituitary tumor. Surprisingly, the adenoma was discovered incidentally during an eye injury evaluation. Referred from an ophthalmology clinic, initial concerns were a possible blood clot or foreign body in the left eye, following a forceful encounter with a tree branch Results (if a Case Study enter NA) Imaging incidentally identified a 2 cm pituitary mass. Further evaluation showed elevated levels of insulin-like growth factor 1 (IGF1) at 1162 ng/ml and GH at 10.2 ng/ml. Remarkably, the patient had not observed signs of acromegaly, until photographic comparison between past and present appearances was made. TSR of the pituitary mass was done. Microscopic examination revealed monomorphic cells with round nuclei with the typical speckled chromatin pattern of neuroendocrine cells with cytoplasm ranging from chromophobic to eosinophilic, consistent with pituitary adenoma. An additional unexpected finding was the presence of large gangliocytic cells (large neurons), dispersed throughout the tumor as single or clustered cells. In some regions, distinct patches of fine neuropil stroma were associated with the clustered ganglion cells. IHC staining with synaptophysin and neurofilament highlighted the gangliocytic component. CAM 5.2 IHC stain showed perinuclear dot-like expression in the adenoma cells, GH IHC showed patchy expression, and prolactin IHC was expressed in scattered cells. Ki67 index was ~ 2%. There was no evidence of necrosis nor mitosis. The coexistence of sellar gangliocytoma with pituitary adenoma, as observed in this case, represents a rare entity known as mixed gangliocytoma-pituitary adenoma Conclusion The adenomatous component of mixed gangliocytoma-pituitary adenoma often secrete GH, leading to its classification as pituitary somatotroph adenoma. This poses a diagnostic challenge due to the lack of specific symptoms or unique brain imaging features, necessitating thorough histological evaluation for precise diagnosis and to ensure the gangliocytoma component is not overlooked

The Predictive Value of Computed Tomography Findings for Poor Visual Outcome in Traumatic Eye Injury.

Background The prognosis of visual outcome is important for patients and healthcare providers and guides proper decision-making in traumatic eye injury. In this study, we have evaluated the predictive value of computed tomography (CT) scan findings for poor visual outcomes in patients with traumatic eye injuries. Methods In a retrospective survey, documents of 200 patients with traumatic eye injury who underwent a diagnostic orbital CT scan were reviewed. Disorganized or collapsed globe, intraocular foreign body or gas, increased or decreased anterior chamber size, hemorrhage in the anterior or posterior chamber, crystalline or intraocular lens dislocation, posterior sclera thickening, globe borders haziness, orbital fracture, orbital hemorrhage, and foreign body, optic canal, and optic nerve injuries are the diagnostic clues for eye injury in CT scan. The predictive value of CT scan findings for poor visual outcome was calculated by sensitivity, specificity, accuracy, predictive values, hazard ratios, and binary logistic regression model. Results The sensitivity, specificity, accuracy, and positive predictive values showed to be high. However, there was a low negative predictive value of CT findings for the prediction of poor vision. Among the investigated factors, disorganized/collapsed globe (HR 47.72, CI 6.13–371.62), increased/decreased anterior chamber size (HR 5.04, CI 2.57–9.88), hemorrhage in anterior/posterior chamber (HR 3.58, CI 1.900–6.774/3.62, CI 1.90–6.89), globe borders haziness (HR 3.06, CI 1.33–7.01), orbital foreign body (HR 3.66, CI 1.11–12.05), and optic canal/nerve injury (HR 21.62, CI 4.73–98.78) reached the statistical significance for increasing the hazard ratio for poor visual outcome in patients with a traumatic eye injury. Logistic regression analysis showed only evidence for disorganized/collapsed globe and optic canal/nerve injury in orbital CT scan as independent predictive factors for poor visual outcome. Conclusion CT scan findings can be used as prognostic factors for visual outcomes in patients with a traumatic eye injury.

Unmet Needs of Individuals With Acute Traumatic Eye Injury

Introduction: Although traumatic eye injuries can have a far-reaching impact on an individual and society, traumatic eye injury has not been a focus of research. The purpose of this study is to examine individuals’ experiences after traumatic vision loss and identify their needs. Methods: We used a qualitative approach to conduct semi-structured interviews with individuals who experienced traumatic vision loss and were treated at a specialty eye hospital in an urban setting. Participants also completed a demographic survey and the National Eye Institute Visual Functioning Questionnaire–25 (VFQ-25). Content analysis was used to analyze qualitative data and descriptive statistics were used to summarize quantitative data. Results: Interviews with 26 participants resulted in three categories of patient needs: informational, functional, and psychosocial. Participants wanted more information from providers about what to expect over time and identified driving as a significant challenge that affected their daily lives. Participants offered suggestions for addressing their functional needs including assistance with transportation to appointments, physical therapy, and occupational therapy. Participants also discussed how vision loss affected their livelihood and finances, with a subset of participants experiencing significant mental health distress. Some participants suggested that a recovery coach, peer support, support groups, and mental health services would be beneficial for addressing their psychosocial needs. Discussion: Our findings point to a significant gap in services available to meet the needs of individuals with traumatic eye injuries. Future research is needed to test the effect of an integrated-care model that includes routine offering of psychosocial and functional services for patients with acute vision loss to determine the effect on outcomes. Implications for Practitioners: This work has far-reaching implications for providers, since it supports the need for the development and delivery of integrated interventions that emphasize addressing psychosocial and functional aspects of recovery.

The psychosocial impact of losing an eye through traumatic injury and living with prosthetic restoration: A thematic analysis

This study aims to explore the psychosocial factors and challenges affecting the lives of those who wear an ocular prosthesis following a traumatic eye injury. Thematic analysis of semi-structured interviews with eight individuals resulted in five themes: emotional devastation in the aftermath; moving forward; fear of negative social evaluation; keeping it normal - protecting self and close others; and threat of injury & blindness. Enucleation or evisceration of an eye causes significant emotional stress. Despite successful prosthetic restoration, many individuals continue to experience ongoing psychosocial challenges, as a consequence of their experiences of visible difference and visual impairment.

Ocular Lesions and Neurologic Findings in Traumatic Birds: A Retrospective Evalution of 114 Cases

This study was conducted to identify the occurrence and types of trauma-related ocular disorders in 114 birds belonging to 39 species. For this purpose, both detailed neurological examination and ophthalmologic examina-tion results of the birds admitted to our clinics with a trauma history or trauma findings are presented. Thirty cases were evaluated to suffer from trauma-related eye injuries. Uvea lesions (n=12) were the most frequent disorder of traumatic eye injury. On cranial nerve assessment, anisocoria, pupillary light reflex, menace response, globe and third eyelid position, palpebral reflex, and nystagmus were evaluated. The most frequent neurologic finding of traumatic eye injury was anisocoria (n=9). Ophthalmologic examination accompanying neurological examination is the most important fac-tor in the early management of traumatic birds.

Microsphere antioxidant and sustained erythropoietin-R76E release functions cooperate to reduce traumatic optic neuropathy

Wild-type erythropoietin (EPO) is promising for neuroprotection, but its therapeutic use is limited because it causes a systemic rise in hematocrit. We have developed an EPO-R76E derivative that maintains neuroprotective function without effects on hematocrit, but this protein has a short half-life in vivo. Here, we compare the efficacy and carrier-induced inflammatory response of two polymeric microparticle (MP) EPO-R76E sustained release formulations based on conventional hydrolytically degradable poly(lactic-co-glycolic acid) (PLGA) and reactive oxygen species (ROS)-degradable poly(propylene sulfide) (PPS). Both MP types effectively loaded EPO-R76E and achieved sustained release, providing detectable levels of EPO-R76E at the injection site in the eye in vivo for at least 28 days. Testing in an in vitro oxidative stress assay and a mouse model of blast-induced indirect traumatic optic neuropathy (bITON) showed that PPS and PLGA MP-mediated delivery of EPO-R76E provided therapeutic protection. While unloaded PLGA MPs inherently increase levels of pro-inflammatory cytokines in the bITON model, drug-free PPS MPs have innate antioxidant properties that provide therapeutic benefit both in vitro and in vivo. Both PLGA and PPS MPs enabled sustained release of EPO-R76E, providing therapeutic benefits including reduction in inflammation and axon degeneration, and preservation of visual function as measured by electroretinogram. The PPS-based MP platform is especially promising for further development, as the delivery system provides inherent antioxidant benefits that can be harnessed to work in complement with EPO-R76E or other drugs for neuroprotection in the setting of traumatic eye injury.

Diagnosis of Traumatic Eye Injuries With Point-of-Care Ocular Ultrasonography in the Emergency Department

Traumatic eye injuries are common emergency department presentations worldwide, and diagnosis may be delayed because of concurrent injuries and lack of guidelines in regard to the utility of clinical examination, computed tomography (CT), and point-of-care ultrasonography. In this study, we compare point-of-care ultrasonography with ophthalmologist clinical examination and CT for 6 types of traumatic eye injury. We conducted a prospective cohort study evaluating patients with suspected traumatic eye injury who were recruited atan academic medical center in Tabriz, Iran. Each patient was evaluated by an emergency physician with point-of-care ultrasonography using a 7- to 15-MHz linear transducer, by a radiologist with orbital CT imaging, and by an ophthalmologist with acomplete bedside ocular examination. Obtained results were tabulated. Sensitivity, specificity, and likelihood ratios were subsequently calculated. Cohen's κ was assessed to evaluate the agreement between ocular point-of-care ultrasonography with orbital CT and point-of-care ultrasonography with complete bedside ocular examination. Two hundred thirty-two patients (351 eyes) with suspected traumatic eye injury were included. In all measures of accuracy, diagnosis by point-of-care ultrasonography compared favorably with CT and a complete bedside ocular examination byan ophthalmologist in the 6 ocular injury patterns included in this study. Compared with CT imaging, point-of-care ultrasonography provided a specificity of 99.4% (95% confidence interval [CI] 97.8% to 99.9%) and a sensitivity of 96.8% (95% CI 83.3% to 99.9%) in the diagnosis of lens dislocation, and a specificity of 99.7% (95% CI 98.3% to 100.0%) and sensitivity of 95.7% (95% CI 78.1% to 99.9%) in the diagnosis of retrobulbar hematoma. Compared with complete bedside ocular examination by an ophthalmologist, point-of-care ultrasonography provided a specificity of 98.7% (95% CI 96.7% to 99.6%) and sensitivity of97.8% (95% CI 88.2% to 99.9%) in thediagnosis of vitreous hemorrhage. In all injury types, positive likelihood ratios were highand negative ones were low. Point-of-care ultrasonography demonstrates high sensitivity and specificity in the diagnosis of traumatic eye injury, and represents a valuable diagnostic tool in addition to orbital CT and complete beside ocular examination by an ophthalmologist in the diagnosis of traumatic eye injury.

Prevalence of ocular morbidity among children aged 17 years or younger in the eastern India

PurposeChildhood ocular morbidity involves a spectrum of eye diseases that critically impact the mental development, future education and quality of life. However, there is limited evidence about the early detection and appropriate treatment of ocular morbidity in children <20 years. This study was aimed to assess the prevalence and make a comparison between the different types of ocular morbidity in children of both sexes in the age group of 6–17 years in the eastern India.MethodsA cross-sectional survey of ocular morbidity among children <17 years of age who presented at the Department of Ophthalmology, Kalinga Institute of Medical Sciences, Bhubaneswar, and Vision Care Center for Retina, Bhubaneswar, in the eastern India between January 2015 and March 2018 was accomplished. Demographic information, visual acuity, type of eye injury, refractive errors and other detailed ophthalmic examination were screened.ResultsA total of 633 children (age 6–17 years) were examined in this study. The majority of cases were observed in children of age 12–17 years, accounting for almost close to half of all the cases. The prevalence of ocular morbidity was 45.92% in males and 53.97% in females. The most common ocular morbidity in children encountered was refractive error (54.62%), followed by congenital abnormalities (9%), allergic conjunctivitis (8.52%) and traumatic eye injury (7.1%). There was an increase in ocular morbidity with age, especially the refractive error and congenital abnormalities.ConclusionA large number of ocular morbidity was observed in children of age <17 years. Since most of this morbidity was preventable or treatable, reasonable service for ocular morbidity and early age screening are effective methods to reduce this load. Moreover, health education for the prevention of childhood ocular morbidity and, at the same time, early presentation of children to ophthalmic hospitals for the treatment of eye disorders are essential.

New approaches to managing open globe eye injuries with a thermoresponsive sealant

Traumatic eye injury is the leading cause of unilateral blindness worldwide, especially in developing countries. Open globe injuries, which have the tendency to lead to severe visual impairment, account for about 10% of these injuries (1). The risk for open globe injury was highest in young adults (2) who were actively engaged in economic activities; therefore, open globe injuries not only affect the quality of life and economic condition of patients, but also cause a great deal of cost for society as a whole (3).

Survey of Traumatic Glaucoma in a Tertiary Hospital

Background: Traumatic eye injury is one of the most common causes of unilateral blindness worldwide and it remains a core root of avoidable blindness worldwide. Traumatic glaucoma can result in severe visual impairment. Recognition of factors related to poor visual outcome, appropriate medical therapy, surgical intervention when indicated and careful follow up will help in preserving vision in these patients. This study is aimed at determining the frequency, clinical forms and types of therapy of traumatic glaucomas as seen in our hospital. Methods: All consecutive patients with ocular injury who received treatment at the eye clinic of Ekiti state university teaching hospital, Ado Ekiti, from January 2012 to December 2014 were selected for the study. All subjects had thorough ophthalmic examinations. The patients with ocular injury and subsequently developed glaucoma were selected extracting from the medical records the demographic data, visual acuity at presentation, clinical form of glaucoma and various therapies for management. The data were analysed using SPSS version 18 (Illinois, Chicago, USA) and presented as tables, and figures, in frequencies, percentage. Result: A total of 5568 patients were seen during this study at the ophthalmology clinic, 365 of them had ocular trauma out of which 31(8.5%) was traumatic glaucoma. Peripheral anterior synerchae (29%), adherent leucoma (16.1%) and Hyphema (16.1%) were the common clinical manifestations (anatomic changes) of traumatic glaucoma. The clinical types of traumatic glaucoma are secondary open angle glaucoma (54.8%) which is higher than the secondary closed angle type (45.2%). 22 (71%) of these patients had medical interventions with antiglaucoma drugs. Conclusion: The prevalence of traumatic glaucoma is 8.5%, this glaucoma may result in severe visual impairment if treatment is not instituted early.

Actinobacillus ureae Isolated After Traumatic Eye Injury

<i>Actinobacillus ureae</i> Isolated After Traumatic Eye Injury

Traumatic endophthalmitis caused by Nocardia kruczakiae in a patient with traumatic eye injury.

BackgroundWe describe a case of traumatic ocular endophthalmitis caused by Nocardia kruczakiae after vegetable trauma in an immunocompetent child.FindingsA 5-year-old boy suffered from a trauma with a palm tree leaflet. Two months later, he was diagnosed with traumatic infectious uveitis and intumescent cataract with anterior capsule rupture. Intensive treatment with systemic and topical vancomycin, ceftazidime and methylprednisolone began. After 1 month, he underwent phacoemulsification with intraocular lens implantation (IOL).After some episodes of reactivation, he was diagnosed with traumatic nocardial endophthalmitis from aqueous humour samples. Several operations and specific antibiotic therapy resolved the infection.ConclusionsIn cases of traumatic endophthalmitis and several recurrences, it is extremely useful to make an etiologic diagnosis in order to treat the patient with specific antibiotics.

Targeting Citrullination in the Injured Retina

ObjectiveTo define the contribution of citrullination on GFAP and vimentin in a traumatic eye injury model.Methods: An ocular alkali injury model of retinal gliosis was employed in mice. Retinas from injured mice were examined at different times by western blot or immunochemistry for expression of GFAP, vimentin and citrullinated proteins. Posterior eye‐cups from 7‐day injured mice were placed into explant culture to investigate effects of peptidyl arginine deiminase (PAD) inhibitor Cl‐amidine.Results: GFAP expression increases initially in the soluble extracts, starting as early as 1 hour after injury and continues over the 7‐day post‐injury period, followed by increased abundance of polymeric filaments in insoluble extracts. GFAP filament growth begins at the Muller glial end‐feet and advances towards the outer retina, showing punctate co‐staining for citrullinated precursors that become incorporated into vimentin and GFAP filaments from soluble pools. At later time points, these citrullinated protein species also become abundant in insoluble extracts. In posterior eye explant culture model from 7‐day injured eyes showing reactive gliosis, global increases in high molecular weight citrullinated proteins were detected. Cl‐amidine treatment strongly downregulates these hypercitrullinated proteins and high‐molecular weight citrullinated GFAP species.ConclusionsGFAP appears to be a major target of hypercitrullination in this traumatic injury model of irreversible blindness because of its abundant overexpression. Our findings suggest that PADs are important targets for reversing pathological reactive gliosis.Supported by EY016782 and Solomon Endowed Chair Fund.

Stachybotrys eucylindrospora isolated from foreign material following a traumatic eye injury

Stachybotrys eucylindrospora was characterised as a new species in 2007, and we present the first report of this organism isolated from foreign material recovered from a patient. It is probable that isolates of this species have been previously identified as either Stachybotrys chartarum or Stachybotrys cylindrospora.

The Usage of Ocular Trauma Scoring in the Visual Prognostic Evaluation of Traumatic Eye Injury

Aim of this study was to investigate the visual prognostic value of ocular trauma score (OTS) in traumatic eye injuries. A hundred and fourteen patients with the ocular trauma, which were underwent surgery between January 2008 and January 2012 at Firat University Hospital Clinic of Ophthalmology, were included in the study. The medical records of the patients were reviewed retrospectively. Similarly to the OTS study group, patients were divided into five groups based on their visual acuity (no light perception (NLP), light perception / hand movements (LP/HM), 1/200-19/200, 20/200-20/50, 20/40 and up) at the presentation. Ocular trauma classification was made according to the Birmingham Eye Trauma Terminology (BETT). The variables used in ocular trauma score (initial and final visual acuity, rupture, endophthalmitis, perforation, retinal detachment, afferent pupillary defect) were evaluated for each patient individually. A numerical value (raw number) was assigned to each of these variables. Numerical values related to the OTS variables were converted into OTS categories and the possible or expected visual outcome and prognosis were obtained. The percentages of the eyes in each category in the OTS study were compared with those of the eyes in our study. The average follow–up duration of patients was 10 months (range 5-12 months). The average age of patients was 24,7± 21,3 (1-86) years. Of the 27 (24%) were females and 87 (76%) were males. When we compared the table of distribution of final visual acuities in all OTS categories, in our group, NLP ratios were significantly lower in category 1 and 2 (p=0.0017, p=0.00009, respectively), whereas LP/HM ratios in categories 1, 2 and 3were significantly higher in our group than in the OTS study (p=0.00002, p=0.001, p=0.000001, respectively). When we compared final visual acuities in each categories of our study and the OTS study, in our study, 20/200 to 20/50 and 20/40 and over ratios in categories 2 and 3 were significantly lower than those in the OTS study, (p=0.00003, p=0.003, p=0.000001, respectively). 20/200 to 20/50 ratio in category 4 in our group was significantly higher than that in the OTS group (p=0.000001), whereas 20/40 and over ratio in category 4 in our study group was significantly lower than that in the OTS group, (p=0.000001, respectively). Ocular trauma scoring might provide information about visual outcomes of injury and categorical evaluation of traumatic ocular injuries at initial examination.

Prevalence of Harmful/Traditional Medication Use in Traumatic Eye Injury

Aim:Ocular trauma of varying aetiologies do occur frequently, however when different traditional/harmful substances are applied before presentation in the hospital, prognosis in terms of visual outcome following treatment may be worse than expected. This study is aimed at determining the prevalence of harmful/traditional eye medication practices among patients with traumatic eye injury in a tertiary institution.Study Design/Setting:It is a retrospective study of patients seen at the eye clinic of the Ekiti State University Teaching Hospital (a state government owned hospital), Ado Ekiti, from January to December 2009.Method:A review of case notes (medical records) of patients with history of ocular trauma both open and closed globe injury and who presented to the eye clinic of the Ekiti State University Teaching Hospital, Ado Ekiti from January to December 2009 was carried out. Demographic data of the patients, nature of the ocular trauma, substances applied to the eyes, visual acuity at presentation and after treatment were extracted. Frequencies and percentages were used in analysing the data.Result:A total of 1420 new patients attended the eye clinic during the study period (January to December 2009). Forty eight (3.4%) applied various substances into their eyes after sustaining ocular injury. Substances applied include Kerosene 25%, cassava water 20.8%, breast milk 12.5%, personal urine 10.8%, and cow urine 8.3%. Nearly half of the patients 23 (47.9%) presented with low vision and after treatment there was no visual improvement in almost all of them, 22 (45.8%). The period before presentation ranges between 1hr -2weeks post injury. However, the number of monocular blindness reduced from 8 (16.7%) to 5 (10.4%) after treatment.Conclusion:Kerosene and Cassava water were the common substances applied to the injured eye. The use of these harmful and traditional eye medications on injured eyes can reduce further the visual prognosis despite ophthalmic intervention.

Scope of resident ophthalmology consultation service and patient follow-up rates at a level 1 trauma center in Brooklyn, New York

BackgroundThe purpose of this study was to investigate the most common reasons for urgent ophthalmology consultations in both the emergency room and inpatient settings at a large public hospital served by a busy ophthalmology residency program, and to track patient follow-up rates.MethodsWe reviewed the medical records of all patients evaluated by the ophthalmology consultation service at Kings County Hospital Center from June 2003 to October 2005 using a retrospective hospital-based study design. We categorized emergency room patients and inpatients into traumatic and nontraumatic subgroups, and looked at diagnoses and patient demographics, as well as follow-up patterns for emergency room consultations.ResultsIn total, 743 patients were evaluated; 436 (59%) were emergency room patients and 307 (41%) were inpatients. Consultation for traumatic eye injury was provided for 399 patients (54%), accounting for 284 (65%) of the emergency room consults and 115 (37.5%) of the inpatient consults. The most common reason for inpatient consultation was to rule out ocular manifestations of systemic disease (57 patients, 29.7%), while the most common final diagnosis for trauma inpatient consultation was orbital wall fracture (59 patients, 51.3%). In total, 262 patients (60%) in the emergency room consultation group returned for follow-up care; 162 (57%) of the trauma patients followed up and 100 (66%) of the nontrauma patients followed up.ConclusionThis study provides a comprehensive analysis of the eye conditions and follow-up rates evaluated by the ophthalmology service at Kings County Hospital Center. By evaluating the follow-up patterns of these patients, we may be able to alter patient counseling to increase patient compliance.

P-1409 - Nonsuicidal self-injury: more than meets the eye…

Nonsuicidal self-injury (NSSI) is defined as intentionally causing bodily harm to oneself without the intent to kill oneself. NSSI can be associated with a number of psychiatric disorders, including mental retardation, schizophrenia, borderline personality disorder, pervasive developmental disorders, stereotypic movement disorder, and Tourettes Disorder. In this paper we present the case of a 23-year old patient with Gilles de la Tourettes syndrome that exhibited severe compulsive self-mutilation and hostility leading to eye surgery following traumatic eye injury, as well as, familiar distress and social malfunctioning. A review of the recent literature on NSSI different contexts and presentations, as well as, a case report, is presented. Our objective is to draw attention to less debated conditions related to NSSI, with particular focus on Tourette's syndrome and its potentially self-harming symptoms.

Conjunctival Squamous Cell Carcinoma Due to Ocular Prostheses: A Case Report and Review of Literature

Conjunctival squamous cell carcinoma (SCC) is a rare finding in everyday clinical practice, but is the most common malignancy of the ocular surface. The incidence of this malignancy in the United States is 0.03 per 100,000 persons. It is one extreme of a spectrum of lesions encompassed in ocular surface squamous neoplasia which range from dysplasia to carcinoma in situ to invasive SCC. Exposure to ultraviolet radiation B (UVB), human papilloma virus (HPV), and human immunodeficiency virus (HIV) infection of eroded ocular surface are important risk factors predisposing to the development of this malignancy. Herein we report a case of SCC arising in chronic conjunctival irritation due to prolonged prosthetic use following enucleation for traumatic eye injury.

Ursache einer Contusio bulbi

A 21-year-old man presented in the emergency department with noticeable deterioration of vision and a feeling of pressure in the right eye. He stated that he had injured his eye when a shot was fired while cleaning a blank cartridge pistol. Ultrasound examination revealed no evidence of intravitreal hemorrhage or detachment of the retina. Examination by computed tomography did not reveal the presence of a foreign body. The severely reduced visual acuity could most likely be attributed to a traumatic cataract. An in-depth psychiatric examination of the anamnesis revealed that the patient had deliberately injured himself with the weapon. The severe traumatic eye injury was the result of an unrecognized hebephrenic schizophrenia.