Physical and chemical injuries to eyes and eyelids

Prevalence, Characteristics, and Management of Pediatric Ocular Trauma in Riyadh, Saudi Arabia: A Retrospective Analysis

PURPOSE

Ocular trauma is a major cause of visual impairment; however, little is known about its burden in Saudi Arabia. Therefore, this study aimed to determine the epidemiological characteristics of ocular trauma in pediatric patients in Riyadh, Saudi Arabia.

PATIENTS AND METHODS

Medical records of pediatric patients diagnosed with eye injuries between January 2016 and December 2020 were retrospectively reviewed. Demographic and injury characteristics were collected, and ocular trauma injuries were classified according to the Birmingham Eye Trauma Terminology.

RESULTS

A total of 855 injured patients were included in the study, of whom 525 (61.4%) were boys. Patient age ranged from one month to 18 years. Most ocular injuries occurred in children aged 5-9 years. The injuries were more prevalent in boys than in girls. Closed globe injuries accounted for 70% of cases, open globe injuries for 21%, and other injuries for 9%. Most ocular injuries occurred at home (n = 87, 42%), followed by school (n = 61, 30%).

CONCLUSIONS

These results may inform the implementation and targeting of interventions to reduce or prevent eye injuries in children. Further, they highlight the importance of well-planned prevention programs to prevent eye injuries from occurring in children's daily lives.

Unlocking the versatile potential: Adipose-derived mesenchymal stem cells in ocular surface reconstruction and oculoplastics

This review comprehensively explores the versatile potential of mesenchymal stem cells (MSCs) with a specific focus on adipose-derived MSCs. Ophthalmic and oculoplastic surgery, encompassing diverse procedures for ocular and periocular enhancement, demands advanced solutions for tissue restoration, functional and aesthetic refinement, and aging. Investigating immunomodulatory, regenerative, and healing capacities of MSCs, this review underscores the potential use of adipose-derived MSCs as a cost-effective alternative from bench to bedside, addressing common unmet needs in the field of reconstructive and regenerative surgery.

Pediatric Craniofacial and Neck Burns

This study aimed to determine the epidemiological features, risk factors, current management trends and prognosis associated with injury severity in paediatric craniofacial and neck burn injuries. In the study conducted between January 2016 and January 2022, the data of 204 paediatric patients with head and neck burns hospitalised in Gazi Yaşargil Training and Research Hospital Burn Centre were scanned from medical records in a hospital computer. Of the total 204 patients, 114 (55.9%) were boys and 90 (44.1%) were girls. The age group most affected by burn trauma was the 1-4 age group at 55.4%. Scald burns were the most common cause in all age groups. Electrical, chemical and sunburns were rare causes. Among the patients, 97 (47.5%) developed acute conjunctivitis due to burns. Among the patients, 91 (44.6%) lived in rural areas and 113 (55.4%) in urban areas. The wound culture results of the patients were 24% positive, and the most common bacteria were Staphylococcus hominis (5.4%) and Staphylococcus aureus (4.9%). During follow-up, neck contracture developed in six (2.94%) patients with neck burns. Four (1.96%) patients died because of sepsis. The mean hospital stay was 5.49 ± 4.14 days. Craniofacial and neck burns in the paediatric population are complex and leave sequelae after burns, often requiring advanced care. Children are at risk for injury by liquid, kitchen and chemical products, which serve as common caustic injury mechanisms.

Community-Level Awareness of Proper Immediate Steps Regarding Ocular Chemical Injury in Qassim Region, Saudi Arabia

Background An ocular chemical injury is a critical medical condition that results in harm to many components within the orbit, including the epithelium, cornea, and anterior segment. Most accidents tend to transpire among individuals in younger age groups, primarily as a result of their exposure to hazardous conditions either within their domestic environment or in occupational settings. Objective The objective of this study is to evaluate the extent of community awareness of chemical eye injuries and the appropriate measures for urgent care, focusing on different age groups within the Al-Qassim region. Methods A cross-sectional study was utilized in this research, employing data from a sample of 384 individuals residing in Qassim. The participants completed a self-administered questionnaire, which was administered online and ensured anonymity. The questionnaire used in this study had been previously validated. Results The study included a total of 384 participants who were not affiliated with the medical field, selected from the Al-Qassim region. Most of the respondents demonstrated fairly good level of awareness regarding ocular chemical injury (69%). There was a statistically significant relationship between age and the level of awareness (p-value=0.00001<0.05). Most participants believed that ocular chemical injury could cause ocular complications (93.8%) and identified chloride and detergents (92.2%) as the main materials that cause ocular injuries. Conclusion Overall summary, this study's findings suggest that there exists a moderate degree of knowledge among the public regarding chemical injuries to the eye and the appropriate rapid response to such injuries. Majority of the community members were aware that ocular chemical injury can cause ocular complications, blindness, perforation, scarring, and cataracts. Additionally, chloride and detergents were found to be the most common causes of ocular injuries among the population. The study found the most common immediate action when exposed to ocular chemical injury was to irrigate the eye with large amount of water. The study established a statistically significant association between the age and awareness about ocular chemical injury; thus, age appears to be a key factor influencing the amount of awareness seen.

Ocular Complications of Facial Burns in the Pediatric Population

Pediatric ocular burns carry a risk of permanent vision impairment. This study identifies risk factors that place these patients at high risk of permanent visual complications. A retrospective review was conducted in our academic urban pediatric burn center. All 300 patients under 18 years of age admitted from January 2010 to December 2020 with periorbital or ocular thermal injuries were included. Variables analyzed included patient demographics, burn characteristics, ophthalmology consultation, ocular exam findings, follow up time period, and early and late ocular complications. Etiologies of burn injuries were as follows: 112 (37.5%) scald, 80 (26.8%) flame, 35 (11.7%) contact, 31 (10.4%) chemical, 28 (9.4%) grease, and 13 (4.3%) friction. Overall, 207 (70.9%) patients with ocular burns received an ophthalmology consult. Of these patients, 61.5% had periorbital cutaneous burns and 39.8% had corneal injuries, and only 61 (29.5%) presented for a follow-up visit. Ultimately, six had serious ocular sequelae, including ectropion, entropion, symblepharon, and corneal decompensation. While thermal burns involving the ocular surface and eyelid margins are relatively infrequent overall, they carry a small risk of serious to long-term sequelae. Recognizing those at greatest risk, and initiating appropriate early intervention is critical.

Ocular Chemical Injuries in Western Saudi Arabia: A Study of the Public's Level of Knowledge and Experience

BACKGROUND

Chemical burns are potentially blinding eye injuries and are serious ocular emergencies that necessitate prompt evaluation and treatment.

AIM

This study aimed to evaluate the knowledge and experience of the current practice of ocular chemical injuries among the general population in western Saudi Arabia.

METHODS

An electronic self-administrated structured survey was distributed among citizens using social media channels in November 2022.

RESULTS

This survey includes 929 participants from western Saudi Arabia. Most of the participants were more than 20 years old (82.7%), while females represented 82.7%. Most participants reported an inadequate level of awareness about previous hearing of ocular chemical injury terms compared with their level of knowledge, in which the majority (56.62%) showed a good level of understanding. Female participants, participants 20 years old or older, and Saudis corresponded significantly with a good level of knowledge (p-values <0.001, <0.00, and 0.025, respectively).

CONCLUSION

This study showed a fair level of knowledge compared to awareness, which can be improved by further national studies in the Saudi region. We recommend expanding the studies' findings and developing suitable interventions, like health awareness campaigns about ocular chemical damage and prompt corrective measures.

Assessing the Perceptions and Practices Toward Eye Injuries First Aid Among General Population in the Western Region of Saudi Arabia: A Cross-Sectional Study

Aim  The eye is a vital and extraordinarily perceptive part of the human body. A wide spectrum of possible outcomes from eye injuries, from temporary vision loss to permanent blindness. There is a lack of information about how to handle an eye injury. Education and raising awareness are the best way to prevent severe complications and eventual loss of vision. Therefore, the purpose of this study is to evaluate and assess general population knowledge and first aid practices regarding eye injuries in the Western Region of Saudi Arabia, focusing on the importance of early management. Methodology A cross-sectional questionnaire was administered among residents of western Saudi Arabia using a validated questionnaire. One thousand two hundred seventy-nine adults of both genders were randomly chosen to represent the sample. In December 2022, we used a web-based survey to gather our data. Result This study analyzed data from 1279 responses on the online platform. Results showed that good knowledge was significantly higher among females than males, those without a history of eye injury than their peers with injuries, and those with higher educational levels than those with lower educational levels. Additionally, good knowledge was predicted by the female gender (OR = 1.6, 95% CI, 1.3 to 2.1, p < 0.001). Conclusion The study found that public awareness of eye injury first aid was good in the western region. The role of physicians should be expanded and health education campaigns and social media are recommended to achieve the goal of reduction and limiting the most crucial damage to the most sensitive organ in the body.

Community-level awareness of proper immediate steps regarding ocular chemical injury in the Jazan region, Saudi Arabia

Background

Although the eyes represent 0.1% of the total human body, they are exposed to many injuries, some of which may cause blindness. Ocular chemical injury is a true ocular emergency requiring immediate assessment and initiation of treatment. The present study targeted the general population in the Jazan region, Saudi Arabia, to evaluate knowledge of chemical injuries to the eye and the immediate management of the injury.

Materials and methods

A cross-sectional design was employed using a convenience sample of 536 residents of the Jazan region who completed an online, self-administered, anonymous, and pre-validated questionnaire.

Results

Most of the respondents were 18-30 years of age (66.0%), and 274 (51.1%) were female. Respondents had an average score of 7.70 (standard deviation: 1.78) out of a total score of 16, indicating an overall lack of knowledge of ocular chemical burns. The majority (95.1%) agreed that ocular complications could result from ocular chemical injury. Regarding the first action in ocular chemical injuries, 317 (59.1%) thought that eye irrigation with a large amount of water, 155 (28.9%) chose to go to the emergency department, 40 (7.5%) chose irrigation of the eye with a small amount of water, 13 (2.4%) chose using eye drops, and 11 (2.1%) chose to cover the eye.

Conclusion

The knowledge of ocular chemical burns is lacking in the general population of the Jazan region. There are several knowledge gaps, some of which are serious, necessitating rigorous efforts to correct them through educational programs at the community level.

Outcome of Primary Management of Scleral Rupture without Vitrectomy Jakarta Eye Trauma Study

Introduction:

To report the outcome of primary management of scleral rupture without vitrectomy.

Methods:

Descriptive retrospective study of primary surgical management of scleral rupture located anterior to the equator. Initial and final visual acuity (FVA, intra ocular pressure, type of injury (sharp/blunt/projectile), wound length, time interval between the incident and primary repair and cause of injury were recorded. Encircling scleral buckle was placed in case of scleral laceration reaching muscle insertion. Patients who had a follow up of 3 months after the primary repair were included in the study .

Results:

There were 41 patients out of 78 who had scleral rupture anterior to the equator. The average age was 21.27 + 9.73 years (range 3-50 years). Thirty-three (80.4%) were males and eight (19.6%) were females. Rupture was located superiorly) in 28 (68.3%) patients, and inferiorly in 13 (31.7%) patients. Eight patients underwent encircling buckle. The time interval from the injury till the primary repair less than 8 hours (p 0.000) and 8-24 hours (p 0.000) were associated significantly with FVA improvements. Initial VA correlated with FVA improvement significantly (p 0.001). Two patients with initial VA of LP became NLP, and they had a wound length 11 mm and 12 mm respectively.

Conclusion:

The primary management of scleral rupture anterior to the equator, without vitrectomy, improves VA significantly. Time interval less than 24 hours and shorter wound length correlated with significant improvement of final VA.

Role of Socioeconomic Status (SES) in Globe Injuries: A Review

Globe injury is a serious worldwide public health issue frequently leading to permanent vision impairment. The plethora of different types of globe injuries is classified into categories, including open and closed globe injuries. Globe injury occurs mainly in the workplace and at home, affecting predominantly middle-aged working men. Socioeconomic status (SES) is defined by income level, educational attainment, and employment status. Low socioeconomic status has been associated with a higher incidence of globe injury and can be utilized to identify at-risk populations. For managing open and closed globe injuries, different strategies are applied and the implementation of adequate globe injury prevention measures is needed for reducing the occurrence of globe injury. The following article aims to provide an overview of globe injury characteristics and their correlation with socioeconomic status and to highlight the significance of considering SES as a variable in globe injury prevention.

In search of disambiguation: development of eye drop bottle sleeves to aid in identification and survey among possible users. A cross-sectional study

BACKGROUND

Considerable numbers of individuals present low vision, blindness, illiteracy and other conditions that could possibly impair their identification of medications, such as eye drops. Through helping these individuals to identify their eye drops, they can achieve greater autonomy. Misidentification can be avoided through use of multisensory sleeves that can be adapted to most eye drop bottles. Correct use of eye drops is important for preventing progression of diseases like glaucoma that could potentially lead to blindness.

OBJECTIVE

To develop bottle sleeves to aid in identification of eye drops and then interview a group of possible users to evaluate the acceptance of the solution.

DESIGN AND SETTING

Cross-sectional survey performed at an ophthalmological clinic in São Paulo (SP), Brazil.

METHODS

We describe the development of multisensory sleeves to assist in identification of eye drops. To assess the acceptance of this solution, we interviewed 18 patients who were currently using three or more types of eye drops.

RESULTS

We developed four prototypes for eye drop bottle sleeves and conducted an acceptance test on them. Most of the patients who answered the survey about the sleeves were elderly. Most (95%) reported believing that the sleeves would help reduce the risk of mixing up eye drops with other medications that also dispense drops. They also believed that these would increase their autonomy in using eye drops.

CONCLUSION

The solution presented was well accepted and may help increase safety in using eye drops through preventing misidentification.

An insight on established retinal injury mechanisms and prevalent retinal stem cell activation pathways in vertebrate models

Implementing different tools and injury mechanisms in multiple animal models of retina regeneration, researchers have discovered the existence of retinal stem/progenitor cells. Although they appear to be distributed uniformly across the vertebrate lineage, the reparative potential of the retina is mainly restricted to lower vertebrates. Regenerative repair post-injury requires the creation of a proliferative niche, vital for proper stem cell activation, propagation, and lineage differentiation. This seems to be lacking in mammals. Hence, in this review, we first discuss the many forms of retinal injuries that have been generated using animal models. Next, we discuss how they are utilized to stimulate regeneration and mimic eye disease pathologies. The key to driving stem cell activation in mammals relies on the information we can gather from these models. Lastly, we present a brief update about the genes, growth factors, and signaling pathways that have been brought to light using these models.

Assessing knowledge and practice about eye injuries first aid, with awareness about the importance of early management among general population in Asser Region, 2020

Background

Eye injury is a leading cause of monocular blindness and is second only to cataract as the commonest cause of visual impairment. Injury is the commonest reason for eye-related emergency department visits.

Aim

To assess population awareness regarding eye injuries first aids in Aseer region, Saudi Arabia.

Methodology

A descriptive cross-sectional approach was used targeting all accessible population in Aseer region, Southern of Saudi Arabia. Data were collected from participants using electronic pre-structured questionnaire. The tool will cover participants' socio-demographic data, participants' history of eye injury, awareness and practice regarding different types of eye injuries first aids.

Results

The survey included 1213 participants who completed the questionnaire. Participants' ages ranged from 18 to 60 years old with mean age of 22.3 ± 11.9 years old. About 69% of the participants reported for having constant eye pain, 68.3% reported in case of Foreign Body (FB) in the eye, 66.9% reported for torn eye lid. Regarding signs of scratch eye, 64.2% reported for feel FB inside, 58% reported for eye pain and 55.2% reported for blurred vision. Exact of 25.7% of participants reported that they should blink several times in case of getting eye scratch, whereas 77.8% reported that they should rub the eye to try to remove any foreign object, 36.3% preferred to use the soothing eye drop.

Conclusions

In conclusion, the study revealed that public awareness regarding eye injury first aid in Aseer region was poor especially for chemical injuries. Physician role should be augmented and health education campaigns are advised.

European Resuscitation Council Guidelines 2021: First aid

The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, management of heat stroke by cooling, supplemental oxygen in acute stroke, and presyncope. For trauma related emergencies the following topics are covered: control of life-threatening bleeding, management of open chest wounds, cervical spine motion restriction and stabilisation, recognition of concussion, cooling of thermal burns, dental avulsion, compression wrap for closed extremity joint injuries, straightening an angulated fracture, and eye injury from chemical exposure.

Pattern of Ocular Involvement in Midface Injuries Seen at a Tertiary Care Hospital in Northern Nigeria

Aim:

The aim of the study was to report the etiology, pattern, and spectrum of ocular injuries in patients with maxillofacial injuries seen at a tertiary care hospital in northern Nigeria.

Patients and Methods:

This is a retrospective evaluation of the etiology, spectrum, and treatment of ocular injures seen in patients with midfacial fractures, who presented at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, a tertiary care hospital in northern Nigeria. Cases were seen at the oral and maxillofacial clinic for those presenting with midfacial fractures, whereas those presenting with ocular injuries due to midfacial injuries were referred from the ophthalmology department. Data were collected on their demographics, etiology of injuries, body part(s) involved, and treatment.

Results:

A total of 256 patients had midfacial injuries during the period, of which 219 patients had 357 associated ocular injuries. The age range was between 3 and 76 years. There were more males (83.8%) than females (16.2%), giving a male-to-female ratio of 5.2:1; the 21–30 years' age bracket was most frequently affected (38.4%). The predominant etiology of injuries was road traffic accidents (RTAs) (90.1%), followed by assault (4.9%). Zygomatic complex fractures (38.6%) and orbital wall fractures (24.7%) were the common midfacial injuries. There were 357 ocular injuries, giving a patient: injury ratio of 1:1.6, with subconjunctival hemorrhage (32.5%) and ruptured globe (20.0%) being common. Treatments performed were reduction and immobilization of midfacial fractures plus evisceration (32.0%), followed by reduction and immobilization of fractures alone (23.9%) and reduction and immobilization plus grafting of soft tissues (21.2%).

Conclusion:

Ocular injuries are quite common in patients with midfacial injuries, with a ratio of 1.6:1. RTA was the most common etiology, with zygomatic complex fractures as the most common midfacial injury. Subconjunctival hemorrhage was the most common ocular injury manifestation, with young adults (21–30 years of age) being most affected. Treatment often involved reduction and immobilization of midface fractures with evisceration and grafting of ocular tissues.

Current status of emergency treatment of chemical eye burns in workplaces

Chemical eye burns present an avoidable, but frequent, occupational injury with potentially detrimental consequences for the quality of life and occupational rehabilitation of the injured. A periodical review of guidelines is required to assure the optimal emergency management. We reviewed the literature with emphasis on current German guidelines, primarily MEDLINE. If the crucial first-line measure, the injury prevention has failed and an eye burn has been sustained, the immediate and copious rinsing of the eye is the pivotal emergency treatment modality. Whereas the immediacy and sufficiency of the emergency rinsing are largely unanimous, there is an ongoing debate about the benefits and risks of specific rinsing solutions, and regular updates on guidelines and recommendations for the emergency treatment are warranted. The easiest and readily available rinsing solution is tap water, which fulfils the crucial criteria conveniently in most industrialized countries: purity, sterility, and neutral pH. Other rinsing solutions are proposing higher osmolality to stabilize the physiological pH, because of their superior buffering capacity. However, there is no compelling evidence for a substantial benefit, and some reports suggest that there could be unwanted side effects. In combination with the substantially increased expenditure and a more complex handling procedure, currently a general recommendation of any other solution than tap water is not warranted.

Population-level investigation of the knowledge of ocular chemical injuries and proper immediate action

Objective

Although the eyes occupy 0.1% of the total body surface, eye injuries are serious because vision is arguably the most important sense. We aimed to assess knowledge of Saudi Arabian residents regarding steps to be taken in cases of chemical eye injury, in order to promote awareness of such procedures.

Results

A cross-sectional design was done. A random sampling method was utilized to select 888 individuals in the Saudi community. Participants completed an electronic closed ended, validated, anonymous, self-administered questionnaire. Two experts assessed content and face validity. Respondents were 18–29 years of age. 74 (8.3%) had a history of chemical eye injury. Regarding the first step taken in case of chemical eye injury, 697 (78.5%) respondents indicated washing with water, 164 (18.5%) indicated visiting the emergency department, 11 (1.2%) indicated using eye drops, and 5 (0.6%) indicated covering the eye immediately. Seventy-five (8.4%) respondents agreed that an eye injured with an acidic material should be washed with an alkaline solution. These results should be confirmed by health authorities and appropriate interventions should be developed for improving knowledge among masses, thereby promoting a healthier society.

Combination of Peroxisome Proliferator-Activated Receptor (PPAR) Alpha and Gamma Agonists Prevents Corneal Inflammation and Neovascularization in a Rat Alkali Burn Model

Peroxisome proliferator-activated receptor alpha (PPARα) and gamma (PPARγ) agonists have anti-inflammatory and anti-neovascularization effects, but few reports have tested the combination of PPARα and PPARγ agonists. In this study, we investigated the therapeutic effects of ophthalmic solutions of agonists of PPARα, PPARγ, and the combination in a rat corneal alkali burn model. After alkali injury, an ophthalmic solution of 0.05% fenofibrate (PPARα group), 0.1% pioglitazone (PPARγ group), 0.05% fenofibrate + 0.1% pioglitazone (PPARα+γ group), or vehicle (vehicle group) was topically instilled onto the rat’s cornea twice a day. After instillation, upregulation was seen of PPAR mRNA corresponding to each agonist group. Administration of agonists for PPARα, PPARγ, and PPARα+γ suppressed inflammatory cells, neovascularization, and fibrotic changes. In addition, the PPARγ agonist upregulated M2 macrophages, which contributed to wound healing, whereas the PPARα agonist suppressed immature blood vessels in the early phase. Administration of PPARα+γ agonists showed therapeutic effects in corneal wound healing, combining the characteristics of both PPARα and PPARγ agonists. The results indicate that the combination of PPARα and γ agonists may be a new therapeutic strategy.

Craniofacial and neck burns in the pediatric population

INTRODUCTION

Burn injuries can present with catastrophic physical and psychiatric harm with extensive, long-term sequelae. The pediatric population may especially be at-risk given this population's early neurocognitive and behavioral state of development. Innovations in treatment modalities and the development of evidence-based guidelines have helped mitigate burn morbidity and mortality in the pediatric population. Unfortunately, a surprising dearth of literature identifies risk-factors, epidemiological data, injury mechanisms, and prognostic factors within the pediatric population in the setting of craniofacial burns.

METHODS

An analysis of emergency department visits under the National Electronic Injury Surveillance System was conducted for the most recent 5-year period available (2014-2018). Available information includes demographical data, such as age and sex, mechanism of injury, visit circumstances, as well as visit disposition. Additionally, details surrounding the injury, including type of burn and anatomical location of injury, were compared.

RESULTS

After a review of results, a total of 2599 patients were included for analysis. Our study shows that infants and young children are at increased risk for grave injury 27.3% and 13% of infants and toddlers transferred or admitted, respectively, p < 0.05). 59.8% of infant burns in particular were caused by liquid or kitchen products, while 44.5% of burns in toddlers were caused by chemical products (p < 0.05 for both). Conversely, adolescents are at greater risk of burns in the setting of occupational and hobby-based activities (20.4% of adolescent burns).

CONCLUSIONS

Craniofacial burns in the pediatric population may present with complex pathology and sometimes necessitate advanced care. Presentations and prognoses are different dependent upon age and injury mechanism. These findings may serve as important framework in the establishment of guidelines for medical and legislative reform.

Optimal timing of vitrectomy for severe mechanical ocular trauma: A retrospective observational study

Mechanical ocular trauma could lead to disastrous visual outcomes. There has been a controversy regarding the timing of vitrectomy for such cases. This study aimed to find out the optimal timing of vitrectomy for severe mechanical ocular trauma. Patients with severe mechanical ocular trauma who had undergone vitrectomy were enrolled and followed up for at least 6 months. Clinical data were collected including ocular trauma score (OTS), the timing of vitrectomy upon injury, visual acuity, vitrectomy results, post-operation complications and etc. All cases were classified according to the timing of vitrectomy upon injury into 3 groups: group A 1–7 days, group B 8–14 days, group C more than 14 days. A total of 62 cases were enrolled, including 20 eyes in group A, 25 eyes in group B, and 17 eyes in group C. No significant differences were shown of the gender, age or OTS among the 3 groups. Both functional success rate and visual outcome were optimal in group B, then in group A, and worst in group C. These results suggested that the best timing of vitrectomy for severe mechanical ocular trauma is 8–14 days upon injury; second best is 1–7 days; worst is after 14 days.

Periocular dermatoses

The periocular area may be affected by infectious or noninfectious diseases such as inflammatory dermatoses, systemic disease, drug reactions, benign and malignant lesions, traumatic lesions, and esthetic complications. We present a review of the most common periocular dermatoses.

Proposal of a new classification scheme for periocular injuries

Background:

Eyelids are important structures and play a role in protecting the globe from trauma, brightness, in maintaining the integrity of tear films and moving the tears towards the lacrimal drainage system and contribute to aesthetic appearance of the face. Ophthalmic trauma is an important cause of morbidity among individuals and has also been responsible for additional cost of healthcare. Periocular trauma involving eyelids and adjacent structures has been found to have increased recently probably due to increased pace of life and increased dependence on machinery. A comprehensive classification of periocular trauma would help in stratifying these injuries as well as study outcomes.

Material and Methods:

This study was carried out at our institute from June 2015 to Dec 2015. We searched multiple English language databases for existing classification systems for periocular trauma. We designed a system of classification of periocular soft tissue injuries based on clinico-anatomical presentations. This classification was applied prospectively to patients presenting with periocular soft tissue injuries to our department.

Results:

A comprehensive classification scheme was designed consisting of five types of periocular injuries. A total of 38 eyelid injuries in 34 patients were evaluated in this study. According to the System for Peri-Ocular Trauma (SPOT) classification, Type V injuries were most common. SPOT Type II injuries were more common isolated injuries among all zones.

Discussion:

Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. The SPOT classification has taken into account the periocular soft tissue injuries i.e., upper eyelid, lower eyelid, medial and lateral canthus injuries., based on observed clinico-anatomical patterns of eyelid injuries.

Conclusion:

The SPOT classification seems to be a reliable system to address eyelid injuries. This classification scheme would guide the ophthalmic and facial reconstructive surgeons to provide optimal outcomes in eyelid injuries. Based on the classification scheme and review of existing literature, an algorithm is presented to facilitate repair and reconstruction.

Impairment of tear film and the ocular surface in patients with facial burns

AIM

The aim of this study is to investigate the factors affecting tear film and ocular surface in patients with facial burns.

METHODS

A total of 273 patients with facial burns, treated at Hallym University Hangang Sacred Heart Hospital from November 2012 to July 2015, were included. Tear break-up time (TBUT), Schirmer's tear secretion test, fluorescein staining score (FSS), ocular surface disease index (OSDI), and visual analogue pain score (VAS) were compared according to burned surface area, burn site, burn cause, time since burn injury, or lid abnormality.

RESULTS

Mean age was 48.66±14.46years (range: 18-85). Tear film stability was not different according to burn area, burn site, or burn cause. Facial burn patients with lid abnormalities had shorter TBUT and higher OSDI scores compared to no lid abnormality (p<0.001 and 0.015, independent t-test). There was no difference in TBUT and tear secretion according to area, site, or cause of burn. FSS was different according to the area of burn (p=0.007, ANOVA). OSDI and VAS was higher in the patients with an electrical burn compared to thermal burn (p=0.003 and 0.024, ANOVA).

CONCLUSIONS

Facial burn patients with lid abnormalities had tear film instability and ocular discomforts. Aggressive treatment may be of benefit in facial burn patients with lid involvement. Electrical burn caused more severe pain compared to thermal burn. Attention should be paid to pain control in patients with electrical burns.

Chemical, Electrical, and Radiation Injuries

This article reviews the unique challenges presented by chemical, electrical, and radiation injuries. The authors discuss pathophysiology and diagnosis of these injuries and provide recommendations for management.

The molecular mechanisms of action of PPAR-γ agonists in the treatment of corneal alkali burns (Review)

Corneal alkali burns (CAB) are characterized by injury-induced inflammation, fibrosis and neovascularization (NV), and may lead to blindness. This review evaluates the current knowledge of the molecular mechanisms responsible for CAB. The processes of cytokine production, chemotaxis, inflammatory responses, immune response, cell signal transduction, matrix metalloproteinase production and vascular factors in CAB are discussed. Previous evidence indicates that peroxisome proliferator-activated receptor γ (PPAR-γ) agonists suppress immune responses, inflammation, corneal fibrosis and NV. This review also discusses the role of PPAR-γ as an anti-inflammatory, anti-fibrotic and anti-angiogenic agent in the treatment of CAB, as well as the potential role of PPAR-γ in the pathological process of CAB. There have been numerous studies evaluating the clinical profiles of CAB, and the aim of this systematic review was to summarize the evidence regarding the treatment of CAB with PPAR-γ agonists.