Penetrating needle injury of the eye

Unusual Penetrating Orbital and Globe Injury With a Veterinary Needle

We present a rare case of a penetrating injury to the globe and orbit by a veterinary needle. The patient underwent globe exploration and retinal detachment repair under general anesthesia after receiving medical treatment for orbital cellulitis. The case was managed by a multidisciplinary team consisting of a pediatric ophthalmologist, an oculoplastic surgeon, and a retina surgeon. The orbital cellulitis resolved gradually, after which the site of globe penetration was found to be self-sealed, and the retinal detachment was repaired. B-scan ultrasonography and magnetic resonance imaging (MRI) were performed to assess the extent of the injury and evaluate the integrity of the globe. Exploration of presumed Self-sealing globe wounds by a needle should be deferred until the treatment of life-threatening complications like orbital cellulitis and optic nerve infiltration is complete. Prompt judicious care was necessary in this case. It is crucial to implement preventive measures to address the risks involved in children manipulating dangerous objects to avoid preventable accidents and mitigate the potential visual outcomes that may arise as a result.

Endophthalmitis and Retinal Detachment after Ocular Injury by Animal Inoculation Needle

Purpose: To report a case of endophthalmitis and retinal detachment after injury caused by an animal inoculation needle. Case summary: A 39-year-old man received an injury to his left eye with an animal inoculation needle while vaccinating a pig came to the hospital due to decreased visual acuity. At initial presentation, the best-corrected visual acuity in the left eye was “counting fingers,” and slit lamp examination revealed corneal lacerations, anterior capsule rupture, and traumatic cataract. Ultrasonography showed no specific findings in the vitreous and retina. Primary corneal suture, phacoemulsification, anterior vitrectomy due to rupture of the posterior capsule and vitreous prolapse, intraocular lens implantation, and intravitreal antibiotic injection were performed. On day 1 postoperatively, vitrectomy, anterior chamber irrigation, intravitreal antibiotic injection, and silicone oil injection were performed as signs of endophthalmitis, such as hypopyon and retinal tear, and focal retinal detachment were observed during surgery. Silicone oil removal was performed 7 months after the operation and the best-corrected visual acuity was 0.6. There has been no recurrence during follow-up. Conclusions: This is the first report in Korea of ocular injury caused by an animal inoculation needle. If the fundus is not observed in such injuries, there is a possibility of endophthalmitis and retinal detachment and early vitrectomy should be considered.

Acupuncture resulting in eye penetration and proliferative vitreoretinopathy - Surgical and medical management with intraocular methotrexate

Purpose

To highlight the surgical and medical management used in an extensive globe penetrating injury caused by an acupuncture needle.

Observations

We report on a case of acupuncture treatment error resulting in needle penetration of the eye, retinal detachment, and progressive post-traumatic proliferative vitreoretinopathy (PVR). This patient required aggressive surgical management with multiple vitrectomies along with adjunctive intravitreal methotrexate to control ongoing PVR. At last follow-up, 15 months after presentation, the patient's BCVA was 20/40 and the periphery was flat with fibrosis stable.

Conclusions and Importance

Open globe injuries are a subtype of ocular trauma which can cause irreparable vision loss. This case highlights the extensive potential complications which can occur following traumatic injury to the retina and choroid, as well as the role of both surgical and medical management of retinal detachment and PVR. In addition, this is the first report of the use of off-label adjunctive intravitreal methotrexate to control post-traumatic PVR. Further research into this treatment approach could reveal a role of adjunctive methotrexate in the management of such injuries.

Enterococcus faecalis Endophthalmitis in Children - A 21 Year Study

PURPOSE

To report Enterococcus faecalis endophthalmitis (EFE) in children and its comparison with adults.

METHODS

Retrospective study of 19 children up to 18 years age, undergoing vitrectomy for EFE at a referral eye center from January 1995 to December 2015. The results were compared to 18 adults with EFE.

RESULTS

The mean age was 7.4 ± 3.06 years. Post-traumatic EFE was seen in 17 (89.4%) children (p < 0.05) versus postoperative EFE seen in 12 (66%) adults. Broomstick 9 (52.9%) and hypodermic needle injury 6 (35.2%) were common associations. "Optimum functional outcome" was achieved in 12 (63.1%) eyes of children and 5 (27.7%) eyes of adults (p = 0.03). Sealed and Zone II wounds, lens, and needle injuries had good outcome whereas intervention after 3 days and retinal detachment had poor outcomes (p < 0.05). The was no correlation with the Ocular Trauma Score.

CONCLUSION

EFE in children is rare; seen with broom stick and needle injuries, if managed early recovers optimum vision.

Posttraumatic endophthalmitis: report No. 2

PURPOSE

To study predisposing factors of endophthalmitis in patients with open-globe injury.

METHODS

All 2,340 patients with open-globe injury admitted to our center over 5 years were studied retrospectively, and patients with endophthalmitis were compared with other patients.

RESULTS

The number of endophthalmitis cases among patients with open-globe injury was 117 eyes, accounting for an incidence of 5.1%. The risk of endophthalmitis was significantly higher among male patients with pure corneal injuries (6.8%), intraocular foreign bodies (9.3%), traumatic lens rupture (7.1%), trauma resulting from needles (22.2%), and shorter lacerations. The existence of hyphema or iris prolapse was associated with lower rates of endophthalmitis. The mean gap between injury time and operation time was longer in the endophthalmitis group (2.1 ± 1.8 vs. 1.1 ± 1.3 days). Patients with endophthalmitis had significantly lower ocular trauma scores compared with other patients.

CONCLUSION

Posttraumatic endophthalmitis is more likely among patients with open-globe injury that are needle related and among those who have intraocular foreign bodies, traumatic lens rupture, smaller wounds, or wounds exclusively in the cornea. Lower ocular trauma scores in this group of patients with penetrating trauma indicated a greater risk of poor visual prognosis. Therefore, it is suggested that necessary measures and immediate treatment be undertaken in high-risk patients.