Incidence of ocular injuries in motor vehicle crash victims with concomitant air bag deployment

Pattern of Ocular Injuries Following Road Traffic Accidents Seen at a Tertiary Eye Hospital

INTRODUCTION

Traffic trauma can lead to ocular damage. Open globe injuries usually have a poor prognosis, which can be ameliorated by prompt diagnosis and appropriate treatment. Nonetheless, few studies have focused on the visual outcomes of patients following traffic accidents. In this study, we aimed to examine the characteristics and prognosis of ocular complications in patients following traffic accidents at a specialized tertiary eye hospital.

METHODS

We classified 44 patients from traffic accidents (88 eyes) into groups with equal or better (better group) and worse (worse group) corrected-distance visual acuity than a logarithm of the minimum angle of resolution 0 at the initial presentation. Final corrected-distance visual acuity, intraocular pressure, corneal injury, presence of traumatic cataracts, and treatment were compared between the groups. In addition, a multivariate linear regression analysis was performed to identify factors associated with the final visual acuity.

RESULTS

Globe contusion, orbital blowout fracture, traumatic iritis, and trochlear nerve palsy were observed in 14.8%, 3.4%, 2.3%, and 2.3% of the patients, respectively. Topical instillation and ophthalmological treatment/surgery were performed in 17.0% and 9.1% of the patients, respectively. The better group (68 eyes) had significantly better final visual acuity than the worse group (20 eyes) (P < 0.001). However, there was no between-group difference in demographic characteristics. Multivariate analysis demonstrated that there was a significant correlation between the initial and final visual acuities (P < 0.001).

CONCLUSIONS

Assessing visual acuity at the initial presentation is crucial for predicting the final visual acuity. Our findings will help to inform ophthalmologists aiming to improve the prognosis and treatment of ocular trauma in patients following traffic accidents.

Bilateral Angle Recession and Chronic Post-Traumatic Glaucoma: A Review of the Literature and a Case Report

Ocular trauma affects millions of people worldwide and is a leading cause of secondary glaucoma. Angle recession is the main cause of post-traumatic glaucoma after blunt eye trauma, and it is usually unilateral. The aim of this paper is to investigate the possible causes of angle recession with a bilateral presentation. Airbag activation during traffic accidents is a likely cause to be ruled out, along with repeated head or eye trauma, due to contact sports or a history of physical abuse. These aspects can aid in early detection, appropriate management, and improved outcomes for patients with ocular trauma. Finally, we report the case of a 75-year-old Caucasian man who developed a bilateral angle recession after an airbag impact, with advanced glaucoma in the right eye and ocular hypertension in the left eye. To our knowledge, this is the first case in the literature of chronic post-traumatic glaucoma probably caused by an airbag.

Effect of restraining devices on eye injury in motor vehicle collisions

The aim of this systematic review is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on eye injury in motor vehicle collisions (MVCs).In a PubMed search, the search terms "eye injury and seatbelt," "eye injury and car belt," "eye injury and airbag," and "eye injury and restraining" were used. Among the 30 potentially relevant articles, 5 articles met our inclusion criteria. The odds ratio (OR) and 95% confidence intervals (CIs) from each study were abstracted. The statistical analysis was performed with Review Manager (The Nordic Cochrane Centre).Three studies were subgrouped, and a meta-analysis of these data suggested no significant effects of an airbag on increasing eye injury in MVCs (n = 10,123,954; OR, 1.10; 95% CI, 0.77-1.56). Two studies were subgrouped, and a meta-analysis of these data suggested that there are beneficial effects of seat belts on decreasing eye injury in MVCs (n = 43,057,271; OR, 0.50; 95% CI, 0.50-0.51).Seat belts were effective to decrease eye injuries in MVCs. However, airbags had no significant effect on an increase to eye injuries. When using airbags, seat belts should be used together.

Eyeglasses-Related Injuries Treated in U.S. Emergency Departments in 2002–2003

PURPOSE

An estimated 60% of Americans wear prescription eyeglasses. Despite the fact that eyeglasses pose a threat for injury, there is little research presenting national statistics of eyeglasses-related injuries.

METHODS

The National Electronic Injury Surveillance System was used to analyze eyeglasses-related injuries treated in U.S. emergency departments (EDs) in 2002-2003. Eyeglasses-related injury cases were identified by the consumer product codes for eyeglasses and sunglasses and each case's narrative description was reviewed to identify the mechanism of injury. Cases (n = 642) were weighted to produce national estimates of eyeglasses-related injuries. Mechanism of injury, body region injured, injury diagnosis, and outcome of ED visit were analyzed by gender and age.

RESULTS

An estimated 27,152 (95% confidence interval [CI]: 21,627-32,677) eyeglasses-related injuries were treated in U.S. EDs in 2002-2003. Overall, males and females were equally likely to sustain eyeglasses-related injuries (53.5% vs. 46.5%), but this distribution varied by age group. A significantly higher percentage of eyeglasses-related injuries due to falls occurred among persons aged 65 years or more (89.5%, 95% CI: 83.5-93.5), whereas sports-related injuries were more common among persons aged 0-17 years (36.6%, 95% CI: 26.1-48.6). Eyeball injuries were significantly more prominent among persons aged 18-64 years. Overall, 3.8% (95% CI: 2.3-6.3) of eyeglasses-related injuries resulted in hospital admission.

CONCLUSIONS

Eyeglasses-related injuries in the U.S. demonstrate age- and gender-specific characteristics. Safer eyeglasses design and the use of protective eyewear during sports activities and other activities with a high risk of ocular trauma will help prevent future eyeglasses-related injuries.

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

PURPOSE

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.

DESIGN

Single-center retrospective observational case series.

PARTICIPANTS

Forty-seven patients involved in MVAs with airbag deployment.

METHODS

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.

MAIN OUTCOME MEASURES

Type of ocular injury and visual acuity at 3 months after an MVA.

RESULTS

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).

CONCLUSIONS

In the current study, the use of seatbelts was associated with less severe ocular injuries and better visual outcomes.

Pediatric eye injury-related hospitalizations in the United States

OBJECTIVE

An estimated 2.4 million eye injuries occur in the United States each year, with nearly 35% of injuries among persons aged 17 years or less. Although previous research has identified some of the characteristics of pediatric eye injuries, many studies focused only on a specific patient population or type of eye injury or relied on self-reported data. In addition, little information has been reported on the total charges associated with treating pediatric eye injuries. Using a large national database, our aim was to examine hospitalizations for the treatment of pediatric eye injuries in the United States, including the demographic, medical care, and financial characteristics associated with major categories of eye injury.

METHODS

Cross-sectional data were derived from the 2000 Kids' Inpatient Database of the Healthcare Cost and Utilization Project. Eye injury-related hospitalizations were identified by using International Classification of Disease, Ninth Revision, Clinical Modification codes. Discharges were selected if the eye injury was the principal or secondary diagnosis. Guidelines from the Centers for Disease Control and Prevention were used to group external-cause-of-injury codes into broader categories to allow meaningful comparison with previous studies. The reported charges for the treatment of eye injuries and the expected primary payer were determined. Cases were statistically weighted to produce national estimates of hospitalizations for pediatric eye injuries and to determine the characteristics of these injuries.

RESULTS

Data were collected by the Kids' Inpatient Database for 3834 actual eye injury-related hospitalizations. These records represent an estimated 7527 eye injury-related hospitalizations among children aged 20 years or less in the United States during 2000. Inpatient charges for the treatment of these injuries were more than $88 million. The rate of hospitalization for pediatric eye injuries in the United States in 2000 was 8.9 per 100,000 persons aged 20 years or less. Young adults aged 18 to 20 years accounted for the highest percentage of hospitalizations (23.7%). Males accounted for 69.7% of hospitalizations. A majority of hospitalizations were for open wounds of the ocular adnexa. Motor vehicle crash was the most common cause of injury, followed by being struck by or against an object and being cut or pierced.

CONCLUSIONS

These findings illustrate the considerable morbidity, financial burden, and proximal causes for pediatric eye injury-related hospitalizations. Our data support the need for eye injury prevention efforts that consider the age, gender, and developmental stage of children. Educating parents and children about the potential for eye injuries at home and during hazardous activities is an important public health goal. In addition, promoting the use of appropriate protective eyewear by children during activities with a high risk of ocular trauma will help prevent future eye injuries.

Effects of airbag deployment: lesions, epidemiology, and management

Airbags are restraining safety devices, but their activation may sometimes induce injuries during road accidents. Rapid deceleration due to an impact causes the ignition of a sodium azide cartridge, which releases nitrogen gas to inflate the nylon rubber bag. Numerous high-temperature gases, sodium hydroxide, carbon dioxide, and various other metallic oxides are also released producing a corrosive alkaline aerosol. Cutaneous and extracutaneous injuries due to airbag deployment may occur. Cutaneous injuries are frequent, and consist of irritant dermatitis, and chemical and thermal burns. Furthermore, numerous kinds of traumatic lesions (abrasions, friction burns, and lacerations) may be observed. Extracutaneous damage may involve the eyes, ears, cardiovascular system, nerves, joints, and bones. The nature of airbag lesions, their frequency, and management are reported. Even though the majority of airbag lesions are minor and do not require hospitalization, correct diagnosis and the choice of the most suitable treatment are necessary.