Childhood ocular trauma in the Copenhagen area from 1998 to 2003: eye injuries caused by airsoft guns are twice as common as firework-related injuries

Eye Injuries Caused by Wooden Projectiles in Finland

INTRODUCTION

Eye injuries can cause decreased vision or even blindness, and predispose to future complications. Wood as an independent cause of eye injuries has infrequently been the focus of the studies. The aim of this study is to report the current population-based epidemiology, treatment, use of resources and outcomes of eye injuries caused by sticks, branches, and other wooden projectiles in Finland.

METHODS

The study included all patients injured by wooden projectiles with ocular or orbital traumas over a 1-y period. Patients were treated at the Helsinki University eye hospital, which covers a population of 1.5 million. The follow-up time was 3 mo.

RESULTS

Wooden projectiles caused 67 eye injuries and compromised 6% of all eye traumas during 1 y. Of the patients, males predominated (76%) and 22% were children under 17 y. Injury was most likely in spring (36%) and in males aged 51 to 67 y. The most common activity to cause injury was playing (27%), but in relation to time spent in each activity, the highest risk for eye injury was in gardening. Diagnoses were mild superficial trauma (54%), blunt ocular trauma (37%), eyelid wound (4%), orbital fracture (3%), and open globe trauma (1%). Permanent disability was estimated for 10% and a need for lifelong follow-up was estimated for 37%. Eleven patients needed major surgeries.

CONCLUSIONS

Wooden projectiles often cause serious eye injuries, permanent disability, and a need for lifelong follow-up. Caution is required to protect the eyes when playing with sticks and during gardening, forest work, and woodwork.

Impact of Value Co-Creation on International Customer Satisfaction in the Airsoft Industry: Does Country of Origin Matter?

The paper’s objective is to investigate the impact of value proposition co-creation on international customer satisfaction in the airsoft industry. This empirical paper aims at answering a question “Which factors influence satisfaction of the international customers involved in the process of value co-creation in the airsoft industry” and sets a hypothesis that value co-creators’ country of origin has a positive impact on customers’ satisfaction. A case study approach of an entrepreneurial company (GATE) was supplemented with data collected via a survey (n = 176), where consumers’ perception of the firm’s value proposition and its influence on their satisfaction were investigated. The study contributes to the value creation theory by identifying the main factors influencing customer satisfaction in the airsoft industry and verifying whether the co-creators’ origin affects the factors’ ratings. The results indicate that the most crucial factors influencing international customer satisfaction in this industry are quality level and product functionality and that the country of origin of customers has no significant impact on international customer satisfaction.

Changing Trends in Firework-Related Eye Injuries in Southern China: A 5-Year Retrospective Study of 468 Cases

Firework-related eye injury is a horrible medical problem and creates huge health and social burdens. Herein, we explored the changing trends and demographic and clinical features of firework-related eye injury, in an effort to inform strategies to prevent this injury. We reviewed the data of 468 hospitalized patients who underwent surgery for firework-related eye injury at the Zhongshan Ophthalmic Center between January 2013 and December 2017. During this period, the trend in firework-related eye injuries was stable (mean, 93 ± 14 cases per year), and fireworks were the major cause of explosive eye injury. The average age of the patients was 24 ± 18 years and 87% of the patients were male, with boys under 10 years of age comprising the largest group (27% of patients). There were an average of 24 ± 7 cases per year from urban areas and 70 ± 8 cases from rural areas (P < 0.05). Furthermore, 21 ± 5% of cases occurred during Spring Festival. After treatment, the best corrected visual acuity was increased compared to that before treatment, and the intraocular pressure tended to become normal by the final visit (P < 0.05). The top three diagnoses were cataract (39%), retinal detachment (18%), and choroidal detachment (14%). Additionally, the most common surgery was cataract extraction (25%), followed by pars plana vitrectomy (19%) and pars plana vitrectomy plus pars plana lensectomy (10%). Over the five-year study period, day surgery hospitalization increased from 1% to 32%. This was associated with a corresponding decrease in the length of hospitalization, without adverse events, demonstrating that day surgery is feasible in firework-related eye injury cases. The present study results suggest that greater attention should be paid to firework-related eye injury, and a variety of measures should be taken to prevent this kind of ocular tragedy.

Toy gun eye injuries - eye protection needed Helsinki ocular trauma study

PURPOSE

We report the epidemiology, findings, treatment, long-term outcome and use of resources for eye injuries caused by toy guns in southern Finland.

METHODS

All new patients injured by toy guns in one year (2011-2012) and treated at Helsinki University Eye Hospital were included. Follow-ups occurred at 3 months and 5 years.

RESULTS

Toy guns caused 15 eye traumas (1% of all eye traumas). Most patients were male (n = 14) and children aged under 16 years (n = 13). Toy guns involved were airsoft guns (n = 12), pea shooters (n = 2) and paintball (n = 1). Eleven patients did not use protective eyewear, and four patients discontinued their use during the game. Seven patients were not active participants in the game. Blunt ocular trauma was the primary diagnosis in 13 patients and corneal abrasion in two. Seven patients had retinal findings. In the 5-year follow-up, eight of 15 patients had abnormal ocular findings: three had artificial intraocular lens, two iridodialysis, and one each retinal plomb, mydriasis or iris tear. None had glaucoma. Seven patients had permanent subjective impairment due to pain, lowered visual acuity, blur or difficulty in focusing. Four patients needed seven operations. The number of outpatient visits was 90. One patient required hospitalization.

CONCLUSION

Toy guns cause serious eye traumas. No glaucoma was found. Proper use of toy guns and protective eyewear during the whole game should be emphasized to both players and bystanders. We recommend that in Finland the selling of airsoft guns be placed under the Firearms Act to make the hazards of airsoft guns known.

PENETRATING INJURY FROM PLASTIC AIRSOFT PELLET SHOWS BEAM-HARDENING ARTIFACT ON COMPUTER TOMOGRAPHY

PURPOSE

To describe a case of left eye corneal perforation, cataract, hyphema, and intraocular foreign body after airsoft pellet injury.

METHODS

The authors reviewed the medical history and diagnostic imaging of a 12-year-old boy injured by a pellet from an airsoft gun. Typically, plastic airsoft pellets cause blunt trauma to the globe, which can lead to visual disability from corneal abrasion or hyphema. Initial computed tomography of the left orbit showed a 6.1 mm × 7.6-mm radiodense foreign body with beam-hardening artifact, a radiographic feature associated with metallic objects.

RESULTS

The patient was taken to the operating room for globe repair, lensectomy, vitrectomy, and removal of intraocular foreign body. The removed foreign body was a plastic airsoft pellet.

CONCLUSION

This is the first report of a plastic intraocular foreign body showing beam-hardening artifact. This finding may have implications in the diagnosis and management of retained intraocular or intraorbital plastic foreign bodies.

Pellet gun injury as a source of ocular trauma; a retrospective review of one hundred and eleven cases

Purpose

To report the demographic data, treatment methods, and outcomes among patients with pellet gun eye injuries.

Methods

This study was a retrospective review of all pellet gun eye injuries coming to Farabi Eye Hospital, a referral ocular trauma center in Iran, from February 2009 to November 2013. Patients' demographics, type of injury, choice of management, complications, and post-treatment visual acuity were recorded.

Results

One hundred eleven patients with a mean age of 25.7 ± 15.6 years entered the study. The most common age group was younger adults (16–45 years old) (61.3%). The mean uncorrected visual acuity after treatment was 2.05 (20/2240) ±1.5 logMAR. The most prevalent ocular zone was zone III (38.7%), and an intraocular foreign body was present in 97 patients (87.4%). Lid laceration and periocular tissue damage were present in 27 patients (24.3%). Lensectomy and vitrectomy were the most common treatment (31.5%). In most patients (87.4%), the injury was non-deliberate, and the most common time of hospitalization was the same day (45.0%). The only statistically significant indicator of post-treatment visual acuity was ocular trauma score (OTS) at admission (P < 0.001). At the end of follow-up, enucleation was performed for 20 patients (18%), and thirty-six patients (32%) had no light perception (NLP) in vision.

Conclusion

Pellet gun injuries were more common among young male patients, and the only statistically significant indicator of post-treatment visual acuity was OTS at admission.

Paediatric eye injuries in Finland - Helsinki eye trauma study

PURPOSE

To determine the current population-based epidemiology, treatment, use of resources and outcomes of children's eye injuries in Finland.

METHODS

The study included all new patients, 16 years of age or under, with ocular or orbital traumas taken into care to the Helsinki University Eye Hospital (population base 1.5 million people) in 1 year. The follow-up period was 3 months.

RESULTS

Two hundred and two children's eye injuries were treated. The eye injury incidence was 5.2-8.3 per 10 000 per year, including all minor and major eye traumas. Eye injury most likely occurred at the junior high school age (13-16 years). Thirty-three percentage of accidents took place at home and 24% at school or in day care. The most common causes were sports equipment (15%), contact with human body (12%) and superficial foreign bodies (11%). Excluding minor injuries, contusion was the most common diagnosis (n = 60, 30%). Eighty-seven percentage of contusion patients were estimated to need lifelong follow-up due to elevated glaucoma risk. Nine percentage of all patients had a permanent disability. Guns, fireworks, tools and pellet guns were relatively the most dangerous objects. Pellet guns caused 6% of eye injuries, 36% of them causing permanent impairment. The number of outpatient visits was altogether 443, inpatient days were 49, and 60 children had major surgeries.

CONCLUSIONS

Use of protective eyewear would have prevented or diminished eye traumas caused by pellet gun, floorball, most of the firework and in many superficial foreign body. The use of pellet guns and protective eyewear should be more supervised. Fireworks and tools are not suitable toys for children.

[Contextual study of Airsoft gun related ocular injuries]

INTRODUCTION

Airsoft guns have become more common in France since the Decree of March 24, 1999, allowing people over 18 years of age to use weapons with an energy level below 2J. The present study aimed to assess the relationship between the context of Airsoft gun pellet related ocular injuries and their clinical consequences, in order to determine an effective prevention strategy.

METHODS

A retrospective analysis of ocular injuries due to Airsoft gun pellets was conducted in two hospitals in northern France between September 2009 and August 2010.

RESULTS

Six patients with a mean age of 12.6 ± 3.2 years were included. The most frequent injuries were corneal abrasion, hyphema and iris trauma. Functional sequelae were observed in 50% of cases and surgical intervention was necessary in one third of cases. A direct shot had occurred in all cases. In 83% of cases, the accident took place while playing in or around the house. In one out of every two cases, the gun had been won at a booth in a fair or had been purchased in a big-box store and in no cases did the patients own safety glasses.

CONCLUSION

The strong appeal of Airsoft guns to minors leads us to propose several practical measures to help protect them, with the main one being to forbid selling these guns outside of specialized stores.

Longterm follow-up of children with traumatic optic nerve avulsion

PURPOSE

We report the longterm follow-up of children with optic nerve avulsion (ONA) caused by traumatic events. The remarkable differences in courses and outcomes may elucidate the spectrum of ONA-associated symptoms and injuries.

METHODS

During the last 15 years, three children with ONA were referred to our department. These cases are presented with special attention to their longterm follow-up.

RESULTS

Two patients suffered from complete ONA after head injury. The third patient presented with partial ONA caused by a bicycle accident. Longterm follow-up varied between 7 and 15 years. In the first patient, a pale swollen retina without any visible retinal vasculature was observed early in the course of follow-up. The retina later completely detached. In the second patient, extended fibroglial scarring occurred and an extremely large epiretinal membrane formed and was finally released spontaneously into the vitreous. The third patient developed only mild fibroglial scarring and retinal pigment epithelium hyperplasia. The optic nerve head in this patient came to resemble a morning glory disc.

CONCLUSIONS

Optic nerve avulsion can adopt different courses and outcomes in different patients. Final visual outcome seems to depend on the degree of visual acuity immediately after injury. Substantial intraocular architecture changes can occur as a result of ONA.

Anesthesia for a thoracic BB gun injury

Pediatric anesthesiologists care for children with penetrating trauma from nonpowder (BB and pellet) guns. We present the case of a 9-year-old boy who required urgent median sternotomy for cardiac tamponade after sustaining a close-range BB gun injury to the chest. After summarizing the epidemiology of nonpowder gun injuries in children, we clarify the nomenclature, ballistics, and mechanisms of these guns, discuss the tendency to minimize these kinds of injuries, explain bullet embolization, and review (by body area) current clinical management issues.

Review of 345 eye amputations carried out in the period 1996-2003, at Rigshospitalet, Denmark

PURPOSE

The aim of this study was to identify the number of eye amputations, and the causative diagnoses, indications for surgery and surgical techniques applied, and to evaluate a possible change in surgical technique in a tertiary referral centre in Denmark.

METHODS

The hospital database was screened using surgery codes for patients who had undergone bulbar evisceration, enucleation or orbital exenteration in the period 1996-2003. Patient records were reviewed for gender, age, time since surgery, causative diagnosis (the disease process leading to the indication for amputation), indication for eye amputation, type of surgery and whether an implant was applied.

RESULTS

A total of 345 patients were identified as having undergone eye amputation during the 8-year period. Indications for eye amputation were: painful blind eye (127); neoplasm (119); infection (42); recent injury (25); disfiguring blind eye (25); prevention of sympathetic ophthalmia (5), and other reasons (2). Surgical procedures included 174 eviscerations, 154 enucleations and 17 orbital exenterations. The mean number of surgeries per year was 43.1. An orbital implant was applied in 168 patients.

CONCLUSIONS

The most frequent indications for eye amputation were painful blind eye (37%) and neoplasm (34%). During the study period, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used in 33% of patients in 1996 and 67% in 2003.

Airsoft gun-related ocular injuries: novel findings, ballistics investigation, and histopathologic study

PURPOSE

To describe the ocular injuries related to airsoft gun bullets, investigate the ballistics of airsoft bullets, record real-time impact of the bullets on an eye, and investigate the histopathologic changes within the cornea after being hit by an airsoft gun bullet.

DESIGN

Retrospective, interventional case series and experimental animal study.

METHODS

All consecutive cases of patients with airsoft gun-related ocular injuries during 2006 to 2008 were included in this study. Porcine eyes were used for high-speed video photographs of bullet impacts. Rabbit eyes were used for the histopathologic investigation. All patients were treated in the Department of Ophthalmology at Soroka University Medical Center, Beer-Sheva, Israel. Laboratory investigations were performed at Ben-Gurion University of the Negev, Beer-Sheva, Israel. The main outcome measures were ocular injuries of the patients, ballistics of the airsoft bullets, nature of corneal deformation upon impact, and corneal histopathologic changes after the hit.

RESULTS

Fifty-nine patients with a mean age of 9.8 +/- 3.8 years (range, 2.8 to 26 years) were examined; 49 were male (83.1%). The ocular injuries included hyphema, corneal edema, corneal erosion, traumatic mydriasis, and posterior segment involvement. A novel, "donut" form of corneal erosion was seen and also demonstrated by the histopathologic investigation. Substantial anterior segment deformation was recorded in real-time using the high-speed video camera.

CONCLUSIONS

Airsoft gun injuries affect mainly young men and can be visually threatening. Typical ocular injuries along with a unique form of corneal erosion can be seen.