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Zhou Y, Osuji E, Beal C. Ocular injury from plastic airsoft bullet through protective steel mesh mask. Am J Ophthalmol Case Rep 2022; 26:101567. [PMID: 35514802 PMCID: PMC9065884 DOI: 10.1016/j.ajoc.2022.101567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
The importance of protective eyewear during activities which involve high velocity projectiles is often emphasized to patients, however the material and design of such eyewear is also important. We present the case of a boy who sustained ocular injury from a plastic airsoft bullet while wearing a protective mask issued by the manufacturer. The patient was found to have decreased vision, a corneal abrasion and hyphema. The patient fully recovered with topical prednisolone, cyclopentolate, and moxifloxacin. It is important to advocate for using polycarbonate protective eye wear for our patients who are engaging in activities which involve high velocity projectiles.
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Affiliation(s)
- Yujia Zhou
- University of Florida Health Shands Hospital, And all authors are affiliated with the University of Florida Health Shands Hospital, located at 1600 SW Archer Rd, Gainesville, FL, 32608, United States
| | - Esther Osuji
- University of Florida Health Shands Hospital, And all authors are affiliated with the University of Florida Health Shands Hospital, located at 1600 SW Archer Rd, Gainesville, FL, 32608, United States
| | - Casey Beal
- University of Florida Health Shands Hospital, And all authors are affiliated with the University of Florida Health Shands Hospital, located at 1600 SW Archer Rd, Gainesville, FL, 32608, United States
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Thuma TB, Bello NR, Rapuano CJ, Wasserman BN. Resolution of traumatic mydriasis and accommodative dysfunction eight years after sweetgum ball ocular injury. Am J Ophthalmol Case Rep 2022; 26:101552. [PMID: 35509280 PMCID: PMC9058597 DOI: 10.1016/j.ajoc.2022.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To present a case of traumatic mydriasis (MD) and accommodative dysfunction (AD) secondary to a sweetgum ball ocular injury that resolved 8 years after the inciting trauma. Observations A 6-year-old female presented with left eye ocular trauma after being hit with a sweetgum ball. Sweetgum balls are the small, spiky fallen fruits of the American Sweetgum tree (Liquidambar styraciflua). Due to their size and shape, children often use them as projectiles during play. On presentation, the patient had a partial thickness corneal laceration, traumatic mydriasis (TM), and accommodative dysfunction (AD). Her corneal laceration was repaired. Her TM and AD persisted. She was treated with bifocal spectacles and patching. At her 7-year follow-up visit, her TM and AD showed minimal signs of improvement. Eight years post-injury, her TM and AD had both improved significantly. Conclusion and Importance Sweetgum balls, when used as projectiles, pose a risk of serious ocular injury. Pupillary and accommodative function in TM may improve much later than previously appreciated. Young age may contribute to parasympathetic neuroregeneration. Patching may have prevented amblyopia in this case, allowing her left eye to achieve its full visual potential once her pupillary and accommodative function returned.
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Affiliation(s)
- Tobin B.T. Thuma
- Pediatric Ophthalmology and Strabismus Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Nicholas R. Bello
- Pediatric Ophthalmology and Strabismus Service, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Barry N. Wasserman
- Pediatric Ophthalmology and Strabismus Service, Wills Eye Hospital, Philadelphia, PA, USA
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Takahashi R, Okamura K, Tsukahara-Kawamura T, Harada K, Saeki Y, Ozaki H, Uchio E. Finite Element Analysis of Changes in Tensile Strain by Airsoft Gun Impact on Eye and Deformation Rate in Eyes of Various Axial Lengths. Clin Ophthalmol 2020; 14:1445-1450. [PMID: 32546952 PMCID: PMC7266397 DOI: 10.2147/opth.s249483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We have carried out three-dimensional finite element analysis (FEA) to determine the physical and mechanical response in several ocular injuries. We applied this FEA model to evaluate an airsoft gun impact on an eye and the deformation rate of eyes of various axial lengths at various velocities. Methods This study was carried out on a human eye model using an FEA program created by Nihon, ESI Group. The airsoft gun pellet was set to impact the eye at initial velocities of 45, 60 and 75 m/s with the addition of variation in axial length of 20 mm (hyperopia), 22 mm (emmetropia), 24 mm (myopia) and 26 mm (high myopia). Deformation of the eye was calculated as the decrease rate of the volume of the eyeball and the decrease rate of the axial length. Results In all emmetropic cases, the cornea reached its strain threshold during the impact, and scleral strain showed a patchy strength distribution in the simulation. The deformation was most evident in the anterior segment, while deformation of the posterior segment was less. The decrease rate of the volume of the eyeball and decrease rate of the axial length were highest in the hyperopic eye, followed by the emmetropic eye and myopic eye, and the high myopic eye showed the lowest decrease rates among the four axial lengths in all impact velocity simulations. Conclusion These results suggest that hyperopic eyes are most susceptible to deformation by an airsoft gun impact compared with other axial length eye models in this simulation. The considerable deformation by an airsoft gun impact shown in this study might indicate the necessity of ocular protection to avoid permanent eye injury. FEA using a human eyeball model might be a useful method to analyze and predict the mechanical features of ocular injury by an airsoft gun.
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Affiliation(s)
- Rie Takahashi
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanno Okamura
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | | | - Kazuhiro Harada
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yusuke Saeki
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroaki Ozaki
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
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Freund A, Nordhaus M, Ritz-Timme S, Hartung B. Alles nur Spielzeug? Eine Untersuchung verschiedener Geschossspielzeuge hinsichtlich ihres Gefahrenpotenzials. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ZusammenfassungGeschossspielzeuge wie die der Marke Nerf werden von der Allgemeinheit zumeist als harmlos und ungefährlich angesehen. In den letzten Jahren wurden die bunten Waffen ständig weiterentwickelt und verschießen mittlerweile Projektile mit Geschwindigkeiten von deutlich über 100 km/h. Unlängst wurde von Augenverletzungen im Zusammenhang mit Geschossspielzeugen dieser Art berichtet. Eine Untersuchung verschiedener auf dem Markt erhältlicher Modelle hinsichtlich ihrer ballistischen Eigenschaften sollte Aufschluss darüber geben, welche Gefahr von ihnen ausgeht. Sowohl die im Versuch ermittelten kinetischen Energien und Kontaktflächen der Geschosse als auch die ungleichmäßige Verteilung des Drucks beim Auftreffen lassen darauf schließen, dass Augenverletzungen im Umgang mit Geschossspielzeugen nicht auszuschließen sind.
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Okamura K, Shimokawa A, Takahashi R, Saeki Y, Ozaki H, Uchio E. Finite Element Analysis of Air Gun Impact on Post-Keratoplasty Eye. Clin Ophthalmol 2020; 14:179-186. [PMID: 32021083 PMCID: PMC6982457 DOI: 10.2147/opth.s236825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Due to the mechanical vulnerability of eyes that have undergone penetrating keratoplasty (PKP), it is clinically important to evaluate the possibility of corneal wound dehiscence by blunt impact. We have previously developed a simulation model resembling a human eye based on information obtained from cadaver eyes and applied three-dimensional finite element analysis (FEA) to determine the physical and mechanical response to an air gun impact at various velocities on the post-PKP eye. Methods Simulations in a human eye model were performed with a computer using a FEA program created by Nihon, ESI Group. The air gun pellet was set to impact the eye at three-different velocities in straight or 12° up-gaze positions with the addition of variation in keratoplasty suture strength of 30%, 50% and 100% of normal corneal strength. Results Furthermore to little damage in the case of 100% strength, in cases of lower strength in a straight-gaze position, wound rupture seemed to occur in the early phase (0.04-0.06 ms) of impact at low velocities, while regional break was observed at 0.14 ms after an impact at high velocity (75 m/s). In contrast, wound damage was observed in the lower quadrant of the suture zone and sclera in 12° up-gaze cases. Wound damage was observed 0.08 ms after an impact threatening corneoscleral laceration, and the involved area being larger in middle impact velocity (60 m/s) simulations than in lower impact velocity simulations, and larger damaged area was observed in high impact velocity cases and leading to corneoscleral laceration. Conclusion These results suggest that the eye is most susceptible to corneal damage around the suture area especially with a straight-gaze impact by an air gun, and that special precautionary measures should be considered in patients who undergo PKP. FEA using a human eyeball model might be a useful method to analyze and predict the mechanical features of eyes that undergo keratoplasty.
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Affiliation(s)
- Kanno Okamura
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Asami Shimokawa
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Rie Takahashi
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yusuke Saeki
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroaki Ozaki
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
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Erickson BP, Feng PW, Ko MJ, Modi YS, Johnson TE. Gun-related eye injuries: A primer. Surv Ophthalmol 2019; 65:67-78. [PMID: 31229522 DOI: 10.1016/j.survophthal.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 02/03/2023]
Abstract
Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.
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Affiliation(s)
- Benjamin P Erickson
- Stanford Health Care, Byers Eye Institute at Stanford, Palo Alto, California, USA.
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marcus J Ko
- Nevada Centre for Eye Plastic Surgery, Reno, Nevada, USA
| | - Yasha S Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Thomas E Johnson
- Oculofacial Plastic Surgery, Bascom Palmer Eye Institute, Miami, Florida, USA
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Haavisto A, Sahraravand A, Puska P, Leivo T. Toy gun eye injuries - eye protection needed Helsinki ocular trauma study. Acta Ophthalmol 2019; 97:430-434. [PMID: 30390370 DOI: 10.1111/aos.13948] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Anna‐Kaisa Haavisto
- University of Helsinki and Helsinki University Eye Hospital Helsinki Finland
| | - Ahmad Sahraravand
- University of Helsinki and Helsinki University Eye Hospital Helsinki Finland
| | - Päivi Puska
- University of Helsinki and Helsinki University Eye Hospital Helsinki Finland
| | - Tiina Leivo
- University of Helsinki and Helsinki University Eye Hospital Helsinki Finland
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Henry T, Palakkamanil M, Rubin U, Tennant M. Traumatic retinal dialysis resulting from Nerf foam bullet. Can J Ophthalmol 2019; 54:e100-e102. [PMID: 31109489 DOI: 10.1016/j.jcjo.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tyler Henry
- University of Alberta, Department of Ophthalmology, Alberta, Canada
| | | | - Uriel Rubin
- University of Alberta, Department of Ophthalmology, Alberta, Canada
| | - Matthew Tennant
- University of Alberta, Department of Ophthalmology, Alberta, Canada.
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Aziz M, Patel S. BB Gun–Related Open Globe Injuries. ACTA ACUST UNITED AC 2018; 2:1056-1061. [DOI: 10.1016/j.oret.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/05/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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Khalaily S, Tsumi E, Lifshitz T, Kratz A, Levy J. Airsoft gun-related ocular injuries: long-term follow-up. J AAPOS 2018; 22:107-109. [PMID: 29412150 DOI: 10.1016/j.jaapos.2017.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the long-term ocular effects of airsoft gun pellet injuries. METHODS The present study extends by 7-10 years the results of a 2010 study on the acute ocular findings related to airsoft gun pellet injuries in 59 patients, wherein we found a variety of anterior and posterior segment injuries, including hyphema (66%), corneal edema (61%), corneal erosions (59%), and traumatic mydriasis (25%), as well as retinal edema in (22%), retinal hemorrhages and mild vitreous hemorrhage in (2.1%), and, in 1 patient, elevated intraocular pressure and traumatic cataract. RESULTS Of the 59 patients in the original study, up-to-date medical records were available for 26 (44%; 20 males). The mean follow-up time was 8 years (range, 7.2-10.3 years); the mean age, 17.1 years. Persistent abnormal findings included traumatic cataract in 3 cases (11.5%) and iris dialysis in 1 case (3.8%). In all traumatic cataract cases, cataract was not present at the time of initial examination after injury. Final mean best-corrected visual acuity was 0.92 (range 0.67-1.0), logMAR 0.03 (range 0.18-0). CONCLUSIONS While most acute airsoft gun-related ocular injuries are transient, some patients may develop significant and potentially sight-threatening ocular damage, even in the absence of significant pathologic findings at the time of the injury. Long-term follow-up on these patients is advisable.
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Affiliation(s)
- Soltan Khalaily
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Erez Tsumi
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tova Lifshitz
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Assaf Kratz
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jaime Levy
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
Firearm injuries are a significant and preventable cause of death in Canadian youth. Adolescent and young adult males are disproportionately affected; however, firearm-related deaths occur in youth of all ages. Canada's rate of firearm ownership is lower than that of the USA, but high compared with other upper-income countries. The availability of firearms to youth is an important factor in adolescent suicide, unintentional firearm deaths, gang homicide and school shootings. Guns should not be kept in homes or environments where children and adolescents live or play. Screening for the presence of a firearm in the home is an essential part of the safety assessment of a depressed or suicidal youth, and removal of the firearm from the home must be recommended in this situation. Legislative measures to strictly control the acquisition, transport, ownership and storage of firearms, and to reduce smuggling of firearms, are also recommended.
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Affiliation(s)
- Katherine Austin
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario
| | - Margo Lane
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario
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Austin K, Lane M. La prévention des blessures par balle chez les jeunes Canadiens. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxx160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katherine Austin
- Société canadienne de pédiatrie, comité de la santé de l’adolescent, Ottawa (Ontario)
| | - Margo Lane
- Société canadienne de pédiatrie, comité de la santé de l’adolescent, Ottawa (Ontario)
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Abstract
Three unrelated patients attended the accident and emergency department with pain and blurred vision after ocular injury with a Nerf gun. Two were adults and one was a child, all of which presented within a 3 months' period. All three cases were found to have ≥1 mm of traumatic hyphema (pooling of blood in anterior chamber of the eye), indicating significant ocular trauma. The two adult patients had formed hyphema and uveitis. The 11-year-old child had formed hyphema, corneal oedema, anterior uveitis, localised angle recession and commotio retinae, which further highlight the severity of the ocular trauma. Significant Nerf gun ocular injuries are not reported in the literature, as far as we know. This case series serves to raise awareness of the seriousness of Nerf gun ocular injuries. It encourages further exploration of reasons for such injuries, as well as a review of protective measures against ocular trauma.
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Affiliation(s)
- Mukhtar Bizrah
- Accident & Emergency Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Seema Verma
- Accident & Emergency Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Engelhard SB, Patrie J, Prenshaw J, Bajwa A, Monahan R, Reddy AK. Traumatic uveitis in the mid-Atlantic United States. Clin Ophthalmol 2015; 9:1869-74. [PMID: 26491249 PMCID: PMC4599638 DOI: 10.2147/opth.s90153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of this study was to conduct an in-depth analysis of traumatic uveitis in patients managed in a mid-Atlantic tertiary care center with the goal of better characterizing the clinical features and outcomes of this large and important subset of uveitis patients. Methods This was a retrospective, observational study comparing traumatic uveitis patients with nontraumatic uveitis patients seen at the University of Virginia, Charlottesville, VA, USA, from 1984 to 2014. Results Fifty-four traumatic uveitis patients (55 eyes) were identified. The patient population was 70.4% male, 57.4% Caucasian, and 37.0% African American. Mean age at diagnosis was 31.2 years; mean duration of follow-up was 5.4 years; and mean number of visits to the clinic was 4. The most common treatment modality was local steroids (77.8%). Glaucoma was medically managed in eight patients (14.8%). Cataract surgery was performed in five patients (9.3%). Mean best-corrected visual acuity at baseline for traumatic uveitis patients was 0.33 logMAR (SD 0.42) at the initial visit and 0.16 logMAR (SD 0.33) at the final visit. Mean baseline intraocular pressure (IOP) in the traumatic uveitis group was 15.5 mmHg (SD 7.4) at the initial visit and 14.6 mmHg (SD 4.0) at the final visit. Patients in the traumatic uveitis cohort tended to have better visual outcomes than those in the nontraumatic uveitis cohort. Conclusion In our series, traumatic uveitis patients tended to be young and male and present with unilateral disease, all findings consistent with other reports. Despite relatively good visual outcomes, the traumatic uveitis patients still experienced a high burden of disease, measured both in the number of clinic visits and duration of follow-up. Due to the young mean age of patients, these disease burdens and decreased quality of life are nontrivial, emphasizing the importance of careful management and prompt treatment of this subset of uveitis patients.
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Affiliation(s)
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - John Prenshaw
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Asima Bajwa
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Rose Monahan
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Ashvini K Reddy
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
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Khoueir Z, Cherfan G, Assi A. Vitreoretinal surgery for shotgun eye injuries: outcomes and complications. Eye (Lond) 2015; 29:881-7. [PMID: 25931167 DOI: 10.1038/eye.2015.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/23/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To analyse the postoperative anatomic and functional outcomes in addition to complications after vitreoretinal surgery for patients with shotgun eye injuries related to hunting accidents. MATERIALS Retrospective review of the clinical records of all cases of shotgun eye injuries presented between January 2000 and January 2011 and with a minimum follow-up of 1 year. Collection of demographics, type of injury, choice of management, complications and final surgical success with final visual acuity is reported. RESULTS Twenty eyes of 19 patients (all male) with a mean age of 36.1 years (range 16-60 years) were included in the study. Mean postoperative follow-up was 47.5 months (range 15-118 months). Best corrected visual acuity (BCVA) at presentation ranged from perception of light to 20/200. Ten eyes had a penetrating injury and 10 others had a perforating injury. All the eyes underwent an initial vitrectomy and the intraocular pellet was removed in all the 10 penetrating injuries. Concurrent cataract surgery was performed in 12 cases, internal tamponade was used in 15 cases and a supplemental encircling scleral buckle was inserted in 12 cases. One additional vitreoretinal surgery was required in seven cases (35%) and two additional surgeries required in two other cases (10%). At last follow-up BCVA ranged from NPL to 20/20 and was 20/100 or better in 10 eyes (50%). All patients had a flat retina except for two cases (10%) that developed severe proliferative vitreoretinopathy. CONCLUSION These results suggest that vitreoretinal surgery can offer good visual rehabilitation in patients with shotgun eye injuries.
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Affiliation(s)
- Z Khoueir
- Beirut Eye Specialist Hospital, Beirut, Lebanon
| | - G Cherfan
- Beirut Eye Specialist Hospital, Beirut, Lebanon
| | - A Assi
- 1] Beirut Eye Specialist Hospital, Beirut, Lebanon [2] Beirut Eye Clinic, Beirut, Lebanon
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Lee R, Fredrick D. Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012. J AAPOS 2015; 19:163-8.e1. [PMID: 25818283 DOI: 10.1016/j.jaapos.2015.01.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/31/2014] [Accepted: 01/26/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify epidemiologic trends in nonpowder gun-related pediatric eye injuries and to determine factors associated with severe injury requiring hospital admission. METHODS US emergency department data on pediatric eye injuries between 2002 and 2012 were reviewed using the National Electronic Injury Surveillance System. Literature review was conducted to determine trends in visual outcomes after treatment and use of eye protection. RESULTS In 2012 roughly 3,161 children were treated in US emergency departments for nonpowder gun-related eye injuries. Since 2010 rates of severe nonpowder gun pediatric eye injury have increased by over 500% (P = 0.039). Specifically, while rates of hospital admission due to paintball gun eye injury have dropped precipitously (P = 0.0077), rates of admissions for air gun eye injuries have increased by over 600% since 2010 (P = 0.033). Children sustaining eye injury due to air guns are more likely to be diagnosed and admitted with foreign body or ocular puncture injury. Roughly 28% of documented cases of airsoft or BB gun-related injury had visual acuity worse than 20/50 after initial treatment. Over 98% of injuries occurred without eye protection. CONCLUSIONS Air guns are rising in popularity and now account for the majority of pediatric eye injuries requiring hospital admissions. These eye injuries occur without ocular protection and may lead to permanent eye injury. Increasing regulations for eye protection, sales, and usage of air guns are needed to prevent serious pediatric eye injuries.
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Affiliation(s)
- Rachel Lee
- Stanford University School of Medicine, Palo Alto, California.
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Rambaud C, Tabary A, Contraires G, El Hassan F, Labalette P. [Contextual study of Airsoft gun related ocular injuries]. J Fr Ophtalmol 2012; 36:236-41. [PMID: 22986026 DOI: 10.1016/j.jfo.2012.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/29/2011] [Accepted: 01/14/2012] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- C Rambaud
- Service d'ophtalmologie, hôpital Huriez, centre hospitalier régional et universitaire de Lille, 1, place de Verdun, 59037 Lille cedex, France.
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Gunshot wound to the eye and orbit: a descriptive case series and literature review. ACTA ACUST UNITED AC 2012; 71:771-8; discussion 778. [PMID: 21909007 DOI: 10.1097/ta.0b013e3182255315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The objective of this study is to report ocular and orbital findings in a series of six patients (8 eyes) with gunshot wounds and to review the literature on the pathophysiology, management, and outcome of such patients. METHODS Retrospective case series and review of the literature. Main outcome measures were ocular and orbital injury, surgical intervention, and presenting and final visual acuity. RESULTS Six male patients (mean age, 32 years) were enrolled. Three patients with globe concussion and low presenting visual acuity were treated by observation. Two patients (25%) underwent primary enucleation or evisceration. Retinal detachment developed in one patient who had a globe perforation, and he underwent vitrectomy and lensectomy with silicone oil injection. Visual acuity remained unchanged in all but one patient who underwent retinal detachment surgery. Final visual acuity was poor in all patients, with five eyes ending in no perception of light. Four patients had orbital fractures, two of whom underwent orbital reconstruction. One of these patients also underwent drainage of orbital abscess, eyelid surgery, and a dacryocystorhinostomy. The mean follow-up time was 26 months. CONCLUSIONS Gunshot wounds to the eye and orbit cause severe open and closed ocular injuries with guarded outcome and poor visual acuity. When feasible, initial wound closure may preserve the globe and allow further surgical rehabilitation. Primary evisceration may be required in cases of a severely ruptured globe. Orbital surgery may be needed in cases of infection, orbital wall disruption with disfigurement, or late enophthalmos.
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Ahmadabadi MN, Karkhaneh R, Valeshabad AK, Tabatabai A, Jager MJ, Ahmadabadi EN. Clinical presentation and outcome of perforating ocular injuries due to BB guns: a case series. Injury 2011; 42:492-5. [PMID: 21144513 DOI: 10.1016/j.injury.2010.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 11/02/2010] [Accepted: 11/03/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the clinical presentations and treatment modalities of a series of BB gun-related perforating ocular injuries. METHODS Clinical records of all consecutive cases of perforating BB gun injuries to the globe seen between September 2004 and September 2008 were reviewed retrospectively. At the time of the trauma and after final treatment, all patients underwent a complete ocular examination, including visual acuity,applanation tonometry for intraocular pressure, slit lamp biomicroscopy, indirect ophthalmoscopy and fundus photography, if possible. In all cases, primary globe repair was performed in the first session, and then appropriate surgery took place based on the individual situation. RESULTS In this study, 13 patients (11 males and 2 females) with a mean age of 20.8 years (range 9–50 years) were enrolled. The mean follow-up period was 7.2 4.3 months (range 1–25 months). Initial visual acuity (VA) ranged from no-light perception (NLP) to finger counting (CF). Vitreous haemorrhage and retinal detachment were present in all involved eyes. Hyphema (30.76%), uveal and retinal prolapse (30.8%), retinalin carceration (30.8%) and retinal haemorrhage (53.8%) were other ocular findings. VA remained stable in 46.2% of the patients (6 cases). The best achieved final VA was CF at 2 min one case after 6 months follow-up.After several surgical procedures, enucleation was necessary in only 2/13 (15.4%) cases. CONCLUSION Despite several surgical procedures which decreased the number of enucleations, BB gunperforating ocular injuries still lead to a grim visual outcome. This implies the importance of political strategies targeting on education of parents and restriction for children to access to these guns.
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Affiliation(s)
- M Nili Ahmadabadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Abstract
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.
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Affiliation(s)
- Shad Misseldine
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA, USA
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Kratz A, Levy J, Cheles D, Ashkenazy Z, Tsumi E, Lifshitz T. Airsoft gun-related ocular injuries: novel findings, ballistics investigation, and histopathologic study. Am J Ophthalmol 2010; 149:37-44. [PMID: 19878919 DOI: 10.1016/j.ajo.2009.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 08/11/2009] [Accepted: 08/12/2009] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Assaf Kratz
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel.
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