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Iftikhar M, Canner JK, Latif A, Shah SMA, Justin GA, Woreta FA. Epidemiology of ophthalmic trauma in the United States from 2009-2018: A Nationwide Emergency Department Sample Analysis. Injury 2024; 55:111209. [PMID: 38012902 DOI: 10.1016/j.injury.2023.111209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To determine the incidence, characteristics, disposition, and economic burden of emergency department (ED) visits for ophthalmic trauma in the United States (US). DESIGN Retrospective study. METHODS The Nationwide Emergency Department Sample was used to calculate and characterize ED visits for ophthalmic trauma in the US from 2009 to 2018. Linear regression was used to estimate trends in annual incidence and mean inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission. RESULTS There were over 7.3 million ED visits for ophthalmic trauma in the US over the 10 years, with an annual incidence of 233 per 100,000 population. Patients were predominantly male (65 %), 21-44 years old (39 %), and from low-income households (56 %). Only 1 % of patients were hospitalized. Older age, male sex, metropolitan teaching hospitals, and trauma centers were associated with significantly higher odds of inpatient admission. The mean inflation-adjusted ED charge per visit more than doubled over the decade ($1,333 to $3,187) with total charges exceeding $14 billion. Superficial injuries (44 %) and eyelid/orbit wounds (20 %) accounted for the majority of visits. Orbital floor fractures (4 %) and open globe injuries (2 %) accounted for a minority of visits but were responsible for most admissions (49 % and 29 %, respectively) and the highest mean ED charge ($7,157 and $6,808, respectively). CONCLUSIONS Ophthalmic trauma represents an increasingly significant burden to EDs in the US. Preventive efforts should target young males from low socioeconomic backgrounds. Strategies to improve outpatient access and redirect non-urgent injuries may help alleviate costs.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asad Latif
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Syed M A Shah
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Grant A Justin
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Framme C, Volkmann I, Kern T. [Explosives-based vole traps-A novel injury pattern in the eye region]. Ophthalmologie 2024; 121:36-42. [PMID: 37733261 DOI: 10.1007/s00347-023-01926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND A novel method for trapping voles is the use of pistol-like explosive tools loaded with bolt-action ammunition. When triggered the vole is killed by the very high gas pressure created. Accidental releases can result in facial and/or eye injuries. The aim of this work was to describe the injury pattern in the patient and to experimentally verify whether there is a risk of penetrating eye injuries. METHODS Two emergency patients presented to our eye clinic with eye injuries after unintentional triggering of the explosive trap. Based on the new pattern of injury noted, experiments were performed on enucleated porcine eyes to determine the possible severity. For this purpose, a vole trap was clamped in a holder and loaded with a Cal. 9 × 17 mm cartridge in each case. In front of the muzzle opening, 3 pig eyes each were fixed on Styrofoam at a distance of 20, 40, 60 and 80 cm. The foreign body indentations in the cornea were visualized and measured by spectral domain optical coherence tomography (SD-OCT). The pig eyes were then dissected and searched for foreign bodies using microscopy. The SD-OCT images of an injured patient were also included for human comparison. RESULTS On patient examination, in addition to the usual fine gunshot marks on the face and conjunctiva/eye area, wax-like, larger and heavier particles of approximately 0.1-0.2 mm in size were found, which originated from the cartridge end cap. Removal of these foreign bodies, some of which were injected more deeply into the cornea, conjunctiva, and tenon, is much more difficult and extensive than in usual blast trauma. There was no evidence of intraocular foreign bodies in either patient. Likewise, no intraocular foreign bodies could be detected experimentally in any pig eyeball (n = 12). Remnants of the wax-like cartridge end were found deeply penetrating into the corneal stroma. The maximum penetration depth measured against the total corneal thickness was 46% at 20 cm device distance and decreased with greater distance to the vole trap (penetration depth at 40 cm at 37%, at 60 cm at 28% and at 80 cm at 19%). For comparisons on the human eye, a penetration depth of 54% was measured at a distance of about 40 cm. In pig eyes the number of foreign bodies per cm2 decreased with increasing distance from the vole trap (mean: n = 174 foreign bodies, FB, at 20 cm distance, n = 46 FB at 40 cm, n = 23 FB at 60 cm, and n = 9 FB at 80 cm). The largest penetrating foreign bodies measured a mean of 383 ± 43 μm with a maximum of 451 μm. CONCLUSION New vole traps with gas-powered mechanisms result in larger deeply penetrating wax-like foreign bodies in the cornea, conjunctiva, and tenon of the eye, which are difficult to remove and only surgically possible. Despite the significant explosion during triggering, there was no evidence of penetrating ocular injury from the foreign bodies either in the patient or experimentally in the pig eyes. Safety goggles should be worn when handling the traps to avoid penetration of foreign bodies into the eye.
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Affiliation(s)
- C Framme
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland.
| | - I Volkmann
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - T Kern
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
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Singla E, Jha UP, Muralidharan S, Singh RB, Ichhpujani P. Management of multi-surface ocular burns caused by molten iron. Trauma Case Rep 2023; 48:100925. [PMID: 37727312 PMCID: PMC10505692 DOI: 10.1016/j.tcr.2023.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/21/2023] Open
Abstract
Ocular thermal burns are medical emergencies that require immediate intervention before the standard management protocol, which involves obtaining a detailed history and performing an ophthalmic examination. In this case report, we report the clinical manifestations of ocular burns caused by molten iron and the steps taken for good clinical outcomes. The patient presented with an inferior epithelial defect and limbal and lower lid ischemia at four hours post-injury. Over the course of treatment, due to non-resolving epithelial defect and increased superior lid notching, amniotic membrane transplantation (AMT) and lid repair by pentagon wedge excision were performed. Following AMT, the corneal surface completely healed with residual opacity and neovascularization. Additionally, limbal ischemia was significantly reduced with the restoration of normal lid anatomy. Corneal burns initiate a cascade of inflammatory reactions disrupting the balance between pro- and anti-angiogenic factors, leading to corneal neovascularization. The eyelid damage can lead to necrosis of tissues with eschar formation and eventually quantitative tissue loss. Therefore, timely intervention is the key to the successful management of ocular burns.
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Affiliation(s)
- Ekta Singla
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Ujjwal Prakash Jha
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Shruti Muralidharan
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, USA
- Department of Ophthalmology, Leiden University Medical Center, 2333ZA Leiden, the Netherlands
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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Hreha K, Jin Y, Whitson HE, Hong I. Trends and risk factors among adults admitted to the emergency department with fall-related eye injuries. Am J Emerg Med 2023; 74:124-129. [PMID: 37806174 DOI: 10.1016/j.ajem.2023.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND/PURPOSE Eye injuries can happen to people of any age and for many reasons; among these is a fall. The aims of this study were to: (1) examine trends among fall-related eye injuries in working-age and older adults admitted to the emergency department (ED) from 2012 to 2021; and (2) investigate and compare the risk factors associated with fall-related eye injuries between working-age adults and older adults. DESIGN We examined a retrospective cohort in the 2012-2021 National Electronic Injury Surveillance System (NEISS) databases. We used the Cochran-Armitage test for trend to determine the fall-related eye injury trend from 2012 to 2021. The associations among fall-related eye injuries, demographics, accident-related environments, and disposition, were analyzed using multivariable logistic regression analysis. RESULTS Among the total of 1,290,205 adults with eye injuries from 2012 to 2021, the incidence rate of fall-related eye injuries was higher in older adults (ranged from 9.0% to 17.4%) than in working-age adults (ranged from 3.7% to 7.1%). Over consecutive years, the number and annual incident rate of both working-age and older adults experiencing fall-related eye injuries increased significantly (all p ≤0.001). Patients who were female (odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.39-1.83), Black/African American (OR = 1.76, 95% CI = 1.47-2.10) had significantly higher odds of fall-related eye injuries. The highest odds ratios found among all of the reported product categories for the fall-related eye injuries were an accident with home structures such as doors (OR = 12.65, 95% CI = 10.00-16.01) and an accident with home furnishings (OR = 11.65, 95% CI = 9.18-14.78) compared to an accident with workshop equipment. Patients who experienced fall-related eye injuries were more likely to be hospitalized/ have an inpatient stay (OR = 7.41, 95% CI = 5.78-9.52) after the ED treatment than those who treated and released after ED visit. CONCLUSION Among Americans treated in the ED for injury, fall-related eye injuries are increasingly common, especially among older adults, and associated with a need for inpatient care. Therefore, these findings suggest opportunities to investigate fall prevention and eye protection interventions, especially in the home setting.
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Affiliation(s)
- Kimberly Hreha
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, and Center for the Study of Aging and Human Development, School of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC 27710, United States of America
| | - Yeonju Jin
- Department of Occupational Therapy, Graduate School, Yonsei University, Gangwon-do 26493, South Korea
| | - Heather E Whitson
- Division of Geriatrics, Department of Medicine and Center for the Study of Aging and Human Development, School of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC 27710, United States of America; Geriatrics Research Education and Clinical Center (GRECC), Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States of America
| | - Ickpyo Hong
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Gangwon-do 26493, South Korea.
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Pion T, Alnouri G, Sataloff RT. A New Risk of Using Alkaline Drops in Patients With Laryngopharyngeal Reflux. J Voice 2023; 37:801.e1-801.e2. [PMID: 34162496 DOI: 10.1016/j.jvoice.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Laryngopharyngeal reflux (LPR) is common in the otolaryngologist's office, and a multimodal treatment regimen is employed often. Counseling patients on lifestyle modifications is important. Alkaline water consumption has been recommended as a nonmedical "antacid" for its value in deactivating pepsin, a proteolytic enzyme responsible for laryngeal tissue inflammatory changes in LPR. Alkaline water can be found as premade bottled water, or it can be made at home by titrating regular-pH water with concentrated alkaline drops. We present a patient who mistakenly instilled the alkaline drops into her eye, causing alkali-related chemical burns to the sclera and cornea, which subsequently resulted in scar.
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Affiliation(s)
- Tyler Pion
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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Cade KL, Taneja K, Jensen A, Rajaii F. Incidence, Characteristics, and Cost of Eyelid Lacerations in the United States from 2006 to 2014. Ophthalmol Ther 2023; 12:263-279. [PMID: 36342648 PMCID: PMC9834453 DOI: 10.1007/s40123-022-00605-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION To report the incidence, demographics, and cost of eyelid lacerations (ELs) in the USA. METHODS The Nationwide Emergency Department Sample is the largest publicly available emergency department database in the US. We conducted a retrospective longitudinal analysis to identify all emergency department (ED) visits in the sample from 2006 to 2014 with a primary or secondary diagnosis of EL. Descriptive statistics were calculated for hospital characteristics, patient demographics, and inflation-adjusted patient ED and in-patient (IP) charges. RESULTS The incidence of primary and total ELs from 2006 to 2014 decreased by 50 per million and 7.1 per million, respectively. In the same period, the total ED and average ED charge, corrected for inflation, increased by almost $37 million and $1600 per person, respectively. Motor vehicle accidents (MVAs) were the mechanism of injury (MOI) associated with the highest average ED and IP costs at $5391 and $42,677, respectively. However, object- (42.2%) and fall-related (28.8%) were the most reported MOI overall. Peak months of EL presentations were seen in May and July, and > 90% of primary ELs were classified as periocular. Most ELs occurred in men and children, representing 69% and 44% of all primary EL cases, respectively. CONCLUSION The incidence of ELs declined from 2006 to 2014. ELs occurred most frequently in children and young adults. The high proportion of object and fall-related injuries in this population highlights an area to develop strategies to reduce the frequency of preventable eye injuries.
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Affiliation(s)
- Keale L. Cade
- Howard University College of Medicine, Washington, DC, USA
| | - Kamil Taneja
- Renaissance School of Medicine, State University of New York Stony Brook, Stony Brook, NY USA ,Wilmer Eye Institute, Johns Hopkins Hospital, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 505, Baltimore, MD 21287 USA
| | - Adrianna Jensen
- Wilmer Eye Institute, Johns Hopkins Hospital, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 505, Baltimore, MD 21287 USA
| | - Fatemeh Rajaii
- Wilmer Eye Institute, Johns Hopkins Hospital, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 505, Baltimore, MD 21287 USA
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Khatri A, Shrestha SM, Kuhn F, Subramanian P, Hoskin AK, Pradhan E, Agrawal R. Ophthalmic Trauma Correlation Matrix (OTCM): a potential novel tool for evaluation of concomitant ocular tissue damage in open globe injuries. Graefes Arch Clin Exp Ophthalmol 2021; 260:1773-1778. [PMID: 34792638 DOI: 10.1007/s00417-021-05491-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To introduce a novel tool to investigate the correlation between concomitant injuries and primary open globe injury (OGI) in the setting of ophthalmic trauma, the "Ophthalmic Trauma Correlation Matrix" (OTCM). METHODS Retrospective cohort review, performed at a tertiary referral eye care center in Eastern Nepal, involving all eyes with OGI meeting the inclusion criteria from 2015-2018. Clinical data including details of primary injury, concurrent injuries, and clinical course were noted from hospital medical records. A correlation matrix chart was devised using matrix correlation and Pearson's correlation coefficient. This chart was then used to evaluate the association of the various injuries in the setting of OGI. RESULTS A total of 109 eyes with OGI were included. Majority of the eyes (78, 71.6%) had zone I injuries, while most of the eyes (66, 60.6%) had penetrating injury. The most frequent concomitant injuries in all zones of OGI were traumatic lens injury (77, 70.64%), followed by hyphema (48, 44.03%), and vitreous hemorrhage (35, 32.11%). The most common concomitant injury associated with zone I was hyphema (0.873), while traumatic subluxation/cataract (0.894) and vitreous hemorrhage (0.972) were commonly associated with zone II and III, respectively. CONCLUSIONS OTCM could be a useful tool to manage injuries related to the primary ocular injury. This additional information will aid in the prognostication, planning, and management of OGI and potentially prevent repeat surgeries and inadequate treatments.
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Affiliation(s)
- Anadi Khatri
- Department of Vitreoretinal Services, Birat Eye Hospital, Biratnagar, Nepal. .,Department of Ophthalmology, Birat Medical College and Teaching Hospital, Biratnagar, Nepal.
| | | | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, USA.,Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary.,International Society of Ocular Trauma, Birmingham, USA
| | - Prem Subramanian
- Colorado School of Medicine, Aurora, CO, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Annette K Hoskin
- Save Sight Institute, University of Sydney, Sydney, Australia.,Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Erdinest N, Sabag OP, London N, Solomon A. Quadrant Asymmetric Design Contact Lens for Visual Rehabilitation after Eye Trauma. Case Rep Ophthalmol 2021; 12:330-336. [PMID: 34054480 PMCID: PMC8136320 DOI: 10.1159/000512505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022] Open
Abstract
The purpose of this case report is to demonstrate the efficacy of an asymmetric peripheral design scleral contact lens in a case of highly irregular corneal-scleral pattern due to trauma. A 63-year-old patient was involved in a jeep accident which caused a partial-thickness penetrating injury to the peripheral cornea of his left eye. The subsequent corneal irregularity extended beyond the limbus into the sclera which made it difficult to stabilize a contact lens. A quadrant specific peripheral curve (quadrant asymmetric periphery) scleral contact lens successfully resulted in improved comfort and visual acuity. This is the first known published case to use this lens design to correct a post-trauma irregular cornea-scleral relationship. Quadrant asymmetric periphery scleral contact lenses can be effective in cases of severe irregular corneal-scleral patterns.
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Affiliation(s)
- Nir Erdinest
- Departments of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Keratoconus Center, Jerusalem, Israel
| | - Ortal Palatchi Sabag
- Soflex CooperVision Specialty Eyecare Division, CooperVision Israel Ltd., D.N. Misgav, Israel
| | | | - Abraham Solomon
- Departments of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Ifantides C, Deitz GA, Christopher KL, Slingsby TJ, Subramanian PS. Less-Lethal Weapons Resulting in Ophthalmic Injuries: A Review and Recent Example of Eye Trauma. Ophthalmol Ther 2020; 9:1-7. [PMID: 32535838 DOI: 10.1007/s40123-020-00271-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Prior reports have highlighted the dangers of crowd control weapons such
as rubber bullets, paintball guns, and pepper spray. Many of these reports were
written decades ago and outside of the USA. We summarize a review of the literature
and discuss a contemporary case of a ruptured globe and facial trauma secondary to a
projectile weapon. This case serves to highlight the severity of eye trauma caused by
less-lethal weapons; severe morbidity or even mortality can occur. Clinical Description A civilian presented after a projectile weapon reportedly fired by
Denver law enforcement struck his face during one of the recent protests in May 2020
in Denver. Upon ophthalmic examination, we observed no light perception (NLP) vision,
periorbital ecchymosis, and devastating globe trauma. Primary Diagnosis, Interventions, and Outcomes Further examination revealed a severely ruptured globe with extensive
hemorrhage and extrusion of intraocular contents. Attempts to repair the ruptured
globe failed because of the lack of remaining scleral tissue and expulsion of
intraocular contents. Postoperatively, the visual acuity remained NLP and the eye was
unable to hold pressure. Subsequently, the patient elected for enucleation. Conclusion Despite the purported safety advancements of less-lethal weapons, we
continue to see high levels of morbidity and mortality. Permanent vision loss, loss
of the eye, and death caused by these weapons have been reported. We hope that this
information will serve as an example to help promote judicious use of these weapons
by the proper authorities. Additionally, protesters and bystanders should be aware of
these dangers and utilize high-quality eye protection.
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Wai KM, Wolkow N, Yoon MK. Displaced bone fragment simulating an orbital foreign body. Orbit 2020; 40:344-345. [PMID: 32524877 DOI: 10.1080/01676830.2020.1775263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen M Wai
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,David G Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Yoon
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Kaye AD, Renschler JS, Cramer KD, Anyama BO, Anyama EC, Gayle JA, Armstead-Williams CM, Mosieri CN, Saus JA, Cornett EM. Postoperative Management of Corneal Abrasions and Clinical Implications: a Comprehensive Review. Curr Pain Headache Rep 2019; 23:48. [PMID: 31147838 DOI: 10.1007/s11916-019-0784-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Total patient care is of extreme importance during the administration of anesthesia. Proper care of the eye is necessary during all anesthetic administrations, especially during the administration of general anesthesia or monitored anesthesia care. By paying attention to details, the likelihood of an occurrence of eye injuries is reduced. RECENT FINDINGS Though perioperative eye injuries are rare during general anesthesia, they do account for 2-3% of claims against anesthesiologists. Ocular injuries may occur during general anesthesia even when tape has been utilized for eye closure. Corneal abrasions are the most common injuries that have been attributed to direct trauma to the eye, exposure keratopathy, or chemical injury. Using a hydrogel patch during general anesthesia is also associated with more frequent corneal injury than previously thought. Prevention of anesthesia-related eye injuries assumes a high priority since the eye is one of the major sense organs of the body. The eye can be damaged during anesthesia for both non-ophthalmic and ophthalmic surgeries.
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Jovanovic N, Peek-Asa C, Young T, Nisic F, Musa S. Eye injury and demographic parameters associated with poor visual outcome. J Fr Ophtalmol 2019; 42:864-73. [PMID: 31122763 DOI: 10.1016/j.jfo.2019.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Eye injuries can result in long-term disability, and healthcare providers need better tools to predict outcomes. Few prognostic models for poor visual acuity have been examined using variables usually present in very severe injuries, which creates a gap in prognosis. Therefore, a model associated with severe and less severe injuries is examined. METHODS Eye injuries hospitalized in Bosnia and Herzegovina from 2006 through 2014 were included. A total of 258 eye injuries met the inclusion criteria of being an acute mechanical, chemical or physical eye injury. Prognostic variables were grouped by patient characteristics, eye injury characteristics and eye injury diagnosis. Poor final visual acuity was the main outcome measure (vision less than 20/200). Multivariable regression analysis used stepwise selection to identify the strongest set of predictive variables. RESULTS Lens subluxation (95 % CI: 2.09-14.83), vitreous prolapse (95 % CI: 2.76-26.87), vitreous hemorrhage (95 % CI: 1.71-10.03), posterior segment intraocular foreign body (95 % CI: 1.19-39.09), and vitritis (95 % CI: 0.97-11.12) were significantly associated with poor final visual acuity. The predictive model identified the combination of age over 36, lens subluxation, vitreous prolapse and hemorrhage, vitritis, and macular hemorrhage as the combination most likely to have poor visual acuity. The final model resulted in a strong fit as measured by AIC, log likelihood, goodness-of-fit, and the c-statistic. CONCLUSIONS This model can be used in clinical practice to evaluate the severity and predict final visual acuity in both severe and less severe eye injuries. The model accounts for characteristics of the injury as well as the patient. Additional studies with larger samples could further verify this model.
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Peñaranda AC, Montoya A, Arciniegas AP, López-de-Mesa C. Opthalmological sequelae due to paintball injuries: Case studies. ACTA ACUST UNITED AC 2018; 93:375-380. [PMID: 29650401 DOI: 10.1016/j.oftal.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Describe the ophthalmological sequelae of patients diagnosed with blunt eye injury by paintball. MATERIAL AND METHODS There were a total 14 cases with a diagnosis of blunt trauma by paintball were treated at the ophthalmology emergency department of the Barraquer Clinic in Bogotá, Colombia. All patients underwent a complete ophthalmological examination with their respective controls according to their outcome. RESULTS The frequency of eye trauma by paintball was 3.01%. Fourteen eyes were evaluated, age range from 9 to 49 years. Cases were unilateral, 1 woman and 13 men, initial visual acuity less than 20/30 in 12 eyes. Only 5 eyes progressed satisfactorily, and 3 were surgically intervened. The cases that did not show any improvement in visual acuity were related to posterior pole problems, with the most frequent being macular alterations, choroidal rupture, choroidal detachment, retinal tear, and retinal folds. In 3eyes, clinical improvement of visual acuity was evidenced secondary to haemorrhagic processes that resolved with medical treatment. One of them underwent surgical treatment of the lens with an intraocular lens implant. In 2eyes, the visual recovery was very satisfactory and 100% in another. CONCLUSION Paintball has increased as a sport and recreational activity, where paint projectiles are fired with compressed air weapons. It carries risks of suffering various trauma that can lead to catastrophic episodes, in terms of visual health, and repercussions on the quality of life of those affected.
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Affiliation(s)
- A C Peñaranda
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá D.C., Colombia
| | - A Montoya
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá D.C., Colombia
| | - A P Arciniegas
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá D.C., Colombia
| | - C López-de-Mesa
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá D.C., Colombia.
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14
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Weill Y, Drabkin E, Hanhart J, Brosh K. An unusual case of globe-sparing penetrating orbital injury by a nail. Oman J Ophthalmol 2018; 11:92-93. [PMID: 29563710 PMCID: PMC5848363 DOI: 10.4103/ojo.ojo_120_2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe a case of a 28-month-old boy who presented to our emergency department with a right orbital penetration by an iron nail. At presentation, no pain or functional loss were noted. Plain head radiographs and computed tomography were performed and demonstrated a two centimeters long nail penetrating the right orbit. The foreign body was extracted carefully in the operating room. No complications were observed upon follow-up. Rarely, orbital penetration by an iron-nail can present without functional disturbances or pain and is not necessarily accompanied by sequelae.
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Affiliation(s)
- Yishay Weill
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel,Address for correspondence: Dr. Yishay Weill, Department of Ophthalmology, Shaare Zedek Medical Center, Shmu’el Bait St. 12, Jerusalem 9103102, Israel. E-mail:
| | - Elena Drabkin
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Joel Hanhart
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Koby Brosh
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
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15
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Abstract
Introduction: Ocular trauma is one of the very important causes of blindness and disability in developing countries; despite the fact that it is preventable in the majority of cases. Considering the importance of the topic and the fact that most of such injuries are preventable, a better understanding of the etiology and epidemiology of the injuries has a vital importance in planning for reduction of their prevalence. The current study has aimed to identify the prevalence and epidemiology of the ocular trauma at the University Hospital Boo-Ali-Sina in the city of Sari (Northern Iran) between 2009-2010. Method: This is a retrospective study of 178 patients’ case notes who were admitted through the ophthalmology service to the above center. A proforma was designed and For the purpose of classification, the International Classification of Diseases (ICD-10) was used. Results: During the study period, 178 patients with eye trauma were admitted to the hospital of these, 135 (75.8%) male and 43 (24.2%) were female. 35 (19.7%) aged 25-34 and 98 (55.1%) cases lived in villages. The injuries were most common during winter (55/30.9% of cases). The most common diagnosis was open wound of eyelid (ICD-10 code: S01.1) (40/ 22.5% of cases) and in the majority of cases it was unilateral (left eye) (96/53.9%). The mode of the trauma was contact with blunt object in 22 (12.4%) cases (ICD-10 code: Y29). Conclusions: Considering the prevalence of ocular trauma, appropriate education and the use of safety equipment are important measures to prevent the injuries. Our data shows that the prevalence of the injuries amongst the young workers is high and this necessitates the age group to be the target for such education. The education should include the vulnerable population at both extremes of age.
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Affiliation(s)
- Azita Balaghafari
- Department of Health Information Technology, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Hasan Siamian
- Department of Health Information Technology, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Kobra Aligolbandi
- Department of Health Information Technology, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
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16
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Jastaneiah SS. Long-term corneal complication of retained anterior chamber-angle foreign body. Saudi J Ophthalmol 2010; 24:105-8. [PMID: 23960885 DOI: 10.1016/j.sjopt.2010.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/05/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022] Open
Abstract
A 33-year-old patient referred to the cornea and anterior segment department to evaluate inferior corneal edema related to a retained intraocular foreign body (IOFB) in the anterior chamber-angle. The foreign body, which was a single piece of glass caused by an exploded light bulb twenty years back, was surgically removed; edema resolved and vision improved to 20/30. In the presence of an anterior chamber IOFB; long-term adverse effects should be considered. We would advise removal of the FB regardless of the inertness and location facts, as long as the risk and benefits of the surgical intervention are carefully evaluated.
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Affiliation(s)
- Sabah S Jastaneiah
- Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia
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