Bungee cord-associated ocular trauma

PURPOSE

To discuss the incidence and to characterize the clinical features of ocular trauma associated with bungee cord injuries.

DESIGN

Retrospective case series.

PARTICIPANTS

The authors identified 67 subjects (60 males) treated at Wills Eye Hospital for ocular trauma resulting from bungee cords between September 1, 1994, and September 1, 1999.

METHODS

The authors reviewed subjects' records from Wills Eye Hospital, records from outside physicians involved in the subjects' care, and conducted telephone interviews when additional information was needed.

MAIN OUTCOME MEASURES

Each chart was reviewed for demographic information, mechanism of injury, presenting visual acuity, anterior segment, posterior segment and periocular injuries, medical and surgical intervention, final visual acuity, and length of follow-up.

RESULTS

Mean visual acuity on presentation was 20/150. The most common anterior, posterior, and periocular injuries were hyphema (42/67, 63%), commotio retinae (30/55, 55%), and eyelid edema/ecchymosis (40/67, 60%), respectively. Seven subjects (10%) sustained open globe injuries, three (4%) of whom required enucleation. Eighteen subjects (27%) required medical treatment, and 4 subjects (6%) required surgical treatment for increased intraocular pressure. A total of 21 subjects (31%) required some form of surgical intervention. Mean final visual acuity was 20/60, with an average follow-up of 34 weeks.

CONCLUSIONS

This series, the largest to date, demonstrates a wide spectrum of serious ocular injuries related to bungee cord use. Medical and surgical treatments are commonly necessary to manage these injuries. We advocate a modification in the design of these cords and appropriate printed warnings directed to the users of bungee cords regarding the potential for severe ocular trauma.

Changing trends in paintball sport-related ocular injuries

OBJECTIVES

To describe the type and severity of ocular injuries caused by paintballs, to summarize the outcomes, to determine if the injury occurred in a commercial or noncommercial setting, to compare the number of injuries in each setting as a function of time, and to ascertain whether eye-protective devices were worn and why they were removed.

DESIGN

Retrospective analysis of 35 patients who sustained ocular injuries caused by paintballs and underwent evaluation and treatment at an eye hospital from January 1, 1985, to September 30, 1998. Thirty-five eyes of 35 patients underwent a complete ocular examination, diagnostic testing, and surgical intervention when indicated.

RESULTS

All patients were male (average age, 22 years). Twenty-six patients (74%) had an initial visual acuity of 20/200 or worse, and visual acuity in 16 (46%) remained 20/200 or worse on follow-up (range, 2 weeks to 22 months). Traumatic hyphema was seen in 21 patients (60%). Twenty-two patients (63%) had access to goggles, 7 (33%) of whom removed them due to fogging before the injury. Injuries sustained after 1995 were 5.8 times (relative risk, 5.8; 95% confidence interval, 1.5-22.4) more likely to occur during a noncommercial war game than those occurring in 1995 or before.

CONCLUSIONS

As the popularity of war games increases, so does the potential for serious ocular injury caused by paint pellet guns. Most injuries seen after 1995 occurred in noncommercial war game settings, where the use of eye-protective devices is not required. Industry standards for eye protection have been developed recently and should be implemented.

Air bags and ocular injuries

PURPOSE

This investigation retrospectively examined ocular injuries associated with air bag deployment to gain a better appreciation of potential risk factors in motor vehicle accidents. National statistics regarding the efficacy of air bags were reviewed.

METHODS

Review of the literature from 1991 to 1998 identified 44 articles describing 97 patients with air-bag-induced ocular injuries. Variables extracted from each case were age, sex, height, position in the car, eye wear, vehicle impact speed, visual acuity, and specific ocular injuries.

RESULTS

Corneal abrasions occurred in 49% of occupants, hyphemas in 43%, vitreous or retinal hemorrhages in 25%, and retinal tears or detachments in 15%. The globe was ruptured in 10 patients. Patients involved in higher-speed accidents (over 30 mph) sustained a greater percentage of vitreous or retinal hemorrhages and traumatic cataracts, while those at slower speeds were more prone to retinal tears or detachments. In a subset of 14 patients with serious ocular injuries, the impact speed of 11 patients was recorded at 30 mph or less. Slower speed may be a risk factor for some ocular injuries. Occupant height was not a significant factor. National statistics confirm that air bags reduce fatalities in motor vehicle accidents. However, children sitting in the front seat without a seat belt and infants in passenger-side rear-facing car seats are at risk for fatal injury.

CONCLUSION

Air bags combined with seat belts are an effective means of reducing injury and death in adults during motor vehicle accidents. However, this study has documented a wide variety of ocular injuries associated with air bag deployment. It is hoped that researchers can develop modifications that continue to save lives while minimizing additional harm.

A standardized classification of ocular trauma

BACKGROUND

No internationally standardized classification of ocular trauma terminology has existed heretofore. Despite a growing interest in eye injuries, the absence of a common language continues to impede both clinical care and research.

METHODS

A classification was initially developed based on the authors' extensive personal experience. It then under-went repeated reviews over a 3-year period by international ophthalmic specialists. Written and oral suggestions from respondents in 19 countries and from selected ocular trauma experts were considered and incorporated.

RESULTS

By always using the entire globe as the tissue of reference, the new classification is unambiguous, consistent, simple, and comprehensive. It provides definitions for the terms commonly used in eye trauma and creates a logical system of injury types.

CONCLUSION

In addition to widespread international acceptance by professionals, the new classification has been endorsed by the International Society of Ocular Trauma, the United States Eye Injury Registry, the American Academy of Ophthalmology, the Hungarian Eye injury Registry, the Vetreous Society, and the Retina Society. It can be reasonably expected that the system will ultimately become the standardized international language of ocular trauma.

A standardized classification of ocular trauma

BACKGROUND

No internationally standardized classification of ocular trauma terminology has existed previously. Despite a growing interest in eye injuries, the absence of a common language continues to impede both clinical care and research.

METHODS

A classification has been developed initially based on the authors' extensive personal experience. It then has undergone repeated reviews over a 3-year period by international ophthalmic audiences, incorporating suggestions from respondents in 13 countries and selected ocular trauma experts.

RESULTS

By always using the entire globe as the tissue of reference, the new classification is unambiguous, consistent, and simple. It provides definitions for the commonly used eye trauma terms within the framework of a comprehensive system.

CONCLUSION

The new classification has been endorse by the Board of Directors of the International Society of Ocular Trauma, the United States Eye Injury Registry, the Hungarian Eye Injury Registry, the Vitreous Society, the Retina Society, and the American Academy of Ophthalmology. It can be reasonable expected that the system eventually will become the standardized international language of ocular trauma. The authors urge ophthalmologists to begin using this terminology in both clinical practice and research.

Ocular injuries related to air bag inflation

BACKGROUND AND OBJECTIVES

The effectiveness of air bags as a safety device in decreasing fatalities and reducing morbidity in frontal impact motor vehicle accidents has been well established. However, case reports have surfaced documenting ocular injuries related to air bag inflation. The purpose of this study was to identify and analyze ocular injuries sustained during air bag inflation.

PATIENTS AND METHODS

Hospital emergency room records were reviewed retrospectively for a period of 4 years for patients who had sustained ocular injuries in motor vehicle accidents. Those injuries associated with air bag inflation were analyzed as to the nature of the injury, type of vehicle, speed, and visual morbidity.

RESULTS

Fourteen cases of ocular injury related to air bag inflation were identified. Hyphema (nine cases) and cornea abrasion (eight cases) were the most common. Three cases, all patients who had been wearing glasses, sustained serious and permanent ocular damage.

CONCLUSION

While air bags are an unequivocal safety feature, ocular injuries do occur that are related to air bag inflation. Eyeglass wear may present an additional risk factor.

The National Basketball Association eye injury study

OBJECTIVE

To investigate the epidemiology of eye injuries sustained by professional basketball players in the National Basketball Association (NBA).

METHODS

A prospective study involving all NBA athletes who sustained eye injuries between February 1, 1992, and June 20, 1993, was conducted. Twenty-seven NBA team athletic trainers, physicians, and ophthalmologists were provided data forms to complete for any player examined for an eye injury. Practice and game exposures during the preseason, regular season, playoffs, and championships were included.

RESULTS

Of the 1092 injuries sustained by NBA players during the 17-month period, 59 (5.4%) involved the eye and adnexa. Eighteen (30.5%) of the injuries occurred while the player was in the act of rebounding, and 16 (27.1%) while the player was on offense. The most common diagnoses included 30 abrasions or lacerations to the eyelid (50.9%), 17 contusions (edema and/or ecchymosis) to the eyelid or periorbital region (28.8%), and seven corneal abrasions (11.9%). There were three orbital fractures (5.1%). Most injuries were caused by fingers (35.6%) or elbows (28.8%). Nine players (15.3%) missed subsequent games because of their injury. Fifty-seven players (96.6%) were not wearing protective eyewear at the time of injury.

CONCLUSIONS

The incidence of eye injuries in NBA players during the 17-month period was 1.44 per 1000 game exposures. Frequent physical contact in professional basketball players leaves them at great risk for sustaining eye injuries. To prevent these injuries, protective eyewear is recommended.

Ocular injuries associated with eyeglass wear and airbag inflation

OBJECTIVE

The purpose of this report is to detail three cases of serious ocular injury associated with eyeglass wear during airbag inflation following motor vehicle crashes.

DESIGN

Although there were too few cases to provide valid statistics, an attempt was made to determine if there were characteristics common to the glasses or accidents that would provide preventive information.

MATERIALS AND METHODS

The emergency room records were reviewed for a 4-year period and cases were extracted involving ocular injuries related to airbag inflation. Fourteen cases were found, and three patients were wearing glasses. These cases were studied in detail.

MEASUREMENTS AND MAIN RESULTS

All three patients sustained serious, vision-compromising ocular damage.

CONCLUSIONS

Eyeglass wear presents an additional risk factor for ocular injury during airbag inflation. Frame damage and lens shatter provide potential for both blunt and penetrating types of ocular injury.

Traumatically ruptured globes in children

This retrospective study was designed to document the etiology of traumatically ruptured globes in children and to determine the prognostic value of several clinical parameters with respect to visual outcome. Forty-six children 16 years of age and under seen in the emergency room over a 2-year period were found to have full thickness penetration of the globe. Fifty-nine percent of injuries occurred during recreational activities, and 59% occurred outside of the home. Boys outnumbered girls by a 6:1 ratio. For children, initial visual acuity proved to be less valuable as a prognostic indicator with regard to final vision than has been reported in adults. Smaller corneal wounds offered better visual outcomes. Four eyes were enucleated. Ten ruptures (22%) were related to activity involving guns. Four of six BB gun injuries were the result of a ricocheted BB. Visual outcomes in gun-related injuries were particularly poor.

The epidemiology of ruptured globes

This retrospective study documented the demographics of 227 ruptured globes in 223 patients admitted to the Wills Eye Hospital over a two-year period from 1988 to 1990. The risk for a ruptured globe was greatest among 18-to-24-year-old men, during the noon to 8PM time frame, on Saturdays, and in the months of May, June, October, and November. The home was the most common injury setting, followed by the work place and assault. Twenty-four globes (11%) were enucleated within 11 weeks of hospital admission. These cases frequently were the result of assault, blunt-type injuries. A disproportionate number occurred in blacks.

An epidemiologic and pathologic study of globes enucleated following trauma

This retrospective study examined demographic, clinical, and histopathologic factors in 24 traumatically ruptured globes that were enucleated at Wills Eye Hospital during a 2-year period. The majority of these injuries occurred in a violent assault setting with a blunt mechanism, during the evening and early morning hours, and in the fall and winter months. Most patients were black males, and 67% were substance abusers. Clinically, the initial visual acuity in 96% of the eyes was light perception or worse. Five of the eyes were enucleated primarily. Gross examination of the globes revealed that 92% of the wounds involved the sclera, 83% of the eyes had hyphema, and 71% of the lacerations were longer than 10 mm. Histopathologic examination demonstrated that the majority of eyes had fragmented or missing lenses, disrupted ciliary bodies, and detached choroids. Ninety-six percent of the retinas were detached. There was one case of acute endophthalmitis.

Eye injuries in lacrosse: women need their vision less than men?

We describe four cases of ocular trauma incurred while playing women's lacrosse without eye protection. Women's lacrosse is potentially hazardous because, unlike men's lacrosse, helmets and face masks are not required. These ocular injuries could have been prevented with the use of protective eyewear.

Aminocaproic acid prophylaxis in traumatic hyphema

Oral aminocaproic acid has been shown to be effective in clot stabilization and in the reduction of secondary bleeding rates in cases of traumatic hyphema. In a retrospective study of 105 patients treated during a 1-year period, we found the incidence of rebleeding in patients with traumatic hyphema who received aminocaproic acid prophylaxis was 2%; the incidence in those who did not was 25%.

Outpatient management of traumatic microhyphemas

Traumatic microhyphema is an entity encountered in emergency rooms and general ophthalmology practices. The management of traumatic microhyphema has not been well defined in the literature. We discuss the effectiveness of our treatment regimen and the incidence of rebleed in patients with microhyphema.

Eye injuries in childhood: demography, etiology, and prevention

A 1-year survey was conducted of all children with eye injuries seen in the Wills Eye Hospital emergency room to determine demographic, etiologic, and prophylactic factors. There were 810 children with ocular trauma. Childhood ocular injuries are frequent, often resulting in serious visual impairment. Many of these injuries are preventable.

Eye injuries in childhood

A 3-year survey was conducted of all children with eye injuries admitted to Wills Eye Hospital to determine demographic, etiologic, and prophylactic factors. There were 278 cases, representing 22% of all ocular injuries in children requiring admission. The frequency of childhood ocular injuries is high, often resulting in serious visual impairment. Many of these injuries are preventable. The causes of pediatric eye injuries and preventive measures are discussed.

Wills Eye Hospital Traumatic Hyphema Study

Hyphema associated with nonpenetrating ocular trauma is a common cause for emergency hospitalization. The complications which result from this form of eye injury can cause permanent impairment of vision. Complications within the study population were reviewed. Analysis found a 16% rate of rebleeding, with the majority of these occurring within three to four days following the traumatic event. Unfortunately, no risk factors could be identified to help predict which patients were more at risk of complications. However, management of the complications which did develop in the study population was effective.

Anterior nongranulomatous uveitis: a seasonal variation

A review of 348 consecutive cases of nontraumatic uveitis seen in the Wills Eye Hospital emergency room between Jan 1, 1981, and Dec 31, 1981, was conducted. Patients who presented with an initial episode of anterior nongranulomatous uveitis, without obvious etiology by history or clinical examination, were further evaluated for epidemiologic clues suggestive of a pathogenesis. This group consisted of 121 patients. A statistical analysis for seasonal variation suggested an increased occurrence during the summer months (p .01).