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Nguedia Vofo B, Navarrete A, Levy J, Chowers I. Ophthalmic Emergency Visits in the Wake of the COVID 19 Pandemic: Our Experience at a Tertiary Hospital in Israel. Isr Med Assoc J 2022; 24:5-8. [PMID: 35077037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND In response to the coronavirus disease-2019 (COVID-19) pandemic, routine clinical visits to the ophthalmic emergency department (OED) were deferred, while emergency cases continued to be seen. OBJECTIVES To assess the consequences of the COVID-19 pandemic for ophthalmic emergencies. METHODS A retrospective chart analysis of patients who presented to the OED during the peak of the COVID-19 pandemic was conducted. The proportions of traumatic, non-traumatic-urgent, and non-traumatic-non-urgent presentations in 2020 were compared to those of the same time period in 2019. Duration of chief complains and best-corrected visual acuity were also assessed. RESULTS There were 144 OED visits in 2020 compared to 327 OED visits during the same 3-week-period in 2019. Lower mean age of OED patients was present in 2020. Logarithmic expression (LogMAR) best corrected visual acuity (BVCA) was similar in both years. In 2020 there was a reduction in traumatic, non-traumatic-urgent, and non-traumatic-non-urgent cases compared to 2019 (15.4% reduction, P = 0.038; 57.6% reduction, P = 0.002; 74.6% reduction, P = 0.005, respectively). There was a higher proportion of same-day presentations at commencement of symptoms in 2020 compared with 2019 (52.8% vs. 38.8%, respectively P = 0.006). CONCLUSIONS During the COVID-19 pandemic, the number of OED visits at a tertiary hospital dropped by more than half. Although the drop in visits was mostly due to decrease in non-traumatic-non-urgent cases, there was also decrease in non-traumatic-urgent presentations with possible important visual consequences. Additional studies should elucidate what happened to these patients.
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Affiliation(s)
- Brice Nguedia Vofo
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ana Navarrete
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Jaime Levy
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Apostolova E, White HA, Morris PA, Eliason DA, Velez T. Open Globe Injury Patient Identification in Warfare Clinical Notes. AMIA Annu Symp Proc 2018; 2017:403-410. [PMID: 29854104 PMCID: PMC5977674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of this study is to utilize the Defense and Veterans Eye Injury and Vision Registry clinical data derived from DoD and VA medical systems which include documentation of care while in combat, and develop methods for comprehensive and reliable Open Globe Injury (OGI) patient identification. In particular, we focus on the use of free-form clinical notes, since structured data, such as diagnoses or procedure codes, as found in early post-trauma clinical records, may not be a comprehensive and reliable indicator of OGIs. The challenges of the task include low incidence rate (few positive examples), idiosyncratic military ophthalmology vocabulary, extreme brevity of notes, specialized abbreviations, typos and misspellings. We modeled the problem as a text classification task and utilized a combination of supervised learning (SVMs) and word embeddings learnt in a unsupervised manner, achieving a precision of 92.50% and a recall of89.83%o. The described techniques are applicable to patient cohort identification with limited training data and low incidence rate.
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Affiliation(s)
| | - Helen A White
- DoD/VA Vision Center of Excellence, Falls Church, VA
| | | | | | - Tom Velez
- Computer Technology Associates, Cardiff, CA
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Rossi T, Boccassini B, Iossa M, Mutolo MG, Lesnoni G, Mutolo PA. Triaging and Coding Ophthalmic Emergency - the Rome Eye Scoring System for Urgency and Emergency (RESCUE): A Pilot Study of 1000 Eye-Dedicated Emergency Room Patients. Eur J Ophthalmol 2018; 17:413-7. [PMID: 17534826 DOI: 10.1177/112067210701700324] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Ophthalmic emergency (OE) triage is essential for prompt recognition of urgent cases. To date, no formal eye-dedicated triaging system has been widely accepted. The purpose of the present study is to propose a fast, accurate, and reproducible coding scale called the Rome Eye System for Scoring Urgency and Emergency (Rescue). METHODS Phase 1 of the study is a retrospective analysis of electronic medical records (EMR); phase 2 is a prospective consecutive series. Phase 1 included 160,936 patients. Phase 2 included 1000 consecutive patients referred to the emergency department (ED) of our institution. In phase 1, the authors retrospectively analyzed EMRs of patients presenting to the ED, listing signs and symptoms most frequently associated with hospitalization. Redness, pain, loss of vision, and the risk for an open eye were identified and assigned a score ranging from 0 to 12. Color coding was assigned based on increasing scoring: 0-3 white, 4-7 green, 8-12 yellow code. In phase 2, 1000 consecutive ED patients were enrolled and prospectively coded according to RESCUE. After diagnosis and proper treatment, EMRs were retrospectively reviewed by a masked physician and patients recoded (Retro coding) according to clinical course. Correlation between Rescue and Retro coding was calculated. MAIN OUTCOME MEASURES Prospective and retrospective ED color coding correlation. RESULTS A total of 160,936 EMR were retrospectively analyzed; 2407 (1.4%) patients required hospitalization. Loss of vision (90%), redness (76%), and pain (47%) were the most frequent complaints. Rescue significantly correlated to Retro coding (p<0.01): 841/1000 patients coded exactly the same color, 45/1000 were overestimated by one color class, none by two, 107/1000 underestimated by one, and 6/1000 by two classes. The 32/1000 hospitalized patients in the prospective cohort had a Rescue score significantly higher than non-admitted patients (p<0.01) and color coding among admitted and dismissed patients was significantly different as well (p<0.01). CONCLUSIONS The Rescue system seems promising in terms of usefulness and ease of implementation. The high correlation between Rescue code assigned prospectively and the post-diagnosis coding, as well as the prompt discrimination of cases that eventually required hospitalization, may lead to a wider use of the Rescue system. Further testing on larger samples and different institutions is warranted.
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Affiliation(s)
- T Rossi
- Department of Vitreoretinal Surgery, Ospedale Oftalmico of Roma, Rome, Italy.
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Abstract
Purpose To determine the nature and types of domestic eye injuries. Methods The authors prospectively analyzed data of 100 consecutive patients with domestic eye injury (104 eyes) referred to the emergency room of Farabi Hospital during October 2003. Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) was used for eye injury classification. Results Domestic ocular trauma represented 4.85% of all ocular emergencies (2061 patients) referred to the emergency room during that period. Male to female ratio was 1.13 and mean age of patients was 26±18 years (range, 1–73). Cornea was involved in 50.0% and sclera, lens, and retina each was involved in 4.8%. There was severe visual loss (best-corrected distance visual acuity <20/200 due to trauma) in 4% of the patients. The most frequent domestic ocular injury was globe injury (93.7%) including mechanical (72.1% closed and 4.8% open), chemical (14.4%), and thermal (1.9%) injuries. Conclusions Closed mechanical injuries were the most common type of domestic ocular injury in our series. Considering the high rate of domestic eye trauma among ocular emergency cases, more preventive measures should be taken at home.
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Affiliation(s)
- M Reza Mansouri
- Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran 16686 43511
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Chang IT, Prendes MA, Tarbet KJ, Amadi AJ, Chang SH, Shaftel SS. Ocular injuries from fireworks: the 11-year experience of a US level I trauma center. Eye (Lond) 2016; 30:1324-1330. [PMID: 27285323 PMCID: PMC5129850 DOI: 10.1038/eye.2016.104] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/07/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeCharacterize ocular trauma and visual outcomes from firework injuries at a level I trauma center.MethodsRetrospective review of all firework injuries at Harborview Medical Center between 2003 and 2013.ResultsThree hundred and twenty-seven patients sustained firework injuries, of which 100 (31%) sustained ocular injuries. The average age of all patients who sustained fireworks injuries was 24.2 years, 89% were male and 54% of injuries occurred within 48 h of 4 July. Ocular injuries were most commonly caused by mortars (24%) and rockets (22%). Rockets were associated with four times the frequency of ocular injuries as compared with non-ocular injuries (P<0.001). Spectators were more likely to sustain ocular injuries than non-ocular injuries (P=0.001). The most common injuries sustained were corneal abrasions (67%), hyphemas (42%), eyelid injuries (39%), and ruptured globes (17%). Twenty-eight percent of patients with ocular injuries required surgical intervention. Ruptured globes occurred in 17% of patients, with the majority being complex corneoscleral lacerations. Fifty-eight percent of patients who sustained ruptured globes were left with no light perception in the affected eye. Average follow-up was 188 days. Average visual acuity significantly improved from logMAR 1.8±1.6 at presentation to logMAR 1.3±1.8 at last follow-up.ConclusionsFirework-related ocular trauma frequently results in vision-threatening pathology. Prompt referral to and treatment by ophthalmologists is critical. This study documents the dangers inherent in the personal use of fireworks and provides data that may help guide public policy to decrease the frequency of these devastating injuries.
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Affiliation(s)
- I T Chang
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - M A Prendes
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - K J Tarbet
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - A J Amadi
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - S-H Chang
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - S S Shaftel
- Department of Ophthalmology, Southern California Permanente Medical Group, San Diego, CA 92120, USA
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Islam QU, Ishaq M, Yaqub MA, Mehboob MA. Predictive Value Of Ocular Trauma Score In Open Globe Combat Eye Injuries. J Ayub Med Coll Abbottabad 2016; 28:484-488. [PMID: 28712218] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Prediction of final visual outcome in ocular injuries is of paramount importance and various prognostic models have been proposed to predict final visual outcome. The objective of this study was to validate the predictive value of ocular trauma score (OTS) in patients with combat related open globe injuries and to evaluate the factors affecting the final visual outcome. METHODS Data of 93 patients admitted in AFIO Rawalpindi between Jan 2010 to June 2014 with combat related open globe ocular injuries was analysed. Initial and final best corrected visual acuity (BCVA) was categorized as No Light Perception (NLP), Light Perception (LP) to Hand Movement (HM), 1/200-19/200, 20/200-20/50, and ≥20/40. OTS was calculated for each eye by assigning numerical raw points to six variables and then scores were stratified into five OTS categories. RESULTS Mean age of study population was 28.77±8.37 years. Presenting visual acuity was <20/200 (6/60) in 103 (96.23%) eyes. However, final BCVA of ≥20/40 (6/12) was achieved in 18 (16.82%) eyes, while 72 (67.28%) eyes had final BCVA of <20/200 (6/60). Final visual outcome in our study were similar to those in OTS study, except for NLP in category 1 (81% vs. 74%) and ≥20/40 in category 3 (30% vs. 41%). The OTS model predicted visual survival (LP or better) with a sensitivity of 94.80% and predicted no vision (NLP) with a specificity of 100%. CONCLUSIONS OTS is a reliable tool for assessment of ocular injuries and predicting final visual outcome at the outset.
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Affiliation(s)
- Qamar Ul Islam
- Department of Ophthalmology, PNS Shifa Naval Hospital, Karachi, Pakistan
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Affiliation(s)
- C O Adeoti
- Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
| | - M A Isawumi
- Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria ; College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - O H Onakpoya
- Obafemi Awolowo University Teaching Hospital, Ile Ife, Osun state, Nigeria
| | - D S Agbeleye
- Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
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Nagata T. [Ocular disorders associated with occupations]. Nihon Rinsho 2014; 72:265-269. [PMID: 24605525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The ocular disorders associated with occupations include asthenopia caused by VDT work and eye disorders from eye injuries or exposure to organic solvents or ionizing radiation. The factors associated with the eye disorders can be divided into two groups: mechanical factors and non-mechanical factors. Furthermore, the latter factors can be divided into two subgroups: chemical factors and physical factors. It is said that we can prevent most accidents that cause occupation-related eye disorders if all workers wear suitable protective gear. However, the compliance with wearing protective gear is relatively low because of inattention or discomfort. The industrial specialists have to educate the workers about the proper use of the protective gear. Then, the safety and health promoters have to remind the workers to frequently check their field site for potential hazards.
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Affiliation(s)
- Tatsuo Nagata
- Department of Ophthalmology, School of Medicine, University of Occupational and Environmental Health, Japan
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Wilson P, Welch JF. Sport-related eye trauma. J R Nav Med Serv 2014; 100:56-61. [PMID: 24881428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sport-related eye injuries are a common cause of acute ocular injury. This article provides a basic clinical overview of the diagnosis and immediate medical management of sport-related eye injuries, and is relevant to all Armed Forces primary care and emergency medicine practitioners.
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Yulish M, Reshef N, Lerner A, Pikkel J. Sport-related eye injury in northern Israel. Isr Med Assoc J 2013; 15:763-765. [PMID: 24449981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Eye injuries are common in sports. Sports-related eye injuries have the potential for major morbidity OBJECTIVES To investigate the occurrence and to classify sport-related eye trauma in northern Israel. METHODS We analyzed the records of the ophthalmology emergency department for the years 2007-2011 and classified the admissions according to type, severity of injury and demographic data. RESULTS In 2% of the patients the injuries occurred during a sport activity. Most of the injuries occurred during soccer, basketball or school sport activity (74%). The majority of patients were young males. CONCLUSIONS Most sports-related eye injuries can be prevented with adequate eye protection.
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Affiliation(s)
- Michael Yulish
- Department of Orthopedics, Ziv Medical Center, Safed, Israel.
| | - Noam Reshef
- Department of Orthopedics, Ziv Medical Center, Safed, Israel
| | - Aleks Lerner
- Department of Orthopedics, Ziv Medical Center, Safed, Israel
| | - Joseph Pikkel
- Department of Ophthalmology, Ziv Medical Center, Safed, Israel
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Ahn SJ, Woo SJ, Kim KE, Jo DH, Ahn J, Park KH. Optical coherence tomography morphologic grading of macular commotio retinae and its association with anatomic and visual outcomes. Am J Ophthalmol 2013; 156:994-1001.e1. [PMID: 23972302 DOI: 10.1016/j.ajo.2013.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 06/12/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the morphologic characteristics of macular commotio retinae using spectral-domain optical coherence tomography (SDOCT) and develop a grading system for traumatic photoreceptor damage. DESIGN Retrospective, observational case series. METHODS setting: Seoul National University Bundang Hospital. patients: Forty-nine patients with macular commotio retinae, examined by SDOCT within 7 days of the initial traumatic event. observations: A 4-step grading system was based on the morphology revealed by SDOCT. Best-corrected visual acuity (BCVA) and structural integrity of the 3 photoreceptor layers (cone outer segment tips [COST], inner/outer segment [IS-OS] junction, external limiting membrane [ELM]) were evaluated at baseline, at 1 month, and at the final visit. Visual and anatomic outcomes at 1 month and at the final visit were compared among subgroups. main outcome measures: The severity of photoreceptor damage as revealed by SDOCT and BCVA. RESULTS The following 4 distinct photoreceptor morphologic features were observed: increase in IS-OS junction reflectivity with the disappearance of the thin hyporeflective optical space (n = 8, grade 1), COST defect only (n = 5, grade 2), COST and IS-OS junction defects (n = 16, grade 3), and COST, IS-OS junction, and ELM defects (n = 20, grade 4). Eyes with higher grades at baseline had significantly worse visual (final BCVA, P = .002) and anatomic outcomes (complete photoreceptor recovery, P < .001). CONCLUSIONS The number of disrupted photoreceptor layers, as determined using SDOCT images, can be used to grade macular commotio retinae. This system may be useful in documenting the baseline severity of photoreceptor damage and in predicting visual and anatomic outcomes.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
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Corre P, Arzul L, Khonsari RH, Mercier J. [Facial trauma and multiple trauma]. Soins 2013:43-45. [PMID: 24218922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The human face contains the sense organs and is responsible for essential functions: swallowing, chewing, speech, breathing and communication. It is also and most importantly the seat of a person's identity. Multiple trauma adds a life-threatening dimension to the physical and psychological impact of a facial trauma.
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Affiliation(s)
- Pierre Corre
- Clinique de stomatologie et de chirurgie maxillo-faciale, centre hospitalier universitaire de Nantes, 1, place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Ritson JE, Welch J. The management of open globe eye injuries: a discussion of the classification, diagnosis and management of open globe eye injuries. J R Nav Med Serv 2013; 99:127-130. [PMID: 24511795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Eye injuries occurred in 10% of UK military major trauma cases in Iraq and Afghanistan between 2004 and 2008, with 33% of these eye injuries open globe in nature(1). This article will consider the diagnosis, classification and management of open globe injuries in the role 1/ pre-hospital environment.
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Affiliation(s)
- J E Ritson
- Acute Care Common Stem (Emergency Medicine) Core Training Year 2, Royal Navy
| | - J Welch
- FRCOphth Consultant Ophthalmologist, Royal Navy
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Mao CJ, Yan H. [Clinical characteristics of mechanical ocular injury and application of ocular trauma score]. Zhonghua Yan Ke Za Zhi 2012; 48:432-435. [PMID: 22932334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To summarize clinical characteristics of mechanical ocular injury and to analyze the role of ocular trauma score (OTS) in the estimation of final visual acuity. METHODS All cases of ocular trauma admitted to the Department of Ophthalmology from January 2009 to December 2010 were retrospectively reviewed. Data extracted included laterality of the injured eye, gender, age, presenting time, cause, ocular trauma classification, initial and final visual acuity. These injuries were classified by ocular trauma classification system (OTCS). We also used the OTS in evaluating the final visual outcome. Comparisons between groups for discontinuous variables were analyzed using rank-sum test. Rank correlation was used in analysis between initial visual acuity and final visual acuity or between final visual acuity and OTS. Chi-square test was used to analyze variables, such as age, cause, type and visual acuity. Comparison of ages between male and female was analyzed by using t-test. RESULTS Of the 168 eyes, there were 106 open globe injury (OGI) and 62 closed globe injury (CGI). There were 140 males (85.71%) and 22 females (14.29%). Presenting time median of OGI and CGI was 5 h and 10 h respectively, and there was significant difference between these two different injuries (Z = -2.547, P = 0.011). The high-risk age group was the young age group (100 eyes, 59.52%), vs. the middle age group (46 eyes, 27.38%) and the elder age group (22 eyes, 13.10%). Occupation-related injury (70 eyes) was the most common cause and mainly resulted in OGI (54/70). Initial and final visual acuities in CGI were better than those of OGI (χ(2) = 37.847, P = 0.000; χ(2) = 44.428, P = 0.000). Initial visual acuity was correlated with final visual acuity (r = 0.858, P = 0.000). Final visual acuity was significantly correlated with total score (r = 0.870, P = 0.000) and OTS (r = 0.869, P = 0.000). CONCLUSIONS In this group of mechanical ocular trauma patients, male is more common than the female. Main type of injury is OGI and presenting time of OGI is earlier than that of CGI. The high-risk age group is the young. Main cause of injury is occupation-related injury. Initial and final visual acuities in CGI are better than those in OGI. OTS calculated at initial examination may be a useful parameter for the estimation of prognosis.
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Affiliation(s)
- Chun-jie Mao
- Department of Ophthalmology, General Hospital, Tianjin Medical University, Tianjin 300052, China
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Cockerham GC, Rice TA, Hewes EH, Cockerham KP, Lemke S, Wang G, Lin RC, Glynn-Milley C, Zumhagen L. Closed-eye ocular injuries in the Iraq and Afghanistan wars. N Engl J Med 2011; 364:2172-3. [PMID: 21631351 DOI: 10.1056/nejmc1010683] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hilber DJ. Eye injuries, active component, U.S. Armed Forces, 2000-2010. MSMR 2011; 18:2-7. [PMID: 21793615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- David J Hilber
- Tri-Service Vision Conservation and Readiness Program, United States Army Public Health Command, Aberdeen Proving Ground, Maryland 21010, USA.
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Abstract
Eye injuries come at a high cost to society and are avoidable. Ocular blast injuries can be primary, from the blast wave itself; secondary, from fragments carried by the blast wind; tertiary; due to structural collapse or being thrown against a fixed object; or quaternary, from burns and indirect injuries. Ballistic eye protection significantly reduces the incidence of eye injuries and should be encouraged from an early stage in Military training. Management of an injured eye requires meticulous history taking, evaluation of vision that measures the acuity and if there is a relative pupillary defect as well as careful inspection of the eyes, under anaesthetic if necessary. A lateral canthotomy with cantholysis should be performed immediately if there is a sight-threatening retrobulbar haemorrhage. Systemic antibiotics should be prescribed if there is a suspected penetrating or perforating injury. A ruptured globe should be protected by an eye shield. Primary repair of ruptured globes should be performed in a timely fashion. Secondary procedures will often be required at a later date to achieve sight preservation. A poor initial visual acuity is not a guarantee of a poor final result. The final result can be predicted after approximately 3-4 weeks. Future research in eye injuries attempts to reduce scarring and neuronal damage as well as to promote photoreceptor rescue, using post-transcriptional inhibition of cell death pathways and vaccination to promote neural recovery. Where the sight has been lost sensory substitution of a picture from a spectacle mounted video camera to the touch receptors of the tongue can be used to achieve appreciation of the outside world.
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Affiliation(s)
- Robert Scott
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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Ojabo CO, Adeniyi OS, Ogli SA. Farm-related ocular trauma in Makurdi, Nigeria. Niger J Med 2011; 20:114-119. [PMID: 21970272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Benue State, Nigeria, is largely an agrarian community. Farm related ocular injuries abound in this environment. Approximately two-third of all patients presenting to the eye casualty department do so because of ocular trauma sustained on the farm. This study aims to study the pattern and burden of farm related ocular injuries and its consequences and institute appropriate measures that will minimize visual loss from such injuries. METHODS A retrospective analysis of 1560 patients' record treated for ocular injuries between June 2000 and May 2005. The biodata extracted for each patient included age, sex, occupation, cause of injury, ongoing activities at time of injuries, severity of injury, time interval before presentation and entry and exit visual acuity. RESULTS AND CONCLUSION Result showed that of the 1560 patients' record audited, 1113 (71%) were male and 447 (29%) female. Their age ranged between 2 and 75 years with peak age incidence in the 2nd and 3rd decades. More than two-third of all ocular injuries were sustained in the farm environment with spear-grass corneal abrasion being the most common lesion. Only 25% presented for attention on the day of injury. On presentation, 55% presented with visual impairment, 15% presented blind in the affected eye. Closed eye injuries were more common than open eye injuries with the former having better prognosis.
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Affiliation(s)
- C O Ojabo
- Department of Ophthalmology, College of Health Sciences, Benue State University, Makurdi, Benue State.
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Razo-Blanco Hernández DM, Lima-Gómez V. Sources of error in the use of a system for classifying mechanical injuries of the eye. CIR CIR 2010; 78:381-386. [PMID: 21219807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND ocular trauma produces psychological, social and occupational effects that can cause significant impairment. Evaluation of ocular trauma has been standardized by a system for classifying mechanical injuries of the eye (SCMIE). Parameters that are most commonly a source of error for the evaluator and that may lead to classification errors have not been identified. METHODS an observational, retrospective, descriptive, cross-sectional and open study was conducted. Files of patients of either gender, aged 6 years or older, with ocular trauma graded with the SCMIE between 1997 and 2009 were re-evaluated by an independent investigator. The rate and 95% confidence intervals (95% CI) of evaluations that resulted in errors during the re-evaluation of ocular trauma were identified in the sample and in general for each parameter. The disparity between the initial evaluation and the re-evaluation (MacNemar) and the concordance between the evaluations (kappa) were analyzed. RESULTS of 817 evaluations, 294 had at least one grading error (36%, 95% CI 32.7-39.3). The most frequent error source was the parameter type. The disparity was significant in parameters type A, D, grade 2 and zone II. Overall concordance was good. CONCLUSIONS it is necessary to reinforce the learning curve for some parameters of the SCMIE, especially type, in order to improve its evaluation, so that it can become a valid communication tool that favors early referral to the specialist.
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Lima-Gómez V, Blanco-Hernández DMR. [Expected effect of treatment on the rate of visual deficiency after ocular trauma]. CIR CIR 2010; 78:302-309. [PMID: 21167095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Ocular trauma (OT) is a common cause of monocular blindness and visual impairment worldwide. The Ocular Trauma Score (OTS) is a scale that estimates visual function that an injured eye can achieve 6 months after OT. In a sample population, the OTS may be useful to compare the expected functional result with the result of therapeutic interventions in OT. We undertook this study to identify the expected effect of treatment on the rate of visual deficiency 6 months after OT. METHODS The rate of eyes with trauma-related visual deficiency (best corrected visual acuity <20/40) at the time of diagnosis was compared with that estimated 6 months later using the OTS (95% confidence intervals, CI). RESULTS We evaluated 742 patients; 46% had visual deficiency initially (95% CI 43-50.2) and 32.1% would demonstrate it 6 months later (95% CI 28.7-35.4, p <0.001, OR 0.54). The rate changed from 29.1 to 18% in closed-globe (CG) trauma and from 84.3 to 63% in open-globe (OG) trauma. CONCLUSIONS Treating OT would reduce the proportion of visual deficiency by 14.5 percentage points (11 in CG, 21.3 in OG trauma). Up to 66% of the injured eyes could reach normal vision. OT prevention requires enhancement because a high rate of eyes would remain disabled despite receiving the best available treatment.
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Affiliation(s)
- Virgilio Lima-Gómez
- División de Investigación, Hospital Juárez de México, Secretaría de Salud, México, D.F., Mexico
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Onyekwe LO. Factors affecting the visual outcome in hyphema management in Guinness Eye Center Onitsha. Niger J Clin Pract 2008; 11:364-367. [PMID: 19320412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND This study aims of determining the complications, outcome of hyphema treatment and recommend ways of enhancing good visual outcome. METHOD The records of all cases of hyphema seen from 1st January 2001 to 31st December 2005 were reviewed retrospectively. The variables analyzed were the biodata of all the patients, the agents causing hyphema, associated injuries and complications. Visual acuity at presentation, discharge and last visit was analyzed. RESULTS Seventy four patients that had hyphema were reviewed. The male:female ratio was 3.5:1. Trauma was predominantly main cause of hyphema. The common agents of injury include whip (23.2%) and fist (18.8%). The common complications were secondary glaucoma (52.5%), corneal siderosis (30.0%) and rebleeding (10%). Visual outcome is related to time ofpresentation, complications and treatment. Significant improvement was achieved following treatment. CONCLUSION Hyphema is a common complication of eye injuries. It is commonly associated with other eye injuries like vitreous haemorrhage and cataract. Common complications include secondary glaucoma, corneal siderosis and rebleeding. Visual outcome is dependent on time of presentation, severity and nature of complications. Visual outcome can be improved by early presentation and detection of complications and appropriate treatment.
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Affiliation(s)
- L O Onyekwe
- Guinness Eye Center, Nnamdi Azikiwe University Teaching Hospital, Onitsha, Anambra State, Nigeria
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Onyekonwu GC, Chuka-Okosat CM. Pattern and visual outcome of eye injuries in children at Abakaliki, Nigeria. West Afr J Med 2008; 27:152-154. [PMID: 19256319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Most studies on ocular injuries have been conducted in urban areas to the neglect of other areas. OBJECTIVE To ascertain the pattern and visual outcome following eye injuries in children at Abakaliki, a largely agricultural communityy in Southern Eastern Nigeria METHODS A retrospective study of all the children aged 0-15 years, who had eye injuries and presented to the Federal Medical Center, Abakaliki, Nigeria, between May 2004 and June 2006. Their medical case records were retrieved and extracted data for analysis included age, sex, type and cause of eye injury and duration prior to presentation. RESULTS Of the 119 medical records of patients (adults and children) with eye injuries within the study period, 34 (28.6%) patients were those of children aged 0-15 years. There were 24 (70.6%) males and 10 (29.4%) females, giving a male to female ratio of 2.4:1.0. Blunt ocular injury constituted 27 (79.4%) cases whereas penetrating injury were 5 (14.7%) cases. Sharp or pointed objects accounted for 14 (41.2%) cases of agents of injuries, sticks being the commonest. While the most common place of trauma was at home 17 (50%) cases, followed by trauma at schools 9 (26.5%) cases, the commonest activity at occurrence of injuries was playing 13 (38.2%) cases. Only three (8.8%) cases presented to the hospital within 24 hours. Majority, 31 (91.2%) cases presented late. Visual prognosis was poorer in penetrating injuries than in mild blunt injuries. Final visual acuity (VA) could not be determined in 11 (32.4%) patients because they were either under age or defaulted from follow up. Of the remaining 23 (67.6%) patients, 12 (35.3%) had a final VA better than 6/18, 1 (2.9%) had VA in the range of 6/18-6/60, 6 (17.6%) had VA of < 6/60 while 4 (11.8%) had NPL. 8 (23.5%) patients needed hospital admission. CONCLUSION Blunt eye injury is the commonest type of injury in rural or agricultural Abakaliki, South-Eastern Nigeria. An increase in parental and care giver awareness and education is emphasized.
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Affiliation(s)
- G C Onyekonwu
- Department of Ophthalmology, Ebonyi State University Teaching Hospital, Abakiliki, Ebonyi State, Nigeria
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Potocková A, Strmen P, Oláh Z. [Use of the international classification of mechanical injuries of the eye in clinical practice]. Cesk Slov Oftalmol 2008; 64:120-122. [PMID: 18630164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Rao SK, Greenberg PB, Filippopoulos T, Scott IU, Katsoulakis NP, Enzer YR. Potential Impact of Seatbelt Use on the Spectrum of Ocular Injuries and Visual Acuity Outcomes after Motor Vehicle Accidents with Airbag Deployment. Ophthalmology 2008; 115:573-576.e1. [PMID: 17765310 DOI: 10.1016/j.ophtha.2007.05.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/29/2007] [Accepted: 05/30/2007] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate the association between seatbelt use and (1) the spectrum of ocular injuries and (2) visual acuity outcomes after motor vehicle accidents (MVAs) with airbag deployment. DESIGN Single-center retrospective observational case series. PARTICIPANTS Forty-seven patients involved in MVAs with airbag deployment. METHODS Medical record review of all patients evaluated after an MVA with airbag deployment between January, 1997, and August, 2005, at a single level 1 trauma center. MAIN OUTCOME MEASURES Type of ocular injury and visual acuity at 3 months after an MVA. RESULTS Seventy-one percent of patients who did not wear seatbelts experienced type III ocular injuries compared with 31% who wore seatbelts (P<0.0002). Posterior segment injuries occurred only in patients who did not wear seatbelts. At the 3-month follow-up, 76% of patients who did not wear seatbelts achieved a visual acuity of 20/40 or better compared with 96% of patients who wore seatbelts (P>0.10); a visual acuity worse than 20/200 was measured in 14% and 0% of patients in the 2 groups, respectively (P<0.03). CONCLUSIONS In the current study, the use of seatbelts was associated with less severe ocular injuries and better visual outcomes.
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Affiliation(s)
- Sunil K Rao
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
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Rumelt S, Kassif Y, Koropov M, Landa E, Marzuk F, Segal ZI, Vinerovsky A, Rehany U. The spectrum of iatrogenic intraocular injuries caused by inadvertent cannula release during anterior segment surgery. ACTA ACUST UNITED AC 2007; 125:889-92. [PMID: 17620566 DOI: 10.1001/archopht.125.7.889] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the causes of inadvertent intraocular injuries resulting from the use of cannulas during anterior segment surgery. Method Retrospective review of all cases with inadvertent release of irrigation and viscoelastic cannulas during anterior segment surgery in 15 years. RESULTS Inadvertent release of cannulas occurred in 9 of 10 230 cases of anterior segment surgery during a 15-year period. The incidence of cannula release was 0.88 per 1000 procedures per year. Twenty percent of the surgeons who performed anterior segment surgery in this period were involved in this unfortunate event. Six cases occurred during cataract extraction and 3 during penetrating keratoplasty or replacement of corneal graft. The latter 3 cases included posterior capsule rupture and vitreous loss. Macular scar in 2 (22%) of the 9 cases was associated with poor visual outcome of counting fingers at 2.1 to 3.0 m (P = .03). In all other surgeries, the cannula caused iris or anterior chamber angle injury without consequences. CONCLUSIONS Inadvertent release of cannulas during anterior segment surgery is a rare, memorable, and unfortunate event. The severity of the injury may be related to the type of the surgical wound. In most cases, visual outcome is not compromised unless the cannula causes retinal disruption.
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Affiliation(s)
- Shimon Rumelt
- Department of Ophthalmology, Western Galilee-Nahariya Medical Center, Nahariya, Israel
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Abstract
Ocular contusions are common and cause significant morbidity. The mechanism of ocular contusion is a decrease in the length of the anterioposterior axis whereas the transversal axis increases. Epidemiology data shows that young men are most injured in relation with sports, aggression, work, or car or work accidents. Injury to the ocular surface (conjunctiva and cornea) is minor. The iris is very frail, usually leading to hyphema which can progress to glaucoma. A cataract can appear after a contusion but usually years after the trauma. Final visual acuity can be compromised by retinal contusion or retinal detachment (due to a retinal dehiscence or post-traumatic dialysis). The worst outcome is optic neuropathy. The most difficult task is to predict visual acuity after the initial ocular lesion.
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Affiliation(s)
- R Montard
- Service d'Ophtalmologie, CHU Jean Minjoz, Besançon, France.
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Bagley DM, Casterton PL, Dressler WE, Edelhauser HF, Kruszewski FH, McCulley JP, Nussenblatt RB, Osborne R, Rothenstein A, Stitzel KA, Thomas K, Ward SL. Proposed new classification scheme for chemical injury to the human eye. Regul Toxicol Pharmacol 2006; 45:206-13. [PMID: 16764976 DOI: 10.1016/j.yrtph.2006.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE Various ocular alkali burn classification schemes have been published and used to grade human chemical eye injuries for the purpose of identifying treatments and forecasting outcomes. The ILSI chemical eye injury classification scheme was developed for the additional purpose of collecting detailed human eye injury data to provide information on the mechanisms associated with chemical eye injuries. This information will have clinical application, as well as use in the development and validation of new methods to assess ocular toxicity. METHODS A panel of ophthalmic researchers proposed the new classification scheme based upon current knowledge of the mechanisms of eye injury, and their collective clinical and research experience. Additional ophthalmologists and researchers were surveyed to critique the scheme. The draft scheme was revised, and the proposed scheme represents the best consensus from at least 23 physicians and scientists. RESULTS The new scheme classifies chemical eye injury into five categories based on clinical signs, symptoms, and expected outcomes. Diagnostic classification is based primarily on two clinical endpoints: (1) the extent (area) of injury at the limbus, and (2) the degree of injury (area and depth) to the cornea. CONCLUSIONS The new classification scheme provides a uniform system for scoring eye injury across chemical classes, and provides enough detail for the clinician to collect data that will be relevant to identifying the mechanisms of ocular injury.
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Abstract
This article presents evaluation and treatment approaches to ophthalmologic conditions that are likely to be encountered in a primary care office. These conditions can be organized by diagnostic category, symptoms, and location of complaint. By using one ora combination of these categories, the practitioner can provide appropriate, timely, and effective ophthalmologic evaluation and treatment. Acute conditions are categorized according to urgency of intervention.
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Affiliation(s)
- Jerry Naradzay
- Emergency Medical Services, Mesa View Regional Hospital, Mesquite, NV, USA
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McCall BP, Horwitz IB. Assessment of occupational eye injury risk and severity: an analysis of Rhode Island workers' compensation data 1998-2002. Am J Ind Med 2006; 49:45-53. [PMID: 16362940 DOI: 10.1002/ajim.20234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Occupational eye injuries have been recognized as a serious health risk to workers and are in need of further investigation to develop effective interventions. METHODS Rhode Island workers' compensation claims of ocular injury between 1998 through 2002 (n=8,877) were examined. The Current Population Survey was used to estimate occupational employment levels as a baseline for rate calculations. RESULTS The estimated ocular injury claim rate was 32.9 per 10,000 workers (95% CI=32.3-33.6), with the cost of claims totaling $1,514,666 and averaging $171 per claim. The highest estimated claim rate of all occupations was found for construction laborers of 373.7 per 10,000 workers (95% CI=267.1-480.3). Relative to the durable manufacturing industry, the highest risk of injury resulting in disability indemnification was the wholesale trade industry (OR=2.18, 95% CI=1.19-4.01, P<0.05). CONCLUSIONS Many of the eye injuries reported were likely preventable. Greater diligence, training, and safety precautions are needed to reduce the risk of eye injury to employees.
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Affiliation(s)
- Brian P McCall
- University of Minnesota, Carlson School of Management, Industrial Relations Center, Minnesota, USA
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Abstract
OBJECTIVE To determine the activities and circumstances proximal to a welding related occupational eye injury, a hybrid narrative coding approach derived from two well developed classification systems was developed to categorize and describe the activity, initiating process, mechanism of injury, object and/or substance, and the use of protective eyewear from the narrative text data reported for each injury. METHODS Routinely collected workers' compensation claims over a one year period (2000) were analyzed from a large US insurance provider. An index term search algorithm of occupation, incident, and injury description fields identified 2209 potential welding related eye injury claims. After detailed review of these claims, 1353 welders and 822 non-welders were analyzed. RESULTS During 2000, eye(s) as the primary injured body part accounted for 5% (n = 26 413) of all compensation claims. Eye injuries accounted for 25% of all claims for welders. Subjects were mainly male (97.1%) and from manufacturing (70.4%), service (11.8%), or construction (8.4%) related industries. Most injuries were foreign body (71.7%) or burn (22.2%) and 17.6% were bilateral. Common activities include welding (31.9%) and/or grinding (22.5%). Being struck by an airborne object occurred in 56.3% of cases. Non-welders showed similar patterns except that burns (43.8%) were more frequent and more often initiated by another worker (13.9%). CONCLUSIONS Narrative injury text provides valuable data to supplement traditional epidemiologic analyses. Workers performing welding tasks or working nearby welders should be trained to recognize potential hazards and the effective use of proper safety equipment to prevent ocular injury.
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Affiliation(s)
- D A Lombardi
- Quantitative Analysis Unit, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA.
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Ma ZZ. [The present situation and progress in the research of the mechanical eye injury in China]. Zhonghua Yan Ke Za Zhi 2005; 41:736-8. [PMID: 16191331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The patients of eye injury of inpatients and outpatients in county and prefecture hospitals were reported in some proportion in the ophthalmologic literature. Eye injury was the leading cause among the blind eyes determined at the discharge from the hospitals. Therefore, the prevention and treatment of eye injury has been the priority for Chinese ophthalmologists. In recent years, the international standard classification of the type and location of eye injury has been accepted and adopted in China. The level of primary wound management for eye injury has been raised in all hospitals. The timing of continued treatment sustaining vitrectomy procedures has been emphasized widely. The indications of primary enucleation have been strictly controlled by ophthalmologists. The remarkable progress has been made in rescue of presumed enucleation candidates. It is essential to establish a nationwide registry system and to conduct the multicenter trial for the control of eye injury in the future.
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Affiliation(s)
- Zhi-zhong Ma
- Peking University Third Hospital, Peking University Eye Center, Beijing 100083, China.
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Lima-Gómez V, Góngora-Bobadilla VJ. [Modification of the presentation of ocular trauma by age group in an urban Mexican population]. CIR CIR 2005; 73:251-7. [PMID: 16283954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION We identified whether ocular trauma presentation, according to the system for classifying mechanical injuries of the eye, had modifications among different age groups, which could be useful as damage predictors during the initial evaluation of these patients. MATERIAL AND METHODS Ocular trauma referrals between 1995 and 2003 were re-qualified according to the system for classifying mechanical injuries. Patients were divided into 5-year groups and the most frequent categories of type, grade, pupil and zone were determined by group. Mean age of each category and the rate of categories between groups were compared (ANOVA and Kruskal-Wallis, chi2 and odds ratio [OR]). RESULTS Five hundred sixty-six eyes of 551 patients were evaluated (age: 0.5-90 years, mean age: 27.7); mean age was lower for type B closed globe trauma and zone II (p < 0.05). There was a higher rate of grade 1 in patients > 60 years (OR 3.8), of grade 4 in patients < 54 years (OR 3.25) and of type B closed globe in patients > 20 years (OR 3.3). The remaining comparisons showed no clinical differences. CONCLUSIONS There were no significant modifications in the presentation of most of the categories between age groups. Age difference was not useful as a predictor for detecting traumatic ocular damage.
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Abstract
BACKGROUND Ocular trauma has significant impact on the patient's future quality of life. Progress in the treatment of ocular trauma may ameliorate the outcome, but preventive measures are more effective. However, prevention of ocular trauma can only be effective when the current epidemiology of ocular trauma is known. Therefore, we have now collected data on ocular trauma over nearly 20 years. This paper provides an overview on the development of open globe injuries in the past 20 years. PATIENTS The records of 1026 patients with open globe injuries who were primarily treated at the Universities of Freiburg and Würzburg between January 1, 1981 and December 31, 1999, were sufficiently analyzed. The following parameters were evaluated: age, extent of injury, sex, cause. and activity at the time of injury. RESULTS After correction for demographic distribution, the risk for open globe injury was highest for young adults and lowest for seniors. In recent years, the risk for severe eye injury is more equally distributed and is increasing for old people. We noted decreasing injuries at work and during traffic accidents, especially for young female front-seat passengers. On the other hand, we observed an increasing proportion of domestic eye injuries related to hobby activities. With increasing age we noted more posterior segment injuries. 9 % of all open globe injuries occurred among seniors (> 65 years old), but 41 % of all ruptures occurred in this age group. Preceding cataract surgery was identified as a risk factor. 38 % of injured persons in this age group had already had intraocular surgery. After the introduction of small incision techniques at the beginning of the 1990 s, the frequency of globe ruptures began to decrease again. 3.6 % of the injured eyes developed an endophthalmitis, in agricultural injuries the rate of endophthalmitis was 12 %. CONCLUSION There is a relative constant incidence of 3.0 open globe injuries per 100,000 population. The circumstances of the injuries underwent major changes within the period of these observations.
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Lima-Gómez V, García-Pacheco JM. [Functional prognosis in ocular trauma. Does visual deficiency help in localizing the injuries that cause it?]. CIR CIR 2004; 72:447-52. [PMID: 15694048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Prevalence of reported trauma-related blindness is 0.6% with almost half of serious ocular injuries involving the retina. Causes of visual deficit (VD) in ocular trauma were identified in patients with different grades (visual capacity), in order to determine the rate of poor functional prognosis at initial evaluation caused by posterior segment involvement and to identify a grade that could predict it. METHODS Ocular trauma referrals were re-qualified (1995-2003) according to the standardized classification. VD (grade >1) and zone were evaluated. The rate of VD and zone III with VD were determined. Injuries causing VD were identified and grouped by zone. The rate of these injuries was compared by zone, between each grade and the remaining, with chi2. RESULTS Five hundred fifty-seven eyes were included (mean age 27.7 years), 165 had VD (29.6%, CI 95% 25.8-33.4); 93 had zone III involvement (16.7%), 53 of whom had VD (9.5%, CI 95% 7.1-11.9%). Among injuries that caused VD (n = 323), 102 involved zone I (31.6%), 144 zone II (44.6%), and 77 zone III (23.8%). Injuries in zone III were more frequent in grade 5 (52%) than in the remaining groups (21.5%, p = 0.0005, OR 3.9). CONCLUSIONS In 90.5% of the eyes (CI 95%, 88.1-92.9), injuries caused VD by means of anterior segment involvement or did not cause it at all. A high rate of ocular trauma patients, even those with grade 5 at initial evaluation, may have an opportunity for visual recovery with early referral.
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Affiliation(s)
- Virgilio Lima-Gómez
- Servicio de Oftalmología, Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Col. Magdalena de las Salinas, 07760 Mexico DF.
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Pülzl P, Wechselberger G, Schoeller T, Pichler M, Piza-Katzer H. [Eyebrow injuries. Classification and therapy concept]. Unfallchirurg 2004; 107:761-8. [PMID: 15502901 DOI: 10.1007/s00113-004-0808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of primary treatment for eyebrow injuries should be preservation of the original eyebrow under any circumstances. Debridement should be kept to a minimum even when the wound is severe. The treatment of total or partial loss of an eyebrow concerning the exact reconstruction of details and aesthetic aspects is a challenge for the surgeon. The therapy option depends on the type of eyebrow selected for reconstruction. We present a classification for eyebrow injuries, which considers type and size of defects. Based on this, different techniques and methods of reconstruction are recommended. Advantages and disadvantages are discussed and illustrated by several examples.
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Affiliation(s)
- P Pülzl
- Klinik für Plastische und Wiederherstellungschirurgie, Universität, Innsbruck, Osterreich.
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Affiliation(s)
- P Dureau
- Service d'ophtalmo-pédiatrie, fondation ophtalmologique Adolphe-de-Rothschild, Paris, France
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Bledsoe BE, Ho B. Sight-threatening eye injuries: prehospital management of ophthalmological emergencies. JEMS 2004; 29:94-106; quiz 108-9. [PMID: 15499332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Nirmalan PK, Katz J, Tielsch JM, Robin AL, Thulasiraj RD, Krishnadas R, Ramakrishnan R. Ocular trauma in a rural south Indian population: the Aravind Comprehensive Eye Survey. Ophthalmology 2004; 111:1778-81. [PMID: 15350336 DOI: 10.1016/j.ophtha.2004.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2003] [Accepted: 02/09/2004] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To determine the rate of ocular trauma in a rural population of southern India and its impact on vision impairment and blindness. METHODS A population-based cross-sectional study of 5150 persons 40 years or older in a randomly chosen rural population of 3 districts of southern India. Prospective information on trauma, type and agent of injury, setting of injury, and details of treatment sought for the last episode was recorded with questionnaires after face-to-face interviews. All interviewed subjects underwent a comprehensive ocular examination, including vision estimations, slit-lamp biomicroscopy examinations, and dilated posterior segment examinations. RESULTS We elicited a history of ocular trauma in either eye from 229 (4.5%) persons, including 21 (0.4%) persons with bilateral ocular trauma. Blunt injuries (n = 124; 54.9%) were the major cause for trauma reported in this population. The most common setting where the ocular trauma occurred was during agricultural labor (n = 107; 46.9%). Nearly three quarters (n = 170; 74.2%) of those reporting ocular trauma sought treatment from an eye specialist (n = 104; 57.8%) and one fifth (n = 37; 20.6%) from a traditional healer. The age-adjusted (adjusted to the population estimates for India for the year 2000) prevalence for blindness in any eye caused by trauma was 0.8% (95% confidence interval [CI], 0.4-1.1). The odds ratios (OR) for trauma were higher for males (OR, 2.2; 95% CI, 1.6-3.0) and laborers (OR, 1.7; 95% CI, 1.2-2.4) and lower for literates (OR, 0.7; 95% CI, 0.5- 0.9). Seeking treatment from a traditional eye healer for trauma was not associated with vision impairment (OR, 1.0; 95% CI, 0.3-3.2) or with blindness (OR, 3.4; 95% CI, 0.2-56.5). CONCLUSIONS Eye care programs may need to consider ocular trauma as a priority in this population, because the lifetime prevalence of ocular trauma is higher than that reported for glaucoma, age-related macular degeneration, or diabetic retinopathy from this population. Simple measures such as education regarding the use of protective eyewear could possibly significantly decrease this preventable cause of visual disability.
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Affiliation(s)
- Praveen K Nirmalan
- Aravind Medical Research Foundation, Aravind Eye Care System, Madurai, India
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40
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Abstract
We describe the injuries of the eyelids depending on the reason, type and severity of the trauma. We are giving a diagnostical guide. By references to the anatomical specialties of the eyelids we deliver therapeutical recommendations for the different types of injuries.
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Affiliation(s)
- J Herde
- Medizinische Fakultät, Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg.
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41
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Abstract
Childhood trauma of the eye and its adnexa represents approx. 4 - 20 % of all eye injuries. Due to ambiguous patient history and limited cooperation a comprehensive diagnosis of pediatric eye trauma is often difficult. The weakness of the infantile cornea, the thin and elastic anterior lens capsule, and the firm vitreous with its strong adherence to the retina bear particular intra- or postoperative problems. Moreover, the quick development of secondary cataract and the high risk of PVR may complicate the posttraumatic and postoperative course. Small infants represent a special subgroup in various regards mainly because of the risk of amblyopia which often causes functional loss in spite of a good anatomical reconstruction. The relative frequency of certain injuries differs between children and adults. The ocular manifestation of child abuse as well as bite and fireworks injuries are characteristic for childhood and will be discussed more in detail.
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42
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Abstract
PURPOSE To evaluate the clinical outcome of children with traumatic hyphema treated on an outpatient basis. METHODS A prospective cases series. Thirty-five children with traumatic hyphema were treated as outpatients for the ocular injury from February 2002 to February 2003. Data regarding initial and final visual acuity, slit-lamp biomicroscopy, hyphema size,ophthalmoscopy, intraocular pressure, rebleeding, clearance time, and medical and surgical intervention were recorded. RESULTS Thirty (85.7%) children were male, and the major cause of traumatic hyphema was domestic tools (14 cases, 40.0%). Twenty-four patients (68.6%) presented low grades of hyphema. Seventeen patients (48.6%) had intraocular pressures higher than 24 mm Hg. The most common lesions associated with traumatic hyphema were corneal injuries (16 cases, 45.7%). The median final visual acuity was 20/25. Unsatisfactory final visual acuity (worse than 20/30) was statistically associated with ocular posterior segment lesions (P = 0.009) and grade of hyphema (P = 0.004). The grade of hyphema was also related to intraocular hypertension (P = 0.018) and time for hemorrhage absorption (P < 0.001). Nine patients (25.7%) underwent surgical intervention. Rebleeding occurred in three patients (8.6%). CONCLUSIONS Outpatient management is a feasible option for children with hyphema. Associated posterior ocular segment injuries and hyphema of greater magnitude were related to the worst final visual acuities.
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Globocnik Petrovic M, Lumi X, Drnovsek Olup B. Prognostic factors in open eye injury managed with vitrectomy: retrospective study. Croat Med J 2004; 45:299-303. [PMID: 15185422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
AIM To evaluate surgery results and establish prognostic factors that predicted final functional (good or poor vision) and anatomic (final retinal detachment) outcome in open eye injury involving the posterior segment managed with pars plana vitrectomy. METHODS Medical records of 52 consecutive patients with open eye injury involving the posterior segment were retrospectively reviewed. Specific variables of a system for classifying mechanical injuries of the eye were analyzed: the type of injury (defined by the mechanism of injury), grade of injury (defined by initial visual acuity), zone of injury (defined by the location of the wound), and relative afferent pupillary defect. Additional variables, such as wound length, retinal detachment, endophthalmitis, and timing of vitrectomy, were also included in the analysis. Final visual outcome and retinal attachment rate were recorded. Data were analyzed with chi-square test, univariate analysis for predictors, and multivariate logistic regression analysis. RESULTS After a mean follow up of 20.0+/-10.5 months, 50% of eyes achieved visual acuity 0.5 or better, 27% of eyes achieved visual acuity 0.1 or worse, and 10% of eyes had final retinal detachment. According to univariate analysis results, the following parameters were predictors of good vision (visual acuity > or =0.5 in comparison with visual acuity <0.5): grade of injury (p=0.008), zone of injury (p=0.01), afferent pupillary response (p<0.001), wound length (p=0.002), and initial retinal detachment (p=0.009). The predictors of poor vision (visual acuity < or =0.1 in comparison with visual acuity >0.1) were zone of injury (p<0.001), relative afferent pupillary defect (p<0.001), wound length (p=0.002), and initial retinal detachment (p<0.001). Relative afferent pupillary defect (p=0.003) and initial retinal detachment (p<0.001) were predictors of final retinal detachment with proliferative vitreoretinopathy. However, multivariate logistic regression analyses revealed that relative afferent pupillary defect was the only significant factor for poor visual acuity (odds ratio, 10.3; 95% confidence interval, 1.1-92; p=0.04). On the other hand, none of the variables was a significant independent predictor for either good visual acuity or final retinal detachment. CONCLUSION Half of the eyes with a good final visual outcome in our study were successfully managed with pars plana vitrectomy for open eye injury after trauma. The classification system may become useful prognostic tool for visual outcome in posterior segment ocular injuries managed with vitrectomy. Relative afferent pupillary defect as a functional test is a good predictor for visual outcome.
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Karaman K, Gverović-Antunica A, Rogosić V, Lakos-Krzelj V, Rozga A, Radocaj-Perko S. Epidemiology of adult eye injuries in Split-Dalmatian county. Croat Med J 2004; 45:304-9. [PMID: 15185423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
AIM To determine the incidence of eye injuries, population groups at risk, circumstances and activities at the time of accident, causes, mechanism, type and severity of injury, therapeutic procedures, final outcome, and the incidence of blindness in patients over 18 years of age. METHODS We retrospectively analyzed data on 383 patients with eye injuries (397 eyes) hospitalized at Split University Hospital, Department of Ophthalmology, between January 1998 and December 2002. Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) and eye injury score were used for eye injury categorization. RESULTS The incidence of ocular injuries requiring hospitalization in Split-Dalmatian County was 23.9 per 100,000 population and the incidence of monocular blindness caused by injuries was 4.1 per 100,000 population. The male to female ratio was 5.4 to 1. Forty-one percent of injuries occurred at home, 27.7% at work, 13.8% in agriculture, 7.0% during assault or scuffle, 5.2% in traffic, 3.7% during sports activities, and 1.6% at school. Among 397 injuries, 86.4% were mechanical and 13.6% chemical. Out of 343 mechanical injuries, 67.3% were closed globe and 32.7% were open globe injuries. The most frequent objects causing mechanical injuries were tree branch or wood (15.9%) causing 26.3% of ruptures and 21.4% of contusions; pieces of metal or stone (13.9%) causing 80.8% of intraocular foreign body lacerations; and nails, wire, or scissors (8.8%) causing 26.7% of lamellar and 23.9% of penetrating lacerations. Closed globe injuries were less severe and had better final visual outcome than open globe injuries. Final visual acuity was 0.4 or better in 91.4% of mild vs 13.9% of severe injuries. Injuries resulted in monocular blindness (visual acuity <0.1) in 71 (17.9%) patients: 35.2% were due to penetrating lacerations, 23.9% to ruptures, 21.1% to contusions, 16.9% to intraocular foreign body lacerations, and 1.4% due to burns as well as lamellar lacerations. CONCLUSION There was a high incidence of ocular trauma and consequent blindness in Split-Dalmatian County. For the prevention of serious eye injuries, health education and safety strategies should be applied both at home and place of work, where blinding injuries most often occur.
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Affiliation(s)
- Ksenija Karaman
- Department of Ophtalmology, Split University Hospital, Spincićeva 1, 21000 Split, Croatia.
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45
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Malla BK. Structural changes in ocular trauma and the visual outcome. Kathmandu Univ Med J (KUMJ) 2004; 2:113-8. [PMID: 15821376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This is the presentation of one year prospective study on the anatomical structural lesions in ocular traumas with their visual outcome among those cases admitted and treated at Nepal Eye Hospital, Kathmandu. The changing life style of the people and environmental changes around with the changing nature of the causative objects on eye injuries have been observed for causing more serious structural lesions or complications including loss of vision.
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Affiliation(s)
- B K Malla
- Department of Anatomy, Kathmandu Medical College, Duwakot
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Pieramici DJ, Kuhn F. Frontal air bags and eye injury patterns in automobile crashes. Arch Ophthalmol 2003; 121:1807-8; author reply 1808. [PMID: 14662616 DOI: 10.1001/archopht.121.12.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Pieramici DJ, Au Eong KG, Sternberg P, Marsh MJ. The prognostic significance of a system for classifying mechanical injuries of the eye (globe) in open-globe injuries. J Trauma 2003; 54:750-4. [PMID: 12707539 DOI: 10.1097/01.ta.0000047053.53821.c8] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to determine the prognostic significance of a previously published system for classifying mechanical injuries of the eye (globe) in open-globe injuries. METHODS The medical records of 150 patients with open-globe injuries identified from an established institutional database were retrospectively reviewed to classify all injuries at presentation by the four specific variables of the classification system: type of injury, defined by the mechanism of injury; grade of injury, defined by visual acuity in the injured eye at initial examination; pupil, defined as the presence or absence of a relative afferent pupillary defect in the injured eye; and zone of injury, defined by the location of the eye-wall opening. Final visual outcomes for these injuries were also recorded. Logistic regression models were used to analyze the data and to determine whether relationships existed between the specific classification variables and final visual acuity in the injured eyes. RESULTS All four classification variables were significant predictors of visual outcome. When adjusted for the other variables, grade and pupil were the most significant predictors of final visual acuity. CONCLUSION This system for classifying mechanical injuries of the eye appears to be prognostic for visual outcomes in open-globe injuries. In particular, the measurement of visual acuity and testing for a relative afferent pupillary defect at the initial examination should be performed in all injured eyes because of their relative prognostic significance.
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Affiliation(s)
- Dante J Pieramici
- The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
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48
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Xia WT, Dong DA, Yu HW. [Identification opportunity for several types of eye injuries]. Fa Yi Xue Za Zhi 2003; 19:129-32. [PMID: 13677310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To study the stability duration of visual acuity after eye injuries in several types, in order to define the earliest and best opportunity for identification. METHODS 160 cases were divided into five groups, in which their stable visual acuity after injuries were divided into several ranges. Then the relationship between stability duration of visual acuity and their visual acuity level, as well as eye injury types were analyzed. RESULTS Significant correlation existed between eye injury types, stable visual acuity level and stability duration of visual acuity after injuries. CONCLUSION The earliest and best opportunity for identification after eyes injuries related to injury types and visual acuity level.
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Affiliation(s)
- Wen-tao Xia
- Institute of Forensic Sciences, Ministry of Justice, Shanghai 200063, China
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49
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Abstract
BACKGROUND Orbital fractures are associated with ocular and periocular injuries. The role of the ophthalmologist in the evaluation and management of facial trauma, including orbital fractures, has not been clearly defined. The purpose of this study is to identify and characterize ocular and periocular injuries associated with orbital fractures to define the role of the ophthalmologist in the management of facial trauma. STUDY DESIGN Retrospective case review. RESULTS Three hundred sixty-five patients with orbital fractures who were evaluated by an ophthalmologist as part of their initial trauma evaluation were studied. The majority of the patients with orbital fractures (74%) did not have associated ocular or periocular injuries. Twenty-three of 104 (22%) ocular injuries in 23 of 95 (24%) patients required immediate intervention by an ophthalmologist. CONCLUSIONS Facial trauma and orbital fractures are associated with significant ocular and periocular injuries, the minority of which require immediate evaluation and treatment by an ophthalmologist. These results differ from those previously reported.
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Affiliation(s)
- Todd Cook
- Department of Ophthalmology, Division of Oculoplastic Surgery, Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
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50
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Abstract
OBJECTIVE To report the epidemiological characteristics of pediatric open globe injuries and to discuss treatment, management and outcomes of such injuries. MATERIALS AND METHOD The hospital records and operative notes of 95 patients 16 years old and younger who were treated for open eye injury at Ibn Sina Hospital, Kuwait between September 1995 and January 1999 were reviewed. The average age of patients was 6.6 years. Patients were divided into three groups according to their final visual acuity (FVA): group 1, FVA of 20/40 or better; group 2, 20/40-20/200, and group 3, 20/400 or worse. The FVA of each group was compared to initial visual acuity (IVA), wound entry site, injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries and medical treatment. RESULTS Injury was most common in children 3-6 years old. Most injuries occurred during play at home (46%), between the months of July and November (58%), and evening time (42%). The most common causes were glass, pencil, stick, soft drink bottle, metal bar, and stone. The cornea was the most common entry site (59 cases). Seventy-three patients presented on the day of injury, and 38 of them had surgical repair that same day. The follow-up period ranged from 2 weeks to 58 months. Thirty-eight patients (40%) had an FVA of 20/40 or better (group 1), 23 (24%) between 20/40 and 20/200 (group 2), 12 (13%) 20/400 or worse (group 3), and 22 (23%) had no record of FVA. The difference between IVA and FVA of wound entry site was statistically significant (p < 0.005). Differences due to injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries, and the use of systemic antibiotics were found not to be statistically significant (p > 0.2). CONCLUSION The prevalence of open globe injury among the pediatric population in Kuwait was high. Most injuries were due to household objects and occurred at home in the evening during the summer and autumn. IVA and anatomical location of the wound impacted on final outcome.
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