Eyelid and orbital trauma for the primary care physician

Predictors of higher pain in possible open globe injury emergency medical services activations

PURPOSE

To determine predictors of high pain in open globe injury (OGI) cases treated and transported by Emergency Medical Services.

METHODS

The National Emergency Medical Services Information System database was queried for activations of OGI between 2017 and 2021. Demographic, location, medication, and date and time information was collected. Cases were divided based on the intensity of maximum pain reported (low pain: below 5/10, high pain: above 5/10). Logistic regression was used to identify significant predictors of high maximum pain.

RESULTS

Of 53,589 cases of OGI, 20,766 reported high levels of pain. Females were more likely to report high pain than males (OR 1.24, CI 1.195-1.285). All age groups between 16 and 75 years old were more likely to report high pain than patients below 15, while all age groups above 75 were less likely. American Indians/Alaska Natives, Black, and Hispanic Americans were all more likely to report high pain than White Americans (American Indian, OR 1.249, CI 1.067-1.461; Black, OR 1.332, CI 1.277-1.390; Hispanic, OR 1.133, CI 1.064-1.207). OGI cases in the Midwest and South regions were less likely to report high pain than those in the West (Midwest, OR 0.868, CI 0.807-0.933; South, OR 0.800, CI 0.748-0.855). Compared to low pain patients, a greater percentage of high pain patients received opioid analgesia (10.04% vs. 0.44%).

CONCLUSIONS

Demographic factors and location may contribute to higher pain in OGI patients. This information may prove useful in the management of OGI and may warrant further investigation into the nature of open globe trauma.Kindly check and confirm the inserted city is correct for affiliation 3.Correct.

Diagnosis and treatment intraorbital foreign body: A case report

Key Clinical Message

Wooden foreign bodies inside the eye socket are an uncommon kind of eye injury that falls into a distinct category of intraorbital foreign bodies. Due to the wide range of clinical presentations and imaging features of intraorbital wooden foreign bodies, misinterpretation and failure to diagnose correctly often happen.

Abstract

Wooden foreign bodies inside the eye socket are an uncommon kind of eye injury that falls into a distinct category of intraorbital foreign bodies. The condition mostly manifested in individuals of youthful and middle age. Due to the wide range of clinical presentations and imaging features of intraorbital wooden foreign bodies, misinterpretation and failure to diagnose correctly often happen during the first examination. The risk of orbital infection might greatly rise if there is a delay in diagnosing woody foreign substances inside the eye socket. The majority of patients need surgical intervention as the recommended course of therapy. Nevertheless, it is essential to avoid disregarding undetected diagnoses and the existence of foreign material remnants after prior surgical procedures. Hence, achieving a precise diagnosis relies on a comprehensive assessment of the patient's trauma history, meticulous examination of the eyes, vigilant monitoring of clinical symptoms, accurate imaging techniques such as magnetic resonance imaging (MRI) or computerized tomography (CT), and prompt and thorough removal of wooden foreign objects within the eye socket.

PAs' skills in providing vision and ocular care

OBJECTIVE

To evaluate characteristics, training, and self-reported skills and abilities in vision and ocular care among PAs not specializing in ophthalmology.

METHODS

A survey on PA practice was administered to 5,763 randomly selected US-based PAs, and 537 respondents who completed the survey were invited to complete a separate vision and ocular care survey. Of those respondents, 382 completed the vision and ocular care survey.

RESULTS

Among respondents, 23% of PAs were involved in eyecare by providing patient information, answering questions, and initiating discussions about vision care and ocular health more than once per month. More than 77% received vision and ocular care training in and/or outside PA training. PAs involved in eyecare had significantly greater odds of reporting higher desired and current skill and ability levels compared with PAs not involved in eyecare, in six of eight vision and ocular care domains.

CONCLUSIONS

PAs who do not practice in ophthalmology provide vision and ocular care but have varying amounts of training and desire higher skill and ability levels. Ophthalmologists and PA institutions may develop vision and ocular care training for PA schools and continuing medical education.

Intraorbital wooden foreign bodies: case series and literature review

Intraorbital wooden foreign bodies (IOWFBs) constitute a relatively rare ocular trauma, which occupy a special type of intraorbital foreign bodies (IOFBs). Data regarding IOWFBs must be obtained from case reports or small case series due to their rarity. Here, we reported 5 cases of IOWFBs and reviewed the related literatures, which could provide comprehensive information regarding the clinical manifestations, diagnosis, and surgical treatment of IOWFBs. Combined with the published literature, a total of 51 independent cases were counted after we added 5 cases. Among them, the number of male and female patients was 35 and 16 respectively; the mean age was 27.3±18.2 (range 1-66)y. Obviously, the disorder seemed to occur mainly in young and middle-aged people. Because of the diversity in the clinical manifestations and imaging characteristics of IOWFBs, misdiagnosis and missed diagnosis often occur during the initial visit. Delayed diagnosis may lead to a high risk of orbital infection caused by IOWFBs. Surgery is the treatment of choice for most patients; however, the missed diagnosis and residue of foreign bodies after previous surgery cannot be ignored. Therefore, an accurate diagnosis is governed by the detailed trauma history, careful ocular examination, close observation of clinical manifestations, correct imaging diagnosis [e.g., magnetic resonance imaging (MRI) or computerized tomography (CT)], and timely and completely elimination of IOWFBs.