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Ocular conditions and injuries, detection and management in spaceflight. NPJ Microgravity 2023; 9:37. [PMID: 37193709 DOI: 10.1038/s41526-023-00279-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Ocular trauma or other ocular conditions can be significantly debilitating in space. A literature review of over 100 articles and NASA evidence books, queried for eye related trauma, conditions, and exposures was conducted. Ocular trauma and conditions during NASA space missions during the Space Shuttle Program and ISS through Expedition 13 in 2006 were reviewed. There were 70 corneal abrasions, 4 dry eyes, 4 eye debris, 5 complaints of ocular irritation, 6 chemical burns, and 5 ocular infections noted. Unique exposures on spaceflight, such as foreign bodies, including celestial dust, which may infiltrate the habitat and contact the ocular surface, as well as chemical and thermal injuries due to prolonged CO2 and heat exposure were reported. Diagnostic modalities used to evaluate the above conditions in space flight include vision questionnaires, visual acuity and Amsler grid testing, fundoscopy, orbital ultrasound, and ocular coherence tomography. Several types of ocular injuries and conditions, mostly affecting the anterior segment, are reported. Further research is necessary to understand the greatest ocular risks that astronauts face and how better we can prevent, but also diagnose and treat these conditions in space.
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High risk and low prevalence diseases: Open globe injury. Am J Emerg Med 2023; 64:113-120. [PMID: 36516669 DOI: 10.1016/j.ajem.2022.11.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis. CONCLUSION An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process.
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[Traumatic optic pit-Optic nerve evulsion caused by indirect ocular trauma]. Ophthalmologe 2021; 118:714-718. [PMID: 32749528 DOI: 10.1007/s00347-020-01190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article describes the case of a 28-year-old man who suffered an optic nerve evulsion (ONE) after falling from a height of 5 m. On admission visual acuity in the affected left eye was light perception, direct pupillary reaction was unresponsive, and the eye was hypotonic. Because of deep eyelid laceration, hyphemia and severe vitreous hemorrhage a globe rupture was suspected and a surgical exploration with vitrectomy was performed. This resulted in the detection of an ONE. During the following 24 months a painful eyeball due to secondary glaucoma developed and enucleation of the eye became necessary.
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The Role of Orbital Computed Tomography as a Prognostic Indicator for Open Globe Injury. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.9.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fully Automated Segmentation of Globes for Volume Quantification in CT Images of Orbits using Deep Learning. AJNR Am J Neuroradiol 2020; 41:1061-1069. [PMID: 32439637 DOI: 10.3174/ajnr.a6538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Fast and accurate quantification of globe volumes in the event of an ocular trauma can provide clinicians with valuable diagnostic information. In this work, an automated workflow using a deep learning-based convolutional neural network is proposed for prediction of globe contours and their subsequent volume quantification in CT images of the orbits. MATERIALS AND METHODS An automated workflow using a deep learning -based convolutional neural network is proposed for prediction of globe contours in CT images of the orbits. The network, 2D Modified Residual UNET (MRes-UNET2D), was trained on axial CT images from 80 subjects with no imaging or clinical findings of globe injuries. The predicted globe contours and volume estimates were compared with manual annotations by experienced observers on 2 different test cohorts. RESULTS On the first test cohort (n = 18), the average Dice, precision, and recall scores were 0.95, 96%, and 95%, respectively. The average 95% Hausdorff distance was only 1.5 mm, with a 5.3% error in globe volume estimates. No statistically significant differences (P = .72) were observed in the median globe volume estimates from our model and the ground truth. On the second test cohort (n = 9) in which a neuroradiologist and 2 residents independently marked the globe contours, MRes-UNET2D (Dice = 0.95) approached human interobserver variability (Dice = 0.94). We also demonstrated the utility of inter-globe volume difference as a quantitative marker for trauma in 3 subjects with known globe injuries. CONCLUSIONS We showed that with fast prediction times, we can reliably detect and quantify globe volumes in CT images of the orbits across a variety of acquisition parameters.
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Diagnostik und Akuttherapie von Augenverletzungen durch Feuerwerkskörper. Ophthalmologe 2019; 116:1152-1161. [DOI: 10.1007/s00347-019-01000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Enhanced Depth Imaging Optical Coherence Tomography of Posterior Globe Rupture. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e171-e172. [PMID: 30395683 DOI: 10.3928/23258160-20181002-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/28/2018] [Indexed: 11/20/2022]
Abstract
Occult globe rupture is a rare but potentially devastating result of eye trauma. The authors present a case of a woman who sustained blunt trauma to the right eye resulting in a peripapillary circumferential posterior globe rupture. Clinically, the eye maintained good vision and normal intraocular pressure with a clear media, though subretinal fluid and retinal hemorrhage were present overlying the scleral defect. Enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT) revealed a sharp step-off of the sclera, choroid, and Bruch's membrane/retinal pigment epithelium, with overlying intact and contiguous inner retina, corresponding to a posterior globe rupture. Following conservative management, the subretinal fluid resolved and visual acuity improved to 20/20 over a month period, whereas the posterior globe step-off remained stable. This case demonstrates the potential for occult open globe injuries with preserved visual function in cases of blunt ocular trauma, and the first to document EDI SD-OCT findings of a posterior globe rupture. Multimodal imaging may help in the evaluation and diagnosis of suspected posterior segment globe rupture. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e171-e172.].
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Occult globe rupture: diagnostic and treatment challenge. Surv Ophthalmol 2018; 63:694-699. [DOI: 10.1016/j.survophthal.2018.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
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Abstract
OBJECTIVES To determine the frequency, clinical characteristics, and visual outcomes of patients who present with high or normal intraocular pressure (IOP) and open globe injuries. DESIGN Retrospective chart review. SETTING University of Maryland Medical Center, a level 1 trauma center. PATIENT OR STUDY POPULATION All cases of open globe injury presenting to The University of Maryland Medical Center from July 2005 to January 2014. OBSERVATION Demographics, initial physical examination, computed tomography findings, IOP of the affected and unaffected eyes, and follow-up evaluations. MAIN OUTCOME MEASURES (1) IOP 10 mm Hg or greater and (2) visual acuity. RESULTS Of 132 eyes presenting with open globe injury, IOP was recorded in 38 (28%). Mean IOP for the affected and unaffected eyes was 14±10.3 mm Hg and 16.6±4.1 mm Hg, respectively. Twenty-three (59.4%) eyes had IOP greater than 10 mm Hg. Six eyes (16.2%) had IOP greater than 21 mm Hg. Using bivariate analysis, IOP greater than 10 mm Hg was associated with posterior open globe injury (P=0.01), posterior hemorrhage (P=0.04), and intraconal retrobulbar hemorrhage (P=0.05). Adjusting for age, sex, and race, IOP greater than 10 mm Hg was associated with the presence of posterior open globe injury on clinical examination (P=0.04). Higher presenting IOP was found to predict light perception or worse vision (P=0.01). Multivariate analysis showed that poor presenting vision was the best predictor of poor final vision (P<0.01). CONCLUSIONS High IOP does not exclude open globe injury. It is a frequent finding in patients with open globe injuries and may be associated with posterior injury and poor visual prognosis.
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Does high intraocular pressure exclude an open globe injury? Int J Ophthalmol 2014; 7:389-90. [PMID: 24790891 DOI: 10.3980/j.issn.2222-3959.2014.02.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 11/25/2013] [Indexed: 11/02/2022] Open
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Large blunt scleral rupture without retinal detachment. Ophthalmic Surg Lasers Imaging Retina 2008; 39:242-5. [PMID: 18556952 DOI: 10.3928/15428877-20080501-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Eyes with scleral rupture after blunt trauma are often complicated by proliferative vitreoretinopathy. A 56-year-old man sustained blunt trauma to his left eye. Visual acuity was light perception. The fundus was obscured by hyphema. Computed tomography imaging and the presence of extensive subconjunctival hemorrhage suggested scleral rupture. Prompt primary surgery to repair a 25-mm scleral rupture was performed under general anesthesia. No retinal detachment developed. Two years postoperatively, visual acuity increased to 12/20. This case shows that retinal detachment and proliferative vitreoretinopathy may not complicate extensive scleral ruptures under certain circumstances.
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TRAUMA TO THE EYE AND ORBIT. CURRENT THERAPY OF TRAUMA AND SURGICAL CRITICAL CARE 2008:181-196. [DOI: 10.1016/b978-0-323-04418-9.50032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Computed tomography in the diagnosis of occult open-globe injuries. Ophthalmology 2007; 114:1448-52. [PMID: 17678689 DOI: 10.1016/j.ophtha.2006.10.051] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 10/07/2006] [Accepted: 10/17/2006] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury. DESIGN Retrospective chart review. PARTICIPANTS Forty-eight eyes (of 46 patients), 34 of which were found to have an occult open-globe injury on surgical exploration. METHODS A retrospective chart review of all eyes of patients 18 years or older undergoing surgical exploration to rule out occult open-globe injury after CT examination at Parkland Memorial Hospital between October, 1998, and September, 2003, was conducted. Patients with obvious corneal or corneoscleral lacerations or with uveal prolapse were excluded. The CT films were obtained and independently reviewed by 3 masked observers (2 neuroradiologists and 1 ophthalmologist). MAIN OUTCOME MEASURES Presence of occult open-globe injury with respect to radiographic globe and orbital findings. RESULTS The sensitivity of CT for determining occult open-globe injury varied from 56% to 68% between the observers, specificity ranged from 79% to 100%, positive predictive value ranged from 86% to 100%, and negative predictive value ranged from 42% to 50%. Open-globe injuries averaged more CT findings per patient compared with intact globes (P = 0.047). Statistically significant CT findings for occult open-globe injury included any change in globe contour (P = 0.001), obvious volume loss (P = 0.003), an absent or dislocated lens (P = 0.048), vitreous hemorrhage (P = 0.003), and retinal detachment (P = 0.044). Additionally, moderate to severe change in globe contour, obvious volume loss, total vitreous hemorrhage, and absence of lens were seen only in eyes with occult rupture. CONCLUSIONS Although CT scanning may provide valuable information in patients in whom an occult open-globe injury is suspected, its sensitivity and specificity are inadequate to be relied on fully, and such patients generally should be taken to the operating room for formal surgical evaluation. Significant changes in globe contour or obvious volume loss are strong predictors of globe rupture, and any vitreous hemorrhage should be a concern for occult injury.
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Abstract
Traumatic subconjunctival crystalline lens is a rare phenomena; we report a case of ocular trauma by the tail of a cow. A 60-year-old female presented with history of trauma to her left eye by the tail of a cow, she had severe headache, redness and pain in her left eye. She was admitted and the crystalline lens was found in the subconjunctival space and was removed surgically.
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Abstract
This review presents typical patterns of posterior segment injuries as well as diagnostic and therapeutic considerations after ocular contusion or rupture of the globe. Vitreal prolapse is associated with retinal detachment (20%), iridodialysis or ciliary body cleft (43%), and contusion cataract (41%). Berlin's edema (35%) and retinal detachment (5-7%) are frequent after ocular contusion. In cases of central Berlin's edema, choroidal infarction (Hutchinson-Siegrist-Neubauer syndrome) or choroidal rupture, macular hole or choroidal neovascularization should be ruled out. A central choroidal rupture is often associated with choroidal neovascularization (14-20%). Globe ruptures (5% of blunt injuries) are associated with hyphema grades III and IV (58 vs 5% in ocular contusions). The prognosis of globe ruptures to develop a visual function <20/200 is 51 times more frequent than in eyes with contusion. The risk of trauma-induced globe ruptures is higher in eyes after cataract surgery (27 x) (in females 5 x).
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Abstract
PURPOSE To evaluate the international eye injury scene and design a standardized terminology for mechanical eye injuries. METHODS Surveys of practicing ophthalmologists and an extensive review of the international ocular trauma literature. Development of the Birmingham Trauma Terminology (BETT) using a logic-based approach. RESULTS BETT always uses the entire globe as the tissue of reference. Its well-defined terms encompass all types of mechanical eye injury. A one-to-one relationship exists between terms and clinical conditions. CONCLUSION BETT provides an unambiguous, consistent, simple, and comprehensive system to describe any type of mechanical globe trauma. Endorsed by several societies and peer-reviewed journals as the standardized international language of ocular traumatology, BETT is expected to become the preferred terminology for categorizing eye injuries in daily clinical practice.
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Abstract
OBJECTIVE Determine sensitivity, specificity, and prognostic signs of orbital and ocular computed tomography (CT) in diagnosing patients with open globe injury. DESIGN Randomized masked review of computed tomograms and retrospective clinical correlation of patients with ocular trauma. PARTICIPANTS Two hundred patients who underwent CT evaluation for ocular trauma between 1989 and 1993. METHODS CTs were read by three masked observers; findings were tabulated and compared for variability among observers; sensitivity and specificity were calculated and CT findings were grouped according to visual outcome retrieved from record review. RESULTS In the absence of clinical information, sensitivity and specificity were 75% and 93%, respectively. The positive predictive value ranged from 88% to 97%, with a calculated overall positive predictive value of 95%. Patients who had a poor visual outcome (visual acuity <2/200) or who underwent enucleation had significantly more CT findings than patients with a good visual outcome. Vitreous hemorrhage, absence of lens, and severe distortion of vitreous space are among the most common CT findings associated with poor visual outcome. CONCLUSIONS CT is not sensitive enough to be solely relied upon for diagnosis of all open globe injuries. CT findings only complement clinical findings, increasing the clinician's overall ability to make an accurate diagnosis of open globe injury, and may provide useful prognostic information regarding visual outcome.
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Abstract
PURPOSE The purpose of this investigation was to evaluate the surgeon's ability to assess various types of globe injury, to determine the force necessary to rupture the globe with these types of injuries, and to determine typical orbital retraction forces used in the clinical setting. MATERIALS AND METHODS Forty-four enucleated globes from recently killed cows were divided into four equal groups-one uninjured control group, one group with a through-and-through scleral laceration, another group with a subtotal scleral laceration, and the last group with an 18-gauge needle perforation. Twenty-seven boarded or board eligible oral and maxillofacial surgeons were asked to assess one sample from each of the four groups. They were then asked to retract a simulated globe on a custom-fabricated jig to determine clinical retraction forces. Ten globes from each of the four groups were then subjected to forces until rupture on an Instron 8501M mechanical testing unit. Accuracy of the clinical assessment was determined, and means and standard deviations of the retraction forces and globe rupture forces were derived. RESULTS Through-and-through lacerations were assessed by surgeons with 100% accuracy, subtotal lacerations with 96% accuracy, uninjured globes with 74% accuracy, and perforated globes with 15% accuracy. Globe rupture occurred at 16.72+/-7.87 kg in the control group, 20.36+/-7.87 kg in the perforated group, 15.38+/-6.06 kg in the subtotal laceration group, and 4.94+/-2.56 kg in the through-and-through laceration group. Statistically significant differences (P < .001) were noted between the total laceration group and all other groups. The mean retraction force was 0.35+/-0.47 kg, which was statistically less than the force used in all of the rupture groups (P < .001). CONCLUSIONS Severe injuries (through-and-through lacerations) were assessed with 100% accuracy by the clinicians, and less severe injuries with less accuracy. Rupture forces for globes with perforations and subtotal lacerations were no different than for the control group, but substantially less than for the total laceration group. The simulated clinical retraction forces were substantially more than the rupture forces in all of the groups, including the through-and-through laceration group.
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Abstract
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.
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Abstract
PURPOSE To determine which signs are sensitive and specific in the setting of trauma to establish the diagnosis of an occult scleral rupture. METHODS The charts of patients with presumed scleral rupture were identified retrospectively. The ocular findings among the patients who had a rupture based on findings at surgery were compared with those patients who were noted to have normal findings at surgery. RESULTS Visual acuity worse than 20/400, decreased intraocular pressure, intraocular pressure less than that in the nontraumatized eye, and an afferent pupillary defect were all significant indicators of an open globe. CONCLUSION Determining the likelihood of an occult rupture can be facilitated by noting the presence or absence of those indicators that are significant and carry a high specificity.
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