Bungee cord-associated ocular injuries

The epidemiology and etiology of pediatric ocular trauma

Eighteen million people worldwide have uniocular blindness from traumatic injury. Injuries occur disproportionally commonly in childhood. Every year a quarter of a million children present with serious ocular trauma. For the vast majority the injury is preventable. We review the international literature that identifies high-risk circumstances.

'My pupil has gone black!' Subluxation of a total cataractous lens

A patient with a history of longstanding opaque cataract and a white pupil reported a return to a black pupil, which was the result of lens subluxation. The case was complicated by optic nerve coloboma of the Morning Glory syndrome type and a total retinal detachment.

Eye injury as a result of coat toggle trauma

PURPOSE

To report the severity of ocular injury in three adults with blunt ocular trauma resulting from elastic corded coat toggles.

DESIGN

Observational case series.

METHODS

We retrospectively reviewed the case records of all patients (n=3) with blunt ocular trauma secondary to elastic corded coat toggles that presented to our department.

RESULTS

Injuries included traumatic hyphaema, cataract, angle recession, vitreous haemorrhage and retinal tears.

CONCLUSIONS

Significant ocular injury can result from elasticated coat toggles. The general ophthalmologist should be aware of this new method of potentially sight threatening trauma.

Ocular bungee cord injuries

Recent trends have indicated that the home and recreational environment have become the most common settings for bungee cord-related ocular trauma. Bungee cords are commonly used to secure items to automobile rooftops and to bicycle racks. The annual incidence of reported ocular injuries secondary to bungee cords has steadily climbed in recent years, and the frequency of bungee cord-related injuries is likely to continue to grow with the ever increasing popularity of sports such as skiing, bicycling, and windsurfing. The elastic recoil of a bungee cord can generate tremendous force, capable of producing severe blunt and penetrating ocular trauma. Though wearing safety glasses while handling bungee cords would likely eliminate a majority of bungee cord injuries, the public has yet to show that they are willing to wear eye protection during recreational activities that pose a risk of ocular trauma. In addition to educating consumers regarding proper safety techniques, bungee cord manufacturers should consider making alterations in the design of bungee cords to significantly reduce the potential for ocular injuries.

Bungee cord-associated ocular trauma

PURPOSE

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

DESIGN

Retrospective case series.

PARTICIPANTS

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

METHODS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Ocular injuries by elastic cords in children

BACKGROUND

Elastic cords hitting the eyeball as high-speed projectiles can severely damage ocular structures and can produce permanent visual function impairment.

OBJECTIVES

To evaluate the frequency, mechanics, and severity of eye injuries caused by elastic cords in children to adopt the most appropriate preventive measures.

METHODS

A retrospective medical records review of hospital admissions secondary to ocular trauma between 1991 and 1997 in a pediatric ophthalmology unit at an urban tertiary care pediatric hospital was performed to select all children admitted for ocular injury caused by an elastic cord.

RESULTS

Eight children fulfilled the inclusion criteria; the prevalence ratio was 2% of all pediatric trauma admissions. In all cases the mechanics of trauma was a combination of blunt and high-speed projectile injury. The mechanism of trauma in younger patients was typically a cord that was misused during unsupervised playtime, whereas cord slipping from car roof racks was noted in older patients. One patient suffered a severe permanent visual impairment caused by retinal detachment. All other children regained full visual acuity at the time of discharge and maintained it through a mean follow-up of 22 months (range: 18-29).

CONCLUSION

Circumstances of injury in younger children are different from those found in older children, the latter being similar to those reported for adults. Prevention is the primary measure to be taken to reduce the prevalence of this injury and to lower the risk for ocular severe anatomic damage as much as possible. This can be achieved primarily by modifying the design of the hooks, intensifying educational campaigns, and keeping elastic cords out of children's reach.