Recovery of Vision in Open Globe Injury Patients with Initial No Light Perception Vision

OBJECTIVE OR PURPOSE

To identify clinical characteristics of injured eyes associated with visual recovery in patients with open globe injuries (OGI) and presenting with no light perception (NLP) vision.

DESIGN

Retrospective chart review.

SUBJECTS, PARTICIPANTS, AND/OR CONTROLS

All patients presenting to Massachusetts Eye and Ear with OGI and NLP vision from January 1999 to March 2022.

METHODS, INTERVENTION, OR TESTING

Manual data extraction to collect patient demographic characteristics, pre-operative, intraoperative, and post-operative characteristics of OGI injury, laceration versus rupture, history of intraocular surgery, time from injury to repair, timing of vitrectomy, lensectomy, choroidal drainage, and silicone oil placement, visual acuity (VA) at last follow-up, and subsequent B-scan ultrasound findings of retinal detachment, choroidal hemorrhage, vitreous hemorrhage, and disorganized intraocular contents. Patients with more than one week of follow-up and a documented VA at most recent follow-up were included. Exclusion criteria included age less than 10 years. Multivariable regression was performed.

MAIN OUTCOMES

VA recovery defined as light perception or better in patients with OGI and initial NLP vision.

RESULTS

147 eyes with NLP vision after OGI were included. 25 (17%) eyes regained vision at last follow-up. The majority of patients recovered light perception vision (n=15, 60%) followed by 20/500 or better (n=5, 20%), hand motion (n=3, 12%), and count fingers (n=2, 8%). Most injuries were zone III (n=102, 69%) and presented with rupture (n=127, 86%). The mean time from OGI to surgical repair was 0.85 ± 1.7 days. B-scan was obtained in 104 (71%) cases. Pars plana vitrectomy was performed in 9 eyes (6%) with NLP at time of vitrectomy. Disorganized intraocular contents on B-scan (OR=0.170, 95%CI: 0.042-0.681, P=0.012) was the only clinical variable significantly associated with visual recovery, corresponding to a lack of visual improvement.

CONCLUSION

Recovery of vision in OGI with NLP vision at presentation cannot be predicted based on presenting clinical features. B-scan findings of disorganized intraocular contents after initial OGI repair was the only factor negatively associated with vision recovery in this patient population. Therefore, all eyes presenting with an OGI and NLP vision should undergo primary repair in hopes of subsequent visual recovery.

Eye and Orbit Injuries Caused by Electric Scooters and Hoverboards in the United States

Introduction

To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019.

Methods

The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries.

Results

Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%).

Conclusion

There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.

Use of nonsteroidal anti-inflammatory drugs in corneal epithelial ingrowth due to traumatic flap dislocation after LASIK: Case report

RATIONALE

Ophthalmologists mainly treat epithelial ingrowth by lifting the flap and scraping the ingrowth or using scraping combined with phototherapeutic keratectomy, mitomycin C, and so on. The potential usefulness of nonsteroidal anti-inflammatory drugs in such circumstances has not been reported before.

PATIENT CONCERNS

A 32-year-old man and a 25-year-old man underwent lifting and scraping of the flap and phototherapeutic keratectomy to remove the epithelial ingrowths. Unfortunately, the ingrowths recurred and continued to develop.

DIAGNOSIS

The patients were diagnosed with corneal epithelial ingrowth.

INTERVENTIONS

The administration of bromfenac sodium and fluorometholone eye drops.

OUTCOMES

Epithelial ingrowths in both patients disappeared after 6 and 1 month of treatment, respectively. There were no adverse reactions to the eye drops.

LESSONS

Nonsteroidal anti-inflammatory drugs may be broadly applied in the treatment of epithelial ingrowth after laser in situ keratomileusis.

Padel an increasing cause of sport-related eye injuries in Sweden

PURPOSE

The objective of this study was to determine the current Swedish epidemiology of sport-related eye injuries and to analyse the effect of the increased popularity of the racquet sport padel.

METHODS

This was a retrospective, register-based, cohort study of medical records in the county of Jönköping, Sweden. All individuals with a sports-related eye injury needing healthcare between January 2017 and December 2021 were included. For these individuals, data about background, consequences and treatment of the injuries were obtained.

RESULTS

During the 5-year study period, 255 patients sought care for sports-related eye injuries at the ophthalmological clinics in Jönköping County. Floorball caused the largest proportion of eye injuries (39%) followed by padel (20%) and football (15%). However, the proportion of injuries caused by padel increased during the study period to be the dominating cause in 2021. Compared to floorball, patients with eye injuries from padel were older and had female gender to a higher extent. The ball caused almost all injuries from padel; the majority occurred in the right eye. Most the eye injuries from padel were mild or moderate but 4% had severe consequences with an imminent risk of long-term complications.

CONCLUSIONS

In a short time period, padel has become the leading cause of sports-related eye injuries in Sweden. To reduce the number of eye injuries, protective eyewear could be recommended.

Eye Trauma in Mixed Martial Arts and Boxing

PURPOSE

To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing.

DESIGN

Retrospective cohort study.

METHODS

Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted.

RESULTS

In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury.

CONCLUSION

Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.

Visual Outcomes of Traumatic Lens Dislocations and Subluxations Managed by Pars Plana Vitrectomy and Lensectomy

AIM

The aim of this study was to evaluate the visual outcome of lens dislocation and subluxation managed by pars plana vitrectomy (PPV) and lensectomy in patients with open (OGIs) or closed globe injuries (CGIs).

METHODS

Medical records of 70 consecutive patients treated by PPV and lensectomy over a period of 11 years (1 January 2010-31 December 2020) were retrospectively reviewed. We collected demographic data, best corrected visual acuity (BCVA) using a Snellen Chart pre- and postoperatively, associated ocular injuries and treatment strategy. Visual outcome was evaluated according to the final BCVA which was defined as poor <0.1 or good ≥0.1.

RESULTS

The mean age was 57.9 ± 17.6 years. CGIs were present in 49 (70.0%) cases and open OGIs in 21 (30.0%) cases. The dislocation mechanism was zonular lysis in 59 cases (84.3%) and capsular rupture in 11 cases (15.7%). The intraocular lens implant (IOL) was sutured to the sclera in 51 (72.9%) cases or positioned in the capsular bag or in the sulcus in 3 (4.3%) cases and 1 (1.4%) case, respectively, whereas 15 (21.4%) patients remained aphakic. A good BCVA ≥ 0.1 was achieved in 45.71% of the eyes. The presence of retinal detachment (RD) (p = 0.014), iridodonesis (p = 0.011) and initial BCVA (p = 0.000) achieved statistical significance in predicting visual outcome. After treatment, 45.71% of patients achieved a final BCVA ≥ 0.1.

CONCLUSION

RD, iridodonesis and initial BCVA were risk factors for poor visual outcome in our series.

Characteristics of work-related eye trauma in construction and manufacturing industries

CLINICAL RELEVANCE

Knowledge of work-related eye trauma in the construction and manufacturing industries will facilitate planning of policies and practices to protect against such occurrences.

BACKGROUND

The aim of this study was to compare demographic, epidemiological, and clinical characteristics of work-related eye trauma in workers in the construction and manufacturing industries.

METHODS

Medical board disability reports of subjects who experienced work-related eye trauma were investigated in this retrospective comparative study. Subjects were separated into two groups - construction and manufacturing - and the demographic, epidemiologic, and clinical characteristics within the two groups were compared.

RESULTS

The construction group included 138 eyes of 132 subjects and the manufacturing group included 82 eyes of 77 subjects. Demographic characteristics of the groups were similar (p > 0.05). The number of work-related eye trauma incidents was found as decreased during winter in construction (p < 0.001), but a similar trend was not found in manufacturing (p > 0.05). Head traumas as reason for work-related eye trauma (p < 0.001), and concomitant systemic diseases including bone fracture and traumatic brain injuries (p < 0.001 and p = 0.012) were significantly associated with eye trauma in manufacturing. Open globe injury was more common in construction (p = 0.046), and chemical injury was more common in manufacturing (p < 0.001). Retinal detachment was more prevalent in construction (p = 0.042). Hand motion or worse final visual acuity was more prevalent in manufacturing (p = 0.007) and the final visual acuity better than 6/60 was more prevalent in construction (p = 0.045).

CONCLUSION

Chemical injuries are more common in manufacturing, whereas open globe injuries and retinal detachments occur more frequently in construction. Permanent low vision and blindness are more commonly associated with work-related eye trauma in manufacturing.

Prevalence, Patterns, and Characteristics of Eye Injuries in Professional Mixed Martial Arts

Purpose

To describe the frequency and type of eye injuries in fighters in mixed martial arts (MMA) competition.

Methods

Fight result data were collected from the Nevada Athletic Commission database from 2001 to 2020. Any fighters in a professional mixed martial arts (MMA) contest with an eye injury were included. Main outcome measures included frequency and rate of eye injuries per fight and the types of eye injuries. Secondary outcome measures were gender, laterality, decision type, and length of no-contact recommended.

Results

Of the 256 MMA events in the database, 187 events (73.3%) had at least one eye injury. Of a total 2208 fights at these events, there were 363 fighters who sustained 369 eye injuries, with the yearly rate of eye injuries per 100 fighters ranging from 2.56 to 12.22. The most common injuries were eyebrow and eyelid lacerations (n=160, 43%), lacerations around the eye (n=98, 27%), and orbital fractures (n=62, 17%). Most eye injuries were right sided (n=197, 53.3%) and the majority of fighters with eye injuries lost their match (n=228, 62.8%). Fifty-seven fighters were recommended for further ophthalmology clearance after the match. The most common reasons for recommended ophthalmology follow-up was orbital fracture (n=25, 44%) and retinal injury (n=7, 12%). Forty-three fighters received no-contact requirements relating to their injury for an average of 8.9 weeks (range 1–24 weeks).

Conclusion

Ophthalmic injuries in professional MMA were prevalent, were most often lacerations surrounding the eye, and often accompanied the fighter losing their match.

Bedside Ocular Ultrasound Diagnosis of a Traumatic Lens Dislocation

Rapid identification of ophthalmologic emergencies can be challenging in the ED, and a missed or delayed diagnosis may have vision-threatening consequences. The application of ocular point-of-care ultrasound (POCUS) by the emergency physician (EP) can facilitate the timely recognition of a myriad of emergent eye conditions. This report describes a case in which EP-performed POCUS established the prompt diagnosis of a traumatic lens dislocation in a patient with chronic vision changes.

Characteristics of Orbital Floor Fractures in the United States from 2006 to 2017

PURPOSE

To examine the incidence, characteristics, and economic burden of orbital floor fractures in the United States.

DESIGN

Retrospective, longitudinal study of the Nationwide Emergency Department Sample (NEDS).

PARTICIPANTS

Patients in the Emergency Department (ED).

METHODS

The NEDS, a representative sample of all hospital-based EDs in the US, was used to identify and describe ED visits with a primary diagnosis of orbital floor fracture from 2006 to 2017. Linear regression was used to estimate the trends in annual incidence and inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission.

MAIN OUTCOME MEASURES

Incidence, injury mechanisms, demographics, clinical characteristics, disposition, and economic burden.

RESULTS

From 2006 to 2017, there were an estimated 350 379 ED visits in the US with a primary diagnosis of orbital floor fracture. The incidence increased by 47% over the study period (P < 0.001): from 7.7 (95% confidence interval [CI], 6.9-8.5) to 11.3 (95% CI, 10.0-12.6) per 100 000 population. The majority were male (67%), aged 21 to 44 years (46%), and from low-income households (32%). The most common cause was assault (43%), which was most frequent in young adults (65%) and increased modestly over time (3.5 to 4.5 per 100 000 population; P = 0.02). The second most common cause was falls (26%), most frequent in patients aged ≥65 years (86%) and more than doubled over time (1.6 to 3.5 per 100 000 population; P < 0.001). The rate of inpatient admission was 14%, with a higher likelihood for patients aged ≥65 years (odds ratio [OR], 2.21; 95% CI, 1.99-2.46; P < 0.001) and falls (OR, 1.54; 95% CI, 1.27-1.86; P < 0.001). The total inflation-adjusted ED charges over the study period exceeded $2 billion, with the mean charge per visit increasing 48% (P < 0.001): from $5881 (95% CI, 5499-6263) to $8728 (95% CI, 8074-9382).

CONCLUSIONS

Orbital floor fractures are becoming an increasingly common and costly injury in the United States. Preventive strategies aimed at reducing assault and falls will be crucial to mitigate the burden of orbital floor fractures on the healthcare system.

Eye-Related Emergency Department Visits and The Opioid Epidemic: a 10-Year Analysis

PURPOSE

To describe the epidemiology of Emergency Department (ED) visits related to opioid abuse with primary ophthalmic diagnoses in the United States (US).

METHODS

This retrospective cross-sectional study used National ED Sample (NEDS) (2006-2015), a representative sample of all US EDs, to analyze and compare the epidemiology of primary ophthalmic diagnoses in opioid abusers and a control group of non-opioid users. National incidence and descriptive statistics were calculated for demographics and prevalent diagnoses. Multivariable logistic regression was used to compare outcomes between primary ophthalmic diagnoses in opioid and non-opioid abusers.

RESULTS

An estimated 10,617 visits had a primary ophthalmic diagnosis and an accompanying opioid abuse diagnosis, and the incidence increased from 0.2 in 2006 to 0.6 per 100,000 US population in 2015. Opioid abuse group had more adults (6,747:63.5%) and middle-aged (3,361:31.7%) patients, while in controls adults (7,905,003:40.4%) and children (4,068,534:20.8%) were affected more. Leading etiologies were similar: traumatic and infectious etiologies were most common; however, opioid abuse patients had more severe ophthalmic diagnoses such as orbital fractures (8.4%), orbital cellulitis (7.4%), globe injury (3.4%) and endophthalmitis (3.2%) compared to controls. Patients in the opioid abuse group were also more likely to be admitted (adjusted Odds Ratio [aOR], 28.38 [95% CI, 24.50-32.87]).

CONCLUSIONS

In the era of opioid crisis, an increase in ED visits with ophthalmic complaints is seen, with increasing direct and indirect costs on the healthcare system. More research is needed to establish causality and devise strategies to lower this burden.

Poor prognoses of open globe injuries with concomitant orbital fractures

PURPOSE

Orbital trauma, particularly with open globe injury, can have a wide range of visual outcomes, which can be difficult to predict at presentation. Clinical features on presentation may provide insight into visual prognosis. We hypothesized that patients with open globe injuries and concomitant orbital fractures have poorer visual outcomes than patients without orbital fractures.

METHODS

We reviewed the charts of 77 patients with isolated open globe injuries (OG) and 76 patients with open globe injuries and concomitant orbital fractures (OGOF). Multivariate regression analysis was performed to assess the relative influence of individual presenting historical and clinical features on visual outcome.

RESULTS

OGOF patients were more likely to have sustained blunt trauma than a sharp, penetrating injury compared to OG patients. Ocular wound locations were more posterior and likely to involve multiple zones in OGOF compared to OG patients. Among OGOF patients, orbital floor fractures were the most common and roof fractures were the least common, but the latter was associated with presenting NLP vision and multiple zone involvement. The presence of an orbital fracture independently increased the odds of subsequent evisceration/enucleation (OR: 4.6, 95% CI 1.3-20.1, p = .0246) and NLP vision (OR: 6.81, 95% CI 2.42-21.85, p = .0005) when controlling for zone, mechanism of injury, uveal prolapse and demographic variables.

CONCLUSIONS

The presence of an orbital fracture independently confers a worse visual and ocular prognosis in patients with open globe injuries. Patients with open globe injuries in this category should be appropriately counseled.

Traumatic Corneal Abrasion

Corneal abrasions can have potentially sight-threatening consequences if not accurately diagnosed and managed appropriately in the acute period. Simple corneal abrasions can be managed with antibiotic and tetanus prophylaxis, analgesia, and next-day follow up with ophthalmology. However, if there is any suspicion for penetrating eye injury, corneal ulcer, a sight-threatening infection such as bacterial keratitis, or ophthalmic zoster, an emergent referral is imperative. In this report, we present a case of classic corneal abrasion and discuss the acute management of this common problem.

Ballistic Eye Protection: Why Are Soldiers Reluctant to Use Them?

INTRODUCTION

The Israel Defense Forces (IDF), as well as many other armies, faces major challenges in balancing the need to protect soldiers from harm while not impeding their ability to fight. Eye protections available in the IDF are underused, for reasons that are as yet unclear. In this study, we aim to gain a better understanding of the influence of eye protection currently in use in the IDF on vision.

MATERIALS AND METHODS

In this cross-sectional study, subjects were assessed for best corrected visual acuity, contrast sensitivity, and binocular visual fields (Goldmann) in a crossover design (with and without eye protection). In addition, we established a comprehensive review on the subjective faults of the eye protection, both from personal experiences of soldiers who used them during their military service and from civilian volunteers who used them in a sterile laboratory setting.

RESULTS

Visual acuity, contrast sensitivity and visual fields with and without the eye protection were assessed in 25 subjects. Eye protection did not cause any statistically significant change in visual acuity. However, the eye protection caused a statistically significant decrease in visual fields in all quadrants and in both isopters used.

CONCLUSIONS

Significant restriction of the visual field can pose a major challenge for soldiers on the battlefield. The use of eye protection with wider lenses or no frame should be considered. Education and instruction should focus on increasing awareness among commanders and soldiers of the benefits of eye protection and fostering trust in the technology's capabilities. In parallel, it is crucial to educate soldiers about its disadvantages, and how such disadvantages can be overcome. We stipulate the findings to the standard IDF goggle and might not apply to other designs.

The epidemiology of ocular trauma in Northern India: A teaching hospital study

AIM:

The aim was to determine the epidemiology of ocular trauma in a large teaching hospital in northern India over 4 years from 2010 to 2014.

MATERIALS AND METHODS:

This prospective, hospital-based, observational study was conducted at the Ophthalmology and Emergency Outpatient Departments of S. S. Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from March 2012 to February 2016. Detailed history was taken with special consideration to time, place and session of trauma, mode of injury, and type and nature of traumatic agent. All patients were thoroughly examined as per the standard clinical procedures to identify the type, extent, and severity of injury and impact on ocular structure and vision. Follow-up period was 6 months. Statistical analysis was based on age, sex, residence, marital status, occupation, per capita income, type of trauma and nature of damage, etc.

RESULTS:

Out of 402 patients, 293 (72.9%) were male and 109 (27.1%) were female. Overall male-to-female sex ratio was 2.7:1. Patients were aged between 2 and 70 years (mean: 26.48 ± 15.88, median: 23 years). The most vulnerable age group was 6–15 years (24.38%) followed by 16–25 years (23.88%). Maximum patients belonged to rural background (61.94%). The extent of ocular trauma was 3.93% (95% confidence interval: 3.23–4.63). Majority of participants were single (78.11%) and rest were married. About 112 (27.9%) participants were illiterate and 24.4% had primary education only. One hundred and eighty-eight (46.8%) participants belonged to lower and lower middle socioeconomic status. The cases were clustered in Rs. 1000–5000 per capita income. Most of the injuries occurred in summer season (46.18%) and in afternoon between 12.00 and 17.59 h (48.8%). Majority of trauma occurred away from home (66.20%) mainly on street (28.6%) and playground (9.2%). The most common injury was nonoccupational (82.3%) including sports related (23.9%) and road traffic accident (23.6%). Mechanical injuries were accounted for 89.3% of all eye injuries, and most common source was wooden object (24.9%) followed by metallic objects (20.9%). Traumatic agents were blunt and sharp in 56% and 17% of cases, respectively. Majority of traumatic agents were solid (82.1%). Seven percent of victims were drowsy during trauma and 98.4% of participants were not using any protective device at the time of injury. In 60.7% of cases, time elapsed between injury and treatment was between 1 and 24 h. Around 44.5% had isolated ocular trauma and rest 55.5% were polytrauma cases. Three hundred and sixty-eight (91.5%) participants had unilateral involvement and 8.5% had bilateral involvement. Almost 52.8% had injuries of adnexa and 32.8% had globe injuries. More than half of the study participants had ≥3 ocular structure involvement. After 6 months, 14.8% of the right eyes and 25.5% of the left eyes showed poor outcome.

CONCLUSION:

This study highlights epidemiology of ocular trauma in northern India. Mass health education and awareness about risk of ocular trauma, morbidity caused by delayed presentation, and need to adopt safety or preventive strategies should be focused, especially during travel, playground, and at workplace.

Ocular traumas in working age adults in Finland - Helsinki Ocular Trauma Study

PURPOSE

To describe epidemiology, causes, treatments and outcomes of ocular injuries in adults aged 17 to 60 in southern Finland.

METHODS

All new ocular trauma patients admitted to the Helsinki University Eye Hospital (HUEH), during 1 year in 2011-2012. The data were from hospital records and prospectively from patient questionnaires. The follow-up time was 3 months.

RESULTS

The incidence for ocular injury was 88/100 000/year. From 831 trauma patients, 80% were men, 34% were work-related injuries, and 11% were assaults. Most of the injuries were minor traumas (54%). Contusions (22.5%) and chemical injuries and burns (13%) were common. Fractures (5%), lid wounds (3%), open globe injuries (OGI, 2%) and optic nerve injuries (0.5%) were rare. The main causes of ocular injury were superficial foreign bodies (33%), chemicals (13%), body parts (13%) and sports equipment (10%). The most dangerous objects were needles, stones, pellet guns, tools and guns. No patient with OGI used protective eyewear. All OGI and most of contusions needed a lifelong follow-up. Permanent impairment (73 patients, 9%) was caused most often by body parts, sports equipment and work tools.

CONCLUSION

A typical ocular trauma patient was a man aged 31-45 with a minor trauma caused by a foreign body at work and a final visual acuity of 20/20. Most common serious injuries were contusion, OGI or fracture at home or at work and were caused by a body part, sport equipment or work tool. Factors causing common and serious eye injuries provide the targets for protective measures.

Epidemiology of Open-Globe Injuries in Hong Kong

PURPOSE

The aim of this study was to review the epidemiology and clinical outcomes of open-globe injuries (OGIs) in Hong Kong over a 10-year period.

DESIGN

Retrospective case-review.

METHODS

This study included patients with OGI who presented to Hong Kong Eye Hospital and Queen Elizabeth Hospital from 1999 to 2008. Patient demographics, causes and mechanisms of injury, visual acuity (VA) at presentation, clinical features, and final VA were collected. Univariate and multivariate analyses using logistic regression were performed to identify poor prognostic factors.

RESULTS

A total of 122 eyes of 121 patients were included. More than half (63%) were male, and the mean age was 54 years. Workplace injuries (36%) ranked first, followed by fall (32%) and assault (13%). The majority (66%) presented with VA less than 5/200. Common associations included hyphema, lens damage, uveal prolapse, and vitreous hemorrhage. Overall, about half (46%) sustained profound visual loss (final VA <5/200). Twelve eyes underwent evisceration or enucleation. Only 1 eye developed endophthalmitis. Univariate analysis suggested that profound visual loss was associated with poor initial VA, relative afferent pupillary defect, and posterior scleral involvement (P < 0.05). Multivariate analysis showed that poor initial VA and posterior involvement were independent poor prognostic factors.

CONCLUSIONS

Profound visual loss was common after OGIs, especially in cases with poor vision at presentation and involvement of the posterior sclera. Identifying poor prognostic factors helps guide clinical management and facilitates counseling for patients. Early medical and surgical treatment may help to reduce the risk of endophthalmitis.

Floorball-related eye injuries: The impact of protective eyewear

Several previous studies have shown that floorball belongs to a high-risk group of sports in terms of eye injuries. Protective eyewear is available, but the extent of its use and impact on eye injuries are unknown. The purpose of this study was to investigate the current incidence of eye injuries caused by floorball and to compare it with the present use of protective eyewear. Medical records were used to identify all eye injuries suffered while playing floorball in Jönköping County from 2008 to 2011 (N = 167). All these patients were sent a questionnaire that included inquiries about the use of protective eyewear. The study shows that floorball caused more eye injuries than all other sports combined (56%). Prolonged decreased visual acuity was very unusual (0.5%), but moderate eye injuries with some risk of future problems were seen in 62% of the sample. More than one fifth of the injured patients reported some kind of vision-related problem 2-7 years after the original injury. Only one player had been using protective eyewear at the time of injury. Our results underline the importance of protective eyewear to prevent floorball-related injuries.

Pediatric open globe injury: A review of the literature

Open globe injury (OGI) is a severe form of eye trauma estimated at 2-3.8/100,000 in the United States. Most pediatric cases occur at home and are the result of sharp object penetration. The aim of this article is to review the epidemiology, diagnosis, management, and prognosis of this condition by conducting a systematic literature search with inclusion of all case series on pediatric OGI published between 1996 and 2015. Diagnosis of OGI is based on patient history and clinical examination supplemented with imaging, especially computed tomography when indicated. Few prospective studies exist for the management of OGI in pediatric patients, but adult recommendations are often followed with success. The main goals of surgical management are to repair the open globe and remove intraocular foreign bodies. Systemic antibiotics are recommended as medical prophylaxis against globe infection, or endophthalmitis. Other complications are similar to those seen in adults, with the added focus of amblyopia therapy in children. Severe vision decline is most likely due to traumatic cataracts. The ocular trauma score, a system devised to predict final visual acuity (VA) in adults, has proven to be of prognostic value in pediatric OGI as well. Factors indicating poor visual prognosis are young age, poor initial VA, posterior eye involvement, long wound length, globe rupture, lens involvement, vitreous hemorrhage, retinal detachment, and endophthalmitis. A thorough understanding of OGI and the key differences in epidemiology, diagnosis, management, and prognosis between adults and children is critical to timely prevention of posttraumatic vision loss early in life.

ANTERIOR CHAMBER SYNCHYSIS SCINTILLANS: A CASE REPORT

Synchysis scintillans is a vitreous condition in which multiple golden brown opacities are formed as a result of chronic vitreous hemorrhage. Anterior chamber synchysis scintillans was described in patients with afakia or lens subluxation. We report a case of a 63-year-old man with a history of left eye trauma and complete loss of vision, who presented for left eye discomfort. The slit lamp examination revealed crystals of synchysis scintillans and rare inflammatory cells in the anterior chamber, stromal iris atrophy, circumferential posterior iris synechiae, and complete lens opacity. Total retinal detachment was observed on ocular ultrasonography. Intraocular pressure value was in normal range. The distinctiveness of this case is the mechanism of vitreous crystals mobilization into the anterior chamber through an atrophic iris while intraocular pressure remains normal.

Changed trends of major causes of visual impairment in Sichuan, China from 1987 to 2006

AIM

To study the trends of major causes of visual impairment (VI) in adults in Sichuan, China and evaluate the effect of aging on the trends.

METHODS

We used data from the National Sample Survey on Disabilities (NSSD) in Sichuan province conducted in 1987 and 2006. The age-adjusted prevalence of major causes of VI and the prevalence stratified by age in each cause were calculated and compared. The association between age and each cause of VI was also analyzed.

RESULTS

Retinal disease increased and became the second leading cause of VI in 2006 while blinding trachoma decreased markedly. Cataract and non-trachomatous corneal diseases were among the leading causes of VI in both years. We found associations between age and causes of VI, with age showing the strongest association with cataract and relatively lower associations with other causes.

CONCLUSION

In the last two decades, dramatic changes occurred in the major causes of VI with significantly increased retinal disease and decreased blinding trachoma. Aging of the population might be an important factor accounting for the changed trends of VI. Understanding the prevalence of VI, its major causes and trends over time can assist in prioritizing and developing effective interventional strategies and monitoring their impact.

Management and treatment of bizarre open globe trauma in three steps: a case report

This is a case presentation of a very bizarre open globe trauma with anterior segment foreign body-fishing hook stuck in the cornea and iris. Complications due to this kind of eye trauma might be very hazardous and with serious impact on visual function. We are representing our approach and experience of three step management of this kind of eye injury: first-extract the foreign body, close and reconstruct the eyeball, second-fight inflammation, and third-restore the visual function by cataract surgery.

Autofluorescence imaging - a useful adjunct in imaging macular trauma

Autofluorescence imaging is a rapid, noninvasive technique, with several applications becoming slowly integrated into ophthalmic clinical practice. We describe its use as a valuable tool for predicting the function of the retinal pigment epithelium following damage from blunt ocular trauma.