Corneal metallic foreign body injuries due to suboptimal ocular protection

Retrospective review of 100 consecutive presentations of metallic corneal foreign body to the Royal Victorian Eye and Ear Hospital emergency department was undertaken between November and December 2009. The majority of the patients (97%) were male with a mean age of 42 ± 13 years (range 19-73 years). The most common mode of injury was grinding (88%). Nearly half (45%) of patients were wearing "safety eye wear" at the time of injury. Combination of 25-gauge needle and burr was the commonest method employed for removal of foreign body. Overall, 88% (n = 88) cases healed with corneal scar at the site of corneal foreign body and 1 case developed bacterial keratitis. Metallic corneal foreign bodies are common presentations to the emergency department and may be related to inadequate implementation of occupational safety measures.

Surveillance of intraocular foreign bodies in the UK

AIMS

To estimate the incidence of penetrating injuries with retained intraocular foreign bodies (IOFBs) in the United Kingdom, and to provide epidemiological data on the aetiology, management, and visual outcome of such injuries.

METHODS

Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period June 2004 to May 2005 inclusive. Questionnaire data were obtained from UK ophthalmologists at presentation and 6 months following presentation.

RESULTS

Data were available on 97 patients at presentation and 95 patients at follow-up. The minimum estimated incidence of IOFBs in the United Kingdom identified in this study was 0.16 per 100 000. All patients were male. Hammering was the most common mechanism of injury, occurring in 62% of patients. The IOFB was found in the anterior segment in 24%, the posterior segment in 73%, and involved both segments in 3%. Endophthalmitis was diagnosed in 9% of patients. Best-corrected visual acuity of the injured eye at final follow-up was 6/12 or better in 67%, 6/18 to 6/60 in 11%, and worse than 6/60 in 22%. Prognostic factors for a poor visual outcome included poor visual acuity at presentation, prolapse of intraocular tissue, development of endophthalmitis, development of retinal detachment, and large size of IOFB.

CONCLUSIONS

The incidence of IOFB in the United Kingdom appears to have reduced compared to previous studies. The majority of patients (67%) retain good visual acuity in the injured eye; however, a significant minority (22%) sustain long-term severe visual loss.

Work-related eye injuries and illnesses

More than 65,000 work-related eye injuries and illnesses, causing significant morbidity and disability, are reported in the United States annually. A well-equipped eye tray includes fluorescein dye, materials for irrigation and foreign body removal, a short-acting mydriatic agent, and topical anesthetics and antibiotics. The tray should be prepared in advance in case of an eye injury. Eye patching does not improve cornea reepithelialization or discomfort from corneal abrasions. Blunt trauma to the eye from a heavy object can cause a blow-out fracture. Sudden eye pain after working with a chisel, hammer, grinding wheel, or saw suggests a penetrating globe injury. Chemical eye burns require immediate copious irrigation. Nontraumatic causes of ocular illness are underreported; work-related allergic conjunctivitis increasingly has been recognized among food handlers and agriculture workers who are exposed to common spices, fruits, and vegetables. The patient's history of eye injury guides the diagnosis. Primary prevention and patient counseling on proper eye protection is essential because over 90 percent of injuries can be avoided with the use of eye protection. As laser use increases in industry and medical settings, adequate personal protection is needed to prevent cataracts. Outdoor workers exposed to significant ultraviolet rays need sun protection and safety counseling to prevent age-related macular degeneration. Contact lenses do not provide eye protection, and physicians should be familiar with guidelines for the use of contacts in the workplace.

Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes

PURPOSE

To identify clinical and microbiologic factors influencing the prevalence and visual outcomes in endophthalmitis after deadly-weapon-related open-globe injuries.

METHODS

In a retrospective study of 228 eyes of 212 patients with deadly-weapon-related open-globe injuries, clinical and microbiologic factors influencing the prevalence and visual outcome in endophthalmitis were analyzed in detail.

RESULTS

Twenty-nine eyes enucleated for irreparable damages at presentation were excluded. Nineteen eyes (18 patients) of 199 (186 patients) were associated with culture-proven endophthalmitis. Presence of grade 4 injury, a variable of Ocular Trauma Classification System, and lens disruption at presentation were the significant risk factors for development of endophthalmitis (P =.001; odds ratio = 15.9 [2.0 to 122.1]), and ([P <.001; odds ratio = 17.7 [2.3 to 136.3]), respectively. Favorable outcome (visual acuity of 5/200 or better) was achieved in only four eyes (21%). Five eyes (26.3%) were phthisical, and five eyes (26.3%) were enucleated or eviscerated. All eyes were under the coverage of prophylactic intravenous antibiotics when culture positivity was obtained. Except two eyes with Acinetobactersp., all were infected by gram-positive micro-organisms (89.5%), the most common of which (42%) was Staphylococcus epidermidis. None of the clinical characteristics and treatment modalities affected final visual outcome. Favorable outcome was associated with infection by the less virulent micro-organism S. epidermidis (P =.018; odds ratio = 0.50 [0.25 to 1.00]).

CONCLUSIONS

Endophthalmitis after deadly-weapon-related open-globe injuries has a dismal visual prognosis. Severity of injury and lens disruption are significant risk factors for development of endophthalmitis. Infection with a less virulent microbe is the only factor associated with favorable outcome.

[Causes and prevention of intraocular foreign bodies]

The most frequent cause of intraocular foreign bodies involves a small piece of metal penetrating the eye following a metal-on-metal impact occurring at work. Other metallic foreign bodies resulting from aggression with firearms have become less frequent due to changes in the law. More rarely, intra-ocular foreign bodies may come from explosives have a telluric origin, or else be made of glass. Treatment is primarily preventive. Eye accidents caused by foreign bodies at work are common. European-level standards therefore impose individual protective equipment adapted to user needs. These measures should be adopted not only in companies but also for handiwork at home.

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.

Prevalence of ocular injuries, conjunctivitis and use of eye protection among dental personnel in Riyadh, Saudi Arabia

AIMS

To find out the prevalence of ocular injury and infection among dental personnel in Riyadh, Saudi Arabia.

PARTICIPANTS

Two hundred and four dental personnel.

METHOD

A questionnaire completed by researchers and observation during practice.

RESULTS

The response rate was 81%. Dentists and dental technicians had a similar prevalence (42.3%) of foreign bodies in their eyes during the period of one month. Almost 50.5% of dentists rarely had foreign bodies in their eyes, while only 22.2% of dental technicians claimed the same. The majority of dental surgery assistants (73.6%) never experienced foreign bodies in their eyes. Only 27.0% of female personnel had foreign bodies in their eyes as compared to 73.0% of male personnel, while only 28.5% of females had conjunctivitis as compared to 71.4% among male personnel. 75% of regular eye protector wearers (EPW) never had foreign bodies while 67.2% EPW never had conjunctivitis. Dental technicians were more prone to ocular injury, 13.8% as compared to 4.4% of dentists. Only 30% of the regular eye protector wearers suffered ocular injury.

CONCLUSIONS

Protection of the eyes should be emphasised and practised at undergraduate level. The awareness of eye protection should be highlighted at all clinical and research symposia. Further studies should be conducted to assess the financial implications of ocular injuries and infections in dental institutions and practices. Recommendations are made for universal precautions and the observation of safety at work guidelines by all dental team members.

Endophthalmitis following open-globe injuries

Endophthalmitis following open-globe injuries is caused by a specific range of microorganisms, of which Bacillus sp. and coagulase-negative Staphylococcus are the most frequent. Risk factors include the presence of an intraocular foreign body, injury inflicted by organic material, delay in surgery, and the type of wound involved. Despite important advances in medical and surgical management, this type of endophthalmitis continues to pose a poor prognosis. In this sense, we consider prevention to be the best approach. We report our protocols for the prevention and treatment of endophthalmitis following open-globe injuries, based on recent experimental studies on the ocular pharmacokinetics of antibiotics and on multicenter studies of the treatment of endophthalmitis.

Scorched eyelashes--do we treat them right?

Scorched eyelashes and burned eyelids are a common finding in facial burns, though the eye itself is often spared. Affected patients often complain of foreign body sensation and ocular discomfort in the absence of objective physical findings, other than scorched eyelashes and burned eyelash particles in the conjunctival sacs. This study was designed to evaluate the efficacy of prophylactic trimming of scorched eyelashes as a treatment for these findings and complaints. Eleven consecutive facial burn patients with bilateral eyelash scorching and no accompanying ocular damage were included. The eyelashes of one eye were trimmed, and those of the fellow eye served as untreated controls. Ophthalmic examinations were performed and eye-related complaints noted every other day for 10 days. We found that symptoms of foreign body sensation and discomfort occurred at a lower rate in the treated eyes (P<0.002) and no scorched eyelash particles were found in their conjunctival sacs (P<0.004) as compared to the untrimmed side. Conjunctival hyperemia was reduced. We suggest that shedding of scorched eyelash particles is a major cause of the ocular complaints in facial burn patients. Trimming the eyelash affords a simple and effective method of prophylactic treatment.

[An analysis of 148 outpatient treated occupational accidents]

BACKGROUND

The most common eye injuries are non-perforating. Eye injuries in the workplace are a major cause of socioeconomical damage, morbidity and disability, despite well publicised standards for industrial eye protection. This study investigates the epidemiological and clinical aspects of 148 occupational cases.

PATIENTS

At the University Eye Clinic of Tübingen, 709 non-perforating eye injuries were registered as occupational accidents between 1995 and 1996. Of these cases, 148 were analysed retrospectively per random.

RESULTS

The 5 most common injuries of 148 patients (m/f = 138/10; mean age 33.4 +/- 12 years) were related to corneal foreign body injuries (35%), chemical burns (15.5%), sub-conjunctival foreign bodies (12%), thermal/ultraviolet injuries (11%) and contusions (7.4%). Of these patients, 22.3% were employed as construction workers and 16.2% as metal workers. At the time of examination the visual acuity of the traumatic eye was 0.9 +/- 0.3. The interval between the beginning of work and accident was 6.2 +/- 6.4 hours in average (0.5-13.5 h). Of all accidents, 8.5% were caused during the first hour of work; in contrast 45.5% of all accidents were caused after 6 hours of work. Another 12.4 +/- 14.5 hours (5min.-72 h; median 7 h) passed by until the patients arrived for eye examination at the Eye Clinic of Tübingen. Only 6% of all patients arrived within the first hour, and 29.7% after 12 hours. Of all cases, 30.4% received first-aid treatment in their company by the factory doctor or by the eye doctor before examination at the Eye Clinic. Only 6.8% of all patients had protective spectacles during work. Incapacity was seen in 30.4%; the average in total was 5.5 +/- 10 days.

CONCLUSION

Despite the late examination at the Eye Clinic the functional loss was mostly little except after chemical burns. Nevertheless, most occupational accidents can be avoided with better protective devices in order to reduce the incidence of injuries and socioeconomical damage. Therefore an intense campaign about protective devices at the place of employment should be required. We conclude that education about safety glasses in the workplace by tradespeople and trades assistants during tasks for which goggles are recommended could considerably reduce the rate of occupational eye traumata. The data of the University Eye Clinic of Tübingen are useful to identify strategies to prevent eye injuries such as wider and better use of safety glasses and improvement in engineering controls.

Screening adolescents for metallic foreign bodies before MR procedures

The report describes a case in which routine prescreening procedures were found to be inadequate for an adolescent patient referred for MR imaging. Recommendations are provided to correct this potential problem.

[Eye injuries during hobby-work using machine tools]

Data from the EU-project EHLASS (European Home and Leisure Accident Surveillance System) collected from five Danish hospitals during the period 1989-1991 contained 185,551 accidents occurring at home and during leisure time. The population in the catchment area is approximately 700,000. Of these accidents, 9900 involved eye-injury, 2940 of these occurred during hobby-activities, and 1460 of these while the subject was using either drilling-, welding- or grinding-equipment. The incidence of eye-injuries occurring during the use of these machines has risen from 0.6/1000/year in 1989 to 0.7/1000/year in 1990 and to 0.8/1000/year in 1991. In 98% of the cases the patients were men, 30% were between 20 and 29 years of age. A common activity at the time of the accident was "car-repairing". Foreign-body-lesions were seen in 60% of the cases, and actinic conjunctivitis in 30%. None of the injuries were serious, but they were often very painful and demanding of resources. All the injuries could have been avoided by the use of proper eye protection.

The incidence and prevention of ocular injuries in orthodontic practice

A postal survey was conducted to determine the use of eye protection and incidence of ocular trauma in orthodontic practice. One-hundred-and-fifty-nine NHS orthodontic consultants and 203 specialist orthodontic practitioners were surveyed. Two-hundred-and-forty-one (66.5 per cent) replies were received. Some form of eye protection was routinely worn by 66.8 per cent of orthodontists, 64.3 per cent of patients, but only 33.6 per cent of DSAs. Eye protection was not offered to DSAs in 31.9 per cent of practices or to patients in 22.1 per cent. Forty-three per cent of orthodontists reported instances of ocular injury in their practices. The majority of these injuries (n = 104) occurred during debonding or trimming acrylic. Other incidents involved ligating materials, intra-oral polishing, and acid etching. Most injuries (83.5 per cent) were treated in the surgery without any long-term effects. The routine use of goggles or spectacles with side-pieces and plastic lenses, which conform to British Standard BS 2092, is recommended for staff and patients during all operative procedures in orthodontic practice.

Penetration eye injuries in the workplace. The National Eye Trauma System Registry

Occupational eye injuries are common and preventable. Between 1985 and 1991, there were 635 work-related penetrating eye injuries among the 2939 cases (22%) reported to the National Eye Trauma System Registry by 48 collaborating centers in 28 states and Washington, DC. The median age of the injured workers was 30 years; 75% were younger than 40 years; and 97% were male. The commonest causes of injuries were projectiles (457 cases), sharp objects (166 cases), blunt objects (60 cases), and blasts (22 cases); these terms are not mutually exclusive. Specific objects causing injuries included nails, wire, screwdrivers, and other hand tools. There was evidence of alcohol use by at least 2% of the injured workers. When they were injured, 6% of the workers were wearing safety glasses; 3% were wearing nonsafety eyewear. Posterior segment trauma, which occurred in 63% of the cases, included vitreous hemorrhage (42%), intraocular foreign bodies (35%), and retinal detachment (10%). Hyphema occurred in 35% and traumatic cataract in 32% of the cases. Initial visual acuity after injury was hand motion or worse in 43% of the cases. National Eye Trauma System Registry data are useful to identify strategies to prevent occupational eye injuries such as wider use of safety glasses and improvement in engineering controls.

The hazards of hammers

Fifty-five patients who had received an intraocular foreign body as a result of using a hammer were identified during a 4-year period. Of these, 36 had suffered the injury while at work and 19 while undertaking do-it-yourself activities at home. None had been wearing suitable protection. Seven patients were bystanders and not actually wielding the hammer. Twenty-three patients had a final visual acuity in the affected eye of 6/24 or worse.

Particulate contamination in eye surgery

Flushing fluid from microsponges (surgical spears) and solutions for irrigation (balanced salt solution and Ringer solution) as well as other medicaments for intraocular use during surgery (solutions of Zolyse, solutions of Miochol and Healon) have been examined for particulate contamination. The method used to collect and analyse the particles involved scanning electron microscopy (SEM) and energy dispersive analysis of X-ray (EDAX) in order to determine elements within the range of atomic number 9-93 in the periodic system. The investigation disclosed particulate contamination of all solutions examined. Particle number (greater than 5 microns) per ml varied from 15 to 400 and the size from 5 microns-800 microns. Microsponges released particles in numbers from 25-90 in a size range of 5-3000 microns per ml flushing fluid (Total flushing volume 20 ml). More than half of the particles were below 10 microns in all specimens examined. The irrigation solutions and solutions of medicaments contained only few particles above 40 microns. Most of the particles were of organic material which is not detectable with EDAX. This analytical system disclosed a wide range of inorganic elements, being present in the examined solution in the form of particles or as solutes.

Eye injuries and ocular protection in the Lebanon War, 1982

There was a high incidence of ocular trauma (6.8% of all casualties) in the Lebanon War, 1982, which is similar to the rates in previous Arab-Israeli wars. Combat in the Lebanon War consisted of both armored warfare and infantry operations, with much of the fighting taking place in built-up areas. Consequently, there were two main types of ocular injuries: perforating eye injuries caused by the small high-velocity missiles that characterize armored combat, and a wide range of injuries to the eye caused by ricochets during combat in built-up areas. The latter injuries varied in severity from complete destruction of the eye to minor corneal erosions. Not a single eye was injured in soldiers who had ballistic protective goggles properly placed over the eyes at the time of injury. Most of the ocular trauma could have been prevented had the goggles been in universal use. A considerable degree of eye protection is also afforded by ordinary ophthalmic eyeglasses.