RETINA ON CORNEA IN CASE OF MECHANICAL OCULAR INJURY: A CASE REPORT

Ocular injuries are one of the major factors for mono-ocular blindness in adult population. Majority of mechanical ocular injuries occurs in factories. Our patient had injury with grinder blade. On examination, vision was no perception of light in right eye, corneoscleral tear along with lens and vitreous in the wound. Ocular trauma score was 1 with chances of visual recovery nil. After primary treatment, when we had taken patient under general anaesthesia, we found whole retina lying over cornea which was a rare event. We excised that tissue and tear repair was done. None of the factors which can lead to expulsive haemorrhage was observed in patient. We have seen many patients with extensive corneoscleral tear but never seen retina coming out of the wound. We recommend to use all protective equipments for workers to prevent industrial ocular injuries.

Snowball-associated ocular injury – An unusual presentation

Background: Snow ball associated ocular injuries are rare. We present the 1st case of a snow ball injury reported in India with symptoms occurring after 10 days. Purpose: To highlight the fact that symptoms can occur many days after the injury. The injuries can cause structural damage to ocular structures and can be permanent. Synopsis: A 25?year?old Asian Indian female presented with increased redness and blurring of vision of a day's duration. She had been playing in the snow and had an apparent injury to the right eye 10 days earlier. She had no symptoms at that point of time. Her uncorrected visual acuity by Snellen’s chart was 20/20 in both the eyes. Intraocular pressure was normal in both the eyes. On evaluation of the right eye she had traumatic anterior uveitis and mydriasis and the left eye was normal. There was no evidence of posterior segment involvement. She was treated with topical steroids and her anterior chamber inflammation improved but she had persistent mydriasis with no effect on her near vision. She was subsequently lost to follow after a month. Highlights: Rare case of ocular injury caused by a hurtling snow ball. Demonstration of anterior chamber inflammation with a video Infrared video imaging of the pupil in bright and dark showing anisocoria worse in bright light. Protective goggles are a must while indulging in these activities.

Demographic Profile & Pattern of Ocular and Adnexal Injuries from Sloth Bear Maul: a Study in Tertiary Centre of Bilaspur District, Chhattisgarh

This study was done in all cases of bear attacked patSients admitted in our tertiary centre Chhattisgarh institute of medical science (CIMS) who suffered ocular and adnexal injuries. Sloth bear (Melursus ursinus) is found to be native in many forest areas of the state of Chhattisgarh including North Bilaspur Forest Division (NBFD). The study was conducted in the department of ophthalmology, Chhattisgarh institute of medical science (CIMS) Bilaspur Chhattisgarh for the duration of 3 years (January 2018 to December 2020). All patients who were admitted in our institute with ocular and/or adnexal injuries from bear attack have been included in this study. 27 patients were attacked by sloth bear in the forest areas of Bilaspur division and referred to our tertiary centre. These patients had ocular and adnexal injuries. These bears were found roaming in the forest areas and also at places of human and animal habitats. 67% (18 of 27) patients were attacked in the forest areas, while some were attacked in the crop fields (15%), home courtyard (7%) and near water bodies (11%). Sloth bears are one of the most aggressive bears who have attacked human populations. The injuries cause severe visual loss and disfigurement to eyeball and adnexa. Proper measures are needed to be implemented to prevent such cases in future.

Perforating Ocular Injuries- A Retrospective Study From Tertiary Care Hospital Of North India.

Background: Ocular trauma is one of the main cause of corneal blindness which affects 12% of world’s population & is amenable to treatment. The leading cause of non-congenital unilateral blindness in children is ocular trauma. Children suffer a higher percentage of open globe injuries than adults which yield worse visual outcomes in ocular trauma. Aims: The objective of the study was to analyse epidemiological pattern of perforating ocular injuries. Materials & Methods: The present 5 years retrospective study involves all the patients who had been reported as a case of perforating/penetrating ocular injury in the tertiary care hospital. The records of all patients with perforating ocular injury seen during this period were reviewed & data such as demographic details, presenting visual acuity, all ocular findings, examinations etc were collected. Results: Total of 365 perforating/penetrating ocular injury patients were seen during study period. Maximum incidence of perforating injuries was noticed ≤10 years of age i.e. 36.2%. Males (79.5%) outnumbered females in the present study. Regarding structural involvement, cornea constitute (65.5%) perforating injuries followed by corneoscleral i.e. 19.7%. Conclusion: From present study, we may conclude that maximum incidence of perforating injury was noticed in children with more preponderance in males. Corneal perforation is more common as it is the most exposed part of eye.

Quality of life after ocular trauma: A prospective, longitudinal, questionnaire based study in a tertiary hospital in the Philippines

Purpose@#To determine the health-related quality of life of patients sustaining ocular injuries prognosticated to be visually disabling and to correlate baseline characteristics with quality of life indices.@*Methods@#A prospective, questionnaire-based health-related quality of life study was conducted in a tertiary hospital in the Philippines among 33 patients prognosticated to have visually-disabling ocular injuries using the ocular trauma score (OTS). Clinical and demographic data were collected and quality of life indices were measured using the EuroQoL five-dimension five-level (EQ-5D-5L) questionnaire at baseline and on three subsequent follow-up visits. Data was analyzed by OTS and type of injury. Baseline characteristics were described and correlated with quality of life indices. @*Results@#Of the 33 participants recruited at baseline, 26 were able to return to at least 1 of the 3 recommended follow-up visits. The median age of study participants upon admission was 35 years old with 31 (94%) being males. The patients were admitted at a median of 4 days from injury. Thirty-one (31) or 94% of the participants sustained open globe injuries, with 14 (42%) being penetrating lacerations and 10 (30%) classified as having intraocular foreign bodies. Most patients reported pain and discomfort (82%), problems in usual activities (70%), and anxiety and depression (70%) at baseline. Those with an OTS of 1 had lower median EQ index score (0.447) and EQ visual analog scale (VAS) score (56). A diagnosis of globe rupture was associated with lower median EQ index scores (0.448) and EQ VAS scores (56). EQ index and VAS scores were lowest at baseline. A statistically significantly increase in EQ VAS was seen from baseline to the first month of follow-up (p=0.01). Using univariate regression analysis, no statistically significant correlation between baseline characteristics and baseline quality of life indices was identified.@*Conclusion@#Health-related quality of life was lowest shortly after admission for management of ocular trauma and significantly improved at 1 month. Most patients reported pain and discomfort, problems in usual activities, and anxiety and depression. None of the clinical characteristics were shown to be significantly associated with quality of life indices, including visual acuity.

A 3-year prospective study on ocular injuries with tennis or cricket ball while playing cricket: A case series

Purpose: The purpose of this study is to study the clinical features, visual outcome, management, and ocular complications of ocular injury, following trauma with tennis or cricket ball. Methods: A prospective, noncomparative case study of patients having injury with tennis/cricket ball while playing cricket was conducted between January 2013 and April 2016. Seventy-six eyes of 76 patients were studied. Presenting vision, age, gender, time since injury, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, B scan, and X-ray/computed tomography scan findings were noted. Patients were managed medically or surgically as per the need and followed up at least for 6 months. Results: Seventy-six eyes of 76 patients were studied. All cases were male, except two. Majority (80.2%) were <25 years. Median presenting visual acuity (VA) was 6/36 and median final VA was 6/18. Significant findings in the decreasing order of frequency were sphincter tear (26.3%), retinal detachment (23.6%), angle recession (18.4%), choroidal rupture (17.1%), and Berlin's edema (15.7%). Most of the cases (69.7%) were managed medically. Only 30.2% cases needed surgical intervention. Final visual outcome in our study was depended on initial VA (P = 0.000). It was also correlating with presenting clinical feature (P = 0.010) and type of intervention (medical/surgical) (P = 0.001). Conclusion: Cricket-related ocular injury generally has a poor prognosis with most cases being closed globe injury; retinal detachment is the most common vision-threatening presentation. In spite of being a common event, cricket-related injury is sparingly documented and hence needs further studies for proper documentation, prognostication, and formulation of definitive management plan.

Open Globe Injury in Hospital Serdang - An 8-year Retrospective Review

Introduction: Open globe injury may lead to devastating visual outcome. Urgent management and subsequent follow-up is important to maximise recovery. More data on open globe injury in Malaysia is needed to identify risk groups and prognostic factors. This study was carried out to investigate open globe injury, the socio-epidemic profile, clinical characteristics and outcome of the open globe injury in the Hospital Serdang, Malaysia. Methods: All patients managed for open globe injury to Hospital Serdang from January 2006 to December 2013 were included in this retrospective case review. Student’s T-test was used to determine difference between means and chi-square for categorical data. P value of less than 0.05 was regarded as statistically significant. Results: There were 155 patients managed for open globe injury with three of them had bilateral involvement. As such, there were 158 cases eligible for analysis in this study. The average age was 32.2 ± 16.5 years (mean ± standard deviation, SD). Male was at higher risk for open globe injury. Predictors for poor visual outcome were foreign nationality (p=0.047), lid laceration (0.008), type of injury (p=0.001), site of injury (p=0.008), RAPD (p<0.001), uveal prolapse (p<0.001), hyphaema (p=0.008), lens damage (p=0.010), vitreous loss (0.014), retinal detachment (p=0.011), intraocular foreign body (IOFB) (0.014) and poor presenting uncorrected visual acuity (UCVA) (p<0.001). Conclusions: Occupational injury was a main cause of open globe injury in Hospital Serdang. Although in general the visual outcome is good, effort should be put to prevent work-related injury.

Review Of Ocular Injuries In Malaysia

Ocular injuries or trauma to the eye can be caused by variety of objects resulting in a spectrum of lesions in the eye. We did a Pubmed/Google/Science Direct search to review the spectrum of ocular injuries in Malaysia. In our review, we included 28 papers providing information on ocular injuries which were published from Malaysia during the period 1991-2016 in different medical journals. Prevalence was more among males with an average age of 35 years. Among adults they were more common in the workplace but in children it occurred at home. Few wore protective glasses at work. The mode of injury was due to sharp objects hitting the eye, motor vehicle and domestic accidents, firecrackers, chemicals and rarer causes like superglue and durian fruit. Prognostic factors for outcome were the initial visual acuity, length of the wound, associated factors like hyphaema, intraocular foreign body and vitreous prolapse. Missing the diagnosis of perforation of the eyeball is possible without eliciting a proper history. Protective devices must be worn to prevent injuries. Display of health education charts showing the effect of injuries in the eye and their preventive measures in health centres, private hospitals, schools, factories and sports centres will increase the awareness of public about the ocular injuries. It is important to diagnose the tissues involved in ocular trauma by the general practitioners and primary care physicians and refer the patients to the Ophthalmologist urgently for treatment to salvage vision. Compensation mechanisms should then be put forth in terms of rehabilitation and for monetary loss.

Characteristics and visual outcomes of open globe injuries in children of amblyogenic age in Hong Kong / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the demographics, characteristics and visual outcomes of open globe injuries in children of amblyogenic age in Hong Kong. METHODS: All medical records of children aged between 0 to 8y old who sustained open globe injuries between Jan. 1st, 2005 and Jan. 1st, 2015 were reviewed retrospectively. The demographics, clinical features ( laterality, etiology and zone of injury, other associated ocular injuries ) , type of primary and secondary operations performed, preoperative and postoperative best spectacle corrected visual acuity ( BSCVA ) complications were collected and analysed. RESULTS: A total of 7 cases, 2 males and 5 females were identified. The median age of presentation was 5 years old. All suffered from penetrating injuries (100%). Four cases ( 57%) had improvement of visual acuity compared with preoperative visual acuity. Final visual acuity was hand movement in one (14%) patient, 20/200-20/50 in four ( 57%) patients, and 20/40 or better in two (29%) patients. CONCLUSION: There is a relative low rate of open globe injuries in young children in Hong Kong. Good visual outcomes may be obtained depending on the location and severity of the open globe injury together with prompt surgical management to restore the integrity of the globe and aggressive management of amblyopia.

Changes in the Clinical Manifestations of Ocular Injuries Induced by Power Lawn Mowers

PURPOSE: To investigate changes in the clinical manifestations of ocular injuries induced by power lawn mowers. METHODS: In a retrospective study of 172 patients with ocular injuries induced by power lawn mowers in 2006, 2010, and 2014. Best corrected visual acuity (BCVA) at the time of presentation and 6 months after trauma, age, sex and seasonal distribution were analyzed. We assessed the degree of injury using slit lamp biomicroscopy, fundus examination, and computed tomography and analyzed the prognoses according to open/closed injury and, anterior/posterior segment injury. All patients underwent medical or surgical treatment, and the factors affecting final BCVA were analyzed. RESULTS: The ratio of closed injuries increased significantly (p = 0.027), as did the ratio of corneal erosion (p = 0.020), and, the ratio of corneal laceration decreased significantly (p = 0.014) over time. In the multivariate analysis, initial BCVA was the only risk factor of poor visual outcome in both open and closed injuries. CONCLUSIONS: The proportion of open globe injury has decreased over time. In contrast, the proportion of simple injuries such as corneal erosion has increased in ocular injuries induced by power lawn mowers. Lower initial visual acuity was the only risk factor of poor visual outcome in both open and closed injuries.

A Case of Penetrating Fish Hook Ocular Injury

PURPOSE: To report a case study of a penetrating fish hook ocular injury. CASE SUMMARY: A 53-year-old male visited the emergency department complaining that he injured his eye with a fish hook. He had no specific ophthalmologic or medical history. A fish hook had penetrated the sclera 1.5 mm temporal to the limbus. The tip of the fish hook was visible at the posterior surface of the lens. His visual acuity was hand motion. The fish hook was removed through the entrance wound using the backout method. Anterior chamber irrigation and extracapsular cataract extraction with phacoemulsification were performed and intracameral antibiotic injection administered. Intraocular lens implantation was performed at a later date. Presently, the patient has a best correctional visual acuity of 0.7 with no signs of infections. CONCLUSIONS: In cases of ocular fish hook injury, determining a removal method is crucial for recovery. Herein, we report a case of successfully treated fish hook ocular perforation along with a literature review.

An unusual case of self-inflicted multiple needles injuries to eye.

Self-inflicted eye injuries among psychiatric patients are rare but important group of ophthalmic conditions that require close cooperation between different medical specialties to ensure optimum care of the severely disturbed patient. They have been associated with a variety of disorders, including paranoid schizophrenia, drug-induced psychosis, obsessive-compulsive disorder, depression, mental retardation, and ritualistic behavior. It has been described in both adults and children, but occurs most commonly in young adults with acute or chronic psychoses.

Epidemiological Profiles of Industrial Ocular Injuries

PURPOSE: To investigate the epidemiological and clinical characteristics of industrial ocular trauma for treatment application and prevention. METHODS: A retrospective survey of 207 eyes from 206 patients who visited Gosin University Gospel Hospital from January 1, 1998 to December 31, 2007 was performed. The age, sex, diagnosis, causes, injury site, primary ocular surgery, duration of hospitalization and treatment, and initial and final visual acuities were reviewed using the United States Eye Injury Registry (USEIR) form based on the Birmingham Eye Trauma Terminology (BETT). RESULTS: The trauma incidence was higher in males (95.65%) in their forties (50.24%). The mean patient age was 41.5 years. Separately counted lesions were presented as a proportion to total injured eyes. The most common diagnosis of industrial ocular traumas was global injuries (124.1%), orbital wall fractures (6.3%), adnexal trauma (5.3%) and optic nerve injuries (3.4%). The most common cause of ocular injuries was flying iron piece (28.67%), and the cornea was the most frequent injured site (69.1%). In 43% of the patients, surgical treatments were performed and the most common surgery was primary closure of the cornea or sclera (82.02%), followed by vitrectomy (30.33%). The average of initial and final visual acuity (log MAR) was 1.2 and 0.93, respectively. In 69.7% of all patients, the final visual acuity was improved or stabilized compared to the initial status. CONCLUSIONS: Flying objects are still the most frequent cause of industrial ocular trauma and in approximately 70% of all patients, the final visual outcome improved or stabilized compared to the initial status. These types of ocular traumas can be significantly reduced by wearing protector shields along with educational safety programs.

The Statistical Observation of Ocular Injury in the Military

PURPOSE: We investigated the clinical characteristics of ocular trauma in the military for prevention and treatment application. METHODS: We retrospectively surveyed epidemiologic characteristics by investigating the medical records of 790 patients who were hospitalized in the Armed Forces Capital Hospital from January 1, 2001 to December 31, 2010 and investigated the prognostic factors that influenced visual outcome. RESULTS: Among the 790 patients with ocular trauma, 22.9% of the patients had an open injury and 77.1% had a closed injury. The most common cause of injury was sports-related ocular trauma (39%) and fatigue duty-related trauma (23.4%). The following 8 risk factors were considered poor prognostic factors: open injury, involved posterior segment, operation, initial visual acuity of 0.1 or less, corneal laceration, hyphema, RD, and intraocular foreign body. There was a significant correlation between the probability of poor visual outcome and the number of risk factors (correlation coefficient = -0.468, p < 0.0001). CONCLUSIONS: In the present study, the cause, characteristics and prognostic factor of military personnel's ocular injury were determined. The results can be useful in the prevention and management of ocular injury in the military.

A Statistical Observation of Non-Penetrating Ocular Injuries

PURPOSE: To investigate the clinical and social characteristics of non-penetrating ocular injuries and use the results for treatment and prevention. METHODS: A retrospective survey was performed on 468 eyes of 421 patients, who visited our clinic due to non-penetrating ocular injuries from January 2010 to December 2010. The incidence of ocular injuries, sex, age, monthly and seasonal distribution, side, cause, influence of alcohol, and change in visual acuity were reviewed statistically. RESULTS: The incidence of non-penetrating ocular injuries was 4.9%. The incidence was more common in males (82.9%), in the 3rd decade of life (23.5%) and in summer (30.8%). Minor injuries (36.1%) were the most common caused by scratches, finger pricks, nails, or small foreign bodies. The second common cause was violence (16.4%), followed by traffic accidents (14.7%). The injuries related to alcohol represented 12.6% of all cases. When considering initial diagnoses, periorbital contusion and corneal abrasion were the most common. The initial visual acuity was less than 20/200 in 9.4% of the eyes and the final acuity after a 6-months of treatment was less than 20/200 in 3.0% of the eyes. CONCLUSIONS: This survey gathered the clinical and social characteristics as well as new insights into non-penetrating ocular injuries which can be used for treatment and prevention.

Clinical Manifestations, Management, and Ophthalmologic Complications of Orbital Roof Fractures and Zygoma Fractures

PURPOSE: To investigate the clinical manifestations, management, and ophthalmologic complications of orbital roof fractures and zygoma fractures. METHODS: A retrospective survey of 119 patients who visited Korea University Medical Center from June 2009 to June 2010 was performed. The sex, age, causes, fracture characteristics, neurologic injury, ocular injury, and combined facial bone fractures of patients who were diagnosed with orbital roof fracture and zygoma fracture were statistically analyzed. RESULTS: The mean age of patients with orbital roof fracture was 33.0 years old. The most common cause of orbital roof fracture was traffic accident (36.1%) with 6 patients receiveing surgical treatement (9.8%). Among the ophthalmologic diagnoses of the patients with orbital roof fracture, traumatic iridocyclitis was the most common (7 eyes) followed by eyeball rupture (2 eyes). The mean age of patients with zygoma fracture was 36.6 years old. The most common cause of zygoma fracture was traffic accident (32.8%), with 51 patients receiving surgical treatement (87.9%). Among the ophthalmologic diagnoses of the patients with zygoma fracture, traumatic iridocyclitis was the most common (6 eyes), followed by commotio retina (4 eyes). CONCLUSIONS: The present study regarding clinical characteristics and treatment of orbital roof fracture and zygoma fracture is helpful for ophthalmologists regarding the treatment of accompanying ophthalmologic complications.

Effect evaluation of psychological intervention in relieving anxiety and depression of patients with ocular injuries caused by automotive air bag / 中国实用护理杂志

Objective To discuss the effect of psychological intervention in relieving anxiety and depression of patients with ocular injuries caused by automotive air bag.Methods.34 patients with ocular injuries caused by automotive air bag were selected and divided into the intervention group and the control group with 17 patients in each group.The control group adopted routine intervention,while the intervention group was given psychological intervention,including music therapy,Beck's cognitive therapy and before-discharge education.Self-rating anxiety and self-rating depression scale were used to evaluated the psychological status of patients at admission and one day before discharge.Results Incidence of anxiety and depression significantly decreased in the intervention group after intervention.Score of anxiety and depression reduced after intervention in the intervention group,also evidently lower than that of the control group.Conclusions Psychological intervention can relieve anxiety and depression of patients with ocular injuries caused by automotive air bag.

A Statistical Observation of Ocular Injuries and Visual Predictive Value of Ocular Trauma Score

PURPOSE: To investigate the clinical characteristics of ocular injuries for the prevention and predictability of visual prognosis and the treatment of ocular injuries using the ocular trauma score. METHODS: A retrospective survey was performed in 1341 eyes of 1257 patients, who visited Korea University Medical Center from May 2009 to December 2009. The sex, age, causes, diagnosis, primary ocular surgery, injury site, initial and final visual acuities and complications were statistically reviewed. The ocular trauma score was calculated by assigning certain numerical raw points to the following six variables: initial visual acuity, globe rupture, endophthalmitis, perforating injury, retinal detachment, and a relative afferent pupillary defect. The correlation of the ocular traumascore with the final visual acuity was investigated. RESULTS: The incidence of ocular injuries was higher in males (79.0%) than in females and was more common in people in their 40s and 20s respectively. Among the patient the diagnoses, corneal erosion was most common in males, orbital wall fracture was most common in females, and corneal erosion, orbital wall fracture, orbital contusion, and hyphema were most common overall. An ocular trauma score was less than 44 in 6 eyes (0.7%), 9 eyes (1.0%) between a score of 45 and 65, 48 eyes (5.2%) between a score of 66 and 80, 122 eyes (13.2%) between a score of 81 and 90, and 737 eyes (79.9%) between a score of 91 and 100. CONCLUSIONS: The present study determined that the ocular trauma score showed a good visual predictive value and could be used in prevention and treatment of ocular injuries.

Application of ultrasound biomicroscopy in open-globe injury / 眼科研究

Background Open-globe injury of zone Ⅱ is a severe eyeball wound in the sclera area near 5mm from the corneal limbus.To accurately evaluate the local tissue structure after the wounding is very important for lessening the complications of eye injury.Ultrasound biomicroscope (UBM) has been proven useful in examining eyeball wall and vitreous at the wound in order to offer the useful information about whether secondary operation is needed for the injured eyes and when is the optimal timing for surgery.Objective The present study is to explore the clinical application of UBM in open-globe injury of zone Ⅱ. Methods This is an observational study of clinical cases.UBM examination was performed on 38 eyes of 38 cases received emergency repair surgery of open-scleral injury.The restore status of sclera,ciliary body and vitreous of injuried zone (zone Ⅱ) were evaluated under the UBM in 3-5 days after the operation.The comprehensive results of UBM,B-scan and ophthalmoscope examinations were analyzed to determine the further treatment.The oral informed consent was obtained from each subject before this trial.Results Vitreous surgery were performed on 15 cases,and all wounds were found by UBM and were proven in the surgery.The other 23 cases were followed up in out-patient department and no obvious complications were found.Conclusion UBM is a valuable and atraumatic examination for open-globe injury of zone Ⅱ.It offers important and appraisal information about ocular injury.

Devastating ocular injury by a rice black bug: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

A 59-year-old female farmer presented with left painful swollen eye for 1 week after being stung by a rice black bug ( Scotinophara sp. ). It was associated with acute progressive blurring of vision. On examination of the left eye, there was a marked periorbital swelling with proptosis and complete ptosis. The extraocular movements were restricted in all the directions. The cornea was hazy with large epithelial defect. Fundoscopy showed combined features of both central retinal vein and artery occlusions with swollen optic disc and ischaemia of the macular area. CT scan and MRI of orbit and brain showed evidence of orbital soft tissue inflammation. Patient was diagnosed with left orbital cellulitis, keratouveitis and central retinal vein and artery occlusions. The periorbital swelling and proptosis were improved after treatment with systemic and topical antibiotics. However, the vision remained no perception of light(NPL)and limitation of ocular movements persisted. The potential ophthalmic insults by Scotinophara sp. Can be severe and permanent. Awareness of the debilitating insults by Scotinophara sp. To human eye should be instilled timely especially in its prone areas.