Epidemiología de las urgencias oftalmológicas / Epidemiology of ophthalmological emergencies

Objetivo: Determinar el comportamiento de las urgencias oftalmológicas en los pacientes que arriban al Cuerpo de Guardia. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, en 194 285 pacientes (103 859 en el año 2017 y 90 426 en el 2018). Resultados: El 52,3 por ciento perteneció al sexo masculino y 116 444 (59,9 por ciento) tenía entre 19 y 59 años de edad. La conjuntivitis fue el diagnóstico más frecuente, realizado en 72 574 (37,4 por ciento) pacientes, 43 186 (41,6 por ciento) en el año 2017 y 29 388 (32,5 por ciento) en el 2018, seguida de los cuerpos extraños superficiales en la córnea, con un total de 24 920 (12,8 por ciento), dividido en 12 544 (12,1 por ciento) en el año 2017 y 12 376 (13,7 por ciento) en el año 2018. En el 2017, 13 500 pacientes fueron diagnosticados de conjuntivitis hemorrágica como consecuencia de una epidemia que afectó a La Habana. Necesitaron ingreso 573 pacientes y de ellos 327 tuvieron cirugía mayor de urgencia, con una edad media de 45,11 años, y como diagnóstico más frecuente el trauma ocular a globo abierto con o sin cuerpo extraño intraocular. Conclusión: La conjuntivitis, los cuerpos extraños superficiales corneales y la hemorragia subconjuntival fueron los diagnósticos más frecuentes, y el trauma ocular a globo abierto con o sin cuerpo extraño intraocular fue la primera causa de ingreso y de cirugía mayor de urgencia(AU)

Objective: Determine the behavior of ophthalmological emergencies in patients attending the emergency service. Methods: A cross-sectional observational descriptive study was conducted of 194 285 patients (103 859 in the year 2017 and 90 426 in 2018). Results: Of the patients studied, 52.3 percent were male and 116 444 (59.9 percent) were 19-59 years old. The most common diagnosis was conjunctivitis, with 72 574 patients (37.4 percent), of whom 43 186 (41.6 percent) were diagnosed in the year 2017 and 29 388 (32.5 percent) in 2018, followed by superficial corneal foreign bodies with 24 920 (12.8 percent): 12 544 (12.1 percent) in the year 2017 and 12 376 (13.7 percent) in 2018. A total 13 500 patients were diagnosed with hemorrhagic conjunctivitis in the year 2017 due to an epidemic affecting Havana in that year. Of the patients studied, 573 required hospitalization, 327 of them undergoing major emergency surgery. Mean age was 45.11 years and the most common diagnosis was open globe ocular trauma with or without an intraocular foreign body. Conclusions: Conjunctivitis, superficial corneal foreign bodies and subconjunctival hemorrhage were the most common diagnoses, whereas open globe ocular trauma with or without an intraocular foreign body was the leading cause of admission and major emergency surgery(AU)

Características y manejo del trauma ocular a globo abierto en zona I / Characteristics and management of open globe ocular trauma in zone 1

Objetivo: Describir las características clínicas del trauma ocular a globo abierto en la zona I y su manejo en el Servicio de Urgencia. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo a una muestra de 35 pacientes ingresados en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre junio del año 2016 y junio de 2017. Las variables estudiadas fueron edad, sexo, ocupación, ojo afectado, lugar del accidente, agente causal, localización, tamaño y forma de la herida, tiempo de evolución, mecanismo de producción y agudeza visual inicial, alteraciones oculares asociadas y tratamiento médico realizado, las cuales fueron procesadas en la base de datos con el uso de SPSS. Resultados: Predominó el sexo masculino, la edad menor de 50 años, el área laboral y los objetos metálicos, así como las heridas penetrantes entre 2 a 5 mm, paracentrales y lineales, asociadas a la catarata. La mayoría requirió tratamiento quirúrgico. Conclusiones: A pesar de la atención temprana y oportuna del trauma ocular a globo abierto, este representa una causa frecuente de disminución unilateral de la visión en pacientes en edad laboral, por lo que se deben intensificar las medidas de protección para su prevención(AU)

Objective: To describe clinical characteristics of open globe eye trauma in zone 1 and its management in the emergency department in patients admitted to the Cuban Institute of Ophthalmology Ramón Pando Ferrer between June 2016 and June 2017. Methods: A prospective longitudinal descriptive observational study was carried out on a sample of 35 patients. The variables studied were age, sex, occupation, affected eye, place of the accident, causal agent, location, size and shape of the wound, evolution time, production mechanism and initial visual acuity, associated ocular alterations and medical treatment that were processed in a database with SPSS. Results: the male sex under 50 years of age, work area and metal objects predominated, as well as penetrating wounds between 2 and 5 mm for central and linear associated with cataract. Most required surgical treatment. Conclusions: despite the early and timely care of open globe eye trauma, this continues to exist as a cause of unilateral decrease in vision in working-age patients, so protection measures should be intensified as a priority for its prevention(AU)

Trauma ocular en el servicio de Oftalmología del Hospital General Docente Dr. Agostinho Neto, 2014-2019 / Eye trauma in the ophthalmology consultation in the General Teaching Hospital Dr. Agostinho Neto in the period 2014-2019

RESUMEN * Introducción: En el Hospital General Docente "Dr. Agostinho Neto" se desconocen las características de los pacientes atendidos por trauma ocular. Objetivo: Caracterizar el trauma ocular en pacientes ingresados en el servicio de Oftalmología del citado hospital en el período de enero de 2014 a julio de 2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal del total de pacientes con este diagnóstico (n=49). Se estudiaron las variables: sexo, edad, procedencia, ocupación, tipo de trauma, diagnóstico y complicaciones, y modificaciones de la agudeza visual de acuerdo al tratamiento que aplicó. Resultados: El 79,0 % de los pacientes fueron hombres, tenían entre 19 y 40 años de edad (43,0 %), procedían de áreas rurales (57,0 %) y se dedicaban a labores agrícolas (45,0 %). El 76,0 % presentó un trauma ocular abierto, la herida corneal fue el más usual (55,1 %). El 95,9 % de los pacientes recibieron tratamiento quirúrgico y reparación de la herida el 83,6 %. Antes y después del tratamiento, el 47,0 % y el 41,0 % respectivamente de los pacientes presentaron agudeza visual y visión cuenta dedos a percepción luminosa. La catarata traumática fue la complicación más frecuente (33,0 %). Conclusiones: El trauma no es un problema de salud, pero sí limita la calidad de vida de los perjudicado al afectar la agudeza visual.

ABSTRACT * Introduction: The characteristics of the patients with eye trauma treated in the General Teaching Hospital Dr. Agostinho Neto remain mostly unknown. Objective: To characterize eye trauma in the patients in the ophthalmology consultation in the mentioned institution, in the stretch of time between January 2014 to July 2019. Method: A descriptive, retrospective and longitudinal study was carried out on the total amount of patients with the diagnosis (n=49). The different variables taken into account were: gender, age, place of origin, occupation, type of trauma, diagnosis and complications, and the modifications in visual acuity according to the treatment given. Results: 79.0 % of the patients were men, with ages ranging between 19 to 40 years old (43.0 %), from rural areas (57.0 %), and involved in agricultural works (45.0 %). 76.0 % were open eye traumas, being corneal wounds the most common one (55.1%). 95.9 % of the patients were surgically treated, and 83.6 % went through wound healing processes. Before and after the treatment, the 47.0 % and the 41.0 % of the patients, respectively, presented visual acuity and good 'counting fingers' and 'visual perception' tests results. Traumatic cataracts were the most common complication (33.0 %). Conclusions: eye traumas are not a significant health issue, but impacts directly in the life quality of the affected, damaging their visual acuity.

Ocular trauma score como predictor de agudeza visual en pacientes con trauma ocular grave: predictor de pronóstico visual en urgencia oftalmológica / Ocular trauma score as a predictor of visual acuity in patients with severe ocular trauma: visual prognosis in ophthalmological urgency

El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.

This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection ­ hand motion (n=89). After six months of distribution, it moved to the category 20/40 ­ 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.

Perfil epidemiológico dos atendimentos em um serviço público de urgência oftalmológica / Epidemiological profile of visits in a public ophthalmic emergency service

Resumo Objetivo: Identificar os principais diagnósticos e características epidemiológicas dos pacientes atendidos em um serviço público de urgência oftalmológica. Métodos: Estudo transversal e retrospectivo, com análise de prontuários de 2834 pacientes atendimentos no período de julho a setembro de 2017, no serviço de Urgência Oftalmológica do Complexo Hospitalar Ouro Verde, Campinas, Brasil. As variáveis estudadas foram idade, gênero e diagnóstico. Resultados: Houve a prevalência do gênero masculino (52,6%) e da faixa etária de 30 a 59 anos (43,5%); 21,1% eram idosos. Os diagnósticos mais prevalentes foram conjuntivite infecciosa (23,9%), trauma ocular (15,7%) e doenças da superfície ocular (14,6%). Entre mulheres e crianças houve o predomínio de quadros infecciosos/inflamatórios; 83,6% dos traumas ocorreram em homens, sendo 62,2% devido a corpo estranho. Conclusão: Os diagnósticos mais prevalentes no serviço de urgência oftalmológica foram conjuntivite infecciosa e trauma ocular. Medidas de educação e prevenção são necessárias para reduzir morbidade e absenteísmo e evitar o uso inapropriado dos serviços especializados de emergência.

Abstract Objective: To identify the most frequent diagnosis and epidemiological characteristics of patients attended in a public ophthalmic emergency service. Methods: This is a retrospective and transverse study based on 2834 patients' chart attended from July to September 2017 at the Ouro Verde Hospital Complex, Campinas, Brazil. The following variables were investigated: age, gender, and diagnosis. Results: Most patients were male (52.6%) and aged between 30 to 59 years (43.5%); 21.1% were elderly. The most frequent diagnostics were conjunctivitis (23.9%), ocular trauma (15.7%), and ocular surface disorders (14.6%). Infectious/inflammatory conditions predominated among children and female; 83.6% of traumas occurred in man, and 62.2% were due to a foreign body. Conclusion: The most prevalent diagnoses in the ophthalmologic emergency department were infectious conjunctivitis and ocular trauma. Education and prevention measures are necessary to reduce morbidity and absenteeism and to avoid inappropriate use of specialized emergency services.

Epidemiological profile and visual outcome of ocular trauma in a referral center in northeastern Brazil / Perfil epidemiológico e prognóstico visual do trauma ocular em um centro de referência da região nordeste do Brasil

Abstract Objectives: To evaluate the epidemiological profile and prognosis of patients with mechanical ocular trauma. Methods: Descriptive cross-sectional observational study of consecutive patients evaluated during a one-year period at a public referral center in São Luis, Maranhão, Brazil. The Ocular Trauma Score (OTS) was used to estimate final visual acuity. The variables were analyzed using the chi-square test with a significance level of 5%. Results: Out of a total of 154 patients (mean age of 30.1 years), 27.92% were younger than 16 years, and 81.8% were men, with most coming from the state's countryside (55.2%). Most of the patients were dependents (34%) or rural workers (19%). Regarding the OTS prognosis, 33.77% of the patients were category 5 and 31.16% category 1 or 2, indicating worse prognosis. The best prognoses (visual outcomes) were inversely proportional to age and time to treatment (p<0.001). Conclusion: Ocular trauma remains an important cause of ocular morbidity in childhood and in informal work. Adult supervision and socio-educational measures are mandatory to change this scenario.

Resumo Objetivos: Avaliar o perfil epidemiológico e o prognóstico visual de pacientes com trauma ocular mecânico. Métodos: Estudo observacional transversal descritivo de pacientes consecutivos atendidos durante o período de um ano em um centro de referência público em São Luís, Maranhão. O Ocular Trauma Score foi aplicado a fim de estimar a acuidade visual final. As variáveis foram analisadas por meio do teste de Qui-quadrado com nível de significância de 5%. Resultados: Encontrou-se 154 pacientes tratados, a média de idade foi 30,1 anos, 27,92% menores que 16 anos, homens (81,8%) e do interior do Estado (55,2%). A maioria eram dependentes (34%), dos trabalhadores ocorreu o predomínio do trabalhador rural (19%). Quanto ao prognóstico, 33,77% dos pacientes apresentavam-se na categoria 5 e 31,16% na 1 ou 2, de pior prognóstico. Os melhores prognósticos foram inversamente proporcionais a idade e ao tempo até o atendimento (p<0,001). Conclusão: O trauma ocular se mantém como importante causa de morbidade ocular na infância e no trabalho informal. A supervisão de adultos e medidas socioeducativas são fundamentais para mudar esse cenário.

Perfil do trauma ocular infantil em unidade de emergência oftalmológica / Profile of childhood eye trauma in an ophthalmologic emergency

Resumo Objetivo: Descrever o perfil do trauma ocular infantil em unidade de emergência oftalmológica. Métodos: Estudo descritivo transversal, revisando prontuários de pacientes até 15 anos em hospital de referência em urgência oftalmológica no período de Abril de 2016 a Março de 2017. Foram coletadas informações do paciente e da história do trauma, agente causador e detalhes envolvidos. No exame oftalmológico, foi verificada a acuidade visual, descrição das lesões e o tipo de conduta realizada. Resultados: Um total de 78 pacientes, 80 olhos foram inclusos. O olho direito foi o menos acometido. Dois pacientes apresentaram afecção bilateral. Cinquenta pacientes (64%) deram entrada pelo sistema único de saúde (SUS). A faixa etária com maior número de casos estava entre 1 a 5 anos. Em relação ao local do acidente, em 42 pacientes ocorreram em ambiente domiciliar. Quanto à lesão ocular envolvida, a maioria dos pacientes apresentaram abrasão corneana como principal tipo de lesão. Sobre a natureza do fator causal do trauma mostrou maior prevalência de traumas com lápis e caneta (14%), bola (13%) e agressão física (19%). Em relação à acuidade visual, 39 pacientes (50%), referiram baixa acuidade visual no olho acometido. Sessenta e nove pacientes (89%) tiveram seguimento exclusivamente ambulatorial. Dois pacientes evoluíram para evisceração ocular. Conclusões: Os acidentes aconteceram mais frequentemente em ambiente domiciliar sendo o trauma fechado a lesão predominante. Sexo masculino representou a maioria dos pacientes inclusos no estudo. A análise epidemiológica do trauma ocular infantil permite elaboração de medidas preventivas baseado no conhecimento dos fatores causais envolvidos.

Abstract Objective: To describe the profile of childhood eye trauma in an ophthalmologic emergency unit. Methods: A descriptive cross-sectional study reviewing medical records of patients under 15 years of age at a referral hospital in the ophthalmologic emergency sector from April 2016 to March 2017. Information was collected from the patient and the history of the trauma, the type of trauma and details involved. Ophthalmologic exam was performed, visual acuity, lesions description and type of conduct were verified. Results: A total of 78 patients, 80 eyes were included. The right eye was the least affected. Two patients presented bilateral affection. Fifty patients (64%) were admitted through the single health system (SUS). The age group with the highest number of cases was between 1 and 5 years. Regarding the location of the accident, in 42 patients occurred in a home environment. Regarding the ocular lesion involved, most of the patients presented corneal abrasion as the main type of lesion. On the nature of the causal factor of the trauma showed a greater prevalence of traumas with external agents like pencil and pen (14%), ball (13%) and physical aggression (19%). Regarding visual acuity, 39 patients (50%) reported low visual acuity in the affected eye. Sixty-nine patients (89%) had exclusively clinical follow-up. Two patients were referred for ocular evisceration. Conclusions: Accidents occurred more frequently in the home environment and closed globe injuries where predominated. Ocular trauma was more frequent among boys. Programs of education and prevention for ocular trauma in childhood are necessary.

Frequency and causes of ocular trauma among children attending Mulago Hospital Eye Department

Background: Ocular trauma is a frequent and avoidable cause of visual impairment. Injuries range from a small corneal epithelial abrasion to pen­etrating and globe rupture leading to blindness or poor vision. Hospital based studies of eye trauma indicate that about two thirds of those affected are male, predominantly children and young adults with injuries by sticks, stones, and metallic objects being the most.Objective: To examine the frequency, pattern and causes of ocular trauma among children at Mulago hospital using a hospital based descriptive cross- sectional study. Results: Of the 161 children seen with ocular trauma, 45.9% were aged 0-5 years, 32.3% were aged >5-12 years and 21.8% were aged >12-17years; the male to female ratio was 2.1. Sticks were the commonest agent of injury. The most common places of trauma was in the home and school, and the commonest activity at occurrence of injuries was playing and fighting. Only 2.5% of cases presented to the hospital within 24 hours. About a quarter presented with immediate visual acuity better than 6/18, while 19.2% presented with visual acuity worse than 6/18-6/60, and 44% presented with visual acuity worse than 6/60-NPL.Conclusion: The frequency of ocular trauma amongst children attending Mulago Hospital is high, one in every five children seen at the eye clinics had ocular trauma

Traumatismes oculaires suite à un accident du travail : étude bicentrique à Antananarivo

Introduction : Les traumatismes oculaires peuvent être graves et entraîner une cécité même avec une prise en charge spécialisée. Cette étude visait une détermination des aspects épidémio-cliniques des traumatismes oculaires au décours d'un accident du travail. Méthodes : Etude rétrospective descriptive sur une période d'une année allant de janvier à décembre 2013, portant sur 215 cas de patients victimes de traumatisme oculaire suite à un accident du travail, vus en consultation dans deux grands hôpitaux d'Antananarivo. Résultats : Vingt virgule quarante-sept pour cent (20,47%) des cas de traumatismes oculaires vus en consultation relevaient d'un accident du travail. La population d'adultes jeunes était la plus concernée (29,77%) avec une prédominance du genre masculin (95,81%). Les soudeurs et les travailleurs en ouvrage métallique étaient les professions les plus en cause avec respectivement 20% et 15,81%. De manière générale, l'agent traumatisant était un corps étranger de nature métallique. Il s'agissait d'une atteinte unilatérale dans la plupart des cas. 4,65% des patients ont présenté des séquelles dont 3 éviscérations. Tous les accidents sont survenus sur le lieu de travail. Seuls 2,33% des travailleurs portaient des lunettes de protection. Conclusion : Une meilleure prévention par l'utilisation de lunettes de protection serait indispensable pour réduire les accidents. Le rôle préventif revient au médecin du travail

Rotura ocular posterior traumática / Traumatic posterior ocular rupture

El trauma ocular es una causa importante de morbilidad oftalmológica en el mundo con implicaciones socioeconómicas importantes para el paciente y sus familiares. Ocurre generalmente en adultos jóvenes, con una buena agudeza visual al inicio del evento traumático, la cual se verá comprometida según la severidad del trauma, las estructuras oculares que afecte y las complicaciones que puedan aparecer. Presentamos dos pacientes con rotura escleral posterior secundario a trauma ocular a globo abierto contuso. Se describe el manejo personalizado el seguimiento en cada caso y sus resultados visuales(AU)

The ocular trauma is an important cause of ophthalmological morbidity in the world with significant socio-economic implications for the patient and its relatives. It generally occurs in young adults, with good visual acuity at the beginning of the traumatic event, which may be affected by the trauma severity, the ocular structures that it affects and the possible complications. This is the report on two patients with posterior scleral rupture secondary to blunt open-globe ocular trauma. The customized management, the follow-up of each case and the visual results achieved were all described(AU)

Trauma ocular a globo abierto con cuerpo extraño intraocular / Open globe ocular trauma with intraocular foreign body

Los cuerpos extraños intraocularesconstituyen hasta el 40 % de los traumas a globo abierto. Se presenta un paciente de 32 años de edad con diagnóstico de trauma ocular a globo abierto en zona I, con cuerpo extraño intraocular en ojo derecho por estar trabajando en la limpieza de un cable sin medios de protección. Al examen oftalmológico con lámpara de hendidura se encontró una herida autosellante en zona I, cristalino transparente y trayecto del cuerpo extraño en vítreo. A la oftalmoscopia binocular indirecta se observó el cuerpo extraño de tipo ferroso sobre la retina en la zona de la mácula con edema de esta, agujero macular, oclusión de la arteria temporal inferior y retina aplicada. Se le realizó ultrasonido ocular, rayos X de cráneo, tomografía de coherencia óptica spectral y Topcon, y retinografia a color para apoyar el diagnóstico. A las 24 horas de llegado al Servicio se le realizó la cirugía de vitrectomía por pars plana más la extracción del cuerpo extraño intraocular. La vitrectomia por pars plana permite la remoción de cualquier opacidad vítrea; el acceso para reparación de otras lesiones; la extracción del cuerpo extraño, magnético o no, con pinzas o imanes; liberar el tejido fibroso, la hialodes y la reparación de coroides y retina si el cuerpo extraño estuviera encarcelado, y disminuye la carga bacteriana si existiera endoftalmitis<(AU)

Intraocular foreign bodies represent up to 40% of open globe ocular traumas. Here is a 32 years-old patient diagnosed with open globe ocular trauma in zone I, with intraocular foreign body in his right eye resulting from the cleaning of a cable without using the protection goggles. On the eye exam with the slit-lamp, an self-sealing injure was observed in zone I, transparent crystalline and trajectory of the foreign body in the vitreous. The indirect binocular ophthalmoscopy showed iron-type foreign body upon the retina in the macular area with edema, macular hole, occlusion of the inferior temporal artery and retina. The patient underwent ocular ultrasound, cranial X-ray, Spectral YTop con optic coherence tomography and color retinography to support the diagnosis. Twenty four hours after being received at the service, he was operated on through the pars plana vitrectomy plus extraction of the intraocular foreign body. Pars plana vitrectomy allows removing any vitreal opacity, accessing to repair other lesions, removing foreign bodies, either magnetic or not, by using tweezers or magnets, releasing the fibrous tissue, the hyaloids and repairing choroides and retina if there is an incarcerated foreign body, as well as reducing the bacterial load if the patient has endophthalmitis(AU)

Application of Ocular Trauma Score in Mechanical Ocular Injury in Forensic Medicine / 法医学杂志

OBJECTIVE@#To evaluate the application value for the prognosis of mechanical ocular injury cases using ocular trauma score (OTS).@*METHODS@#Four hundred and eleven cases of mechanical ocular trauma were retrospectively reviewed. Of the 449 eyes, there were 317 closed globe injury and 132 open globe injury. OTS variables included numerical values as initial visual acuity, rupture, endophthalmitis, perforat- ing or penetrating injury, retinal detachment and relative afferent pupillary block. The differences be- tween the distribution of the final visual acuity and the probability of standard final visual acuity were compared to analyze the correlation between OTS category and final visual acuity. The different types of ocular trauma were compared.@*RESULTS@#Compared with the distribution of final visual acuity in standard OTS score, the ratio in OTS-3 category was statistically different in present study, and no differences were found in other categories. Final visual acuity showed a great linear correlation with OTS category (r = 0.71) and total score (r = 0.73). Compared with closed globe injury, open globe injury was generally associated with lower total score and poorer prognosis. Rupture injury had poorer prognosis compared with penetrating injury.@*CONCLUSION@#The use of OTS for the patients with ocular trauma can provide re- liable information for the evaluation of prognosis in forensic medicine.

Ruptura coroidea y neovascularización coroidea secundarias a trauma con seguimiento de 24 años. Reporte de caso / Choroidal rupture with choroidal neovascularization secondary to trauma. Case report with 24 years follow-up

Objetivo: describir el seguimiento clínico por 24 años de una ruptura coroidea y su neovascularización coroidea secundaria a trauma ocular cerrado. Efectuar una revisión bibliográfica de esta patología. Destacar la importancia de observaciones prolongadas para completar su historia natural. Diseño: reporte de caso no intervencionista. Método: retrospectivo, en caso de trauma ocular cerrado y sus consecuencias estudiadas en seguimiento cuidadoso de 24 años y la ayuda diagnóstica de la tomografía óptica coherente, la fluoroangiografía y el campo visual. Resultado: reconocimiento de glaucoma y catarata que disminuyeron la visión a 20/120 veinticuatro años después de la contusión ocular. Conclusión: La neovascularizacion coroidea secundaria a ruptura coroidea traumática subfoveal aparece en tiempo variable luego de trauma ocular contuso, compromete la recuperación anatómica y visual, y es de pronóstico reservado de acuerdo con su localización según hallazgos en observación prolongada.

Purpose: to describe findings and follow-up for 24 years in a choroidal rupture with secondary choroidal neovascularization following closed ocular trauma. To perform a literature review on this topic. To remark the importance of long follow-up to complete natural history of disease. Design: non-interventional case report. Methods: retrospective, in a case ofbclosed ocular trauma and sequels on a follow-up of 24 years using optical coherence tomography and fl uorescein angiography as diagnostic techniques. Results: recognition of glaucoma, cataract and decreased visual acuity to 20/120. Conclusion: choroidal neovascularization following indirect subfoveal traumatic choroidal rupture may occur in variable time after blunt trauma, affecting ocular structures and visual function with poor prognosis demonstrated on long follow-up.

Paintball: juego de guerra, ¿Qué tan lesivo puede ser? / Paintball: war game how harmful can be?

Objetivo: Ilustrar las consecuencias oculares de pacientes que han sufrido trauma ocular con Paintball. Diseño: serie de casos. Materiales y Métodos: se realizó una revisión de las historias clínicas de pacientes tratados en el servicio de oftalmología del Hospital Militar Central que habían sido examinados por presentar trauma ocular secundario a lesiones por paintball. Se realizó seguimiento de los casos por 12 meses. Resultados: se evaluó la magnitud del trauma ocular secundario a paintball encontrándose muy baja recuperación de la agudeza visual y la necesidad de cirugía ocular en todos los pacientes Se determinó la severidad y extensión del daño ocular asociado a esta lesión.

Objective: to show the eye consequences of a group of patients who suffered eye trauma because of paintball. Design: case series. Materials and methods: through revision of medical records, information from patients treated at the ophthalmology area of the Hospital Militar Central, who presented a diagnosis of eye trauma caused by playing paintball, during 2011. We followed up the cases through 12 months of treatment. Results: We evaluated the magnitude of eye trauma produced by paintball, finding a very low final visual recovery and also the need for surgery in all patients. Determining the extent and severe eye damage caused by the trauma of paintball.

Fundus autofluorescence in blunt ocular trauma / Autofluorescência do fundo de olho no trauma ocular contuso

Purpose: To describe the findings of fundus autofluorescence (FAF) imaging in patients with blunt ocular trauma. Methods: In this non-interventional retrospective study, we reviewed medical records and imaging examination results. The data analyzed included gender, age, laterality, trauma etiology, time between trauma and imaging, visual acuity, changes in the retinal periphery, fundus examination results, and FAF imaging findings. FAF imaging was performed using a Topcon TRC-50DX Retinal Camera (Tokyo, Japan). Results: Eight eyes from 8 patients were studied. The mean age was 27.6 years (range, 19-43 years). Men (n=7) were more frequently affected by blunt ocular trauma than women (n=1). Physical aggression was the most common trauma etiology (n=3), followed by accidents with fireworks (n=2). Other causes were car accidents (n=1), occupational trauma caused by a grinder (n=1), or being hit by a stone (n=1). Visual acuity ranged from 20/80 to light perception. Traumatic pigment epitheliopathy (TPE) was identified in 5 cases, choroidal rupture in 3 cases, subretinal hemorrhage in 3 cases, and Purtscher's retinopathy in 1 case. Hypoautofluorescence was observed in cases of choroidal rupture, recent subretinal hemorrhage, and intraretinal hemorrhage, and in two cases of TPE. Hyperautofluorescence was observed in cases of old subretinal hemorrhage and at the edge of the lesion in two cases of choroidal rupture. Mild hyperautofluorescence was observed in the posterior pole in Purtscher's retinopathy. Three cases of TPE exhibited hypoautofluorescence with diffuse hyperautofluorescent areas. Conclusion: FAF imaging is a non-invasive method for assessing changes in the posterior segment of the eye resulting from blunt ocular trauma. Furthermore, this technique provides valuable information. We described the findings of FAF imaging in cases of TPE, choroidal rupture, subretinal hemorrhage, and Purtscher's retinopathy. .

Objetivo: Descrever os achados do exame de autofluorescência do fundo de olho (AFF) em pacientes vítimas de trauma ocular contuso. Métodos: Estudo retrospectivo, não intervencionista, realizado através da revisão de prontuários e exames de imagem. Os dados analisados foram: sexo, idade, lateralidade, etiologia do trauma, tempo decorrente entre o trauma e a realização do exame, acuidade visual, alterações na periferia da retina, diagnóstico fundoscópico e achados ao exame de AFF (realizada no aparelho Topcon TRC-50DX Retinal Camera). Resultados: Oito olhos de 8 pacientes foram estudados. A idade média foi de 27,6 anos (de 19 a 43 anos), o sexo masculino (n=7) foi mais acometido do que o feminino (n=1), agressão física foi a etiologia mais comum do trauma (n=3), seguido de acidente com fogos de artifício (n=2). Outras causas foram acidente automobilístico (n=1), trauma ocupacional com lixadeira (n=1) e pedrada (n=1). A acuidade visual variou de 20/80 a percepção luminosa. Epiteliopatia pigmentar traumática (EPT ) foi identificada em 5 casos, rotura de coroide em 3, hemorragia subretiniana em 3 e retinopatia de Purtscher em 1 caso. Hipoautofluorescência foi observada nos casos de rotura de coroide, hemorragia subretiniana recente, hemorragia intrarretiniana e em 2 casos de EPT. Hiperautofluorescência foi visualizada nos casos de hemorragia subretiniana em degradação, na borda de 2 casos de roturas de coroide e discretamente no polo posterior na retinopatia de Purtcher. Três casos de EPT apresentaram hipoautofluorescência com pontos hiperautofluorescentes difusos. Conclusão: O exame de AFF permite avaliar as alterações do segmento posterior do olho decorrentes do trauma ocular contuso de forma não invasiva, somando informações valiosas. Foram descritos achados do exame ...

Correlativity between projected visual chart vision and contrast vision / 法医学杂志

OBJECTIVE@#To study the correlativity between the projected visual chart vision ("projector vision" in this paper) and the measured values of contrast vision, and to explore the application of contrast vision in identifying visual impairment after eye injury in the clinical forensic medicine.@*METHODS@#One hundred and twenty nine eyes of seventy-nine young volunteers were collected for examination both of projector vision and contrast vision. In the examination of contrast vision, the contrast of optotypes were set to 100%, 25% and 10%, respectively. The correlativity of both collected experimental data were statistically analyzed.@*RESULTS@#Projector vision was consistent with 100% contrast vision. There was a close and positive correlation between the contrast of optotypes and measured vision values. Under the same contrast of optotypes, projector vision presented a linear correlation with the average value of contrast vision.@*CONCLUSION@#There is a close correlation between projector vision and contrast vision. The contrast vision can be applied to judicial identification in the clinical forensic medicine.

Patterns of Ocular Trauma at the Main Referral Hospital in Rwanda: Kigali University Teaching Hospital

Background: Eye injuries are the most common cause of referral to the Ophthalmology department; KUTH. No research data is available on ocular trauma in Rwanda. To understand the impact of eye injuries in KUTH and to plan for preventive strategies; it is important to understand the magnitude of this problem. Aim: The aim of this study was to identify the patterns of ocular trauma at Kigali University Teaching Hospital. Methods: In this retrospective study; 352 reviewed patients were referred to KUTH; from January 1st; 2007 to January 1st; 2013. Patient's ocular trauma details were recorded and analyzed. Patients' demographic data; medical history; diagnosis; treatment and possible complication were retrieved from files in archive and recorded on a questionnaire for further analysis. Results: Out of the 352 patient's files; 72.7 were males and 27.3 were females. The male to female ratio was 2.7. Majority of patients were of age group between 11 and 40 years. Among files reviewed; 75.2 sustained blunt ocular injuries whereas 22.1 sustained penetrating injuries. Main risk factors for those injured patients were work place injuries (37); road traffic accident (21) and assault (15). Most frequent offending agents were pieces of wood (21.5); foreign bodies (16.4) and vehicle crush (16.1). However; metal objects; motorbike and stone missile represented important causes of ocular trauma at KUTH respectively 13.9; 13.06 and 11.07. A big number of patients were found to have corneo-limbal perforation (29.2); corneal abrasions (18.4); corneal abrasions (18.4); sub-conjunctival hemorrhage (17.8) and peri-orbital injuries (17.6). The common visual acuity observed on the affected eye on admission was (6/60-3/60) (38) and below 3/60 (30). The main post-traumatic complication at KUTH was corneal scaring (42.04). Conclusion: Males and young patients were more affected by ocular injuries because of their involvement in high risk activities in their daily life. Blunt and penetrating ocular injuries were two main types of ocular trauma recorded. Work place ocular injuries; road traffic accident and assaults were the main risk factors of ocular trauma at KUTH. Piece of wood; ocular foreign bodies and vehicle crush were the main offending agents causing ocular injuries. Main diagnoses in ocular trauma were corneo-limbal perforation; corneal abrasion and sub-conjunctival hemorrhage. On admission; most of injured patients had visual acuity (6/60-3/60) and below 3/60. Management of ocular trauma mainly described at KUTH was antibiotherapy and steroid therapy; however surgery was performed for penetrating trauma and conservative treatment for few cases. The most common complication due to ocular trauma at KUTH was corneal scaring

Retinose pigmentada unilateral secundária a trauma: relato de caso / Unilateral retinitis pigmentosa secondary to eye injury: case report

A retinose pigmentada constitui um grupo de doenças causadas por alterações genéticas que levam à degeneração progressiva dos fotorreceptores, principalmente bastonetes. Em geral, tem apresentação bilateral. Este estudo é um relato de caso de uma paciente com acometimento unilateral da retina, de características semelhantes às da retinose pigmentada, com história de trauma ocular antigo. Descrevem-se sua história clínica e achados oftalmológicos.

Retinitis pigmentosa is a group of diseases caused by genetic changes that lead to progressive degeneration of photoreceptors, rods mainly. In general, it has bilateral presentation. This study is a case report of a patient with unilateral involvement of the retina, similar to the characteristics of retinitis pigmentosa, and an old ocular trauma history. It describes her history and ophthalmologic findings.

Lesões oculares por Processionária (Thaumetopoea pityocampa Schiff): relatos de casos / Processionary (Thaumetopoea pityocampa Schiff) induced ocular lesions: case reports

A Processionária (Thaumetopoea pityocampa Schiff), vulgarmente conhecida como "lagarta do pinheiro" é um inseto dos pinheiros e cedros, endêmico em meios rurais mas também em meios urbanos. A toxicidade ocular, rara nas últimas décadas pelo desenvolvimento de métodos de erradicação eficazes, é provocada pelos seus pelos e prevê-se mais frequente com o recrudescimento deste inseto. Revemos a epidemiologia da Processionária e as suas lesões oculares a partir de 3 casos clínicos. Caso 1: Doente de 64 anos recorre ao Serviço de Urgência (SU) com olho direito vermelho e sensação de corpo estranho após prática de jardinagem. A observação revela AVODc: 0,5, erosão epitelial, presença de um filamento no estroma corneano profundo, flare (++) e Tyndall (+++). Caso 2: Doente de 28 anos, recorre ao SU por dor intensa no olho direito acompanhada de hiperemia após contato com lagarta. Apresenta AVODc: 0,6 e Tyndall (+++) com presença de múltiplos filamentos (mais de 20) a diferentes profundidades da córnea. Caso 3: Doente de 26 anos, recorre ao SU por sensação de corpo estranho e lacrimejamento constante no olho direito, após realizar exercícios militares num parque urbano. Apresenta AVODc: 0,3, múltiplas erosões epiteliais puntiformes na metade nasal da córnea que recobriam filamentos de cor laranja e Tyndall (+). Foi instituída terapêutica com corticoide tó­pico e vigilância sintomática a cada um dos casos. A patologia ocular por Processionária decorre da toxicidade dos seus pelos, cuja migração ocorre preponderantemente no sentido intraocular. Inclui por isso lesões precoces (conjuntivite, queratite e uveíte) e tardias (catarata, pars planite, vitreíte e retinite). Os casos apresentados possuíam lesões iniciais, tendo recuperado totalmente do quadro inflamatório após seis meses mas mantendo os pelos inativos no estroma corneano. A gravidade destes casos prende-se à possibilidade de migração intraocular, que pode ocorrer anos após o episódio inicial, obrigando a uma vigilância ao longo da vida. CONCLUSÃO: O recrudescimento da Processionária, tanto em meios rurais como urbanos, justifica o conhecimento das lesões oculares que pode causar e o seu tratamento.

The Processionary (Thaumetopoea pityocampa Schiff), is an endemic insect of pine and cedar trees, existing both in rural and urban areas. Ocular toxicity, once rare due to the efficacy of eradication methods, is caused by the insects' hair and is expected to be more frequent with its recrudescence. We report two clinical cases and review the epidemiology of Processionary and its eye injuries. Case 1: a 64 year-old patient complained of red eye and foreign body sensation after being gardening. She had a BCVA of 0.5 and biomicroscopy revealed an epithelial erosion, flare (++), Tyndall (+++) and the presence of a setae in the deep corneal stroma. Case 2: a 28 year-old patient complained of severe pain in the right eye and hyperemia after having had contact with a caterpillar. He presented with a BCVA of 0.6, Tyndall (+++) and multiple filaments (over 20) at different depths in the cornea. Case 3: a 23 year-old patient refers to the ER with foreign body sensation and constant lacrimation in the right eye after having been completing military exercises in an urban park. He presented a BCVA of 0.3, multiple epithelial erosions in the nasal half of the cornea that cove­red multiple orange strands and an anterior chamber reaction (Tyndall +). Therapy was initiated with topical steroids and symptomatic surveillance. Ocular toxicity due to Processionary hairs, whose movement occurs preferentially towards the posterior pole, includes early signs (conjunctivitis, keratitis, and uveitis) and late signs (cataract, pars planitis, vitritis, and retinitis). The 3 cases presented had early lesions, having fully recovered from the inflammatory condition after 6 months. However, inactive setae were still visible in the corneal stroma. Intraocular migration, which can occur years after the initial episode, is possible and might be severe, thus requiring a life-long surveillance. CONCLUSION: Processionary recrudescence has been observed, both in rural and urban areas. It is therefore imperative to be familiar with eye injuries caused by the insect and its treatment.

Magnetic resonance imaging of intact globe superior subluxation into the intracranium.

A 67-year-old man with right-sided blunt ocular trauma is reported here. Despite having received primary medical care, the patient complained of severe headache for 14 days. Initial computed tomography (CT) indicated hematoma in the right frontal lobe. However, magnetic resonance imaging (MRI) indicated that the right globe along with its optic nerve had been intactly dislocated into the intracranium and differentiated from hematoma. In this case, the significance of MRI, in blunt ocular trauma work-up, and also regaining successful ocular function are highlighted.