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 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.

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 na Faculdade de Medicina de Botucatu / Ocular trauma at the Botucatu medical school

RESUMO Objetivo: Avaliar os traumas oculares graves atendidos em um hospital universitário e que demandaram internação. Métodos: Estudo retrospectivo envolvendo 303 portadores de trauma ocular grave atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP, entre Janeiro de 1998 até Dezembro de 2008 e que necessitaram internação. Foram avaliadas as variáveis demográficas, as causas dos acidentes, os fatores envolvidos, a acuidade visual inicial e final, assim como os procedimentos realizados. Os dados foram submetidos à análise estatística. Resultados: No período ocorreram 307 traumas oculares graves que foram internados e operados, com maior frequência entre 26 e 40 anos de idade (26%) e do sexo masculino (82%). A maioria dos casos entre os adultos decorreu de acidentes de trabalho ou de trânsito e em crianças, em ambiente de lazer ou doméstico. A córnea foi o local mais afetado (75%) e a zona I foi a mais atingida (82%). O trauma perfurante foi o mais frequente e o agente causal principal foi o vidro (18%), acometendo principalmente os lavradores (41%). A grande maioria dos portadores de trauma ocular atendidos não usava equipamentos de segurança. Após a cirurgia, a AV se manteve abaixo de 0,1 em 48% dos acometidos. O tempo entre o trauma e o tratamento influenciou o prognóstico visual. Conclusão: O trauma ocular grave permanece como uma importante causa de morbidade e cegueira monocular prevenível. O tratamento cirúrgico bem conduzido pode minimizar o prejuízo para a função visual, devendo ser reforçada a necessidade de medidas de prevenção.

ABSTRACT Purpose: To evaluate serious eye trauma requiring admission for treatment at a university hospital. Methods: This was a retrospective study involving 303 patients with severe ocular trauma who required hospitalization at the Hospital of the Faculty of Medicine of Botucatu - Unesp, from January 1998 to December 2008. Demographic data were evaluated and also the causes of accidents, factors involved, initial and final visual acuity (VA) as well as the procedures performed. Data were statistically analyzed. Results: Three hundred and seven severe eye traumas were admitted for surgery, most commonly affecting subjects between the ages of 26 and 40 (26%) who were male (82%). The trauma affecting adults occurred due to work or traffic accidents and in children, during leisure time or in the domestic environment. The cornea (75%) and area I (82%) was the most affected place. A penetrating trauma was most frequent, and the main causal agent was glass (18%), mainly affecting farmers (41%). The majority of the affected patients were not wearing protective equipment at the time of the ocular trauma. After surgery, the AV remained below 0.1 in 48% of affected individuals. The time between trauma and treatment influenced the visual prognosis. Conclusion: Severe eye trauma remains an important cause of morbidity and preventable monocular blindness. Although the severity of the ocular traumas, surgical treatment that is well conducted can minimize the damage to visual function and should reinforce the need for preventive measures.

Traumatic wound dehiscence after corneal keratoplasty / Deiscência de sutura pós-trauma ocular em olhos submetidos a transplante de córnea

ABSTRACTPurpose:To assess patient characteristics, risk factors, outcomes, and the treatment of wound dehiscence (WD) in patients after corneal keratoplasty.Methods:Retrospective chart review of 11 eyes of 11 patients with corneal grafts who underwent repair of WD from January 1, 2004 to December 31, 2012 at Hospital Oftalmologico de Brasilia.Results:Eight (72.7%) patients were men and three were women. Six (54.5%) patients had deep anterior lamellar keratoplasty (DALK) and 5 had penetrating keratoplasty. The mean age at trauma was 31.1 years. The mean time from corneal keratoplasty to WD was 12.82 months (range, 3-33 months). The mean best-corrected visual acuity of patients before trauma was 20/60 (0.48 logMAR) and after final treatment was 20/160 (0.90 logMAR) (P=0.15). In one case, visual acuity decreased to no light perception because of retinal detachment and phthisis bulbi. Accidental blunt trauma and fall were the most common causes of WD.Conclusion:Patients who undergo corneal keratoplasty have a life-long risk of WD. The full-thickness rupture at the graft-host junction in our study suggests that the junction remains vulnerable, even following DALK, and can rupture with trauma. In our series, depending upon the severity of the trauma, postkeratoplastic WD can be associated with a good visual prognosis.

RESUMOObjetivo:Avaliar as características, os fatores de risco, resultados, e tratamento de pacientes que apresentaram deiscência traumática de sutura após transplante de córnea.Métodos:Estudo retrospectivo em que foram avaliados 11 olhos de 11 pacientes submetidos a transplante de córnea e que desenvolveram deiscência de sutura entre janeiro de 2004 e dezembro de 2012 no Hospital Oftalmológico de Brasília.Resultados:Oito (72,7%) pacientes eram homens e três mulheres. Seis (54,5%) pacientes foram submetidos a ceratoplastia lamelar anterior profunda (DALK) e 5 pacientes a ceratoplastia penetrante (PK). A média de idade dos pacientes no momento do trauma era de 31,1 anos. O tempo médio entre o transplante de córnea e a deiscência de sutura foi de 12,82 meses (variando de 3 a 33 meses). A melhor acuidade visual corrigida (AVCC) doa pacientes antes do trauma era de 20/60 (0,48 logMAR), e após o trauma era de 20/160 (0,90 logMAR) (P=0,15). Em um caso, a acuidade visual reduziu para sem percepção luminosa devido a descolamento de retina e posterior atrofia bulbar. O trauma ocular acidental e a queda da própria altura foram as principais causas de deiscência de sutura nos olhos transplantados.Conclusão:Pacientes previamente submetidos a transplante de córnea apresentam um risco prolongado de deiscência de sutura. A ruptura completa na junção doador-receptor no nosso estudo sugere que mesmo após um DALK a junção permanece vulnerável e pode romper com o trauma. Na nossa série, dependendo da severidade do trauma, a deiscência pós-ceratoplastia pode estar associada a um bom prognóstico visual.

Uveítis anterior por cuerpo extraño en iris: presentación de un caso / Anterior uveitis caused by foreign body in iris: case report

Objetivo: reportar el caso de un paciente con uveítis anterior por cuerpo extraño intraocular en iris de ojo derecho. Diseño del estudio: reporte de caso. Descripción del caso: paciente de 69 años de edad, con antecedente de catarata hace 6 años por trauma ocular en ojo derecho. Consultó por trauma ocular derecho de 4 días de evolución. En la valoración inicial debido a la gran inflamación ocular y edema corneal no se logró la visualización de un cuerpo extraño intraocular en iris derecho, que posterior al tratamiento antiinflamatorio se hizo evidente. Se realizó extracción quirúrgica combinado con facoemulsificación e inserción de lente intraocular a pesar de existir mayor riesgo inflamatorio secundario. Discusión: la presencia de cuerpos extraños intraoculares secundarios a trauma ocular tienen mayor incidencia en adultos jóvenes de sexo masculino; para un correcto enfoque es necesario la realización de un diagnóstico temprano, apoyados con imágenes diagnósticas, con el fin de evitar secuelas. La cirugía de catarata con implante de lente intraocular en casos de trauma penetrante, generalmente se realiza una vez haya concluido el proceso inflamatorio; en este caso se asumió el riesgo de retirar la catarata con implantación de lente intraocular, aprovechando un adecuado control inflamatorio, logrando un buen resultado final.

Objective: to report a case of a patient with anterior uveitis by an intraocular foreign body in the iris of the right eye. Study Design: case report. Case Description: It's a 69 years old patient, with a history of cataract from six years that were the result of an ocular trauma in the right eye. He consulted for right ocular trauma with 4 days of duration. In the initial assessment due to the large ocular inflammation and corneal edema viewing an intraocular foreign body in the right iris was not achieved, that became apparent after post-infl ammatory treatment. Surgical removal of the foreign body combined with phacoemulsification and intraocular lens insertion despite the existence of secondary inflammatory greater risk was performed. Discussion: the presence of secondary intraocular foreign bodies after ocular trauma have a higher incidence in young adult males; it is necessary to suspect the diagnosis and perform the proper diagnostic tests, to avoid any sequelae. Cataract surgery with intraocular lens implantation in cases of penetrating trauma, is usually performed after accomplishing the inflammatory process; in this case the risk of cataract removal with insertion of intraocular lens is assumed, taking a proper infl ammatory control, achieving a good outcome.

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

Trauma ocular: experiencia de 16 Años de la UTO / Ocular trauma: UTO 16 years of experience

Se presenta una visión personal del jefe de la unidad de trauma ocular, en la cual se describen los hechos históricos más importantes, y los pasos que se dieron para la creación del primer centro nacional de referencia en Chile de trauma ocular severo. También en estudios previos se han mencionado las características principales de los pacientes que se atienden en este centro. El objetivo del artículo es revisar los hitos históricos más importantes que participaron en la creación de la Unidad de Trauma Ocular del hospital el Salvador hasta ahora, haciendo énfasis en los resultados epidemiológicos en estudios previos. Desde 1971, el primer esfuerzo por dar atención de urgencia oftalmológica, se concentró en el de la Urgencia de la asistencia pública Dr. Alejandro del Río. Con solo 12 oftalmólogos, y muchas dificultades para operar como un departamento de urgencia independiente. El servicio tuvo una lento deterioro, hasta mediados de los 80, en que comenzaron a colapsar otros servicios oftalmológicos. Sin embargo, diversos personajes de la esfera oftalmológica presionaron a las autoridades para la creación de una unidad de trauma ocular. De este modo en 1994 se creó la primera unidad de trauma ocular con dos oftalmólogos con turno de medio día, una pequeña sala de emergencia, que fue gradualmente creciendo y prosperando hasta como se conoce hoy día. Desde el 2007, fue declarada por ley, el centro de referencia del trauma ocular severo, en el nuevo régimen de garantías explícitas de salud. Actualmente, desde el 2010, nuestra unidad se convertido el Centro Nacional de trauma ocular severo y accidentes del trabajo, con más de 33.000 atenciones y 1.500 cirugías al año. La creación del Centro Nacional de Trauma Ocular severo es el resultado de largos años de trabajo y representa el esfuerzo conjunto para prevenir la ceguera por trauma en Chile.

Purpose: To review the main historical landmarks of the creation of the Ocular Trauma Unit of Hospital del Salvador until nowadays, making emphasis in epidemiological findings of previous studies. Methods: A personal point of view, made by the Ocular Trauma Unit head chief is presented here describing the most important historical facts that they took step to the creation of the First Center of National Reference for Severe Ocular in Chile. Also, a previous epidemiological study is mentioned in order to reference main characteristics of patients attended here. Results: Since 1971, the first effort to provide ophthalmological emergency attention was concentrated in its beginnings in the Emergency Department of The Public Assistance Dr. Alejandro del Río. With only 12 ophthalmologists and many difficulties to operate as an independent emergency department, the service had a slow deterioration until middle eighties, starting to collapse other Ophthalmology Services. Nevertheless, diverse personages of the ophthalmological sphere, pressed to the authorities for the creation of a unit of ocular trauma. Thus, in 1994 it was created the first ocular trauma unit with only two ophthalmologists with half-day shifts in a small emergency room that gradually prospered to which we know now. Since 2007, it was declared by law as The Referral Center for Severe Ocular Trauma in the new regimen of Explicit Guaranties in Health, and currently (since 2010) our unit has become the National Center for Severe Ocular Trauma and Work-Related accidents, with more than 33,000 attentions and 1,500 surgeries per year. Conclusion: The creation of The National Center for Severe Ocular Trauma has been the result of long years of work and represents a joint effort in preventing the blindness by ocular trauma in Chile.

Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries.

A prospective observational study was done to assess ocular survival, visual outcome and prognostic factors of open globe injury. Eighty eyes of penetrating trauma between 2004 and 2006 were categorized according to the ocular trauma classification system. Primary repair was done and outcomes were assessed at one, three and six months. The final vision was categorized as per World Health Organization classification of visual impairment. Factors at presentation were evaluated for prognostic value towards visual outcome. Sixty-nine eyes with minimum one month follow-up were included for analysis. Statistical analysis was done using Univariate and Multivariate analysis. We found Grade IV visual acuity (<5/200) at presentation (64%) as the most important factor contributing to poor visual outcome. Statistically insignificant factors were time since injury, cataract, and presence of intraocular foreign body. Ocular survival was 97%. We concluded that initial visual acuity, hyphema, zone and length of injury, retinal detachment and vitreous hemorrhage are statistically significant factors affecting outcome in open globe injuries.

Firecracker eye injuries during Deepavali festival: A case series.

We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS). Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public education regarding proper use of firecrackers may help in reducing the incidence of ocular injuries.

Frequency of different types of paediatric ocular trauma attending a tertiary care paediatric ophthalmology department

To assess the etiological factors and circumstances associated with the occurrence of eye injuries in children attending a tertiary care pediatric ophthalmology department. This study was conducted at the Department of Pediatric Ophthalmology, Civil Hospital, Karachi from August 2007 to July 2009. Personal information, clinical findings and management plan was recorded on a prescribed performa. Variables studied included: age, sex, date of injury, place of injury, involved eye, circumstance and mechanism of injury, initial visual acuity and immediate management. A total of 462 patients under the age of 16 years presented with ocular trauma. There were 297[64.3%] males and 165[35.7%] females. Mean age was 7.03 +/- 3.61 years. Most cases 198 [42.9%] belonged to the schoolgoing age group [6 to 11years]. The injuries occurred most frequently at home [215 patients, 46.5%].Blunt trauma occurred in 228[49.4%] cases followed by penetrating in 162[35.1%] cases. Injuries restricted to the eyelid occurred in 61 [13.2%] accidents, closed globe injury occurred in 338 [73.1%] and open globe injury in 63 [13.7%] accidents. Visual acuity was better than 6/12 in 245 [53.0%] children. Two hundred and fifteen children [46.5%] were prescribed only general measures like pressure patching, warm or cold compresses antibiotics or lubricant eye drops. Surgical management was required in 121[26.2%] patients. This study has shown frequencies of different type of ocular trauma which can be minimized by taking preventive measures as adopted in developed countries

Ocular sequelae of blast injuries: experience at a teaching hospital

To study the ocular sequlae of blast injuries, their management and visual outcome. Retrospective review of over 4 years of the records of the patients admitted during [1 January 2003 to 31 December 2006] with blast injuries in Ophthalmology Department of Saidu Teaching Hospital, Saidu Sharif, Swat. Files of patients with blast injuries of all ages and both gender were retrieved from the record room. A separate data collecting proforma was filled for every patient. Personal data, occupation, nature of blast, duration between the accident and presentation, ocular findings, management and visual outcome were recorded in all cases. A total of 7446 patients were admitted in the department during the study period of whom 34 had blast injuries [31 males and 3 females]. Nature of blast showed that 24 [70.6%] cases got injury while breaking stone in the marble and precious stone excavations or clearing the rocks for house building or road lying; while 6 [17.7%] cases had injury due to explosives planted by others for the same purpose. Three [8.8%] cases had accidental and 1[2.9%] battery blast injury. Ages of the patients ranged from 7 to 55 years [mean 27.4 years]. Of the 47 eyes affected bilateral ocular damage was seen in 13 patients [26 eyes] and unilateral in 21 patients [10 right eyes and 11 left]. Bilateral blindness was seen in 1 case [2 eyes] while 20 patients [20 eyes] got blindness in one eye. The frequency of blindness caused by bomb blast injuries is high and there is a high like hood of psychological trauma to the patient and their families which needs to be addressed

Trauma ocular / Ocular trauma

El trauma ocular es una causa frecuente de consulta en los servicios de urgencia, representando el 3 por ciento del total de ellas en nuestro país, afecta con mayor frecuencia a personas en edad productiva con un promedio de 30,6 años, el sexo masculino representa el 87 por ciento del total de los casos. Es responsable de 1/3 de los casos de ceguera unilateral en la primera década de la vida. Sus causas son muy variadas, siendo de suma importancia en la evaluación del paciente una completa anamnesis y un examen ocular acucioso, poniendo mucha atención a los síntomas y signos que sugieran patología ocular grave, siendo en algunos casos necesario complementar la clínica con imagenología como la Ultrasonografía o la TAC. Se clasifica según el compromiso de estructuras oculares en trauma cerrado o abierto el cual orientara a la terapia a realizar, siendo el principal y único factor pronóstico conocido la visión inicial al momento del examen ocular. Finalmente es importante mencionar que las complicaciones o la resultante de un trauma ocular puede producir gran discapacidad y deterioro en la calidad de vida de las personas por lo que es imperante educar a la población sobre la prevención de este.

Epidemiological findings of ocular trauma in childhood

PURPOSE: To describe epidemiological findings of ocular trauma in childhood in an emergency unit. METHODS: A retrospective study was carried out including patients under 16 years old who were treated for ocular trauma at the emergency unit of the Federal University of São Paulo from September 2001 to September 2004. Age, sex, involved eye, place, circumstance and mechanism of injury, initial visual acuity and immediate management were recorded. RESULTS: A total of 273 patients were included in the study. The age group comprising most cases was 7 to 10 years (39.9 percent). The most frequent cause of ocular injury was traumatism by external agents like stone, iron and wood objects (27.9 percent). The commonest place was the home (53.1 percent). Initial visual acuity was over 20/40 in 63.4 percent of cases. Closed globe injury occurred in 201 (73.6 percent) accidents. Seventy-six children (27. 8 percent) were treated with medicines and in forty-eight (17.6 percent) cases surgery was necessary. CONCLUSION: Ocular trauma in childhood was more frequent in the male schoolchild and was due mostly to traumatism with agents like stone, wood and iron pieces, domestic utensils and leisure objects. The injuries occurred most frequently at home. Closed globe injuries predominated. Programs of education and prevention for ocular trauma in childhood are necessary.

OBJETIVO: Descrever os achados epidemiológicos do trauma ocular na infância em uma unidade de emergência. MÉTODOS: Em estudo retrospectivo, foram analisados prontuários de pacientes menores que 16 anos que foram atendidos por trauma ocular no Pronto-Socorro de Oftalmologia da Universidade Federal de São Paulo de setembro de 2001 a setembro de 2004. Foram coletadas informações a respeito da idade, sexo, olho envolvido, local, circunstância e mecanismo do trauma, acuidade visual inicial e conduta imediata. RESULTADOS: Um total de 273 pacientes foi incluído no estudo. A faixa etária com maior número de casos foi a de 7 a 10 anos (39,9 por cento). A causa mais freqüente de lesão ocular foi traumatismo com objetos externos como pedra, ferro ou madeira (28,9 por cento) e o local mais comum foi a própria casa (53,1 por cento). A acuidade visual inicial foi melhor que 20/40 em 63,4 por cento dos casos. Houve trauma ocular fechado em 201 (73,6 por cento) acidentes. Setenta e seis pacientes (27,8 por cento) foram tratadas com medicamentos e em quarenta e oito (17,6 por cento) casos foi necessário procedimento cirúrgico. CONCLUSÃO: O trauma ocular na infância foi mais freqüente no sexo masculino, em escolares e foi associado a objetos tais como pedra, madeira, ferro, utensílios domésticos e brinquedos. Os acidentes aconteceram mais freqüentemente em casa e trauma fechado foi a lesão predominante. São necessários programas de educação e prevenção do trauma na infância.

Análise dos conhecimentos básicos sobre urgências oftalmológicas em plantonistas não-oftalmologistas / Lack of basic ophthalmic information about ocular emergencies among non-ophthalmologists

OBJETIVO: Avaliar conhecimentos básicos sobre urgências oftalmológicas entre plantonistas (não-oftalmologistas) que realizam atendimento primário a pacientes. MÉTODOS: Aplicou-se questionário padronizado, contendo dados pessoais e questões sobre urgências, entre plantonistas em servicos de emergência de Sorocaba (São Paulo) e região. RESULTADOS: Foram entrevistados 100 plantonistas, com tempo médio de formacão de 10,5 anos (1-44 anos), e desses 74 por cento eram do sexo masculino. Foi considerável a diversidade de especialidades encontradas, predominando a de Clínica Geral (23 por cento). A maioria dos entrevistados, 93 por cento, não se sente seguro ao atender uma urgência. CONCLUSAO: O conhecimento sobre urgências oftalmológicas mostrou-se insuficiente entre os plantonistas entrevistados. Este estudo confirma a importância da difusão de conhecimentos oftalmológicos a todas as especialidades médicas.

Experiencia clínica del interferón alfa 2B en hemangioma periorbitario: a propósito de un caso / Clinical experience of the interferon alpha 2B in hemangioma periorbitario: a purpose of a case

Los hemangiomas son tumores de partes blandas, del endotelio vascular y benigno más frecuente en la infancia, con una incidencia entre 5 por ciento y 15 por ciento. Se consideran también los tumores primarios más frecuentes de la órbita. En este estudio, se recoge nuestra experiencia con interferón alfa en el tratamiento de hemangiomas orbitarios infantiles. Se estudia la eficacia del mismo y la aparición de efectos secundarios atribuibles al tratamiento. Preescolar masculino de 28 meses de edad, quien desde los 12 meses presentaba discreto aumento de volumen en parpado superior derecho y de dos meses y medio de evolución aumento progresivo, cambios de coloración y desplazamiento del globo ocular hacia fuera de la línea media. Valorado por los Servicios de Oftalmología y Oncología Pediátrica deciden iniciar protocolo de tratamiento con interferón alfa 2B. El paciente recibió el fármaco durante 2 meses y medio consecutivos tres veces por semana, vía subcutánea, a 3.000.000 Uds/m2SC/dosis; encontrándose efectos adversos, durante los primeros días de la administración; los últimos 15 días el tratamiento se cumplió diariamente sin efectos adversos. Al cabo de los tres meses se observo reorganización del hemangioma con aplanamiento de la coloración violácea y disminución de 1cm de diámetro. La incidencia de complicaciones de los hemangiomas periorbitarios es muy alta. Según diferentes autores, el interferón alfa, consigue una reducción de más del 50 por ciento del tamaño del hemangioma en 58 por ciento de los casos, y en 26 por ciento una reducción entre el 20 y 40 por ciento. En aproximadamente un 15 por ciento de los casos, no existe respuesta al tratamiento.

Management of non-penetrating traumatic hyphema in ophthalmology department of HMC. Review of 83 cases

To review the management strategy of non-penetrating traumatic hyphema in ophthalmology department of HMC [Hamad Medical Corporation] and compare it with other international approaches. This is a retrospective study for evaluating the management of non-penetrating traumatic hyphema in the Ophthalmology Department of Hamad Medical Corporation. Records of 83 patients over the period between January 1999 and May 2003 were studied for various criteria including: demographic factors; causes; severity and type of hyphema; visual and intraocular pressure outcome; and application and outcome of medical and surgical treatment. Patients' criteria and treatment policy was compared with other studies.Visual acuity as defined according to the WHO system. Total of 83 patients; 76% males and 24% females, their average age was 24.4 years. The majority had hyphema due to work trauma 45.8%, 76% recovered 6/12 or better vision within one month, 14% developed glaucoma, 2.4% complicated by corneal blood staining. Mydriatics were used in 65%, 5% had rebleeding. All the patients were treated as inpatients, only one case required surgical intervention for uncontrolled IOP and early corneal staining. Dependent on the findings of our study and other studies, we rationalized alterations to be concerned according to Qatar locality, however, the general outcome of traumatic hyphema in our department was not bad

Utilisation of ophthalmic services by foreign nationals in Johor: a review of 452 patients

Between 1st January 1999 and 31st December 2000, 452 foreign nationals were treated at the Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru. Eighty-five percent were male. The peak age range was from 21 to 30 years old. The patients were predominantly Indonesians (61%). A history of trauma was present in 63% of patients. Eight percent of eyes had severe visual impairment. Six patients (1.3%) were blind by WHO standards. Traumatic eye conditions, inflammatory/allergic eye conditions and degenerative eye conditions comprised 66%, 13% and 10% respectively of ocular pathology seen. The commonest ocular findings were corneal foreign body, corneal abrasion and subconjunctival haemorrhage.