Exercise Resistance Band induced injuries during Covid 19 Pandemic Lockdown Training.

The COVID-19 (coronavirus disease 2019) pandemic forces athletes to perform their workout at home with alternative training methods. Exercise resistance bands, often used for this purpose, can cause damage when they recoil or tear. Potentially resulting injuries include bruises, head injuries, lacerations, facial fractures and eye injuries. The following article presents two case reports including accident mechanism, injuries, diagnostic evaluation and treatment.The first patient presented with an open depressed skull fracture caused by a recoiling exercise resistance band, while the second patient sustained a complex ocular trauma caused by a tearing exercise resistance band when performing supported chin-ups.

A stitch in time saves my (ne) (vision).

Background: Corneal melt with iris prolapse is a rare complication of autoimmune diseases, especially rheumatoid arthritis. Purpose: To highlight a challenging case of a peripheral ulcerative keratitis (PUK) with corneal melt and iris prolapse in a patient's only eye. Synopsis: A 56-year-old Asian Indian male presented with blurring of vision in the right eye and was diagnosed with cataract. He was a known type 2 diabetes mellitus and a rheumatoid arthritis patient and was not on treatment. He had been previously diagnosed with PUK in the left eye and was lost to follow-up due to coronavirus disease 2019 (COVID-19) after therapeutic penetrating keratoplasty and lost his vision in that eye. Cataract surgery in the right eye was done under cover of immunosuppression. Subsequently, he developed PUK and was treated with a glue and bandage contact lens. Again, he was lost to follow-up and then presented a few months later with corneal melt with iris prolapse in the right eye. We describe in the video the surgical and medical challenges and successful salvage of both the eyeball and the vision. Highlights: Highlights include the following: 1. A rare case of corneal melt with iris prolapse. 2. Demonstration of surgical technique of patch graft. 3. Anterior segment optical coherence tomography before and after the procedure. Video link: https://youtu.be/HbgixlEAYKU.

Bilateral Hyphema - An Unexpected Complication of Exercise Resistance Band Use: A Case Report.

BACKGROUND: Resistance bands commonly used for strength training exercise come with an unexpected risk for ocular trauma. CASE REPORT: In this report, we describe an unintended consequence of a 28-year-old man sustaining an unusual injury-bilateral hyphema-as a result of the use of elastic resistance bands. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Resistance bands are commonly used for strength training exercise and, in this case, a potentially severe, vision-threatening injury-traumatic hyphema-occurred. Traumatic hyphema occurs when blood pools in the anterior chamber of the eye, usually as the result of blunt force trauma or penetrating injury. Early recognition of this condition is imperative, as complications of traumatic hyphema, such as intraocular hypertension or rebleeding, can lead to permanent vision loss.

Globe and Adnexal Trauma Terminology Survey.

Importance: Ocular trauma terminology should be periodically updated to enable comprehensive capturing and monitoring of ocular trauma in clinical and research settings. Objective: To update terminology for globe and adnexal trauma. Design, Setting, and Participants: A 2-round modified Delphi survey was conducted from January 1 to July 31, 2021, using an expert panel, including 69 ophthalmologists identified through their membership in ophthalmology (globe and adnexal trauma) societies. Consensus was defined as at least 67% expert agreement. A steering committee developed questions after identifying gaps in the current terminology via a targeted literature review. Round 1 sought consensus on existing and newly proposed terminology, and round 2 focused on unresolved questions from round 1. Experts included ophthalmologists who had managed, on average, 52 globe or adnexal trauma cases throughout their careers and/or published a total of 5 or more globe or adnexal trauma-related peer-reviewed articles. Main Outcomes and Measures: Expert consensus on ocular and adnexal terms. Results: A total of 69 experts participated in and completed round 1 of the survey. All 69 participants who completed round 1 were asked to complete round 2, and 58 responses were received. Consensus was reached for 18 of 25 questions (72%) in round 1 and 4 of 7 questions (57%) in round 2. Existing Birmingham Eye Trauma Terminology system terminology achieved consensus of 84% (58 of 69 experts) in round 1 and 97% (56 of 58 experts) in round 2. Experts agreed on the need for further refinement of the definition of zones of injury (55 of 69 [80%]), as the zone affected can have a substantial effect on visual and functional outcomes. There was consensus that the mechanism of injury (52 of 69 [75%]) and status of the lacrimal canaliculi (54 of 69 [78%]), nasolacrimal ducts (48 of 69 [69%]), lens (46 of 58 [80%]), retina (42 of 58 [73%]), and central and paracentral cornea (47 of 58 [81%]) be included in the revised terminology. Conclusions and Relevance: There was consensus (defined as at least 67% expert agreement) on continued use of the existing Birmingham Eye Trauma Terminology system definitions and that additional terms are required to update the current ocular trauma terminology.

Ocular Trauma During COVID-19 Pandemic: A Systematic Review and Meta-analysis.

PURPOSE: This study aimed to summarize the latest literature on the trends and incidence of ocular trauma during the COVID-19 pandemic. DESIGN: Systematic review and meta-analysis. METHODS: A systematic literature search was conducted to identify the relevant literature. The search period was between January 1, 2020, and September 20, 2021. The incidence of overall and various types of ocular trauma during the COVID-19 pandemic and the control period was analyzed. The data from different studies were pooled. The odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS: A total of 32 articles were included. After pooling the data from all included studies, the incidence of total and pediatric ocular trauma during the COVID-19 pandemic was 67.7% and 54.3% of those in the control period, respectively. However, the proportion of ocular trauma in eye emergency visits increased during the pandemic (OR, 95% CI: 1.46, 1.04-2.06). The proportion of domestic ocular trauma increased (OR, 95% CI: 3.42, 1.01-11.62), while ocular trauma related to sports and outdoor activities and occupational ocular trauma decreased (OR, 95% CI: 0.64, 0.09-4.29 and 0.18, 0.10-0.33, respectively). It was also reported that chemical injury caused by alcohol-based sanitizers, photokeratitis caused by ultraviolet lamps, and mechanical eye injury caused by masks increased during the COVID-19 pandemic. CONCLUSIONS: There was a reduction in overall eye injuries and substantial differences in the spectrum of ocular trauma during the COVID-19 pandemic. Proper health education and supervision should be strengthened to prevent ocular injuries related to COVID-19 preventive interventions.

A Comparative Evaluation of Globe Trauma Features in a Tertiary Care Hospital Before and During the COVID-19 Pandemic

Objectives: To compare the clinical features, preoperative evaluation, and surgical approaches of globe trauma patients presenting to the emergency department before and during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We retrospectively analyzed 54 eyes of 54 patients with traumatic globe perforation who underwent primary globe repair. The patients were divided into two groups according to the official start of the COVID-19 pandemic in Turkey: Group 1, 1 May 2019-11 March 2020 and Group 2, 11 March 2020-1 January 2021. The demographic features, trauma history, time from trauma to admission and from admission to surgery, COVID-19 serology (polymerase chain reaction [PCR]) result, ophthalmological examination findings at admission, surgical interventions, and postoperative clinical features were obtained from the patients' records. Results: The mean ages of the patients in Group 1 (n=21) and Group 2 (n=33) were 42.76±20.72 and 37.78±23.47 years, respectively (p=0.431). During the pandemic, garden/farm injuries increased while workplace injuries decreased. In Groups 1 and 2 respectively, time from trauma to admission was 461.4±1228.6 and 935.4±2039.6 min (p=0.342), time from admission to surgery was 604.2±679.8 and 392.7±306.9 min (p=0.125), and length of hospital stay was 7.23±4.96, and 3.78±2.28 days (p<0.005). All patients had a COVID-19 PCR test and all resulted negative. There was no significant difference between the groups in terms of the clinical features of the ocular and adnexal injuries, surgical interventions, or postoperative complications (p>0.05). Preoperative visual acuity was found to be an important prognostic factor associated with postoperative visual acuity. Conclusion: Globe injuries require urgent intervention in terms of visual morbidity. Patterns of injury differ during the pandemic due to both restrictions and lifestyle changes. During the pandemic, patients were discharged as soon as possible after emergency treatment to minimize the time spent in the hospital.

Impact of the COVID-19-induced lockdown on the incidence of ocular trauma presenting to a tertiary care hospital.

Objective: To assess the effects of lockdown and unlock phases mandated in view of COVID-19 on the incidence and characteristics of ocular trauma presenting to a tertiary care hospital. Methods and Analysis: The study was carried out as a hospital record based retrospective comparative analysis on patients presenting with ocular trauma in the lockdown period (March-July 2020) compared with the same time frame of the previous year considered as prelockdown period (March-July 2019) and during the unlock phases (August-December 2020). Results: Overall, the casualty department saw 464 patients of ocular trauma in the prelockdown period, 173 in the lockdown and 253 in unlock. The study showed a 44% reduction in patients visiting the casualty department for trauma during the lockdown compared with prelockdown, and a 62% reduction specifically in ocular trauma. The unlock phase showed a 21% reduction in ocular trauma compared with prelockdown and a 41% increase compared with the lockdown. In all three phases, the majority of people affected by ocular trauma were middle aged males from a rural background, sustained by assault. The lockdown saw a decrease in outdoor assaults (45%) and road traffic accidents (22%). Trauma sustained by females (18%) increased in the lockdown, as did home-based assaults (150%) and sexual assaults. The presentation of trauma, especially road traffic accidents and outdoor assaults saw a steady rise during the unlock. Conclusion: The lockdown mandated by the government in response to the COVID-19 pandemic had a significant impact on the trends of trauma presenting to healthcare facilities. There was a decrease in the overall number of patients approaching the casualty during the lockdown. However, during the lockdown, there was an increase in home-based trauma as opposed to outdoor assaults being the primary cause of trauma prior to the lockdown.

Shifting trends in demographic features of chemical eye injuries during COVID-19 pandemic.

OBJECTIVES: To evaluate the etiological cause distribution in chemical eye injuries during COVID-19 pandemic. METHODS: In this retrospective case series, the medical records of patients, who presented with chemical eye injuries between March 30, 2020, and March 1, 2021, were evaluated and compared with the data covering 10 years before the pandemic. RESULTS: Twenty-seven eyes of twenty-three patients (19 adults, 4 children) who presented in pandemic period were included. Alcohol-based hand sanitizer was one of the two most common agents (n = 6 eyes) in the pandemic era. In the last 10 years before the pandemic, 137 eyes of 102 patients were treated for chemical eye injuries. Injuries due to alcohol-based hand sanitizer increased from 3.1 to 21.1% among all patients, and from 0 to 75% among pediatric patients during the pandemic era compared to the pre-pandemic period. The increase was statistically significant both in all patients (p = .003) and in the pediatric patient group (p = .048). CONCLUSION: Due to COVID-19 pandemic, alcohol-based hand sanitizer use became more common. Consequently, the frequency of hand sanitizer related chemical injuries showed a 13-fold increase and the age group affected by such accidents is altered during the pandemic. Three out of four pediatric patients (75%) were injured with alcohol-based hand sanitizers, which draws attention to the fact that improperly placed hand sanitizer stations, being just at the eye level of children, can cause chemical eye injuries in the pediatric population even more.

Comparison of Ocular Trauma Between Normalized and The COVID-19 Epidemic Periods in China: A Multi-Center Cross-Sectional Study (preprint)

Background: To compare the feature of ocular trauma between normalized period and the COVID-19 epidemic period in China, to provide a scientific basis for prevention and control eye injuries in special times in future. Methods: This study is a multi-center cross-sectional study with 30 participated hospitals involving the China Ocular Trauma Society members. All hospitalized cases who visited the ophthalmology department in participated hospitals with eye injuries during the normalized period (2019) and the COVID-19 epidemic period (2020) were included in this study. Demographic characteristic of cases, date of injury, sites and types of injury were collected. Results: This study involved 13525 (61cases with both eyes) injured cases. There were 7269 (53.74%) eye-injured cases and 6256 (46.26%) eye-injured cases in 2019 and 2020 separately. Compared with 2019, the incidence of ocular trauma in retirees, housewives and unemployed increased with year-on-year of 4.96%, 102.67% and 11.64% among all occupations. In 2020, the incidence of eye injuries decreased in all injury sites except for an increase in home (30.29% year-on-year). The incidence of mechanical eye injuries decreased, while that of non-mechanical eye injuries (Chemical/Thermal/Radiation) increased (47.45% year-on-year). There were 255 (3.50%, 255/7269) and 376 (6.01%, 376/6256) non-mechanical injured cases in 2019 and 2020 (Pearson chi2 = 47.33, P < 0.001) separately. Conclusions: During the COVID-19 epidemic period, the incidence of eye injuries decreased. The prevention and control measures should be focused on the non-mechanical injuries, and the retirees, unemployed and housewives during public events period in future.

Changing patterns of posterior segment trauma during the COVID-19 pandemic: A regional analysis from the Bodhya Eye Consortium.

Purpose: To assess changes in the presentation patterns of posterior segment trauma during the COVID-19 pandemic from six tertiary eye care institutes of North and Central India. Methods: A multicenter, hospital-based, retrospective comparative analysis of patients presenting with posterior segment trauma was done during the COVID-19 (Group A) (March 25, 2020 - September 30, 2020) period and the pre-COVID-19 (Group B) (March 25, 2019 - September 30, 2019) period. Results: A total of 405 patients were diagnosed with posterior segment trauma (Group A: 206, Group B: 199). The time interval between onset of trauma and presentation was higher in Group A (16.59 ± 29.87 days) as compared to Group B (9.41 ± 19.19 days) (P = 0.004). A majority of patients in Group A had a history of prior consultation before presentation (P = 0.049). In Group A, 120 (58.2%) patients sustained ocular trauma at home as compared to 80 (40.2%) patients in Group B (P < 0.0001). Patients presenting with light perception were significantly more in Group A (43.7%) as compared to Group B (30.2%) (P = 0.004). In Group B, 37.6% patients had presenting visual acuity of counting finger or better as compared to 27.6% patients in Group A (P = 0.07). Patients in Group A had a significantly higher proportion of post-traumatic endophthalmitis with delayed presentation (P = 0.011) and retinal detachment (P = 0.041). Patients undergoing surgery for foreign-body removal were significantly fewer in Group A (P = 0.05). Conclusion: Although the number of patients presenting with posterior segment trauma was comparable in Groups A and B, a greater number of patients sustained home injuries during the COVID-19 pandemic. A majority of these patients had delayed presentation with poor presenting visual acuity and a higher tendency of retinal detachment.

Paediatric eye injuries during a COVID-19 pandemic lockdown.

CLINICAL RELEVANCE: Eye injuries, both accidental and non-accidental, are a significant cause of long-term visual impairment in children. An understanding of when and how such injuries occur is key to development of adequate prevention strategies. BACKGROUND: To evaluate accidental and non-accidental eye injuries in children presenting to the major tertiary emergency department and outpatient ophthalmology clinic in Western Australia during the nationwide COVID-19 lockdown and to determine whether the frequency or nature of these injuries differed from pre-pandemic presentations. METHODS: Retrospective review of the medical records of paediatric patients presenting to the emergency department and specialist ophthalmology clinic with an ocular injury and those presenting to the hospital Child Protection Unit with physical injuries during March-August 2020 and the same period in 2019. RESULTS: There was no significant difference in the total number of accidental eye injury presentations during the lockdown period despite a significant decrease in emergency department attendance overall. Closed-globe injuries were the most common accidental eye injury presentation during lockdown (70/110, 64%), followed by adnexal injuries (39/110, 35%) and open-globe injuries (1/110, 1%). In contrast, referrals to the hospital Child Protection Unit for suspicious injuries declined during lockdown.Although eye injury presentations have changed in other parts of the world since the start of the pandemic, during COVID-19 lockdown in Western Australia, accidental paediatric ocular and adnexal trauma sustained at home continues to be a significant cause for hospital attendance. Public education regarding in-home eye injury prevention must be ongoing.

Pediatric Ocular Injury Due to Hand Sanitizer Exposure: An Emerging Hazard.

OBJECTIVES: The objective of this study was to describe the incidence and severity of ocular exposure to alcohol-based hand rub (ABHR) in children presenting to a tertiary medical center during the severe acute respiratory syndrome coronavirus 2 pandemic. METHODS: A retrospective single-center observational study conducted from February 21, 2020, to October 11, 2020. Subjects 10 years or younger who presented with ABHR-induced ocular injury were included. The same period from 2019 was studied and a comparison was performed between the 2 years. Outcome measures included the number of subjects with ocular injury due to ABHR, extent of ocular epithelial defects, length of hospitalization and time to resolution. RESULTS: A total of 9 patients presented to the Pediatric Emergency Department after sustaining ocular chemical injuries from ABHR during this period. Treatment included immediate irrigation followed by topical antibiotics, steroids, and lubrication. Six children were discharged and followed as outpatients with no reported adverse ocular sequelae. Three patients exhibited epithelial defects involving 85% to 100% of the cornea, 30% to 75% of the conjunctiva and required inpatient treatment ranging from 4 to 11 days. All patients experienced a complete resolution of the ocular epithelial defects after 12 to 19 days. No long-term irreversible damage was observed and visual acuity returned to normal in all patients. CONCLUSIONS: The utilization of ABHR during the severe acute respiratory syndrome coronavirus 2 pandemic resulted in childhood ocular injury. Prompt treatment led to good visual outcomes. These products should be regarded as potentially toxic and stored out of the reach of young children.

Ocular Injury Associated With Prone Positioning in Adult Critical Care: A Systematic Review and Meta-Analysis.

PURPOSE: Prone positioning during the COVID-19 pandemic has become increasingly used as an adjunct to increase oxygenation in critical care patients. It is associated with an adverse event profile. This study sought to investigate the occurrence of ocular injuries reported in prone versus supine groups in adult critical care. DESIGN: Systematic review and meta-analysis. METHODS: A systematic review and meta-analysis were carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, SCOPUS, and the Cochrane Library were searched. The search period was January 1, 1990, to July 1, 2020. RESULTS: Eleven randomized controlled trials were included, with 2,247 patients. Twenty-eight events were recorded in 3 trials (174 patients) and no events in the other 8 trials (2,073 patients). The rates of eye injury were 5 events in 1,158 patients (1.30%) and 13 events in 1,089 patients (1.19%) in the prone and supine groups, respectively, which were reduced to 2 of 1,158 patients (0.17%) and 2 of 1,089 patients (0.18%), respectively, when reports of eye or eyelid edema were removed. Meta-analysis demonstrated no significant differences between groups with (an OR of 1.40 (95% CI: 0.37-5.27) and without (OR: 0.78; 95% CI: 0.11-5.73) reported edema. CONCLUSIONS: This meta-analysis showed no significant difference in the rate of reported ocular injury between prone and supine critical care groups. These rates remain higher than the incidence reported during general anesthesia. There is a need for studies in critical care settings in which ocular injury is an end-point and which include extended patient follow-up.

Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute.

PURPOSE: To evaluate the impact of the COVID-19 pandemic and the national lockdown on the demographic and clinical profile of patients presenting with ocular trauma. METHODS: In this retrospective, hospital-based, comparative analysis, patients presenting to the emergency department with ocular trauma in the following COVID-19 period (March 25, 2020 to July 31, 2020) were compared with patients in the pre-COVID-19 period (March 25, 2019 to July 31, 2019). RESULTS: Overall, 242 patients (COVID-19 period: 71 and pre-COVID-19 period: 171) presented with ocular trauma. The mean age of the patients in COVID-19 and pre-COVID-19 periods were 26.7 ± 17.3 and 34.1 ± 20.3 years, respectively (P = 0.008). A majority of patients (68.6%) in both groups were from the rural background. Home-related injuries were common in the COVID-19 period (78.8%) as compared to pre-COVID-19 period (36.4%) (P < 0.0001). Iron particles (29.5%) were the common inflicting agents in the COVID-19 period while it was plant leaves (25.5%) in the pre-COVID-19 period. The most common ocular diagnosis was open globe injury (40.8%) in the COVID-19 period and microbial keratitis (47.9%) in the pre-COVID-19 period. Surgical intervention was required in 46.4% of patients in the COVID-19 period and 32.1% of patients in the pre-COVID-19 period (P = 0.034). CONCLUSION: During the COVID-19 period.there was a significant decline in the number of patients presenting with ocular trauma. In this period, a majority of patients sustained ocular trauma in home-settings. About half the patients required surgical intervention which was most commonly rendered in the form of primary wound repair.