Refractive surgery for active patients: weighing the pros and cons.

Athletes who need corrective lenses may ask about refractive surgery. Radial keratotomy, photorefractive keratectomy, and laser in situ keratomileusis surgically alter the shape of the cornea. All three methods generally result in vision sufficient to pass a driver's test without corrective lenses. A thorough patient evaluation and education about risks must be undertaken before an active patient undergoes any type of refractive surgery.

Clinical features of bleb disorder of the cornea.

BACKGROUND: Bleb disorder of the cornea is a rare corneal epithelial disorder that has previously been described in asymptomatic patients or those with recurrent nontraumatic corneal erosions. METHODS: We report two cases of bleb disorder, each presenting with blurred vision from irregular astigmatism secondary to the bleb changes. We also report on the detection of bleb disorder in siblings. RESULTS: Both patients underwent surgical debridement of the epithelium with resolution of symptoms on epithelial resurfacing. CONCLUSION: The diagnostic clues, inheritance pattern, differential diagnosis, and treatment options of bleb disorder of the cornea are discussed.

Air bag-related ocular trauma.

Automobile air bags have recently gained acceptance as an effective measure to reduce the morbidity and mortality associated with motor vehicle accidents. This report describes 11 cases of air bag-related ocular trauma and reviews cases previously reported in the literature, for a total of 32 patients and 39 eyes. This is the first comprehensive report on various types of ocular trauma related directly to air bag deployment. The most common type of ocular injuries seen are to the eyelids (23 patients, 28 eyes), conjunctiva (21 patients, 25 eyes), and cornea (23 patients, 28 eyes). Hyphema was frequently seen (10 patients, 11 eyes). Several serious cases of vision-threatening injuries, including retinal detachment, retinal dialysis, scleral rupture, and dislocated lens, were also reported. The following patterns were found: 55% of patients were male and 45% female; ages ranged from 2 to 81 years with a mean age of 36 years; the right eye was involved in 35% of cases, the left in 38%, and 27% were bilateral. Based on these findings, it is recommended that all patients who present with air bag-related ocular trauma undergo a complete ophthalmologic examination because the high-velocity blunt trauma causes ocular injuries that may be more serious than they initially appear. Further refinements in design and deployment need to be made to reduce the frequency and severity of air bag-related ocular injuries.

Treating corneal abrasions and lacerations.

Corneal abrasions and lacerations injure the 'windshield' of the eye, exposing the patient to potential vision loss and infection. Diagnosis rests on physical examination of the eye, using fluorescein stain and a penlight; further examination with a slit lamp is often required for lacerations. Treatment of abrasions includes application of topical antibiotics and except in contact-lens users and perhaps with certain small abrasions patching the eye. Lacerations require urgent referral to an ophthalmologist, who usually repairs the defect surgically. Topical anesthetics, though effective pain relievers, should never be prescribed for home use.

Psoriatic corneal abscess.

PURPOSE/METHODS: We examined a patient with psoriasis and stromal infiltrate that was treated with topical corticosteroids. RESULTS/CONCLUSIONS: The patient gradually improved and the stromal infiltrate diminished. The cause of psoriasis and its ocular manifestations remains unknown. A corneal abscess without epithelial infiltration that responds to topical corticosteroid therapy may represent a specific ocular manifestation of psoriasis.

The National Basketball Association eye injury study.

OBJECTIVE: To investigate the epidemiology of eye injuries sustained by professional basketball players in the National Basketball Association (NBA). METHODS: A prospective study involving all NBA athletes who sustained eye injuries between February 1, 1992, and June 20, 1993, was conducted. Twenty-seven NBA team athletic trainers, physicians, and ophthalmologists were provided data forms to complete for any player examined for an eye injury. Practice and game exposures during the preseason, regular season, playoffs, and championships were included. RESULTS: Of the 1092 injuries sustained by NBA players during the 17-month period, 59 (5.4%) involved the eye and adnexa. Eighteen (30.5%) of the injuries occurred while the player was in the act of rebounding, and 16 (27.1%) while the player was on offense. The most common diagnoses included 30 abrasions or lacerations to the eyelid (50.9%), 17 contusions (edema and/or ecchymosis) to the eyelid or periorbital region (28.8%), and seven corneal abrasions (11.9%). There were three orbital fractures (5.1%). Most injuries were caused by fingers (35.6%) or elbows (28.8%). Nine players (15.3%) missed subsequent games because of their injury. Fifty-seven players (96.6%) were not wearing protective eyewear at the time of injury. CONCLUSIONS: The incidence of eye injuries in NBA players during the 17-month period was 1.44 per 1000 game exposures. Frequent physical contact in professional basketball players leaves them at great risk for sustaining eye injuries. To prevent these injuries, protective eyewear is recommended.

Corneal perforation in a premature infant.

BACKGROUND: Few cases of corneal perforation in a premature infant have been described in the literature. METHODS: Identical twins were born at 30-weeks gestation. One twin developed a corneal epithelial defect, infiltration, and perforation with extrusion of intraocular contents, requiring an emergency penetrating keratoplasty. The second twin developed a progressive corneal opacity, requiring a lamellar keratectomy. RESULTS: After penetrating keratoplasty, the patient developed absolute glaucoma with buphthalmos, leading to enucleation. The twin's lamellar keratectomy specimen proved to be a dermoid. CONCLUSIONS: One must be aware of the danger of the development of spontaneous corneal perforation with extrusion of intraocular contents in premature infants presenting at birth with an epithelial defect.

Lid imbrication syndrome. Diagnosis with rose bengal staining.

BACKGROUND: Lid imbrication syndrome is an abnormality of lid apposition in which the upper lid overlies the lower lid. Patients often complain of irritation, tearing, and foreign body sensation. The condition may be difficult to diagnose. METHOD: Twenty-one patients with suspected lid imbrication syndrome were compared with 21 age-matched controls. All patients were given 0.5% topical rose bengal. RESULTS: The diagnosis of lid imbrication syndrome was confirmed by the presence of rose bengal staining of the tarsal conjunctiva of the upper lid margin. The amount of rose bengal staining correlated with the severity of lid imbrication. Eighteen of 21 patients had received a diagnosis previously of dry eye syndrome. Four patients had persistent epithelial defects. CONCLUSIONS: Rose bengal staining of the superior lid margin tarsal conjunctiva offers an extremely reliable aid for diagnosing lid imbrication syndrome. The condition commonly presents as a dry eye or persistent epithelial defect. Treatment ranges from viscous tear substitutes to horizontal lid shortening of the upper lid.

Urban eye trauma. A one-year prospective study.

PURPOSE: The authors conducted a 1-year prospective study investigating the demographics, causation, and treatment of eye trauma in an urban population at one medical center. METHODS: All patients sustaining eye injuries who were evaluated by the ophthalmology service over a 1-year interval were included. A formal questionnaire was completed with demographic data and details of the injury being obtained. An ophthalmologic examination was performed on each patient, and examination findings, diagnostic tests obtained, diagnosis, and treatment were recorded and analyzed. RESULTS: This study included 584 eye injuries. Three hundred seventy-one injuries (70%) occurred in males and 159 (30%) in females. The average age was 30.5 years; 110 (21%) patients were pediatric. Sixty-two percent of all patients presented within 24 hours of their injury. Thirty-seven percent of all injuries occurred in the street, 31% at home, and only 13% at the workplace. For those older than 65 years of age, 48% of injuries were the result of a fall. Sixty percent of all eye injuries were caused by blunt trauma. Only 42 (8%) patients wore eye wear at the time of their injury. Diagnoses and management were recorded. CONCLUSIONS: The inner city population is more likely to sustain eye trauma as the result of an assault and is less likely to be involved in a work- or sports-related injury. Given poor compliance with outpatient management and follow-up, aggressive primary management may be indicated to optimize visual outcome.

Endocapsular hyphema.

A 67-year-old female developed an endocapsular hyphema after uncomplicated extracapsular cataract surgery. With a neodymium:YAG laser capsulotomy, we drained the blood into the vitreous and restored excellent visual acuity. We hypothesize that endocapsular hyphemas may fail to resorb because of sequestration of the clot from the fibrinolytic system of the anterior chamber.

Corneal complications associated with the use of crack cocaine.

BACKGROUND: A case series of patients with corneal complications associated with crack cocaine use is presented. Patients had infectious keratitis or sterile epithelial defects. METHODS: Entry criteria into this series included the presence of an infectious corneal ulcer or sterile epithelial defect after the patient used crack cocaine routinely. Patients were prospectively identified from July 1, 1989 to June 30, 1991. RESULTS: Fourteen patients with crack-related corneal problems were identified. In 10 patients with infectious corneal ulcers, both bacterial and fungal organisms were isolated, and patients were treated with appropriate antimicrobial therapy. The group of patients with sterile corneal epithelial defects were seen after they had rubbed their eyes vigorously after crack cocaine use. The epithelial defects were treated and healed without complication. CONCLUSION: Crack cocaine users appear to represent a unique subset of young patients predisposed to infectious keratitis and corneal epithelial defects. A number of hypotheses are offered to explain this effect. Both ophthalmologists and the general public should be aware of these severe corneal problems associated with the use of crack cocaine.

Sports-Related Eye Trauma.

In brief Encounters with balls, fingers, elbows are common mechanisms of eye injury in patients who participate in sports. A careful history and a systematic approach to the eye examination are important steps when diagnosing and treating eye injuries on the playing field or in the office. Seemingly minor injuries require close scrutiny because severe underlying injury may not be obvious. Patients should be encouraged to protect their eyes during high-risk activities, as this can reduce the number and severity of eye injuries.