Ocular Trauma Score as prognostic value in traumatic ocular injuries due to rotating wire brushes.

PURPOSE: Rotating wire brushes are used, e.g., for rust removal. Detaching fragments can cause severe eye injuries. The purpose of this study was to investigate mechanism, severity, clinical outcome, validity of Ocular Trauma Score (OTS) and to assess the likelihood of final visual acuity. METHODS: Twenty patients with traumatic ocular injuries by rotating wire brushes were included. Location and type of injury, grade of injury according to OTS, surgical procedure, and development of visual acuity were evaluated. RESULTS: Eleven accidents (55%) happened at work, nine at home (45%). Eighteen injuries (90%) were penetrating, one (5%) was perforating. In one case (5%), an intraocular foreign body was present. One case each was classified OTS 1 and 2 (5%), six cases OTS 3 (30%), four cases OTS 4 (20%), and eight cases OTS 5 (40%). None of the patients was wearing safety goggles. Fourteen patients (70%) were surgically treated. Of these, five were treated at the anterior segment only, nine additionally underwent pars-plana vitrectomy. Nine patients received phacoemulsification. Mean best corrected visual acuity was logMAR 1.0 (2/20) at admission and 0.3 (10/20) at last follow-up. Our results were similar to those in the OTS study, except for OTS 1 (p = 0.046). Comparing the categorical distribution of final visual acuity in all OTS categories, no statistically significant difference was found (p = 0.119) between our results and the OTS study group. CONCLUSIONS: OTS may provide prognostic information in traumatic ocular injuries by rotating wire brushes. The injuries could have been avoided by wearing safety goggles.

Traumatismo ocular con cuerpo extraño intraocular / Eye injury with an intraocular foreign body

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Corneal Abrasions and Corneal Foreign Bodies.

Corneal abrasions and corneal foreign bodies are frequently encountered ophthalmological injuries that are commonly diagnosed and managed by primary care physicians. The clinical course of a corneal epithelial defect can range from a relatively benign self-healing abrasion to a potentially sight-threatening complication such as a corneal ulcer, recurrent erosion, or traumatic iritis. A detailed clinical history regarding risk factors and exposure, along with a thorough slit lamp examination with fluorescein dye are essential for proper diagnosis and treatment, as well as to rule out penetrating globe injuries. Referral to an ophthalmologist is recommended in difficult cases or if other injuries are suspected.

Corneal metallic foreign body injuries due to suboptimal ocular protection.

Retrospective review of 100 consecutive presentations of metallic corneal foreign body to the Royal Victorian Eye and Ear Hospital emergency department was undertaken between November and December 2009. The majority of the patients (97%) were male with a mean age of 42 ± 13 years (range 19-73 years). The most common mode of injury was grinding (88%). Nearly half (45%) of patients were wearing "safety eye wear" at the time of injury. Combination of 25-gauge needle and burr was the commonest method employed for removal of foreign body. Overall, 88% (n = 88) cases healed with corneal scar at the site of corneal foreign body and 1 case developed bacterial keratitis. Metallic corneal foreign bodies are common presentations to the emergency department and may be related to inadequate implementation of occupational safety measures.

[Black spots in the eye]. / Schwarzer Fleck am Auge.

Senile scleral plaques are characterized by a calcification located at the insertion of the horizontal rectus muscles. As a possible cause for their development a combination of solar tissue damage and continuous mechanical stress is discussed. We present a case of a 76-year-old male whose wife noticed expulsion of a calcified scleral plaque while applying antiglaucoma eyedrops. The local antiglaucoma therapy was stopped and acetacolamide was administered. Local therapy consisted of hyaluronic acid eyedrop and calcium pantothenate and retinol palmiate eye ointment. This treatment led to a rapid reepithelialization. The expulsion of calcified senile scleral plaques is a described complication which can necessitate surgical treatment.

Recurrent corneal metallic foreign bodies in children with autism spectrum disorders.

Corneal metallic foreign body is a common condition in working-age adults due to occupational exposure, such as grinding, welding, and hammering. Ocular trauma is a leading cause of vision loss in children; however, corneal metallic foreign bodies are rare in the pediatric population. Here we describe 2 children suffering from autism spectrum disorders presenting with recurrent corneal metallic foreign bodies. Meticulous history revealed that both children extensively used a therapeutic home swing with metallic suspensions, suggesting the potential mechanism for the recurrent corneal metallic foreign bodies. Furthermore, the use of protective eyewear during swinging prevented further recurrences. Awareness of this potential danger is particularly important in children with disabilities, who may have difficulty communicating their concerns and cooperating during examination and treatment.

Eye problems in mountain and remote areas: prevention and onsite treatment--official recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM.

Although eyes are not frequently injured in the mountains, they are exposed to many adverse factors from the environment. This article, intended for first responders, paramedics, physicians, and mountaineers, is the consensus opinion of the International Commission for Mountain Emergency Medicine (ICAR-MEDCOM). Its aim is to give practical advice on the management of eye problems in mountainous and remote areas. Snow blindness and minor injuries, such as conjunctival and corneal foreign bodies, could immobilize a person and put him or her at risk of other injuries. Blunt or penetrating trauma can result in the loss of sight in the eye; this may be preventable if the injury is managed properly. In almost all cases of severe eye trauma, protecting the eye and arranging an immediate evacuation are necessary. The most common eye problems, however, are due to ultraviolet light and high altitude. People wearing contact lenses and with previous history of eye diseases are more vulnerable. Any sight-threatening eye problem or unexplained visual loss at high altitude necessitates descent. Wearing appropriate eye protection, such as sunglasses with sidepieces and goggles with polarized or photochromic lenses, could prevent most of the common eye problems in mountaineering.

Frequency, source, and prevention of cotton fibers in the anterior chamber during cataract surgery.

PURPOSE: To prospectively evaluate the frequency of fibers in the anterior chamber during and after cataract surgery, their source, and preventive measures. SETTING: Department of Ophthalmology, Setagaya-Shimoda Hospital, Tokyo, Japan. METHODS: Slitlamp biomicroscopy was used to examine 422 eyes after cataract surgery for frequency of fibers in the anterior chamber. In another 78 eyes having cataract surgery, fibers in the anterior chamber were removed and compared with fibrous materials used during surgery using microscopic and Raman spectrometric analyses. Dust-generation tests were conducted on the fibrous materials used in surgery. In 337 eyes having cataract surgery, highly dust-generating materials were excluded during surgery and the frequency of fibers in the anterior chamber was determined. RESULTS: After surgery, fibers were detected in the anterior chamber in 7 (1.7%) of 422 eyes. No inflammation was observed during a 1-year follow-up. During surgery, fibers suspended in the anterior chamber were observed in 5 (6.4%) of 78 eyes. Microscopic and Raman spectrometric analyses showed that the fibers were identical to the cotton fibers in cotton balls and gauze. Cotton balls had the highest dust-generation rate of fibrous materials used intraoperatively. Excluding cotton balls significantly reduced the frequency of fibers to 5 (1.5%) of 337 eyes (P = .0239). CONCLUSIONS: During routine cataract surgery, fibers were introduced into the anterior chamber in 6.4% of cases. Of the fibrous materials used in surgery, cotton balls generated the most fibers. Eliminating cotton balls alone significantly reduced the frequency of fibers in the anterior chamber to 1.5%.

Accidental BTX drops into the conjunctival sac: is this a cause for concern?

Any injector can accidentally spill a few drops of BTX into the eye. It might very well be a harrowing experience to the uninformed: the good news is that the patient is at no risk of untoward sequelae. Although the BTX that diffuses into the orbit from these injections might well cause adverse effects, the same neurotoxin dropped into the eye is no more than a matter of wasting expensive material. We present herein our experience with such an accident, and support it with theoretical considerations.

[Occupational trauma due to superficial corneal foreign body]. / Trauma ocupacional por corpo estranho corneano superficial.

PURPOSE: To evaluate the epidemiology of superficial corneal foreign body. METHODS: Patients who were seen at the Emergency Service of the Federal University of São Paulo, from April/05 to June/05, were screened and those with superficial corneal foreign body were interviewed. Data regarding gender, age, occupation, employment status, availability and use of protective devices and supervision of their use were collected. Awareness of the possible complications was also assessed. Results were analyzed using chi-square or Fisher exact test. RESULTS: One hundred twenty-three patients were interviewed. Only 3 patients were female. The mean age was 36 years. Most injuries occurred at the workplace (86.2%), and 58.4% of the patients did not have a legal employment registration. The occupational activities most frequently reported were construction related activities (44.3%) and welding/soldering (11.3%). In most workplaces (79.8%) protective devices were available and 85.3% of the patients were instructed to use them. A safety device was being used during the accident in 34.2% of the cases and this was more frequent among patients that had legal employment registry (p=0.008) and among those under supervision (p=0.0415). The majority of the patients (68.9%) were aware of the risk of severe complications. CONCLUSIONS: Most patients with superficial corneal foreign body are aware of its severe complications and injuries usually occur in places where safety devices are available and often during their use. Our findings suggest that prevention should focus on supervision and correct use of safety devices.

Safety goggles: are they adequate to prevent eye injuries caused by rotating wire brushes?

Rotating wire brushes can cause severe ocular injuries. Wearing safety goggles has been recommended to prevent injury. A case is described of a superficial penetrating eye injury secondary to the use of a rotating wire brush, despite the use of safety glasses conforming to British safety standards. It is concluded that wearing safety goggles is not an adequate safety measure while using rotating wire brushes. The use of a full face shield is recommended during all professional and domestic activities involving equipment or tools that potentially produce high-speed foreign bodies.

Trauma ocupacional por corpo estranho corneano superficial / Occupational trauma due to superficial corneal foreign body

OBJETIVO: Avaliar a epidemiologia do trauma ocular por corpo estranho superficial de córnea. MÉTODOS: Os pacientes atendidos no Pronto-Socorro da Universidade Federal de São Paulo entre abril e junho de 2005 que apresentaram corpo estranho superficial de córnea foram entrevistados. Foram avaliados: sexo, idade, profissão, registro legal do emprego, uso, disponibilidade e tipo de equipamentos de proteção utilizados e a fiscalização do seu uso. O conhecimento das complicações deste tipo de acidente também foi avaliado. Os resultados foram analisados com teste do qui quadrado ou teste de Fisher. RESULTADOS: Foram entrevistados 123 pacientes. Apenas 3 eram do sexo feminino e a idade média foi de 36 anos. A maioria destes traumas ocorreu no ambiente de trabalho (86,2 por cento) e 58,4 por cento não possuíam registro legal do emprego. As profissões mais freqüentemente envolvidas foram serralheiro, pedreiro e metalúrgico. Em 79,8 por cento dos locais de trabalho havia equipamentos de proteção e 85,3 por cento dos pacientes eram orientados a usá-los. Em 52,4 por cento dos locais sua utilização era fiscalizada, mas apenas 34,2 por cento usavam no momento do trauma. A utilização foi mais freqüente (p=0,008) e fiscalização mais presente (p=0,0415) entre pacientes com registro legal de emprego. Questionados sobre os riscos, 68,9 por cento dos pacientes tinham consciência das complicações graves deste tipo de acidente. CONCLUSÃO: A maioria dos pacientes tem conhecimento sobre a gravidade do trauma ocular e este tipo de lesão ocorre mesmo em locais com equipamentos de proteção disponíveis, alguns deles até durante o seu uso. Os dados sugerem que enfoque maior da prevenção deve ser na fiscalização e utilização de equipamentos adequados.

PURPOSE: To evaluate the epidemiology of superficial corneal foreign body. METHODS: Patients who were seen at the Emergency Service of the Federal University of São Paulo, from April/05 to June/05, were screened and those with superficial corneal foreign body were interviewed. Data regarding gender, age, occupation, employment status, availability and use of protective devices and supervision of their use were collected. Awareness of the possible complications was also assessed. Results were analyzed using chi-square or Fisher exact test. RESULTS: One hundred twenty-three patients were interviewed. Only 3 patients were female. The mean age was 36 years. Most injuries occurred at the workplace (86.2 percent), and 58.4 percent of the patients did not have a legal employment registration. The occupational activities most frequently reported were construction related activities (44.3 percent) and welding/soldering (11.3 percent). In most workplaces (79.8 percent) protective devices were available and 85.3 percent of the patients were instructed to use them. A safety device was being used during the accident in 34.2 percent of the cases and this was more frequent among patients that had legal employment registry (p=0.008) and among those under supervision (p=0.0415). The majority of the patients (68.9 percent) were aware of the risk of severe complications. CONCLUSIONS: Most patients with superficial corneal foreign body are aware of its severe complications and injuries usually occur in places where safety devices are available and often during their use. Our findings suggest that prevention should focus on supervision and correct use of safety devices.

Surveillance of intraocular foreign bodies in the UK.

AIMS: To estimate the incidence of penetrating injuries with retained intraocular foreign bodies (IOFBs) in the United Kingdom, and to provide epidemiological data on the aetiology, management, and visual outcome of such injuries. METHODS: Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period June 2004 to May 2005 inclusive. Questionnaire data were obtained from UK ophthalmologists at presentation and 6 months following presentation. RESULTS: Data were available on 97 patients at presentation and 95 patients at follow-up. The minimum estimated incidence of IOFBs in the United Kingdom identified in this study was 0.16 per 100 000. All patients were male. Hammering was the most common mechanism of injury, occurring in 62% of patients. The IOFB was found in the anterior segment in 24%, the posterior segment in 73%, and involved both segments in 3%. Endophthalmitis was diagnosed in 9% of patients. Best-corrected visual acuity of the injured eye at final follow-up was 6/12 or better in 67%, 6/18 to 6/60 in 11%, and worse than 6/60 in 22%. Prognostic factors for a poor visual outcome included poor visual acuity at presentation, prolapse of intraocular tissue, development of endophthalmitis, development of retinal detachment, and large size of IOFB. CONCLUSIONS: The incidence of IOFB in the United Kingdom appears to have reduced compared to previous studies. The majority of patients (67%) retain good visual acuity in the injured eye; however, a significant minority (22%) sustain long-term severe visual loss.

Work-related eye injuries and illnesses.

More than 65,000 work-related eye injuries and illnesses, causing significant morbidity and disability, are reported in the United States annually. A well-equipped eye tray includes fluorescein dye, materials for irrigation and foreign body removal, a short-acting mydriatic agent, and topical anesthetics and antibiotics. The tray should be prepared in advance in case of an eye injury. Eye patching does not improve cornea reepithelialization or discomfort from corneal abrasions. Blunt trauma to the eye from a heavy object can cause a blow-out fracture. Sudden eye pain after working with a chisel, hammer, grinding wheel, or saw suggests a penetrating globe injury. Chemical eye burns require immediate copious irrigation. Nontraumatic causes of ocular illness are underreported; work-related allergic conjunctivitis increasingly has been recognized among food handlers and agriculture workers who are exposed to common spices, fruits, and vegetables. The patient's history of eye injury guides the diagnosis. Primary prevention and patient counseling on proper eye protection is essential because over 90 percent of injuries can be avoided with the use of eye protection. As laser use increases in industry and medical settings, adequate personal protection is needed to prevent cataracts. Outdoor workers exposed to significant ultraviolet rays need sun protection and safety counseling to prevent age-related macular degeneration. Contact lenses do not provide eye protection, and physicians should be familiar with guidelines for the use of contacts in the workplace.