Doubles trouble-85 cases of ocular trauma in badminton: clinical features and prevention.

OBJECTIVES: To describe ocular injuries caused by badminton and to explore the implications for future prevention strategies. METHODS: We enrolled 85 patients with ocular trauma caused by badminton. Information collected from patients included type of game, instigator, instrument of injury and lessons in badminton from a professional, and ocular trauma information such as type of injury, treatment and final outcomes. RESULTS: The 85 patients (52 men, 33 women) were aged 15-65 years with an average age of 42.9 (±10.7) years. In 60 cases the player was hit by a shuttlecock and in 25 the player was hit by a racquet. 73 cases occurred in doubles matches and 10 in singles matches. In 31 cases the trauma was caused by an opponent and in 52 cases by a partner; 2 cases involved bystanders, not players. About 70% (43/61) of the injured and 82% (40/49) of the instigators had not received badminton lessons from a professional. 80 injuries were non-penetrating and 5 were penetrating. There were 58 cases with hyphaema, 36 with secondary glaucoma, 23 with lens subluxation and 2 with retinal detachment. Surgery comprised phacoemulsification or lensectomy and vitrectomy in 16 cases, silicone oil tamponade in 2 cases, trabeculectomy in 3 cases and direct cyclopexy in 5 cases. CONCLUSION: The vast majority of the badminton related eye injuries occurred among doubles players and were instigated by the injured person's partner. Non-penetrating injury was more frequent; penetrating injury was usually more serious. We recommend that badminton players use protective eyewear and receive safety education and professional coaching/instruction on techniques to protect against serious eye injuries.

Cannula-associated Ocular Injuries during Cataract Surgery: A Preventable Intraoperative Complication?

Although rare, inadvertently dislodged cannula can occur during cataract surgery. We report two cases of cannula-associated ocular injury during stromal hydration of the main corneal incision despite the use of Luer-lock syringes. Case 1 suffered from an initially occult intraocular injury which led to a delayed presentation of vitreous prolapsing into the anterior chamber, presumed posterior capsular rupture, vitreous hemorrhage, and multiple retinal tears, which required a three-port pars plana vitrectomy and cryotherapy. Case 2 sustained an iris laceration, anterior capsular tear, and postoperative raised intraocular pressure with no late sequelae. The former case highlights the need for close monitoring postoperatively despite the absence of initial apparent evidence of intraocular injury. Herein, we propose a systematic approach in reducing the risk of inadvertent cannula-associated ocular injury.

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.

Eye injury in the Israeli Defense Force: "an ounce of prevention is worth a pound of cure".

BACKGROUND: The eye occupies 0.1% of the total body surface yet it accounts for 8-13% of battle injuries in modern warfare worldwide. Protective eyewear can prevent over 90% of these eye injuries in both military and civilian settings. This study presents an analysis of a military casualty database and describes the proportion and distribution of eye injuries among Israel Defense Force (IDF) Soldiers. METHODS: All trauma patients recorded in the IDF Trauma Registry (ITR) in whom ocular injury related to combat or to training was documented were reviewed. RESULTS: There were 129 patients with documented eye injury sustained during combat or training between 1997 and 2013: 75% of injuries were related to combat and the remainder occurred during training. Penetrating fragmental injuries accounted for 74% of combat related injuries and 28% of training related injuries. Sixty-six percent (66%) of these casualties were subsequently re-classified as no longer fit for combat duties. Combat related injuries resulted in a higher incidence of severe injuries compared to training related injuries (P<0.05). CONCLUSIONS: Despite optimal medical care, the majority of soldiers who sustain eye injuries during military service suffer from substantial disability and most are no longer fit for combat service. A majority are discharged from military service. Protective eyewear could potentially prevent penetrating fragmental wounds which are the most common cause of injury. Further research on optimal orbital protection is critical for both the military and the civilian sectors.

Six-year clinical study of firework-related eye injuries in North China.

PURPOSE: To analyse the demographic data, clinical characteristics, management and prognosis of patients with firework-related eye injuries. METHODS: A retrospective review was performed of patients with eye injuries related to fireworks referred to TianJin Eye Hospital in North China from 2008 to 2013. Demographic information, clinical features, management and visual outcome were analysed and prognosis factors were evaluated. RESULTS: Ninety-nine patients (86 men) with 118 eye injuries were enrolled in the study. The average age of the patients was 32.0±20.5 years; 70/99 (70.7%) were aged >20 years. Eighty-one of the patients had been lighting the fireworks while the rest were bystanders. The main ophthalmic manifestations were hyphaema, vitreous haemorrhage, corneal/sclera/corneoscleral open globe injury, eyelid laceration, traumatic cataract, retinal/choroid detachment, endophthalmitis and intraocular foreign body (IOFB). Ninety patients required surgical intervention including repair of open globe injury, vitrectomy, cataract extraction and enucleation. 56/118 eyes (47.5%) received multiple operations. After treatment, final best-corrected visual acuity (BCVA) significantly improved (p=0.015). Some factors were significantly correlated with better final BCVA, including initial BCVA (p=0.036), closed globe injury (p=0.031), absence of endophthalmitis (p=0.014), absence of IOFB (p=0.024) and absence of retinal detachment (p=0.046). CONCLUSIONS: Firework-related eye injuries mainly occur in adult men and result in severe visual damage. The most common clinical manifestations are hyphaema and vitreous haemorrhage. Better initial BCVA and closed globe injury have a better visual result while endophthalmitis, IOFB and retinal detachment have a negative visual outcome. Improved eye protection, along with enhanced public education and legal ban on fireworks, could reduce the incidence of eye injuries.

Novel method for comparing coverage by future methods of ballistic facial protection.

The wearing of eye protection by United Kingdom soldiers in Afghanistan has reduced the morbidity caused by explosive fragments. However, the remaining face remains uncovered because there is a lack of evidence to substantiate the procurement of methods to protect it. Using a new computerised tool we entered details of the entry sites of surface wounds caused by explosive fragments in all UK soldiers who were injured in the face between 1 January 2010 and 31 December 2011. We compared clinical and predicted immediate and long term outcomes (as defined by the Abbreviated Injury Score (AIS) and the Functional Capacity Index (pFCI), respectively). We also used the tool to predict how additional protection in the form of a visor and mandible guard would affect outcomes. A soldier wearing eye protection was 9 times (1.03/0.12) less likely to sustain an eye injury than one without. However, 38% of soldiers in this series were not wearing eye protection at the time of injury. There was no significant difference between the AIS and pFCI scores predicted by the tool and those found clinically. There is limited evidence to support the use of a mandible guard; its greatest asset is better protection of the nose, but a visor would be expected to reduce long-term morbidity more than eye protection alone, and we recommend future trials to assess its acceptability to users. We think that use of this novel tool can help in the selection of future methods of ballistic facial protection.

[Mason's lacing cord. Potential danger of severe open ocular injuries]. / Maurerschnüre. Potenzielle Gefahr für schwere offene Augenverletzungen.

BACKGROUND: Introduction of new working equipment or the modification of established working routines could induce new trauma mechanisms. In all of theses cases ophthalmologists are not only responsible for ocular treatment they also have to act as assessors. This might include legal aspects, e.g. to validate the circumstances of an accident. METHODS: We present a new trauma mechanism caused by a mason's lacing cord which was fixed with nails. In addition to two case studies we collected experimental data (maximum tension and maximum elongation of various mason's lacing cords) about the triggering event using standard test conditions. RESULTS: A tensile force of 96.2 N was needed to achieve maximum elongation of mason's lacing cords. With a cord length of 5 m, an elongation of 0.09 m was enough to cause penetrating injuries (for 10 m cord length the critical elongation was 0.13 m). Under these conditions a nail could be accelerated to a velocity of 18 m/s. This may lead to open eyeball injuries with severe visual loss. CONCLUSIONS: Nails fixed to elastic mason's lacing cords are potential risk factors for occupational ocular injuries and severe loss of vision. Caution labels should be attached to the work equipment and proper eye protection should be used to prevent severe occupational ocular injuries.

Experimental assessment of eye protection efficiency against high speed projectiles.

INTRODUCTION: Work in hazardous zones with the risk of mechanical injuries requires protection with safety spectacles. Mechanical eye injuries with metal foreign bodies are often caused by rotational material machining or production processes with high pressure or high velocity moving parts. Normative regulations restrict to tests with small and fast flying objects (e.g. 6mm ball). The literature does not provide any information about protection capabilities against larger objects with high mass and arbitrary shape. The purpose of this study was to test the protection efficiency of safety spectacles against flying objects. The scope of this paper is to present a new test setup for mechanical impact resistance testing of personal protective eyewear against objects with arbitrary shape and mass. MATERIAL AND METHODS: The setup is based on a catapult platform, accelerating a sliding carriage on a rail. A pull rope system allows velocities up to 62±2 m·s(-1). A photo sensor was used for velocity measurement. The carriage can be loaded with projectiles of up to 30mm×30mm×40mm in size with arbitrary orientation, depending on the carriage insert. Testing and validation was done with projectiles such as 7g metal chips and fragments with approximate dimensions of 10mm×15mm. Samples were standard occupational safety spectacles mounted on a test head. The projectile impact was captured with a monochrome high speed camera. RESULTS: The aiming accuracy test showed deviations of approximately 1mm of two impacts on the same spectacle surface with a free flight distance of 150mm. All tests with slow, medium and high speed projectiles showed no contact with the eye medium. Objects with velocities from 10 m·s(-1) to 62 m·s(-1) fired the spectacle off from the test head. The medium speed test cut off one side of the spectacle frame. The high speed test with 62±2 m·s(-1) cracked the polycarbonate shield. DISCUSSION: We describe a method for accelerating arbitrary objects up to 62 m·s(-1) and for aiming these objects on safety eyewear, mounted on a test head. The setup allows a variety of projectile shapes, orientations and velocities. The accuracy of velocity measurement is ± 2 m·s(-1) for high velocity (< ± 5%). Further studies will address optimization of this setup due to signs of wear and gliding properties of the carriage, wireless ignition and higher velocities.

Characteristics of open globe injuries in geriatric patients.

BACKGROUND: We aimed to evaluate the etiological and demographic characteristics of open globe injuries in geriatric patients, to determine the factors affecting the prognosis and to discuss the differences between geriatric and young populations in light of the current literature. METHODS: The medical files of 30 patients aged 65 years and older who were treated and followed up for open globe injuries between 1998 and 2009 were evaluated retrospectively. RESULTS: The mean age was 73.1 years. Sixty percent of the patients were male, with a predominance of left eye involvement. The most common type of trauma was rupture due to a blunt object. The presenting visual acuity was no light perception in 13 patients, light perception/hand movement in 15 patients and 1/200-19/200 in 2 patients. In a univariate analysis assessing the effects of demographic and clinical characteristics on final vision, the wound location, type of trauma and Ocular Trauma Score were found to be statistically significant variations. CONCLUSION: The prognosis of open globe injuries is very poor in geriatric patients. Age-related structural changes and previous history of surgeries contribute to easy development of a rupture. During the treatment process, limited recovery capacity, ocular pathology in patients and low functional capacity in this age group exert negative effects on the prognosis.

Pattern of open eye injuries in northwest Turkey: a retrospective study.

BACKGROUND: We aimed to review the epidemiology and visual outcome of patients with open globe injuries in the northwest part of Turkey. METHODS: All patients admitted to the Department of Ophthalmology, Kocaeli University Faculty of Medicine with open globe injuries between 2004-2008 were reviewed retrospectively. RESULTS: Ninety-five eyes of 95 patients, aged between 3 and 79 years, were reviewed. The type of open eye injury was laceration in 76 eyes (80%) and rupture in 19 eyes (20%). In all age groups, projectile objects were the most common cause of injury. In patients 18 years and older, sharp objects (11.1%) were the least prevalent cause of open globe injuries; however, traumas with sharp objects were common in patients younger than 18 years (38.1%) (p=0.01). In patients younger than 18 years, most injuries occurred at home (68.3%), while in patients 18 years and older, the majority of ocular traumas occurred at work (59.2%) (p=0.000). Isolated Zone I lesions showed more improvement in visual acuity than other zones (p=0.043). CONCLUSION: Open globe injury in northwest Turkey varied with age and gender. Education and safety precautions are essential to prevent open eye injuries.

Ocular firework trauma: a systematic review on incidence, severity, outcome and prevention.

AIM: To provide a systematic review on ocular firework trauma with emphasis on incidence and patient demographics, the extent of ocular trauma and visual function loss, and firework regulation effects on injury rates. METHODS: A literature search was performed using predetermined inclusion and exclusion criteria. Demographic characteristics of ocular firework casualties were obtained and incidence rates of sustained trauma and vision loss calculated. RESULTS: Twenty-six relevant articles were suitable for calculation of trauma incidence and patient demographics, of which 17 articles could be used for calculating trauma severity and vision loss. Victims were male (77%), young (82%) and often bystander (47%). Most of the trauma was mild and temporary. Penetrating eye trauma, globe contusions and burns accounted for 18.2%, with a 3.9% enucleation rate. Mean visual acuity was >10/20 in 56.8%, with severe vision loss (<10/200) in 16.4%. Countries using restrictive firework legislation show 87% less eye trauma (p<0.005). CONCLUSIONS: One in six ocular firework traumas show severe vision loss, mostly in young males. Bystanders are as frequently injured. Firework traumas are a preventable cause of severe ocular injury and blindness because countries using restrictive firework legislation have remarkable lower trauma incidence rates.

Mechanical injuries of the eye: incidence, structure and possibilities for prevention.

BACKGROUND/AIM: Despite technological advances used in everyday clinical practice, injuries of the eye caused by various agents still produce blindness and poor vision in a significant number of people. The aim of this study was to analyze factors leading to occurrence of mechanical injuries of the eye. METHODS: Mechanic injuries of the eye in patients treated at the Institute for Eye Diseases of the Clinical Center of Serbia in Belgrade, in an eight-year period were analyzed. Investigated parameters were: sex and age of patients, their profession, time of injury (months, days and hours), place and way of injury and a visual acuity on admission and dismiss, as well as further follow-up. Type of injury (closed or opened injuries of the eyeball), with all the complications that followed were carefully noted and monitored. The time of primary surgical repair was noted and analyzed, whenever necessary. RESULTS: In the period of eight years, 2 701 patients (2 257 males and 444 females) were treated in the hospital due to mechanical injury of the eye. Almost equally, both the right (50.5%) and the left eye (49.5%) were injured, while in 39 (1.4%) patients both eyes were injured at the same time. The injuries occurred in all age groups, but mostly in adults, employed persons, aged from 16 to 65 (70%). Among injured children, 18.8% were beyond the age of 15. Most frequent injuries occurred in workers (39%), and then in pupils (16.3%). Wood was the mean of injury in 23.7% of cases, sharp and pointed objects in 16.1%, hammering and metal particles in 14.4%, glass in 10.1%, and other different objects in the rest of 35.7% of all injured persons. There were other very serious means or mechanisms of eye injuries, like hair band, dog bite, rooster's beak, rubber bullet, etc. Considering months in the year and days in the week, the injuries were almost equally distributed, and related to the time of day even 75% occurred between 10 a.m. and 10 p.m. Most injuries (38.2%) occurred while doing some work out of professional working place, while only 25.4% injuries occurred at the working place. Most of the patients (30.3%) had visual acuity L+P+ (light perception with correct projection) only, on attendance, but it varied from complete blindness to 1.0. There were 1 282 blunt injuries (contusion) (47.5%) and 1 373 penetrating eyeball injuries (50.8%), while the rest (1.7%) were injuries of ocular adnexa. Most of the primary surgical treatments (63.7%) were done in the first 24 hours from the moment of the injury. At dismiss, visual acuity was normal in 53.2%, the eye was blind in 19.1% injured patients. CONCLUSION: The results of this study showed that the injuries occurred most frequently in actively working people and pupils, that men were injured five times more often than women; that wood, sharp objects and glass were the most common means, that there was an equal number of blunt injuries and penetrating wounds, and that it was very important to treat injury promptly, preferably within the first 24 hours. By further analysis, it might be concluded that many injuries could have been prevented, avoiding long medical treatment and accompanying costs, and what is most important--permanent invalidity caused by reduced visual function or blindness of the injured eye is avoidable.

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.

Educational interventions for the prevention of eye injuries.

BACKGROUND: Ocular injury is a preventable cause of blindness, yet it remains a significant disabling health problem that affects all age groups. Injuries may occur in the home, in the workplace, during recreational activities or as a result of road crashes. Types of injuries vary from closed globe (contusion or lamellar laceration) to an open globe injury, which includes penetration and even perforation of the globe. To date, the main strategy to prevent these injuries has been to educate people to identify high-risk situations and to take correct action to avoid danger. OBJECTIVES: To assess the evidence for the effectiveness of educational interventions for the prevention of eye injuries. SEARCH STRATEGY: We searched the Cochrane Injuries and the Cochrane Eyes & Vision Group Specialised Registers, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, Current Controlled Trials metaRegister (now includes National Research Register), AgeInfo, HMIC Health Management Information Consortium, WHOLIS (World Health Organization Library Information System), LILACS (Latin American and Caribbean Health Sciences), MEDCARIB (Caribbean Health Sciences Literature), ISI Web of Science: (Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI) Conference Proceedings Citation Index-Science (CPCI-S)), ERIC, ZETOC and SPORTdiscus. We also checked reference lists of relevant papers and contacted study authors in an effort to identify published, unpublished and ongoing trials. Searches were last updated in August 2008. SELECTION CRITERIA: We included any randomised controlled trials (RCTs) and controlled before-and-after studies which evaluated any educational intervention aimed at preventing eye injuries. DATA COLLECTION AND ANALYSIS: Four authors independently screened the electronic search results and data extracted. Three authors entered data into RevMan 5. As we judged there to be substantial heterogeneity between participants and interventions, we did not pool the studies' results, but have reviewed the results narratively. MAIN RESULTS: We included two RCTs and three controlled before-and-after studies in this review. One study reported eye injuries as an outcome and four studies reported change in behaviour or knowledge. AUTHORS' CONCLUSIONS: The included studies do not provide reliable evidence that educational interventions are effective in preventing eye injuries. There is a need for well-conducted RCTs with adequate allocation concealment and masking (blinding). Studies should have a longer follow-up time and more studies need to be conducted in low and middle-income countries.

Epidemiology of pediatric eye injury in Split-Dalmatia County.

AIMS: The aim of this study was to assess the etiological factors and circumstances associated with the occurrence of eye injuries in children in Split-Dalmatia County, and to assess the visual outcomes of such injuries. METHODS: All 106 cases of pediatric eye trauma presenting to the Clinical Hospital Split, during a 4-year period, were identified by a medical record search. RESULTS: The annual calculated incidence of serious eye injuries in pediatric patients of Split-Dalmatia County that required hospitalization was 22.5 per 100,000 in the underage population. The most common causes of ocular injury were blunt objects and missiles, which mostly caused contusions and lamellar lacerations, and sharp objects, which mostly caused penetrating eye injury. In 99 (90.83%) eyes, the injuries were mechanical. Open globe injuries were significantly severer than closed globe injuries. Final visual acuity was better than upon admission in 78.10% of cases. The annual incidence of pediatric monocular blindness in Split-Dalmatia County was 0.63 per 100,000 in the underage population. CONCLUSIONS: Eye trauma in children occurs most frequently outdoors and generally results from the use of blunt objects. Prevention of ocular injury requires greater education of both children and their parents and adult supervision of children, especially while at play.

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.