Ocular foam round injury: A case report and literature review.

PURPOSE: To report the case of a 25-year-old male who sustained significant ocular trauma from a confirmed foam round. To review the scientific literature on kinetic impact projectiles and legislation currently proposed to regulate their use. OBSERVATIONS: A 25-year-old male presented to the emergency department with acute pain and vision loss in his left eye after being struck by a foam round. Initial exam showed significant periorbital ecchymosis, multiple eyelid lacerations, microhyphema, and vitreous hemorrhage. Computed tomography revealed fractures of the inferior and medial orbital walls. Optical coherence tomography also demonstrated full-thickness macular hole. Microhyphema resolved after 15 days with steroid and mydriatic drops. Vision at 60 days after injury stabilized at 20/60. Repeat OCT at this time revealed closure of the macular hole. Care for the patient is ongoing. CONCLUSIONS AND IMPORTANCE: Foam rounds can cause a pattern of vision-threatening ocular trauma similar to that of rubber bullets with the additional risk of chemical injury. During the George Floyd protests, isolated reports of significant foam round-related ocular injuries have been reported in the press, but systematic epidemiologic and clinical data on the subject remains lacking. While accurate identification of the causative weapon is not required in the management of ocular trauma, it may impact advocacy efforts undertaken by physicians and the subsequent legislative efforts they inspire. Current state and federal law does not adequately protect individuals from these munitions. Multiple proposals in Congress aptly recognize the significant risk of blinding injury and mortality posed by all kinetic impact projectiles.

Massive spontaneous subconjunctival hemorrhage in a patient on therapeutic warfarin: A case report.

PURPOSE: To describe a case of massive spontaneous subconjunctival hemorrhage in a patient taking warfarin with a therapeutic international normalized ratio (INR). OBSERVATIONS: Massive circumferential hemorrhagic chemosis, extensive periorbital and facial ecchymosis, and active arterial extravasation in the subconjunctiva which required cessation and reversal of anticoagulation. Findings gradually resolved over several months after discharge. CONCLUSIONS AND IMPORTANCE: While subconjunctival hemorrhage, even in anticoagulated patients, is usually benign, rare examples of severe presentations exist. We present, to our knowledge, the first documented case of a subconjunctival hemorrhage necessitating cessation and reversal of anticoagulation in the setting of a therapeutic INR.

Current Scope of Online Ophthalmology Education and Curriculum Impact Due to COVID-19.

Objective Abrupt changes in ophthalmology education caused by the COVID-19 pandemic have resulted in novel online curriculum development. The aims of this study were to identify (1) the scope of online curricula implemented both prior to and during the COVID-19 pandemic; (2) perception of educators on these online modalities; and (3) early lessons from online implementation that may guide future curricular planning. Methods Implementation of online curricula was evaluated by using a national online survey of Ophthalmology Directors of Medical Student Education (DMSE) via Qualtrics software. Participants Medical Student Educators of the Association of University Professors of Ophthalmology (AUPO) were surveyed. Results Fifty responses were collected, representing a 64.9% response rate. Prior to the COVID-19 pandemic, 44% of institutions had no online components in their courses, but 78.3% of institutions reported increasing online components in response to the pandemic. Required courses were significantly associated both with having implemented online components before the pandemic and implementing online-only versions of these courses in response to the pandemic. The three most popular modalities used for online teaching were lectures, interactive cases, and problem-based learning, with a median satisfaction of 4.0, 4.32, and 4.35, (out of five) respectively. The least popular modalities used were online teaching of physical exam skills and telemedicine, both with a median satisfaction of 2.5. Median overall educator satisfaction with online teaching was four (out of five). The most common weakness related to online teaching was the lack of effective physical exam skills training. Conclusion Our data demonstrate that most institutions successfully shifted their ophthalmology curriculum to a virtual and online version in response to the COVID-19 pandemic. DMSEs adapted quickly, transitioning in-person clinical courses, and extracurricular activities to online formats. Overall, educator satisfaction with online curricula was high. Integration of online curricula provides the opportunity to enrich institutional curriculums and overcome limitations imposed by decreasing curriculum time. This study reveals an early window into the utilization, strengths, and weaknesses of online ophthalmology education, which can serve as a guiding point to enhance ophthalmology curriculum development.

Impact of Resident-Led Small-Group Learning Sessions on Preclinical Students' Perceptions of Ophthalmology.

Introduction Resident physicians have a significant role in the education of medical students, and limited research has demonstrated that positive interactions with residents are linked with enhanced students' perceptions of a specialty. Minimal research on residents as teachers has been done in ophthalmology, and no research has examined the impact of residents as teachers on the perceptions of preclinical students. This is an important area of interest because ophthalmology conducts an early match. The competitiveness of the field increases the importance of early involvement in research and clinical activities. This study aimed to assess the role of a resident-led workshops as a vehicle for exposing preclinical students to ophthalmology. Methods A 2-hour workshop on the Ophthalmology Clinical Skills was held at the University of Cincinnati College of Medicine in November 2018. The workshop was conducted by seven ophthalmology residents, and the learners were 15 first-year and 11 second-year medical students. The workshop format consisted of a 30-minute introductory lecture on the field of ophthalmology, followed by a 60-minute small-group clinical skills' session focusing on direct ophthalmoscopy and slit lamp examination. Preworkshop and postworkshop surveys were administered to the medical students, and Student's paired sample t -test was used to assess the differences in responses before and after the workshop. Results Students' average interest in ophthalmology rose ( p = 0.049) as did their likeliness to approach a resident for career advice ( p = 4.65 × 10 -6 ) and their likeliness to attend the Secrets of the Match Lunch talk, a yearly talk held by a student matched into ophthalmology ( p = 0.002). Conclusion These results suggest that resident intervention can have a positive impact on preclinical students' perceptions of ophthalmology and may be a good educational strategy to foster their positive attitudes toward the field.

Prospective study of the sensitivity of the Wood's lamp for common eye abnormalities.

OBJECTIVE: The Wood's lamp, a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2-3 times, is commonly used by non-ophthalmologists for examining patients with eye complaints. The goal of current research was to determine the sensitivity and specificity of the Wood's lamp for common eye abnormalities. STUDY DESIGN: We examined a convenience sample of patients, 18 years of age and older, who presented for eye complaints to an urgent clinic of a large ophthalmology practice. This prospective observational trial was performed from December 2016 until July 2017. An ophthalmologist examined the patient's eyes with a Wood's lamp, followed by examination of the eyes using a slit lamp. The Wood's lamp was compared with the slit lamp, which served as the gold standard. RESULTS: There were 73 patients recruited. The mean age of study subjects (29 female and 44 male) was 49 years. The overall sensitivity of the Wood's lamp was 52% (38/73; 95% CI 40% to 64%). Based on the principal final diagnosis made with the slit lamp, the Wood's lamp only detected 9 of 16 corneal abrasions, 5 of 10 corneal ulcers, 5 of 9 corneal foreign bodies, 0 of 4 cases of non-herpetic keratitis, 1 of 2 cases of herpes keratitis, 1 of 5 rust rings and 18 of 28 other diagnoses. CONCLUSIONS AND RELEVANCE: Examination using the Wood's lamp fails to detect many common eye abnormalities. Our findings support the need for a slit lamp examination of patients with eye complaints whenever possible.