The Israeli ocular injuries study: incidence of legal blindness from ocular trauma.

A 3 year nationwide study of the incidence of hospitalized civilian ocular injuries was conducted in Israel between October 1981 and September 1984. Of the 2,276 hospitalized cases (2,416 eyes), 457 resulted in unilateral, and 6 in bilateral legal blindness. These figures represent an average annual incidence rate of legal blindness of 3.8/100,000 persons, which was highest among 6-17 year olds (4.9/100,000). Injuries sustained in road accidents were the most highly morbid, resulting in blindness in 34% of road accident victims. Sports injuries accounted for 5% of all injured eyes and led to blindness in 10% of the cases so injured. Blindness resulting from injury occurs among people of all ages, often leads to a lifelong disfiguring disability, and increases the risk of bilateral blindness. It is widely maintained that with proper education and adoption of proper safety standards, such injuries can be largely prevented.

[Merkel cell carcinoma of the eyelid].

Merkel cell carcinoma is an infrequent but highly malignant cutaneous neoplasm. In a 73-year-old woman, a Merkel cell carcinoma of the right upper lid developed within 1 month, recurred within a month after its first removal, and metastasized to the parotid 2 months after secondary excision.

[Ocular injuries from seashore racketball].

A 3-year prospective study revealed 39 hospitalized cases of ocular injuries from seashore racketball sports. Most were children and young adults and most had internal injuries of the globe. Over a third had retinal edema, 2 eyes were blinded, and at least 4 are subject to serious future complications.

Eye injuries in children in Israel. A nationwide collaborative study.

A nationwide prospective collaborative study on ocular trauma was performed in Israel during a period of 3 years (1981 through 1983). Almost half of the traumas (1127 [47%] of 2416 eyes) were sustained by children younger than age 17 years, and mainly between the ages of 6 and 12 years. Most of the injuries happened at home (38.1%) or in the street (26.8%) and during play and sport (65.1%). The male-to-female ratio among the children was 4:1. Blunt injuries accounted for 59.2%; 30.5% were perforating injuries and the rest were chemical and radiation injuries. The visual acuity at the time of hospital discharge was better than 6/30 in the majority of the eyes but 122 patients (11%) had a visual acuity of less than 6/60, and no light perception was the result in 40 eyes (3%). The reasons for the severe outcome were as follows: 23 eyes (2%) owing to phthisis, 22 eyes (1.9%) were enucleated, and 16 eyes (1.4%) suffered from endophthalmitis.

Vitamin A in Stevens-Johnson Syndrome.

A 9-year-old boy was admitted to the Pediatric Department with high fever, severe photophobia, and a rash on his face, eyelids, and neck. Two days before admission he received injections of penicillin. During the night his general condition worsened, and his fever rose to 40 degrees C. He began to hallucinate, and clear fluid-filled blisters appeared on his skin and mouth. Severe photophobic epiphora, conjunctival injection, and punctate keratitis were also observed. Several hours after local administration of corticosteroids and antibiotic eye drops, his eyelids swelled severely, the corneas became covered by pseudomembranes, and later, in attempting to open the eyelids, the skin peeled off and the eye lashes fell out. Treatment consisted of artificial tear eye drops, and intravenous antibiotics and steroids. His condition improved gradually, visual acuity became 6/15 in both eyes, and a superficial punctate staining of the cornea was observed. The Schirimer test showed lacrimal hyposecretion. A tarsal conjunctival biopsy showed a complete absence of goblet cells. Vitamin A was administered topically and systemically. After three months of treatment with Vitamin A, tear secretion was almost normal, and conjunctival biopsy indicated a regeneration of goblet cells.

Retinal periphlebitis after hormonal treatment.

Two cases, those of a man and a woman, developed retinal periphlebitis after hormonal treatment for infertility and contraceptives, respectively. Both had a unilateral severe decrease in visual acuity, and a central scotoma and defect in color vision were also present. The fundus had retinal edema, especially of the macula, a hyperemic disc with blurred margins, normal arteries, congested veins, and marked sheathing along the main veins, with retinal hemorrhages in the inferior half of the retina. Fluorescein angiography showed a delayed filling of the veins in the affected retina and late staining of these veins. Since there was severe visual impairment in each case, systemic adrenocorticosteroids were administered, and a rapid improvement in visual acuity occurred. In one patient, a trace Marcus-Gunn sign, a few small paracentral scotomas, and a defect in color vision were permanent sequelae.

The Israeli Ocular Injuries Study. A nationwide collaborative study.

A nationwide study of patients hospitalized for ocular injuries was conducted in Israel during the years 1981 through 1983, with the participation of 17 ophthalmic departments. The study comprised 2276 patients (2416 eyes), 47% of whom were children. The male-female ratio was 4.3:1. Bilateral injuries occurred in 140 patients, with children sustaining the most severe injuries. Ocular injuries occurred most frequently at home, and children at play were most vulnerable. Most patients retained good vision, 3.7% lost vision totally, and 2% of the eyes had to be enucleated.

Intraocular ossification.

Intraocular ossification was investigated in a series of 20 eyes. Only 12 eyes were phthisical. The etiological factors were trauma, inflammation, glaucoma and massive intraocular gliosis. Bone tissue was of the compact and spongy type. A correlation was found between the intraocular ossification and retinal detachment, intraocular hemorrhage, intraocular neovascularization and uveitis.

Influence of systemic administrated beta-blockers on tear secretion.

The secretion of tears was evaluated by the Schirmer test in 96 patients and 66 controls. This article reports on the pharmacologic and not the immunologic effects of adrenergic beta-blockers on tear flow. The facilitation of lacrimal flow depends not only on the parasympathetic nerves but also on the beta adrenergic nerves. We found that the unselective adrenergic antagonist, propranolol, decreased the tear flow while, oxprenolol because of its intrinsic sympathomimetic activity, did not decrease significantly lacrimal secretion.

Posttraumatic recurrent corneal erosion, #2. Ultrastructural findings in epithelium and stroma.

Basement membrane deficiency, accompanied by alterations in basal epithelial cells, was shown in a case of posttraumatic recurrent corneal erosion (RCE) by Goldman et al. [1] and in other corneal disorders [2, 3, 4, 5, 6]. We have previously [7] described a case of posttraumatic RCE which was treated successfully by surgical procedure. This report presents electron microscopic observations of the excised tissues which indicate significant changes in the corneal stroma as well as in its epithelium and basement membrane.

Simultaneous trabeculectomy and cataract extraction.

A combined trabeculectomy and cataract extraction was performed on 46 eyes of 39 patients. The average follow-up period was of 27 months. The intraocular pressure remained controlled without the need of postoperative medication in 33 eyes (71.74%); 12 eyes (26.09%) needed further medical treatment; and in one eye the pressure remained uncontrolled and further surgery was necessary. After surgery the visual acuity improved considerably and the complications were few. The combined procedure has many advantages. The patient is cured by one surgical procedure, his visual acuity improves, his intraocular pressure is reduced to normal, and he is relieved from the need for medication postoperatively. By a single stay in hospital and by reducing the number of postoperative medical routine controls the expenses are reduced considerably. Owing to these advantages the combined procedure deserves to be considered in cases of glaucoma and cataract.

Posttraumatic recurrent corneal erosion. 1. Clinical and histological studies.

A severe, bilateral, posttraumatic recurrent corneal erosion in a 29-year-old woman was treated by bilateral lamellar keratectomy. The surgical procedure was performed first in the right eye. Under local anesthesia the defective corneal region stained by fluorescein was completely removed. It comprised a lamella measuring 2 X 3 mm and included epithelium and underlying superficial stroma, both of which showed abnormal features. Following this procedure, her right eye was asymptomatic for over 6 yr. Surgical procedure in the left eye was performed in the same manner except that only a part of the stained cornea containing superficial layers of epithelium was removed, in order to prevent central scarring. Despite surgery, the recurrent painful attacks in this eye continued.

Photocoagulation in retinal vein occlusion.

Photocoagulation was used to treat 40 eyes, 20 with central and 20 with branch vein occlusion. Panretinal photocoagulation was used over the fundus in central vein occlusion, and regional photocoagulation over the affected area in branch vein occlusion. No complications were observed during a follow-up period of 8 to 24 months. Recent as well as long-standing cases with macular edema were treated. Visual acuity improved in 85% of eyes with central vein occlusion and 80% of eyes with branch vein occlusion. Visual acuity results were more satisfactory with early treatment.