Intraocular Foreign Body: Diagnostic Protocols and Treatment Strategies in Ocular Trauma Patients

Intraocular foreign bodies (IOFBs) are critical ophthalmic emergencies that require urgent diagnosis and treatment to prevent blindness or globe loss. This study aimed to examine the various clinical presentations of IOFBs, determine the prognostic factors for final visual outcomes, establish diagnostic protocols, and update treatment strategies for patients with IOFBs. We retrospectively reviewed patients with IOFBs between 2005 and 2019. The mean age of the patients was 46.7 years, and the most common mechanism of injury was hammering (32.7%). The most common location of IOFBs was the retina and choroid (57.7%), and the IOFBs were mainly metal (76.9%). Multivariate regression analysis showed that poor final visual outcomes (<20/200) were associated with posterior segment IOFBs (odds ratio (OR) = 11.556, p = 0.033) and retinal detachment (OR = 4.781, p = 0.034). Diagnosing a retained IOFB is essential for establishing the management of patients with ocular trauma. To identify IOFBs, ocular imaging modalities, including computed tomography or ultrasonography, should be considered. Different strategies should be employed during the surgical removal of IOFBs depending on the material, location, and size of the IOFB.

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A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area

BMC Ophthalmology ◽

10.1186/1471-2415-8-6 ◽

2008 ◽

Vol 8 (1) ◽

Cited By ~ 62

Author(s):

Salvatore Cillino ◽

Alessandra Casuccio ◽

Francesco Di Pace ◽

Francesco Pillitteri ◽

Giovanni Cillino

Keyword(s):

Retrospective Study ◽

Ocular Trauma ◽

Mediterranean Area ◽

Visual Outcomes ◽

Epidemiological Characteristics

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OCULAR INJURY TREND IN COVID-19 ERA- A TERTIARY EYE CARE STUDY IN INDIA

10.36106/gjra/5013376 ◽

2021 ◽

pp. 158-160

Author(s):

R. B. Goyal ◽

Karishma Goyal

Keyword(s):

Ocular Trauma ◽

Care Center ◽

Ocular Injury ◽

Trauma Patients ◽

Delayed Presentation ◽

Eye Care ◽

Education And Awareness ◽

Future Strategy ◽

Mass Health ◽

Care Study

Aim- To study the change in demography and injury pattern of ocular trauma during the lockdown period tothat of a similar period of the previous year. Materials & Methods- This is a retrospective analysis of the data of 362 patients with ocular trauma during the lockdown period from 25 March 2020 to 3 May 2020 and during a similar period of the previous year at a tertiary eye care center in India. Results- There was a decrease of 62.87% of patients of ocular trauma during the lockdown period because of the restricted lifestyle. Although home related and violence-related trauma increased, there was a decrease in trafc and sports-related trauma. Patients with chemical injury by sodium hypochlorite also had a sharp rise. Majority of the patients presented after two days during this period. Conclusion- Guidelines for mass health education and awareness about the risk of ocular trauma, morbidity caused by delayed presentation, and need to adopt safety or preventive strategies should be formulated so that future strategy can be planned to ght with the next pandemic or epidemic.

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Asymptomatic dislocation of a Watchman left atrial appendage occluder

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318805620 ◽

2018 ◽

Vol 27 (5) ◽

pp. 394-395 ◽

Cited By ~ 1

Author(s):

Gyoten Takayuki ◽

Oliver Grimmig ◽

Just Sören ◽

Fritzsche Dirk

Keyword(s):

Left Atrial ◽

Left Atrial Appendage ◽

Treatment Strategies ◽

Atrial Appendage ◽

Intestinal Bleeding ◽

Surgical Removal ◽

Device Management ◽

Coagulation Therapy ◽

Watchman Device ◽

Surgical Options

Device dislocation associated with left atrial appendage closure with a Watchman device is rare. Few cases of surgical treatment have been reported. Therefore, surgical options and the effects of the surgery on subsequent operations are unknown. This device was implanted in 2 patients in another hospital because of frequent brain and intestinal bleeding related to coagulation therapy for atrial fibrillation. However, routine echocardiography revealed dislocation from the left atrial appendage orifice in the early and late postoperative periods. Emergency surgical removal of the devices was performed. Perioperative device management and treatment strategies are discussed briefly.

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Mechanisms of Injury Among the Amish Population in Central Pennsylvania

The American Surgeon ◽

10.1177/00031348211050592 ◽

2021 ◽

pp. 000313482110505

Author(s):

Larissa Whitney ◽

Kelly Bonneville ◽

Madison Morgan ◽

Lindsey L. Perea

Keyword(s):

Pediatric Population ◽

Traumatic Injury ◽

Age Groups ◽

Geographic Location ◽

Future Research ◽

Common Mechanism ◽

Trauma Patients ◽

Trauma Centers ◽

Injury Patterns ◽

Level Of Evidence

Background Individuals presenting with traumatic injury in rural populations have significantly different injury patterns than those in urban environments. With an increasing Amish population, totaling over 33 000 in our catchment area, their unique way of life poses additional factors for injury. This study aims to evaluate differences in mechanism of injury, location of injury, and demographic patterns within the Amish population. We hypothesize that there will be an increased incidence of agriculture-related mechanisms of injury. Methods All Amish trauma patients presenting to our level I trauma center over 20 years (1/2000-4/2020) were retrospectively analyzed. Mechanism and geographic location of injury were collected. Demographic and clinical variables were compared between the age groups. Results There were 1740 patients included in the study with 36.4% (n = 634) ≤ 14 years. Only 10% (n = 174) were ≥ 65 years. The most common mechanism across all ages was falls. However, when separating out the pediatric population ( ≤ 14 years), 27.8% (n = 60) fell from a height on average > 8-10 feet. The most common geographic location of injury was at home in all age groups, except for the 15-24 year group, which was roadways. Discussion The Amish population poses a unique set of mechanisms of injury and thus injury patterns to rural trauma centers. We have found the most common injuries to be falls, buggy accidents, animal-related injuries, and farming accidents across all age groups. Future research and collaboration with other rural trauma centers treating large Amish populations would be beneficial to maximize injury prevention in this population. Level of Evidence Level 3a, epidemiological.

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Substernal goitre presenting with upper and lower extremity oedema

BMJ Case Reports ◽

10.1136/bcr-2021-245036 ◽

2021 ◽

Vol 14 (11) ◽

pp. e245036

Author(s):

Rebekah LeAnn Bennett Daggett ◽

Daniel Farishta ◽

Hugo Cuellar ◽

Cherie-Ann O Nathan

Keyword(s):

Lower Extremity ◽

Initial Assessment ◽

Uneventful Recovery ◽

Surgical Removal ◽

Extensive Literature ◽

Rare Presentation ◽

Clinical Presentations ◽

Left Innominate Vein ◽

Home Placement ◽

Work Up

Substernal goitre is characterised by compressive symptoms of the airway and oesophagus. Chronic, progressive symptoms usually result in surgical removal. We report a rare presentation of substernal goitre in a male in his early 70s who suffered from severe bilateral lower extremity (LE) lymphoedema, resulting in immobility and nursing home placement, and left upper extremity lymphoedema. Our initial assessment led to a filariasis work-up, which was negative, due to the patient’s prior 2-year residence in India and service overseas. Chest CT scan revealed an incidental substernal goitre extending posterior to the left innominate vein and aortic arch to the level of the left mainstem bronchus. The patient underwent a left hemithyroidectomy via cervical excision and sternotomy and had an uneventful recovery with resolution of lymphoedema and mobility. Despite extensive literature regarding clinical presentations of substernal goitre, severe lymphoedema of the LE is not a well-established association.

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Integration of ophthalmology in ocular trauma to improve patient care: A narrative review

Trauma ◽

10.1177/14604086211030793 ◽

2021 ◽

pp. 146040862110307

Author(s):

Christopher Bartimote ◽

Clare L Fraser ◽

Stephanie Watson

Keyword(s):

Ocular Trauma ◽

Improve Patient Care ◽

The United States ◽

Narrative Review ◽

Trauma Patients ◽

Severely Injured ◽

Specialist Care ◽

Trauma Service ◽

Trauma Model ◽

Meta Analyses

Introduction Ocular trauma can cause significant morbidity and is a leading cause of unilateral blindness. In multi-trauma, life- and sight-threatening injuries can co-occur causing increased complexity in the assessment and management of ocular injuries as the competing priorities in the severely injured must be balanced. We conducted a narrative review to determine how ophthalmology may be further integrated into a trauma service and/or the organisation of an ocular trauma service. Methods The literature was reviewed via EMBASE, MEDLINE, CINAHL and Google Scholar utilising comprehensive search strategies and keyword searches. Our review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results The search yielded 437 articles, 30 studies met selection criteria and were included in the review. The included literature comprised guidelines, observational studies and reviews of registry data from Australia, England, the United States, Singapore, Iran and Israel. Conclusion The Australian Trauma Model has clear guidelines for referral of trauma patients to ensure appropriate care of the severely injured. However, there are no clear guidelines for the integration of ophthalmology into trauma. Therefore, early referral to ophthalmology and streamlining of referral pathways of specialist care would improve the care of patients with ocular trauma.

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Fungal keratitis: A review of clinical presentations, treatment strategies and outcomes

The Ocular Surface ◽

10.1016/j.jtos.2021.12.001 ◽

2021 ◽

Author(s):

Namrata Sharma ◽

Bhupesh Bagga ◽

Deepali Singal ◽

Ritu Nagpal ◽

Anahita Kate ◽

...

Keyword(s):

Treatment Strategies ◽

Fungal Keratitis ◽

Clinical Presentations

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Ocular trauma in patients presenting to Dhulikhel Hospital

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i1.6264 ◽

2012 ◽

Vol 9 (1) ◽

pp. 54-57 ◽

Cited By ~ 1

Author(s):

P R Sthapit ◽

S Marasini ◽

U Khoju ◽

G Thapa ◽

B P Nepal

Keyword(s):

Visual Acuity ◽

Clinical Presentation ◽

Ocular Trauma ◽

Public Awareness ◽

Prevalence Studies ◽

Young Males ◽

Common Location ◽

One Year ◽

Complete History ◽

Better Than

Background Ocular trauma is an important cause of blindness and ocular morbidity throughout the world. Prevalence studies help to define the target group, plan strategies and thereby lessen trauma related blindness in the country. Objective To identify the risk factors for ocular trauma, those at risk, describe the visual acuity at time of clinical presentation, and assess the nature and severity of ocular trauma in patients presenting to Dhulikhel Hospital’s emergency department and eye OPD with ocular trauma. Methods It is a descriptive and prospective study of all the patients with ocular trauma presenting to Dhulikhel Hospital from December 2009 to December 2010. A complete history and detailed ophthalmologic evaluation was done and noted down. Results There were 112 subjects with ocular trauma. Mean age was 28.43±16.36 years with a range of one year to 74 years. Males predominated with 72.3% frequency (p<0.001). Incidence peaked in third decade of life (p<0.01). Ocular trauma peaked in months of September and October. Presenting visual acuity better than 6/12 was noted in 83.9% of cases whereas 2.7% of cases had visual acuity of <3/60. Household (56.3%, p<0.001) was the commonest place of injury with wooden objects (19.6%) being the commonest object of injury. Most of the injuries were mechanical (85.7%, p>0.001). ConclusionBlunt injuries were more common in young males. Household and workplace were common location of ocular injuries. Public awareness and strict legislation to use personal protective devices can help to reduce the occurrence of ocular injury.http://dx.doi.org/10.3126/kumj.v9i1.6264 Kathmandu Univ Med J 2011;9(1):54-7

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P142: The anticoagulated trauma patient: a Canadian experience in the era of direct oral anticoagulants

CJEM ◽

10.1017/cem.2016.316 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S125-S125 ◽

Cited By ~ 1

Author(s):

B. Wood ◽

A. Ackery ◽

S. Rizoli ◽

B. Nascimento ◽

M. Sholzberg ◽

...

Keyword(s):

Trauma Patient ◽

Injury Severity ◽

Hematological Parameters ◽

Oral Anticoagulants ◽

Demographic Data ◽

Direct Oral Anticoagulants ◽

Significant Proportion ◽

Common Mechanism ◽

Trauma Patients ◽

Trauma Population

Introduction: The anticoagulated trauma patient is a particularly vulnerable population. Our current practice is guided by experience with patients taking vitamin K dependent antagonists (VKA, like warfarin). It is currently unknown how the increasing use of direct oral anticoagulants (DOACs) will change our trauma population. We collected data about this new subset of patients to compare their clinical characteristics to patients on pre-injury VKA therapy. Methods: Retrospective review of anticoagulated trauma patients presenting to Toronto’s two adult trauma centres, Saint Michael’s Hospital and Sunnybrook Health Sciences Centre, from June 2014-June 2015 was undertaken. Patients were recruited through the institutions’ trauma registries and were eligible if they suffered a traumatic injury and taking an oral anticoagulant pre-injury. Clinical and demographic data were extracted by a trained reviewer and analysed with descriptive statistics. Results: Our study recruited 85 patients, 33% were taking DOACs and 67% VKAs. Trauma patients on DOACs & VKAs respectively had similar baseline characteristics such as age (75.9 vs 77.4), initial injury severity score (ISS (16.9 vs 20.6)) and concomitant antiplatelet use (7.1% vs 5.4%). Both groups’ most common mechanism for injury was falls and the most common indication for anticoagulation was atrial fibrillation. Patients on DOACs tended to have lower average INR (1.25 vs 2.3) and serum creatinine (94.9 vs 127.4). Conclusion: Patients on DOACs pre-injury now account for a significant proportion of orally anticoagulated trauma patients. Patients on DOACs tended to have less derangement of basic hematological parameters complicating diagnosis and management of coagulopathy.

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