Corneal Trauma

Trauma is often the main cause of unilateral loss of vision in developing countries. Although corneal trauma can range from tiny corneal abrasions to sight-threatening and penetrating ocular injuries, even minor corneal trauma that breaches the epithelium has the potential to result in microbial keratitis and its associated complications, up until complete loss of vision. Even though ocular trauma is a global problem, blindness from eye injuries occurs mostly in developing countries, especially those where wars and civil conflicts bring around eye traumas from various weapons such as land mines, chemical substances, etc. Chemical injuries from both acids and alkalies are common causes of corneal injury due to their easy availability and soft regulations regarding their use. This chapter includes photos of trauma cases of the anterior segment, corneal and conjunctival foreign bodies, sequelae of blunt and penetrating trauma, chemical injuries, as well as a case of posttraumatic iris cyst.

Fireworks Ocular Injury in Saudi Children; Profile and Management Outcomes

Background: To explore the demographic profiling, causes, types, complications, management outcomes, and severity of fireworks- inflicted ocular injuries and traumas in children in KSA.Methods: This is a retrospective study of 115 cases with eye injuries managed at the Emergency Department, of our institution between 2003 and 2019. Demography, clinical features at presentation, mode of management and the Best Corrected Visual Acuity (BCVA) were evaluated at the last follow up. Results: The study included 117 eyes of 115 children [median age: 9 years; 96 (83.5%) boys; 19(16.5%) girls]. Fifty-six (48.7%) participants were bystanders. The injuries were caused mainly due to bangers (n=47; 40.9%), rockets in bottle (n=28; 24.3%), firecrackers (n=27; 23.5%), and nonspecific reasons (n=13; 11.3%). The children had presented with various severity levels: corneal abrasion (n=52; 44.4%); cataract (n=47;40.2%); penetrating injury (n=40; 34.2%); secondary glaucoma (n=22;18.8%); subluxated lens (n=19;16.2%); limbal stem cell deficiency (n=14;12.0%); Iridodialysis (n=12;10.3%), and vitreous hemorrhage (n=11;9.4%). Management interventions of the eyes under study included: penetrating injury repair (n=40; 34.2%), lens removal plus intraocular lens implantation (n=26; 22.2%), removal of foreign body (n=9; 7.7%). The BCVA after six months was 20/20- 20/60 in 49(41%) cases; 20/70 - 20/200 in 27 (23.1%) cases; <20/200-20/400 in 7 (6%) cases, and <20/400 in 34(29.1%) of the cases. Out of 51.3% eyes with <20/200 before management, only 35% recorded severe visual impairment.Conclusion: Fireworks-related eye injuries were mainly observed in boys primarily due to the use of bangers . Visual disability remained in one-third of the managed cases.

Eye Injury Registries: A Review on Key Registry Processes

Background: Data management related to eye injuries is vital in improving care process, improving treatment and implementing preventive programs. Implementation of a registry to manage data is an integral part of this process. This systematic review aimed to identify processes related to eye injury registries. Methods: Databases such as PubMed, Web of Science, Embase and Scopus were used in searching for articles from 2010 to Oct 2020 using the keywords “eye injuries” and” registry”. The identified processes related to eye injuries registry such as case finding, data collection, abstracting, reporting, follow-up and data quality control are presented in this review. Results: Of 1493 articles retrieved, 30 articles were selected for this study based on the inclusion and exclusion criteria. Majority of these studies were conducted in the United States. All registries had case finding and the most common resources for case finding included medical documents, reports and screening results. Moreover, majority of registries collected data electronically. However, few registries used data quality attributes to improve the data collected. Conclusion: Eye injury registry plays an important role in the management of eye injury data and as a result, better management of these data will be established. Taking into consideration that the quality of collected data has a vital role in adopting prevention strategies, it is essential to use high-quality data and quality control methods in planning and designing eye injury registries.

Current pattern of ocular trauma as seen in tertiary institutions in south-eastern Nigeria

Background Ocular trauma is a leading cause of monocular blindness worldwide and in developing countries, are not only more common but also more severe. Industrialization and urbanization may alter or modify prevalent aetiological factors and the presentation of ocular trauma. Objective To determine the current pattern of eye injuries in Teaching Hospitals in Enugu State. Methods This prospective cross-sectional descriptive study was carried out at the eye clinics and emergency units of two tertiary institutions in Enugu, Nigeria. Consecutive ocular trauma patients were enrolled over a 5-month period. On presentation, they underwent ocular examination including visual acuity (which was categorized according to the WHO classification of visual impairment and blindness}, anterior and posterior segment examinations. Injuries were grouped using the Birmingham Eye Trauma Terminology system. Results Within the study period, 2545 new patients presented to the hospitals where the study was conducted. A total of 89 patients presented with ocular trauma, giving an incidence of 3.5%. The male to female ratio was 1.3:1 and patients aged 10 to 19 years formed the majority (24%). Domestic accidents (22%) were the most common cause of ocular injuries while blunt objects (57%) were the most common agents. Closed globe injuries constituted 76% of all injuries. Forty-three per cent of patients presented within 24 h of injury. Conclusion Ocular trauma is still prevalent in South-eastern Nigeria and there has indeed been a change in the pattern as well as the incidence. Assault and road traffic accidents have emerged as important causes of eye injuries. In addition, there has been an improvement in the health-seeking behaviour of people living in Enugu and this may reflect positively on the uptake of recommended preventive strategies.

Ophthalmic surgery

This chapter discusses the anaesthetic management of ophthalmic surgery. It begins with a description of general principles, including anatomy and physiology of the globe and orbit, preoperative considerations of ophthalmology patients, and a discussion of different ocular block techniques. Surgical procedures covered include cataract extraction and intra-ocular lens (IOL) implantation; strabismus surgery; vitreo-retinal surgery; dacrocystorhinostomy (DCR), and repair of penetrating eye injuries.