Penetrating eye injury by dart

Darts are constantly gaining in popularity. However, their risk of injury is often underestimated. This report is about a juvenile who suffered from a severe eye injury including the opening of the eye bulb. The attending ophthalmologists ruled out the possibility that this kind of injury could be caused by a dart with a plastic point. However, by reconstructing the course of action and throwing darts at porcine eyes, the forensic medical advisory opinion was able to state that darts with damaged plastic points may cause the exact same form of injury. This casuistic illustrates the essential significance of forensic-traumatological knowledge and, especially in the case of rare injury patterns, case-related practical experiments.

Severity of Penetrating Eye Trauma in Children in Tajikistan

Purpose. To assess the severity of penetrating eye trauma in children in Tajikistan. Material and methods. Retrospectively there was analyzed 277 case histories of children with a diagnosis of penetrating eye injury, admitted to the children’s department of the National Medical Centre of the Republic of Tajikistan for the provision of specialized ophthalmological care. Results. The average age of children at the time of injury to the organ of sight was 7.06 ± 3.01 years, mainly these were villagers (70%). Children under 7 years old accounted for 57.8% of those admitted to the hospital. The terms of admission to the hospital ranged from 1 to 14 days, an average of 43.02 ± 33.35 hours. The severity is caused by damage to 2 or more structures of the eyeball in 81,3%. Wounds larger than 6 mm prevailed and amounted to 63,5%. Endophthalmitis at admission was noted in 8,3% of cases. Enucleation was performed in 2 children; 244 children underwent primary surgical treatment. Visual acuity at discharge was higher than 0.1 in 72 of 275 children (26.2%), lower than 0,1 in 194 (70.7%). Conclusion. Almost every second child (43.0%) is admitted to the hospital for primary surgical treatment of an eyeball wound after 24 hours. About 2/3 of cases of eye damage are characterized by large wound sizes. Stab wounds were noted in 90.2% of cases. In 58.8% of cases, damage to the cornea was observed and in 68.6% – damage to the lens area.

Unusual presentation of Retinoblastoma

Most cases of retinoblastoma are diagnosed before the age of 5 years. The cases in older age groups can have variable presentations leading to misdiagnosis and management challenges. We report a case of retinoblastoma in an 8-year-old female who was primarily referred as a case of sympathetic ophthalmia due to a co-incidental misleading history of penetrating eye injury to other eye 3 weeks prior. The patient complained of decreased vision in the left eye after 3 weeks of repair of the corneo-scleral laceration in the right eye. Visual acuity in the right and left eye was 3/60 and light perception respectively. The anterior segment examination showed moderate sized keratic precipitates, intense inflammatory cellular reaction with large fluffy cells, hypopyon and dense vitreous exudates. Ultrasonography showed abundant hyperechoic contents within the vitreous cavity in the left globe. The retino-choroid was thickened. The possibility of endophthalmitis and sympathetic ophthalmia was considered. Diagnostic vitrectomy was planned. Intraoperatively, after clearing the exudates, a yellowish white mass lesion was seen superiorly. Post- operatively contrast-enhanced MRI scan confirmed the presence of an enhancing mass lesion in the globe consistent with the diagnosis of intraocular retinoblastoma. Enucleation of left globe was done after chemotherapy. Thus, a high risk of suspicion has to be kept for this malignant tumour in children with unexplained visual loss.

Ophthalmology

This chapter in the Oxford Handbook of Emergency Medicine investigates ophthalmology in the emergency department (ED). It examines a general approach to eye problems before dealing with specific issues such as corneal trauma, contact lens problems, blunt eye injury, penetrating eye injury, sudden visual loss, the red eye, and pupillary abnormality.

Ocular siderosis resulting from a retained intralenticular metallic foreign body

Intraocular foreign bodies are a potential factor threatening with loss of vision. The development of cataract and symptoms of ocular siderosis are the most common signs of ferrous metal entering the eye. We present a case of a 45-year-old man who reported to the hospital for planned cataract surgery. He denied the possibility of any past eye injury. Despite this, apart from the cataract, X-ray and CT scans confirmed the presence of an intralenticular foreign body and symptoms of ocular siderosis. Cataract surgery was successfully performed using phacoemulsification, and the metallic foreign body was removed. Intraocular foreign body symptoms may be overlooked by patients and even physicians and may occur with considerable delay. Hence, in patients with indirect symptoms of penetrating eye injury, the presence of an intraocular foreign body should not be ruled out, even if the patient denies this possibility.

Trauma-induced filtering bleb formation and blebitis 40 years following a penetrating eye injury

A 49-year-old man presented to the emergency eye clinic with a 3-week history of redness, irritation and blurred vision in his right eye, with a noticeable lesion superotemporally on the conjunctiva. He had a previous ocular history of penetrating glass injury in the right eye at the age of 9 years (40 years ago), of which no surgical intervention was performed at that time, as his parents did not seek medical attention. Slit lamp examination revealed a thin, conjunctival cystic bleb at 10 o’clock position with surrounding conjunctival injection and chemosis at close proximity to the site of previous ocular trauma. Investigations confirmed a diagnosis of trauma-induced filtering bleb with blebitis (bleb inflammation). The patient was treated with a combination of steroid and antibiotic drops for duration of 2 weeks. Subsequent follow-up revealed marked improvement of symptoms with reduced inflammation. Patient is being monitored regularly to prevent recurrence of blebitis and bleb associated complications.

Detection of Retinal Fibrosis in a Rabbit Model of Penetrating Eye Injury

ABSTRACT Introduction To establish a rabbit model of posterior penetrating eye injury as a platform to test potential therapeutics. Materials and Methods Anesthetized rabbits received posterior penetrating eye injury in one eye, whereas contralateral eyes were maintained as uninjured controls. Rabbits were randomized into two experimental groups. Group A was euthanized on Day 14 postinjury to determine retinal fibrosis at an early phase of disease progression. Group B was euthanized on Day 28 postinjury to examine retinal fibrosis at a late phase of disease progression. We examined animals on postinjury Days 7, 14, 21, and 28 with indirect ophthalmoscope and fundus photography. After euthanasia, eyes were processed for histology and immunofluorescence labeling of fibrotic proteins α-smooth muscle actin and collagen I. Results Early fibrosis was detected by Day 14, as indicated by indirect ophthalmoscopy and fundus imaging. Fibrotic membranes were visible at sites of injury. Immunofluorescence analysis detected α-smooth muscle actin and collagen I within the fibrotic membranes. Conclusions These data show that ocular fibrosis can be detected within 14 days after initial injury, with more severe fibrosis detected at 28 days postinjury. These results will be used to determine the optimal time points for later studies designed to test treatment strategies.

Long-term Observation of Patients with Sympathetic Ophthalmia from a Diagnostic and Therapeutic Perspective. Overview of Literature

Aim: To evaluate options of diagnostic and therapeutic procedures of sympathetic ophthalmia (SO) compared with literature data. Backgroud: SO is an ocular autoimmune disease. It is characterized by disbalance in the imunoregulatory T-subsets within cell mediated immune response. Methods: File examination of SO by evaluation humoral and cellular immunity was ranked nukleolar test (NT). It evaulates the current status of lymphocyte activation based on the nucleolar morphology and RNA transcription aktivity. The classical histological examination was supported by immunohistochemical analysis of lymphocytic subpopulations in the eyeball enucleated for. SO in one case. Material: Five boys and men overall were monitored and treated in two studies from 1979 to 1994 and from 1999 to 2017 with SO In four cases it was subsequent after penetrating injuries and once after lensectomy with vitrectomy. The age of patients in the time of onset of SO was between 4 and 24 years (average 12 years). The time interval between insult and onset of SO varied between 10 days and 3 months (average 1.7 months). The relaps of disease appeared in the all cases in the time interval from 3 months to 38 years (average 15 years). Another two patients with SO were examined only in consultation: 16 years old boy with relaps of SO after cataract extraction and 71 years old women with SO subsequent after lensectomy and vitrectomy. There was examined and compared group of 19 patients with other types of uveitis in the same time. The lens-associated uveitis were caused after ocular contusion and penetrating eye injury in 16 patients (13 male patients). In another three cases (young women) with uveitid underlined by II. or III. type of hypersenzitivity the enucleation of dolorous eyeball calmed down the secondary uveitis on their second eye without any change of immunosupressive treatment and without change in NT. Results: There were changes in the complex immunological laboratory tests results in the SO cases in the counts of activated lymphocytes in the peripheral blood. The count of activated lymphocytes was increased in SO cases unlike in lens-associated uveitis. There was detected in NT statistically significant difference (p = 0,0134) between the two groups of uveitis. The histological examination (5 eyes with SO and 7 eyes without sympathetic uveitis) confirmed the diagnoses, supporting basically the clinical diagnosis. The immunohistochemical examination corfirmed the presence of populations of T-lymphocytes, macrophages and also B-lymphocytes. A basis of immunosuppressive therapy was the combination of prednisone and azathioprin at the first time. Effective therapy featured cyklosporine later. Conclusion: The nucleolar test of lymphocytes draws attention of their up-to-day increased activity without the diferentiation of subpopulations and their absolute number increase related to the current activation of type IV. hypersensitivity (cell-mediated) in uveitis mechanism. The immunosupressive therapy calmes down this activation predominantly in SO, but also in other case sof uveitis with different types of hypersensivity. The immunohistochemical examination illustrates different presence of lymphocytic types according to the stage of SO.

Ophthalmology surgery

This chapter describes anaesthesia for paediatric ophthalmic cases. Management is generally straightforward, but is not without its problems and complications. Most procedures are day cases, but they may involve children who are unable to comply with tests when awake, children having multiple procedures, or syndromes associated with their ophthalmic condition. Ages range from the neonate to teenagers and involve procedures such as examination under anaesthesia (EUA), squint surgery, cataract surgery (and its complications), nasolacrimal surgery, oculoplastic surgery, and glaucoma surgery. The side effects of ocular drops are discussed, as are the risks of surgery in and around the eye, e.g. the oculocardiac reflex. Also covered are emergencies such as ‘the penetrating eye injury’ scenario.