The Upper Paralimbal Zone is Especially Susceptible to Ruptures Due to Blunt Trauma

Background Globe ruptures are ophthalmological emergencies where the primary diagnosis using a slit lamp is often a challenge. Objectives The retrospective case study aimed to characterise the predilection sites, the demographic profile and the causes of bursts due to blunt globe trauma. Materials and Methods The surgical plan of the Eye Centre of the Medical Centre (University of Freiburg) was electronically searched using the keyword “globe rupture” over a period of 18 years (2000 – 2018). This led to 350 hits, which were scrutinised by hand. 134 globe ruptures due to blunt globe trauma were then identified. Results The most common predilection sites were the upper nasal and the upper temporal paralimbal zones with 37 and 32% of the examined globe ruptures, respectively. The average age at the time of rupture was 60 (from 2 to 97) years. The median age was 62.5 years. 37% (49/134) of patients were female. The most frequent causes of accidents were falls (43%), “flying” wooden and metal objects (18%) and acts of violence (10%). Conclusions Special attention should be paid to the upper paralimbal zone in the exploratory primary care of globe ruptures. If the rupture occurred due to “flying” wooden and metal objects, the posterior sclera burst most frequently. The epidemiological data suggest that targeted prevention against falls for individuals over 60 years and consistent wearing of protective eyewear when working with wood or metal could reduce the incidence of bulbar bursting. It was also noticeable that acts of violence were the third most frequent cause of rupture, although woman did not report that they were affected by this. Given the high occurrence of violence against women, shame and stigma may lead to an incorrect inquiry about the cause of the accident. This could be mitigated by training employees specifically to take a sensitive history.

Influence of safety glasses, body height and magnification on the occupational eye lens dose during pelvic vascular interventions: a phantom study

Objective By simulating a fluoroscopic-guided vascular intervention, two differently designed radiation safety glasses were compared. The impacts of changing viewing directions and body heights on the eye lens dose were evaluated. Additionally, the effect of variable magnification levels on the arising scattered radiation was determined. Methods A phantom head, replacing the operator’s head, was positioned at different heights and rotated in steps of 20° in the horizontal plane. Thermoluminescent dosimeters (TLD), placed in the left orbit of the phantom, detected eye lens doses under protected and completely exposed conditions. In a second step, radiation dose values with increasing magnification levels were detected by RaySafe i3 dosimeters. Results Changing eye levels and head rotations resulted in a wide range of dose reduction factors (DRF) from 1.1 to 8.5. Increasing the vertical distance between the scattering body and the protective eyewear, DRFs markedly decreased for both glasses. Significant differences between protection glasses were observed. Increasing magnification with consecutively decreasing FOV size variably reduced the dose exposure to the eye lens between 47 and 83%, respectively. Conclusion The safety glasses in the study effectively reduced the dose exposure to the eye lens. However, the extent of the protective effect was significant depending on eye levels and head rotations. This may lead to a false sense of safety for the medical staff. In addition, the application of magnification reduced the quantity of scattering dose significantly. To ensure safe working in the Cath-lab, additional use of protective equipment and the differences in design of protective eyewear should be considered. Key Points • Eye lens dose changes with physical size of the interventionist and viewing direction. • The use of magnification during fluoroscopic-guided interventions reduces scattered radiation.

Floorball Injuries Presenting to a Swiss Adult Emergency Department: A Retrospective Study (2013–2019)

Background: The popularity of floorball has surged throughout Switzerland in the last 20 years. However, epidemiological studies are still scarce. Objective: To collect information on floorball-related injuries, their severity and approximate cost in adults who presented to our emergency department from 2013–2019. Moreover, to use this information to suggest possible strategies to prevent injuries. Materials and Methods: The study population includes all patients who suffered injuries related to floorball and were then seen at the University Hospital in Bern during a 7-year period. Bern University Hospital, Switzerland, has a comprehensive management system (Ecare) that was used to generate the data for this study. The data were then used to create an injury profile of all cases presented during the said period. Results: A total of 263 injures were recorded from 2013 to 2019. The most common locations for injuries were to the eyes (43.73%), followed by the lower extremities (25.48%). The mean cost per case was CHF 1191.43. However, the vast majority of admissions could be sent home (93.16%) and did not cost more than 500 CHF/case (57.41%). Of the 22 cases that cost more than CHF 2000, 10 were located around the torso and 6 affected one or both eyes. Significant differences were observed between the age groups and treatment area (p = 0.008), costs (p = 0.008), route of discharge (p = 0.023) and type of trauma (p = 0.020). Conclusion: Although floorball is still a relatively minor sport, its impact on sport-related injuries must not be underestimated. Injuries to the eyes are particularly common. In our opinion, our findings provide strong evidence that all floorball players (not only children and adolescents) should wear protective eyewear. We conclude that the Swiss Floorball Association (Swiss Unihockey) should mandate the use of protective eyewear.

Survey of the use of laser protective eyewear among international retina specialists: a European vitreoretinal society study

ObjectiveTo report the trends for the use of eye protection methods during retinal laser in clinic and operating room.Methods and analysisRetrospective analysis of a 14-item survey questionnaire submitted to the European Vitreoretinal Society members.ResultsResponses from 630 members were analysed. Most of the respondents practised in Europe (52.7%), followed by North America (21.0%). The majority of respondents had laser filters in the microscope for the operating surgeon (92.1%), or used protective goggles (6.8%). Only 38.9% of respondents indicated that auxiliary staff in the operative room used protective goggles during laser treatment. Three-dimensional retina viewing system was used by only 22.5% of respondents, of those, 34.5% reported use of laser protection goggles by the operating surgeon. Rates of laser protection by auxiliary staff were 62.9% for indirect laser and 60.8% for slit lamp laser. We found a higher rate for use of laser protection by auxiliary staff in North America-based practices for endolaser (p<0.00001), laser indirect ophthalmoscope (p<0.00001) and slit lamp laser (p=0.00033) compared with the rest of the world.ConclusionThe use of laser protection methods is routinely adopted by the physicians in the operating room and clinic, but less so by their assisting or auxiliary staff.

Epidemiology and risk factors for sports- and recreation-related eye injury: a multicenter prospective observational study

AIM: To identify the epidemiologic characteristics of sports- and recreation-related eye injuries in a large metropolitan city and investigate risk factors associated with visual impairment. METHODS: We performed a multicenter prospective observational study on patients using the regional eye injury registry data. This study included patients with sports- and recreation-related eye injury in four tertiary teaching hospitals in Daegu, Republic of Korea, from August 2016 to July 2018. The primary outcome was visual impairment at the first hospital visit. Distributions of sex, age, place, and causative materials were analyzed according to causative activities. To examine the association between causative activities and visual impairment, a Logistic regression analysis was used. RESULTS: Of the 349 sports- and recreation-related eye injuries, soccer was the most common causative activity, with 21.8% (n=76). Sports- and recreation-related eye injuries occurred mainly in teenagers, individuals in their 20s, and men. Badminton and soccer were significantly associated with visual impairment at the first hospital visit compared with combat sports [(adjusted odds ratio (AOR), 5.18; 95% confidence interval (CI), 1.67-16.09 for badminton and AOR, 3.87; 95%CI, 1.36-10.99 for soccer]. CONCLUSION: Intervention efforts such as deployment of protective eyewear in sports facilities and schools and promotion of wearing protective eyewear during these activities in teenagers and individuals in their 20s are mandatory.

The Effects of Aesthetic Lasers on Three Study Materials Used for Ocular Protection

Background It is dangerous, though not uncommon, in some clinical settings for laser operators to place gauze underneath external patient protective eyewear when performing laser procedures. Objectives The purpose of this study was to evaluate four lasers, commonly used for aesthetic facial procedures, on three materials commonly found in the clinical setting. Methods Four lasers were utilized, the 2940nm Erbium-doped Yttrium Aluminum Garnet (Er:YAG) laser, the 532nm Potassium Titanyl Phosphate (KTP) laser, the 1064nm Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser, and a Lumenis UltraPulse 10,600nm carbon dioxide (CO2) laser. Their effects were evaluated on dry gauze pads, wet gauze pads, and adhesive external eye shields. Results When exposed to the 2940nm Er:YAG and 10,600nm COs lasers, dry gauze smoked on the first pulse and ignited on the second pulse, while no damage occurred to the wet gauze or adhesive eye shields after 8 and 4 pulses, respectively. No damage to any material or the underlying surface was seen after 30 pulses of the 532nm KTP laser. After 2 pulses of the 1064nm Nd:YAG laser, the adhesive eye shields sparked; dry gauze smoked after 1 pulse, but no damage to the underlying surface occurred after 30 pulses. Conclusions The results of our study highlight the inherent flammability of gauze when exposed to lasers commonly used to address aesthetic facial concerns. Although moistened gauze conveyed more protection than dry gauze, these results do not guarantee patient ocular safety. Therefore, the authors do not recommend the use of any gauze under protective eyewear.