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Australian Journal of General Practice Jul 2022Ocular trauma may result in pathology of the ocular surface and adnexa, extraocular muscles, orbital walls, eye and optic nerve. Detailed history followed by a... (Review)
Review
BACKGROUND
Ocular trauma may result in pathology of the ocular surface and adnexa, extraocular muscles, orbital walls, eye and optic nerve. Detailed history followed by a complete ocular and, if indicated, radiological examination is therefore a crucial part of any trauma assessment. It is important to determine whether a patient with ocular trauma can be reassured or requires immediate referral for further investigation and surgical repair.
OBJECTIVE
This review examines chemical eye injuries, orbital fractures, superficial corneal foreign bodies, closed globe injury and suspected open globe injury with or without intra-ocular foreign bodies. A structured approach to the history and examination is provided. The aim of this article is to enhance clinician confidence when encountering these patients.
DISCUSSION
Ocular trauma can lead to serious sight‑ and eye-threatening consequences. Accurate history-taking and astute observation are paramount for timely treatment or referral that may prevent blindness. This review discusses the management and referral pathways for common presentations of ocular trauma.
Topics: Eye; Eye Injuries; Foreign Bodies; Humans
PubMed: 35773155
DOI: 10.31128/AJGP-03-21-5921 -
American Family Physician Jan 2010Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common... (Review)
Review
Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. Allergies or irritants also may cause conjunctivitis. The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.
Topics: Algorithms; Anti-Bacterial Agents; Blepharitis; Burns, Chemical; Corneal Diseases; Corneal Ulcer; Diagnosis, Differential; Dry Eye Syndromes; Endophthalmitis; Eye Burns; Eye Diseases; Eye Foreign Bodies; Eye Infections; Eye Injuries; Family Practice; Glaucoma; Glucocorticoids; Humans; Keratoconjunctivitis; Primary Health Care
PubMed: 20082509
DOI: No ID Found -
American Family Physician Nov 2020Central retinal artery occlusions, chemical injuries, mechanical globe injuries, and retinal detachments are eye emergencies that can result in permanent vision loss if...
Central retinal artery occlusions, chemical injuries, mechanical globe injuries, and retinal detachments are eye emergencies that can result in permanent vision loss if not treated urgently. Family physicians should be able to recognize the signs and symptoms of each condition and be able to perform a basic eye examination. Patients with a central retinal artery occlusion require urgent referral for stroke evaluation and should receive therapy to lower intraocular pressure and vasodilating agents to minimize retinal ischemia. Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface. A globe laceration or rupture is common in patients with a recent history of trauma from a blunt or penetrating object. Physicians should administer prophylactic oral antibiotics after a globe injury to prevent endophthalmitis. The eye should be covered with a metal shield until evaluation by an ophthalmologist. Patients with symptomatic floaters and flashing lights should be referred to an ophthalmologist for a dilated funduscopic examination to evaluate for a retinal tear or detachment.
Topics: Adult; Aged; Consultants; Eye Injuries; Humans; Male; Retinal Artery Occlusion; Retinal Detachment
PubMed: 33118787
DOI: No ID Found -
International Journal of Legal Medicine Mar 2021Darts 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...
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.
Topics: Adolescent; Eye Injuries, Penetrating; Female; Forensic Medicine; Games, Recreational; Humans
PubMed: 33336294
DOI: 10.1007/s00414-020-02477-9 -
American Family Physician Oct 2013Ocular emergencies such as retinal detachments, mechanical globe injuries, and chemical injuries can cause permanent vision loss if they are not recognized and treated... (Review)
Review
Ocular emergencies such as retinal detachments, mechanical globe injuries, and chemical injuries can cause permanent vision loss if they are not recognized and treated promptly. Family physicians should be familiar with the signs and symptoms associated with each condition, and be able to perform a basic eye examination to assess the situation. The assessment includes measurement of visual acuity, pupillary examination, visual field testing, slit lamp or penlight examination of the anterior segment of the eye, and direct funduscopic examination. Patients with symptomatic floaters and flashing lights require a dilated fundoscopic examination and prompt referral to an ophthalmologist for evaluation of a retinal tear or detachment. A globe laceration or rupture should be suspected in patients with a recent history of trauma from a blunt or penetrating object. Prophylactic oral antibiotics can be administered after a globe injury to prevent endophthalmitis, and the eye should be covered with a metal shield until evaluation by an ophthalmologist. Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface.
Topics: Burns, Chemical; Emergencies; Eye Burns; Eye Injuries; Humans; Prognosis; Retinal Detachment
PubMed: 24364572
DOI: No ID Found -
Eye (London, England) Nov 2020Chemical eye injury (CEI) is an acute emergency which can threaten sight and life. These commonly occur at home or the workplace with the former being generally mild and... (Review)
Review
Chemical eye injury (CEI) is an acute emergency which can threaten sight and life. These commonly occur at home or the workplace with the former being generally mild and the latter more severe and bilateral. Major workplace accidents involve other parts of the body and can be associated with inhalation or ingestion of the chemical. Alkali injuries cause damage by saponification of tissue and deeper penetration as a consequence. Acid injuries cause rapid coagulation of tissue, which impedes penetration and limits damage. Irritants such as alcohols, cause superficial epithelial denudation. Severe chemical insult can affect all anterior segment structures causing iris, pupil and lens abnormalities. Eye pressure is variably affected and can be low or high or start as one and rapidly change to the other. Chorioretinal changes in the form of vasculopathy are seen and ascribed to be secondary to anterior segment inflammation rather than due to the direct effect of CEI. Final outcome related to structure and function is determined by the injurious agent, duration of exposure, nature of treatment and the rapidity with which it is instituted. Prevention of further damage by profuse and prolonged eye wash, after ascertaining pH of both eyes, together with exploration and removal of all particulate matter, is the key. Other management principles include a complete and thorough assessment, control of inflammation, facilitation of healing and prevention and management of sequelae and complications. Intraocular pressure is often forgotten and must be assessed and managed. Management often requires a multidisciplinary approach.
Topics: Alkalies; Eye Diseases; Eye Injuries; Humans; Intraocular Pressure; Iris
PubMed: 32572184
DOI: 10.1038/s41433-020-1026-6 -
Acta Ophthalmologica Sep 2019To describe the history of eye injuries and the consequent evolution of eye protection. (Review)
Review
PURPOSE
To describe the history of eye injuries and the consequent evolution of eye protection.
METHODS
A comprehensive search of Medline and the grey literature using the terms 'ocular trauma' and 'eye protection' or 'injury prevention' and 'history'. References were used to identify other relevant publications. Publications were classified according to the setting of eye injury: occupational, recreational or combat-related.
RESULTS
Eye protection has been described in a wide range of sources, including in literature and art. With advances in eye protection material and design, as well as government and societal promotion of appropriate eye protection usage in the workplace, the epidemiology of ocular trauma has changed over time. In developed countries, the use of eye protection in the workplace has reduced the proportion of occupation-related eye injuries over the last century, with a higher proportion occurring during sports or at home. New protection devices and policies have evolved to meet this change.
CONCLUSION
Vision loss has broad implications for the individual and for society and despite available prevention strategies, ocular trauma is a significant cause of preventable monocular and bilateral vision loss. The use of appropriate eye protection has reduced the burden of ocular trauma. History provides lessons for informing current eye protection and eye injury prevention strategies.
Topics: Eye Injuries; Eye Protective Devices; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Ophthalmology
PubMed: 30907494
DOI: 10.1111/aos.14086 -
Biomedical Engineering Online May 2023Open-globe injury is a common cause of blindness clinically caused by blunt trauma, sharp injury, or shock waves, characterised by rupture of the cornea or sclera and... (Review)
Review
Open-globe injury is a common cause of blindness clinically caused by blunt trauma, sharp injury, or shock waves, characterised by rupture of the cornea or sclera and exposure of eye contents to the environment. It causes catastrophic damage to the globe, resulting in severe visual impairment and psychological trauma to the patient. Depending on the structure of the globe, the biomechanics causing ocular rupture can vary, and trauma to different parts of the globe can cause varying degrees of eye injury. The weak parts or parts of the eyeball in contact with foreign bodies rupture when biomechanics, such as external force, unit area impact energy, corneoscleral stress, and intraocular pressure exceed a certain value. Studying the biomechanics of open-globe injury and its influencing factors can provide a reference for eye-contact operations and the design of eye-protection devices. This review summarises the biomechanics of open-globe injury and the relevant factors.
Topics: Humans; Biomechanical Phenomena; Eye Injuries; Cornea; Tonometry, Ocular
PubMed: 37226242
DOI: 10.1186/s12938-023-01117-8 -
Philosophical Transactions of the Royal... Jan 2011Eye injuries come at a high cost to society and are avoidable. Ocular blast injuries can be primary, from the blast wave itself; secondary, from fragments carried by the... (Review)
Review
Eye injuries come at a high cost to society and are avoidable. Ocular blast injuries can be primary, from the blast wave itself; secondary, from fragments carried by the blast wind; tertiary; due to structural collapse or being thrown against a fixed object; or quaternary, from burns and indirect injuries. Ballistic eye protection significantly reduces the incidence of eye injuries and should be encouraged from an early stage in Military training. Management of an injured eye requires meticulous history taking, evaluation of vision that measures the acuity and if there is a relative pupillary defect as well as careful inspection of the eyes, under anaesthetic if necessary. A lateral canthotomy with cantholysis should be performed immediately if there is a sight-threatening retrobulbar haemorrhage. Systemic antibiotics should be prescribed if there is a suspected penetrating or perforating injury. A ruptured globe should be protected by an eye shield. Primary repair of ruptured globes should be performed in a timely fashion. Secondary procedures will often be required at a later date to achieve sight preservation. A poor initial visual acuity is not a guarantee of a poor final result. The final result can be predicted after approximately 3-4 weeks. Future research in eye injuries attempts to reduce scarring and neuronal damage as well as to promote photoreceptor rescue, using post-transcriptional inhibition of cell death pathways and vaccination to promote neural recovery. Where the sight has been lost sensory substitution of a picture from a spectacle mounted video camera to the touch receptors of the tongue can be used to achieve appreciation of the outside world.
Topics: Blast Injuries; Eye Injuries; Eye Protective Devices; Humans; Military Medicine; Military Personnel; Visual Acuity; Warfare
PubMed: 21149360
DOI: 10.1098/rstb.2010.0234 -
Annals of Saudi Medicine 2017Individuals with a factitious ocular disorder feign or exaggerate having an eye injury or intentionally produce an eye injury so as to assume the role of a sick person....
UNLABELLED
Individuals with a factitious ocular disorder feign or exaggerate having an eye injury or intentionally produce an eye injury so as to assume the role of a sick person. We report two cases of self-inflicted ocular injury using needle-like foreign bodies and razor that represent possible diagnoses of Munchausen syndrome. Both patients presented with different clinical pictures that misguided the clinical diagnosis and delayed proper management. Although self-inflicted ocular injuries are rare, ophthalmologists should be aware of the possibility of their existence, particularly when caring for patients with psychiatric conditions.
SIMILAR CASES PUBLISHED
13.
Topics: Adult; Eye Foreign Bodies; Eye Injuries, Penetrating; Humans; Male; Munchausen Syndrome; Self Mutilation
PubMed: 28578365
DOI: 10.5144/0256-4947.2017.245