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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 -
BMC Ophthalmology Apr 2021Retrobulbar hemorrhage (RBH) is a rare complication after orbital surgery but associated with ocular complications including blindness. The aim of this study was to...
BACKGROUND
Retrobulbar hemorrhage (RBH) is a rare complication after orbital surgery but associated with ocular complications including blindness. The aim of this study was to identify clinical characteristics of patients with RBH requiring emergent orbital decompression after blowout fracture repair.
METHOD
A retrospective review of 426 blowout fracture patients at a tertiary oculoplastic clinic provided data regarding demographics, physical examination findings, and computed tomography (CT) images. Extraocular motility had been recorded in patient charts on a scale from 0 to - 4. Patients requiring emergent orbital decompression due to RBH after surgery (RBH group) were compared with those who did not (Control group), using the Mann-Whitney U-test. Incidences of RBH according to primary or secondary surgery were also investigated, using Fisher's exact test.
RESULT
Five (1.2%) of the 426 patients who underwent blowout fracture repair developed RBH requiring emergent intervention. All RBH patients fully recovered after the decompression procedure or conservative treatment. Number of days to surgery was significantly longer in the RBH group (97.0 ± 80.1) than in the Control group (29.0 ± 253.0) (p = 0.05). Preoperative enophthalmos was also significantly greater in the RBH group (RBH vs. Control group, 3.6 ± 1.7 mm versus 1.2 ± 1.3 mm (p = 0.003)). The incidence of RBH was significantly higher in patients that underwent secondary surgery (odds ratio = 92.9 [95% confidence interval, 11.16-773.23], p = 0.001).
CONCLUSIONS
Surgeons should pay more attention to hemostasis and postoperative care in patients with a large preoperative enophthalmic eye, when time from injury to surgery is long and in revision cases. When RBH occurs, time to intervention and surgical decompression is critical for visual recovery and preventing blindness.
TRIAL REGISTRATION
The institutional review board of the Yeungnam University Medical Center approved this study ( YUMC 2018-11-010 ), which was conducted in accord with the Declaration of Helsinki.
Topics: Enophthalmos; Humans; Incidence; Orbital Fractures; Retrobulbar Hemorrhage; Retrospective Studies
PubMed: 33888073
DOI: 10.1186/s12886-021-01943-1 -
Case Reports in Radiology 2015Background. Spontaneous orbital haemorrhage is a very rare condition and vision-threatening event. It may occur due to trauma, orbital surgery/injections, orbital...
Background. Spontaneous orbital haemorrhage is a very rare condition and vision-threatening event. It may occur due to trauma, orbital surgery/injections, orbital vascular anomalies, and a variety of systemic predisposing factors. Signs of retrobulbar hemorrhage include proptosis, ophthalmoplegia, increased intraocular pressure, loss of pupillary reflexes, and optic disc or retinal pallor. Both Computed Tomography scan and Magnetic Resonance Imaging may be performed in the diagnosis. Case Report. A 31-year-old woman was referred to our hospital with a complaint of headache and blurred vision following a strong sneeze. Ophthalmological examination revealed mild Relative Afferent Pupillary Defect in left eye. Computed Tomography revealed left hyperdense retrobulbar mass and displaced optic nerve. T1 weighted hypointense, T2 weighted hyperintense and non-enhanced round shape, sharply demarcated lesion measuring 18 × 15 × 14 × mm in diameter compatible with haematoma was detected by MRI. Surgically Caldwell-Luc procedure was performed. Histological examination confirmed haematoma. Follow-up Magnetic Resonance Imaging revealed a small reduction in the size of lesion but not complete resolution. The patient's complaint was regressed. She is now free of symptoms and is still under surveillance. To our knowledge, this is the first reported case of retrobulbar haematoma caused by sneeze.
PubMed: 26090258
DOI: 10.1155/2015/796834 -
The Cochrane Database of Systematic... Jul 2015Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local anaesthesia involves the blockage of a nerve subserving a given part of the body. It involves infiltration of the area around the nerve with local anaesthetic. The two main approaches in the eye are retrobulbar and peribulbar. There is debate over whether the peribulbar approach provides more effective, safer anaesthesia for cataract surgery than retrobulbar block.
OBJECTIVES
The objective of this review was to assess the effects of peribulbar anaesthesia (PB) compared to retrobulbar anaesthesia (RB) on pain scores, ocular akinesia, patient acceptability and ocular and systemic complications.
SEARCH METHODS
In the previous version of our review, we searched the databases until December 2007. In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (March 2015); MEDLINE (1960 to March 2015); and EMBASE (1980 to March 2015).
SELECTION CRITERIA
We included randomized controlled clinical trials comparing peribulbar anaesthesia and retrobulbar anaesthesia for cataract surgery.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. We contacted trial authors for additional information, study methodology and missing data. We carried out a descriptive narrative of results as the included studies used varied methods for reporting the outcomes. We performed a subgroup analysis for globe akinesia.
MAIN RESULTS
We included six trials involving 1438 participants. Three of the six trials had adequate sequence generation while all the trials had unclear allocation concealment There was no evidence of any difference in pain perception during surgery with either retrobulbar or peribulbar anaesthesia. Both were largely effective. There was no evidence of any difference in complete akinesia or the need for further injections of local anaesthetic. Conjunctival chemosis was more common after peribulbar block (relative risk (RR) 2.11, 95% confidence interval (CI) 1.46 to 3.05) and lid haematoma was more common after retrobulbar block (RR 0.36, 95% CI 0.15 to 0.88). Retrobulbar haemorrhage was uncommon and occurred only once, in a patient who had a retrobulbar block.
AUTHORS' CONCLUSIONS
There is little to choose between peribulbar and retrobulbar block in terms of anaesthesia and akinesia during surgery measuring acceptability to patients, need for additional injections and development of severe complications. Severe local or systemic complications were rare for both types of block.
Topics: Anesthesia, Local; Cataract Extraction; Humans; Nerve Block; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 26133124
DOI: 10.1002/14651858.CD004083.pub3 -
Diagnostics (Basel, Switzerland) Jun 2022The orbit is a closed compartment defined by the orbital bones and the orbital septum. Some diseases of the orbit and the optic nerve are associated with an increased... (Review)
Review
The orbit is a closed compartment defined by the orbital bones and the orbital septum. Some diseases of the orbit and the optic nerve are associated with an increased orbital compartment pressure (OCP), e.g., retrobulbar hemorrhage or thyroid eye disease. Our aim was to review the literature on the different approaches to assess OCP. Historically, an assessment of the tissue resistance provoked by the retropulsion of the eye bulb was the method of choice for estimating OCP, either by digital palpation or with specifically designed devices. We found a total of 20 articles reporting direct OCP measurement in animals, cadavers and humans. In nine studies, OCP was directly measured in humans, of which five used a minimally invasive approach. Two groups used experimental/custom devices, whilst the others applied commercially available devices commonly used for monitoring the compartment syndromes of the limbs. None of the nine articles on direct OCP measurements in humans reported complications. Today, OCP is mainly estimated using clinical findings considered surrogates, e.g., elevated intraocular pressure or proptosis. These diagnostic markers appear to reliably indicate elevated OCP. However, particularly minimally invasive approaches show promises for direct OCP measurements. In the future, more sophisticated, specifically designed equipment might allow for even better and safer measurements and hence facilitate the diagnosis and monitoring of orbital diseases.
PubMed: 35741290
DOI: 10.3390/diagnostics12061481 -
Indian Journal of Ophthalmology Feb 2018
Topics: Child; Diagnosis, Differential; Eye Injuries; Humans; Male; Orbit; Retrobulbar Hemorrhage; Tomography, X-Ray Computed
PubMed: 29380755
DOI: 10.4103/ijo.IJO_1311_17 -
American Journal of Ophthalmology Case... Mar 2024This case report presents an event of retrobulbar hemorrhage (RH) occurring during the initial stage of strabismus surgery after incision of the conjunctiva and Tenon's...
PURPOSE
This case report presents an event of retrobulbar hemorrhage (RH) occurring during the initial stage of strabismus surgery after incision of the conjunctiva and Tenon's capsule.
OBSERVATION
Significant bleeding with subsequent proptosis was observed intraoperatively after the incision of conjunctiva and Tenon's capsule during routine strabismus surgery on the medial rectus muscle in a 5-year-old boy. Intravenous mannitol was administered intraoperatively and surgery was completed as planned. The RH receded within 24 hours without the necessity of orbital decompression. Tenon's capsule prolapse was noted on the first postoperative day and managed with surgical excision under shallow intravenous anesthesia. No damage to the optic nerve or ganglion cells was detected a week after and three months post-surgery.
CONCLUSIONS AND IMPORTANCE
Strabismus surgery bears a risk of RH at every stage of the operation. Careful hemostasis should be provided at each step of the procedure to decrease the risk of such an event. Patients after events of serious intraoperative bleeding should undergo careful post-operative investigation towards coagulation insufficiencies, though no such deficits were identified in the present case.
PubMed: 38292880
DOI: 10.1016/j.ajoc.2024.101991 -
Journal of Neurological Surgery. Part... Aug 2020Transcaruncular and transconjunctival approaches are commonly used by ophthalmic plastic surgeons to access various orbital compartments. These approaches are versatile...
Transcaruncular and transconjunctival approaches are commonly used by ophthalmic plastic surgeons to access various orbital compartments. These approaches are versatile and may be combined with transnasal or transcranial approaches to the orbit to gain optimal access to challenging locations. A major advantage of the transcaruncular and transconjunctival approaches is the lack of a visible skin incision with excellent postoperative cosmesis. As with all orbital surgery, an in-depth knowledge of orbital anatomy and physiology, as well as meticulous hemostasis, is needed to prevent complications including globe injury, permanent vision loss, diplopia, and retrobulbar hemorrhage. This article reviews the surgical steps of these approaches. The indications for each approach and case examples are illustrated.
PubMed: 33072482
DOI: 10.1055/s-0040-1713849