We report a case of globe avulsion secondary to maxillofacial trauma and propose potential mechanisms of injury. This case highlights the importance of wearing proper safety attire, especially during motorcycling.
Durian may inflict severe body injury when it drops from the tree. This case report describes a patient who presented with facial and penetrating eye injury when a ripe durian fruit dropped onto her face while harvesting the fruits under the tree. The authors emphasized the importance of facial and eye protective devices during durian fruit harvesting season.
Blunt ocular trauma may result in expulsion of the intraocular lens in a patient who has undergone cataract surgery. This case report describes a patient who presented with an extrusion of intraocular lens following blunt ocular trauma post-operatively. The authors emphasise the importance of patient counselling and protection of the operated eye after surgery.
Corneal perforation is an ocular emergency that requires early intervention to avoid permanent visual loss from endophthalmitis or irreversible structural changes. Although tectonic keratoplasty is the best choice for patching a large perforation, a donor cornea is not always immediately available. Consequently, an alternative material is required while awaiting a donor cornea. We report the use of preserved bovine pericardium as a temporizing graft to maintain the ocular integrity in two patients with corneal perforation.
Ocular fishhook injuries are rare, yet potentially vision threatening as complications such as corneal scarring, retinal detachment and endophthalmitis may result. The surgical management of these cases is challenging due to the construction of barbed fishhooks.
The results of sixty-four perforating eye injuries with intraocular foreign bodies (IOFB) treated at University Hospital over ten years were reported. Compared to an earlier report we found that the population at risk was the same and consisted of patients under 35 years (70%), males (95.3%) and work related (86%). The commonest causes of IOFB were hand hammer (64.1%) and grass cutting (20.3%). We also noted that while the incidence of cases had increased by 23%, the final visual outcome has improved significantly due to advances in preoperative diagnosis and surgical techniques. Preoperative factors found to have a statistically significant effect on the final visual outcome were the size of the IOFB, poor initial visual acuity, and the presence of the following complications: cataract, iris damage and vitreous haemorrhage. The outcome was also worse in posterior segment IOFBs but this was not statistically significant.
One hundred and sixty seven (167) perforating eye injuries involving 159 patients were analyzed in a retrospective study over a three-year period. The degree of blindness and their associated factors were determined. Most patients were in the first three decades of life and were males. One hundred and seven (64%) eyes had vision of 3/60 or worse at initial assessment. Of these only 45% of eyes had improved vision to 6/36 or better at six months of follow-up. Fifty-five per cent of eyes were blind. The only significant associated factor identified was the extent of injury. Age, time interval and mechanism of injury were not significant factors.
A retrospective study of 37 intraocular foreign bodies treated over a five-year period is presented. Their aetiology, complications and visual results are discussed in the light of recent development in the management of serious ocular trauma.
Study site: Hospital Kuala Lumpur, Malaysia (UKM unit)
45 patients (50 eyes) were treated for juvenile rhegmatogenous retinal detachments between August 1979 and July 1984. A review of these cases revealed high myopia and trauma to be the main aetiological factors. Eight-six per cent detachments were successfully reattached. Visual acuity of 6/36 or better was present in 16% preoperatively and in 52% postoperatively, some of the characteristics of juvenile rhegmatogenous retinal detachments in Malaysian population are discussed.
Between 1st January 1999 and 31st December 2000, 452 foreign nationals were treated at the Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru. Eighty-five percent were male. The peak age range was from 21 to 30 years old. The patients were predominantly Indonesians (61%). A history of trauma was present in 63% of patients. Eight percent of eyes had severe visual impairment. Six patients (1.3%) were blind by WHO standards. Traumatic eye conditions, inflammatory/allergic eye conditions and degenerative eye conditions comprised 66%, 13% and 10% respectively of ocular pathology seen. The commonest ocular findings were corneal foreign body, corneal abrasion and subconjunctival haemorrhage.
Between 1st January 1999 and 31st December 2000, 152 patients (156 eyes) with open-globe injuries were treated in the Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru. The majority were male (88.2%), Malay (63.2%), from the Johor Bahru district (51.3%) and aged between 21 and 30 years (23.7%). Most injuries were workplace-related (41.4%). Lens injury, retinal detachment, endophthalmitis, intraocular foreign bodies and phthisis occurred in 40.4%, 15.4%, 14.7%, 12.2% and 11.5% of eyes respectively. A favourable visual outcome occurred in 55.4% of eyes. Prognostic factors for visual outcome include presenting visual acuity, relative afferent pupillary defect, wound location, lens injury, retinal detachment and endophthalmitis.
Ocular chemical injury is a true ophthalmic emergency requiring immediate medical intervention. Damages can be devastating and potentially resulting in blindness, corneal perforation and phthisis bulbi. We describe here a successful treatment outcome in a patient who sustained Roper-Hall Grade 4 injury to both eyes. Patient received medical therapy followed by serial ocular surgeries with eventual visual recovery in one eye from counting finger to 6/15 after a decade. In conclusion, after maximum medical therapy, a carefully planned serial surgeries of cultivated oral mucosal epithelial transplantation (COMET) and PK has proven beneficial for this patient with advanced limbal stem cell deficiency (LSCD).
A hot water burn is a thermal injury that results in cell death. Thermal eye injury triggers inflammatory processes, including inflammatory cell influx and/or the activation of various inflammatory cells, which result in the rapid accumulation of extravascular fluid in the ocular tissue. The ocular effect depends on the temperature of the water, and the final visual outcome depends on the severity of the damage to the intraocular structures. We report a 23-year-old woman who experienced a facial hot water burn that resulted in blindness. The patient presented late to the hospital after the unsuccessful use of traditional medication. Facial burns are a known cause of blindness. Public health education on prompt hospital presentation, and resistance to the use of potentially harmful traditional medicine in facial burns is suggested.
A giant retinal tear (GRT) is a full-thickness neurosensory retinal break that extends circumferentially around the retina for three or more clock hours in the presence of a posteriorly detached vitreous. Its incidence in large population-based studies has been estimated as 1.5% of rhegmatogenous retinal detachments, with a significant male preponderance, and bilaterality in 12.8%. Most GRTs are idiopathic, with trauma, hereditary vitreoretinopathies and high myopia each being causative in decreasing frequency. The vast majority of GRTs are currently managed with a pars plana vitrectomy; the use of adjunctive circumferential scleral buckling is debated, but no studies have shown a clear anatomical or visual advantage with its use. Similarly, silicone oil tamponade does not influence long-term outcomes when compared with gas. Primary and final retinal reattachment rates are achieved in 88% and 95% of patients, respectively. Even when the retina remains attached, however, visual recovery may be limited. Furthermore, fellow eyes of patients with a GRT are at higher risk of developing retinal tears and retinal detachment. Prophylactic treatment under these circumstances may be considered but there is no firm evidence of its efficacy at the present time.