1/7. The role of ultrasound biomicroscopy in ocular trauma.PURPOSE: To demonstrate the usefulness of ultrasound biomicroscopy (UBM) in detecting and localizing small ocular foreign bodies. methods: This is a retrospective study of the records of 555 consecutive patients evaluated by UBM by the Visual physiology Unit of the wills eye Hospital from August 1994 to November 1997. RESULTS: In 9 patients, a foreign body was identified. In 6 patients, the history suggested the presence of a foreign body, but one could not be detected by clinical examination. In 2 patients, the referring physicians requested UBM to determine whether or how deep a known foreign body had penetrated the globe. In 1 patient, the foreign body was not suspected clinically. In regard to other diagnostic techniques, CT failed to identify the foreign body in 1 patient. In another, contact B-scan ultrasonography failed. In a third, both CT and contact B-scan ultrasonography failed. The foreign body was intracorneal in 2 eyes, subconjunctival in 2, intrascleral in 3, and intraocular in 2. Six were nonmetallic. Two were metallic. In one case, the foreign body was lost and its composition is unknown. In 5 cases, the UBM findings altered the patient's management. CONCLUSIONS: UBM is a valuable adjunct in the evaluation of small, anteriorly located foreign body that may not be detectable by other methods. UBM may be especially useful for finding nonmetallic foreign bodies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Pediatric eye injury due to Avena fatua (wild oats).OBJECTIVE: We report on florid and unusual ophthalmic physical signs in three children where the trauma was caused by seeds from Avena fatua, a grass common in western north america. DESIGN: Case series and literature review. SETTING: Three local emergency departments (ED) during the fall of 1998. patients OR PARTICIPANTS: Three children reporting to an ED with an acutely painful eye from which the foreign body was identified botanically as Avena fatua. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Symptoms, interventions, duration of problem. RESULTS: Three male children (6, 10, 14 years) presented separately following incidents in which they had sustained direct eye injury. Each child immediately experienced severe pain and profuse watering of the eye. Severe localized edema of the conjunctiva and inflammation was evident with conjunctival vessel injection leading to bleeding, reminiscent of a chemical "burn." Initially, two children appeared to have an eyelash caught behind the lower lid. In both instances, the emergency physicians initially dismissed the possibility of there being a significant foreign body, but because of the severity of the pain, conjunctival vessel injection, and edema, they attempted to remove the "lash." Removal of the foreign body proved difficult in all three cases, requiring far greater traction than anticipated. Intact seedpods had become embedded in the subconjunctival space. Ophthalmic analgesia relieved the pain immediately, but in one child who was treated with topical antibiotic alone, significant pain was experienced for 18 hours, until steroid-antibiotic therapy was instituted. All injuries occurred in late summer when the grass propagates. CONCLUSIONS: The physical signs of scleral vasculitis and conjunctival edema can be mistaken for chemical injury or allergic chemosis, but where a foreign body resembling a hair or eyelash is visible, the presence of a seed-pod retained in the subconjunctival space must be considered, particularly if the patient reports exposure to wild grass. Application of local analgesia, foreign body removal, and steroid-antibiotic treatment is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. A metallic foreign body presenting in the anterior chamber angle.PURPOSE: This article describes a case in which a patient presented with a previously undetected metallic foreign body in the anterior chamber angle. methods AND RESULTS: A 42-year-old Hispanic man presented with a 5-day history of foreign-body sensation and redness in his left eye. He had been using a hand saw without safety glasses 2 days before the onset of his initial symptoms. Physical examination revealed a metallic foreign body embedded in the inferior angle of his left eye. Surgical removal of the foreign body was performed, and the patient remains well 1 year after surgery. CONCLUSIONS: All physicians should maintain a high degree of clinical suspicion for intraocular foreign bodies when presented with a patient who may have sustained ocular trauma. All eye-care providers need to emphasize the need for proper eye protection to patients who engage in high risk activities that may lead to penetrating ocular trauma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Attack of the sand brier.Corneal foreign bodies represent one of the more common sources of eye-related trauma presenting to emergency and primary care physicians. Presented is the case of a man in whom the diagnosis was overlooked because a magnifying optical device was not used.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. iron mydriasis. Pupillary paresis from occult intraocular foreign body.Two patients presented with unilateral dilated and poorly reactive pupils and were found to have a previously unsuspected intraocular iron foreign body. Both of them had normal vision and one had normal color of the iris so that the condition was missed by several physicians. The pupils reacted normally to pilocarpine 1% and also showed response to dilute (0.1%) pilocarpine. There was no response to phospholine iodide. These findings indicate that the mydriasis was due to a local siderotic parasympathetic neuropathy of the pupil.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Common eye disorders: six patients to treat, pitfalls to avoid.Primary care physicians have an important role in diagnosing and treating eye disorders--including dacryocystitis, blepharitis, and conjunctivitis--and in determining when ophthalmologic referral is needed. Fundus examination for diagnosis of glaucoma and diabetic eye complications should be a part of the routine examination in all adults. patients with hiv or AIDS should be carefully monitored for cytomegalovirus retinitis. Children should be tested for amblyopia. orbital cellulitis can have serious complications and must be vigorously treated. Finally, careful use of ophthalmologic topical agents, especially corticosteroid drops, is essential.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Intracranial penetrating injuries via the optic canal.Two cases of intracranial penetration of a plastic or wooden chopstick via the optic canal are described. CT scans showed the chopsticks as linear hypodense structures in the suprasellar cistern contiguous with the optic canal. In one case, MR imaging was performed, which clearly depicted the foreign body and adjacent brain structures. Although they are extremely rare, transorbital intracranial penetrating injuries via the optic canal require physicians' awareness.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |