Cases reported • Eye Injuries

1/29. Air bag-associated ocular trauma in children.

OBJECTIVE: To describe a series of children with ocular injuries related to air bag deployment. DESIGN: Retrospective, observational case series. PARTICIPANTS: Seven patients with ocular injuries sustained in motor vehicle accidents in which air bags were deployed. methods: Review of medical records. RESULTS: All patients had periocular contusions. Minor injuries included corneal abrasions (n = 5), superficial eyelid laceration (n = 1), and traumatic iritis (n = 2). Serious injuries included corneal edema (n = 1) and a traumatic hyphema with secondary glaucoma and cataract (n = 1). The latter patient required surgery. All other injuries resolved with medical therapy. All patients recovered normal visual acuity. CONCLUSIONS: Serious ocular injuries in children may result from air bag deployment. Most such injuries are minor and resolve without sequela. It is recommended that infants and children travel in the rear seat of automobiles to minimize their risk of injury.

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2/29. Post hoc, ergo propter hoc.

Three cases are described in which patients sought damages for retinal detachments that followed minor trauma. In fact, the traumatic incidents were not responsible for the detachments. Criteria for diagnosing traumatic retinal detachments are summarized, and ophthalmologists and attorneys are cautioned to be wary of post hoc reasoning.

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3/29. More than tears in your eyes (exophiala jeanselmei keratitis).

PURPOSE: To describe a patient with exophiala jeanselmei keratitis. methods. CASE REPORT: One patient with persistent corneal infiltrate that developed several days after a minor ocular trauma from an onion slice. RESULTS: culture plates from corneal scraping showed a growth of the yeast exophiala jeanselmei, a rare causative agent of ocular infection. CONCLUSIONS: Whenever a corneal abscess does not improve with the usual antibiotic treatment, a thorough ophthalmic history should be taken to determine whether there was a recent ocular trauma. If the trauma was caused by a plant material, the physician should raise the possibility of an unusual fungal infection.

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4/29. Penetrating keratoplasty as a globe-saving procedure in fragile cornea.

PURPOSE: To report a case of fragile cornea associated with osteogenesis imperfecta type I in which primary penetrating keratoplasty was done as a tectonic procedure. methods: A 6-year-old boy with osteogenesis imperfecta type I presented with a corneal laceration in his right eye following minor trauma. Since wound repair was not possible due to tissue loss, he underwent a primary penetrating keratoplasty. RESULTS: Postoperatively, the eye healed well without any wound leak. The boy had uneventful suture removal 10 weeks following surgery. CONCLUSION: Primary penetrating keratoplasty is a viable option to restore ocular integrity in fragile corneas following trauma when tissue loss precludes simple repair.

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5/29. Late anterior traumatic subluxation of a circular in-the-bag intraocular lens associated with lack of posterior capsule opacification.

We report a case of traumatic subluxation of a circular poly(methyl methacrylate) intraocular lens (IOL) 5 years after surgery. Slitlamp examination revealed the lack of epithelial cells or fibrosis in the intact capsule bag. Trauma was minor, and no other complication was found in the eye and orbit. The subluxated IOL was easily relocated in the bag with a hook, revealing the poor capsule sealing. Among the factors ensuring the fixation of IOLs placed in the bag after continuous curvilinear capsulotomy are sealing of the anterior and posterior capsules and proliferation of epithelial cells from the equator of the bag.

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6/29. cataract after minor trauma in a young patient with an iris-fixated intraocular lens for high myopia.

PURPOSE: To report a case of traumatic cataract in a young patient with an iris-fixated phakic intraocular lens (PIOL). DESIGN: Interventional case report. METHOD: A 32-year-old woman with bilateral iris-fixated PIOLs for high myopia presented with a cortical cataract 2 weeks after minor ocular trauma. Ultrasound biomicroscopy and endothelial cell count were performed before and after cataract surgery. RESULTS: The distance between the PIOL and the crystalline lens was 0.82 mm; the distance between the PIOL and the corneal endothelium was 2.30 mm. Endothelial cell count was 2,500 cells/mm(2) before surgery and 2,476 cells/mm(2) at 1 year follow-up. CONCLUSIONS: patients with iris-fixated PIOLs are at risk of rapid cataract progression after minor ocular traumatism.

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7/29. Post traumatic subconjunctival dislocation of lens in ehlers-danlos syndrome.

Ehlers-Danlos Syndromes are a rare group of inherited connective tissue disorders of defective collagen synthesis. They predominantly involve the skin, joints and vessels. Ocular involvement in the form of blue sclera, microcornea and susceptibility to trauma is a common feature of EDS type VI. A minor ocular trauma in these patients can cause globe rupture. We herein report simple and successful management of a case of traumatic subconjunctival dislocation of lens in a patient of EDS type VI.

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8/29. Atypical mycobacterium keratitis.

We present two cases of mycobacterium chelonae keratitis, both of which followed minor corneal trauma. One case initially showed improvement with medical therapy alone but eventually required penetrating keratoplasty. The second case required surgical intervention to provide tectonic support, but the infection resolved with antibiotic therapy.

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9/29. Ophthalmic injuries in children involved in all-terrain vehicle crashes.

PURPOSE: To describe the spectrum of ophthalmic injuries in children involved in all-terrain vehicle (ATV) crashes. methods: We retrospectively reviewed the medical records of a level 1 children's trauma center to identify cases with ICD-9 codes pertaining to crashes involving ATVs and cross-referenced for ophthalmic trauma. From these cases, we documented the nature of the crash, patient's age, ophthalmic injuries received, and length of hospitalization. RESULTS: Twenty children, 5 to 16 years of age (mean, 11.1 years), involved in ATV crashes were admitted between June 1997 and April 2002. One was riding with an adult and 3 with other children; 16 were operating the vehicles alone at the time of their crashes. None was wearing a helmet, and all had head trauma. Nine patients had ophthalmic injuries, including lacerations of the eyelid (n = 5), orbital fractures (n = 9), and traumatic optic neuropathies (n = 2). The latter two had final visual acuities of count fingers and no light perception. The average length of hospitalization was 6.6 days. CONCLUSIONS: Ophthalmic trauma is a frequent complication of ATV crashes involving children. Injuries may range from minor lacerations to complex orbital fractures; visual loss may be severe. We believe that the age of the vehicles' operators and their failure to wear protective helmets contribute to the severity of injuries.

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10/29. Pseudopterygium arising in a patient with multiple keloids.

We describe an unusual case of mechanical restriction of the globe caused by pseudopterygium formation at the site of a minor ocular injury, which led to a possible link between ebstein's anomaly and keloids.

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