1/21. Giant retinal tears resulting from eye gouging in rugby football.A 29 year old myopic man sustained two separate giant retinal tears in his right eye following deliberate eye gouging during a rugby tackle. These were successfully repaired by vitrectomy and intraocular silicone oil injection. Although the postoperative course was complicated by pupil block glaucoma, he regained corrected visual acuity of 6/5 after oil removal. This injury highlights the potentially sight threatening nature of this type of rugby injury and the importance of early referral for specialist treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/21. Surgical treatment of penetrating orbito-cranial injuries. Case report.Penetrating orbital injuries are not frequent but neither are they rare. The various diagnostic and therapeutic problems are related to the nature of the penetrating object, its velocity, shape and size as well as the possibility that it may be partially or wholly retained within the orbit. The authors present another case with unusual characteristics and discuss the strategies available for the best possible treatment of this traumatic pathology in the light of the published data. The patient in this case was a young man involved in a road accident who presented orbito-cerebral penetration caused by a metal rod with a protective plastic cap. Following the accident, the plastic cap (2.5x2 cm) was partially retained in the orbit. At initial clinical examination, damage appeared to be exclusively ophthalmological. Subsequent CT scan demonstrated the degree of intracerebral involvement. The damaged cerebral tissue was removed together with bone fragments via a bifrontal craniotomy, the foreign body was extracted and the dura repaired. Postoperative recovery was normal and there were no neuro-ophthalmological deficits at long-term clinical assessment. Orbito-cranial penetration, which is generally associated with violent injuries caused by high-velocity missiles, may not be suspected in traumas produced by low-velocity objects. Diagnostic orientation largely depends on precise knowledge of the traumatic event and the object responsible. When penetration is suspected and/or the object responsible is inadequately identified, a CT scan is indicated. The type of procedure to adopt for extraction, depends on the size and nature of the retained object. Although the possibility of non-surgical extraction has been described, surgical removal is the safest form of treatment in cases with extensive laceration and brain contusion.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
3/21. Airbags and bilateral eye injury: five case reports and a review of the literature.We report five cases of bilateral eye injuries from airbag deployment in motor vehicle crashes and review the world's literature on ocular injuries associated with airbags. The cases in the literature were identified by cross-referencing medline searches from airbags and ocular injuries. Additional cases were identified after review of references from each article in the search. An additional 89 cases from the literature were identified and are included for discussion. patients were treated individually in a noncontrolled, nonrandomized fashion according to the nature of each injury with regular follow-up examinations in clinic. Of the 94 cases studied, 24 (27%) were bilateral eye injuries, and 15 (16%) patients were wearing spectacles at the time of the accident. The most common injuries included corneal abrasions, eyelid trauma, and hyphemas. Outcomes ranged from complete resolution of symptoms and return of normal visual acuity to primary enucleation. This report describes the wide spectrum of eye injuries that may occur after airbag deployment. We suggest a management plan for the evaluation and treatment of the ocular complications of airbag-related trauma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/21. Severe eye trauma in boys caused by girls' headbands.Two Alaskan boys were struck in the eye by flexible, bow-shaped girls' headbands. One suffered blunt, non-penetrating injury with hyphema and retinal injury resulting in loss of vision. The other suffered penetrating injury due to the atypical sharp nature of the headband; he required vitrectomy, lensectomy, secondary intraocular lens implant and intense amblyopia therapy. These cases highlight the preponderance of eye injury in boys who use "toys" in a manner for which they were not designed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/21. Strangulation injuries.Strangulation accounts for 10% of all violent deaths in the united states. Many people who are strangled survive. These survivors may have minimal visible external findings. Because of the slowly compressive nature of the forces involved in strangulation, clinicians should be aware of the potential for significant complications including laryngeal fractures, upper airway edema, and vocal cord immobility. survivors are most often assaulted during an incident of intimate partner violence or sexual assault, and need to be specifically asked if they were strangled. Many survivors of strangulation will not volunteer this information. Accurate documentation in the medical chart is essential to substantiate a survivor's account of the incident. Medical providers are a significant community resource with the responsibility to provide expert information to patients and other systems working with survivors of strangulation. This case study reviews a strangulation victim who exhibited some classic findings.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/21. A review of anesthesia for the open globe.There are many factors, both physiological and pharmacological, that influence IOP during anesthesia. The choice of anesthetic technique must consider factors other than IOP such as the patient's general condition, concomitant injuries, and the nature of the operation. At this time, there is no ultrarapidly acting neuromuscular blocking agent to allow succinylcholine to be completely abandoned and no method of succinylcholine pretreatment is completely effective in blocking the increase of IOP. The anesthesia provider must balance the overall risk to the patient with the risk to the injured eye when deciding if succinylcholine is to be used. The controversy regarding the actual risk that succinylcholine presents to the open eye has gone on for years and can be expected to continue.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/21. 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.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/21. Strabismic complications following endoscopic sinus surgery: diagnosis and surgical management.INTRODUCTION: Endoscopic surgical techniques improve the surgeon's view of sinus structures but are subject to extraocular muscle complications that cause permanent diplopia. methods: A series of 15 patients with strabismus following endoscopic sinus surgery was reviewed retrospectively to characterize the type of muscle injury and report the results of surgical correction. RESULTS: A variety of insults to the medial rectus (MR) muscle occurred, ranging from contusion, hematoma, oculomotor nerve damage with paralysis, muscle transection, and muscle destruction. Inferior rectus and superior oblique muscle trauma was observed. High-resolution computed tomography and magnetic resonance imaging scans proved essential in determining the extent and nature of muscle injury. Surgical approaches included anterior orbitotomy with muscle recovery and transposition procedures. CONCLUSIONS: Several extraocular muscles may be traumatized. Timing and type of surgical treatment depend on severity, type of injury, and number of muscles involved. If the remaining posterior segment of the MR muscle is longer than 20 mm and is contractile, muscle recovery via anterior orbital approach is suggested. If injury is more severe, muscle transposition procedures may be helpful. In cases where there is coexistent medial and inferior rectus injury, transposition procedures may not be possible. Inactivation of the antagonist and use of an orbital periosteal flap as a globe tether to center it may be options.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/21. ectopia lentis secondary to physical abuse in a traumatized, elderly individual.The proper diagnosis of ocular emergencies is usually straightforward since the patient generally can communicate the nature and circumstances of the injury. However, the mental status of the patient occasionally may seriously complicate obtaining an accurate history of the trauma. This may be particularly important when the patient has been physically abused by a relative. ectopia lentis is a possible consequence of trauma. The elderly patient herein presented suffered ectopia lentis and had evidence of other systemic trauma. The proper management of a patient of this type will be discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/21. Barbed spear injury to the skull base: case report.A case of a barbed spear injury to the left orbit and skull base is presented. The unusual nature and circumstances of the injury and the management problems related to the proximate neurovascular bundles are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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