1/8. Internal orbital fractures in the pediatric age group: characterization and management.OBJECTIVE: To evaluate the specific characteristics and management of internal orbital fractures in the pediatric population. DESIGN: Retrospective observational case series. PARTICIPANTS: Thirty-four pediatric patients between the ages of 1 and 18 years with internal orbital ("blowout") fractures. methods: Records of pediatric patients presenting with internal orbital fractures over a 5-year period were reviewed, including detailed preoperative and postoperative evaluations, surgical management, and medical management. MAIN OUTCOME MEASURES: Ocular motility restriction, enophthalmos, nausea and vomiting, and postoperative complications. RESULTS: Floor fractures were by far the most common fracture type (71%). Eleven of 34 patients required surgical intervention for ocular motility restriction. Eight were trapdoor-type fractures with soft-tissue incarceration; five had nausea and vomiting. Early surgical intervention (<2 weeks) resulted in a more complete return of ocular motility compared with the late intervention group. CONCLUSIONS: Trapdoor-type fractures, usually involving the orbital floor, are common in the pediatric age group. These fractures may be small with minimal soft-tissue incarceration, making the findings on computed tomography scans quite subtle at times. Marked motility restriction and nausea/vomiting should alert the physician to the possibility of a trapdoor-type fracture and the need for prompt surgical intervention.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Avoidance of radiation injuries from medical interventional procedures.Interventional radiology (fluoroscopically-guided) techniques are being used by an increasing number of clinicians not adequately trained in radiation safety or radiobiology. Many of these interventionists are not aware of the potential for injury from these procedures or the simple methods for decreasing their incidence. Many patients are not being counselled on the radiation risks, nor followed up when radiation doses from difficult procedures may lead to injury. Some patients are suffering radiation-induced skin injuries and younger patients may face an increased risk of future cancer. Interventionists are having their practice limited or suffering injury, and are exposing their staff to high doses.In some interventional procedures, skin doses to patients approach those experienced in some cancer radiotherapy fractions. Radiation-induced skin injuries are occurring in patients due to the use of inappropriate equipment and, more often, poor operational technique. Injuries to physicians and staff performing interventional procedures have also been observed. Acute radiation doses (to patients) may cause erythema at 2 Gy, cataract at 2 Gy, permanent epilation at 7 Gy, and delayed skin necrosis at 12 Gy. Protracted (occupational) exposures to the eye may cause cataract at 4 Gy if the dose is received in less than 3 months, at 5.5 Gy if received over a period exceeding 3 months.Practical actions to control dose to the patient and to the staff are listed. The absorbed dose to the patient in the area of skin that receives the maximum dose is of priority concern. Each local clinical protocol should include, for each type of interventional procedure, a statement on the cumulative skin doses and skin sites associated with the various parts of the procedure. Interventionists should be trained to use information on skin dose and on practical techniques to control dose. Maximum cumulative absorbed doses that appear to approach or exceed 1 Gy (for procedures that may be repeated) or 3 Gy (for any procedure) should be recorded in the patient record, and there should be a patient follow-up procedure for such cases. patients should be counselled if there is a significant risk of radiation-induced injury, and the patient's personal physician should be informed of the possibility of radiation effects. Training in radiological protection for patients and staff should be an integral part of the education for those using interventional techniques. All interventionists should audit and review the outcomes of their procedures for radiation injury. Risks and benefits, including radiation risks, should be taken into account when new interventional techniques are introduced.A concluding list of recommendations is given. Annexes list procedures, patient and staff doses, a sample local clinical protocol, dose quantities used, and a procurement checklist.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/8. 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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Vitreous floaters following use of dermatologic lasers.BACKGROUND: Laser eye protection has been designed to protect operators and patients from severe eye injuries. OBJECTIVE: To describe two cases in which lasers used for cutaneous therapy may have been associated with the induction of vitreous floaters, a subacute eye injury, in physicians operating these devices, and to review the theoretical feasibility of such injuries, prior reports of the same, and strategies for minimizing risk. methods: Report of two cases and review of the literature. RESULTS: Given the circumstantial evidence, it is possible that subacute vitreous injuries may be sustained by the operators of dermatologic lasers. Ex vivo experiments and previous case reports have demonstrated the possibility of laser-induced vitreous injury, including changes in vitreous conformation and vitreous hemorrhage, in the absence of permanent retinal deficits. It may be speculated that vitreous floaters are a milder manifestation of such subacute injuries. CONCLUSION: To the extent that vitreous floaters can multiply and presage the onset of severe retinal injury, the risk of their induction by dermatologic lasers should be minimized. Simple strategies and further research can help achieve this goal.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Penetrating injuries to the orbit.Although penetrating orbital wounds are an uncommon entity they are often associated with vision and life-threatening complications. By careful attention to the history and physical signs of the injured patient and the use of modern computed tomography (CT) scan imaging, the physician will be better able to make an accurate analysis and prognosis of the problem at hand as well as a well-planned therapeutic approach.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Severe ocular trauma without corneal rupture after radial keratotomy: case reports.The vulnerability of the ocular coat to trauma following radial keratotomy is an issue of concern to both patients and physicians. Herein, we report two cases of eyes which were exposed to severe trauma after previously undergoing radial keratotomy procedures. In the first case, a woman sustained multiple facial bone fractures in a fatal airplane crash. In the second case, a man was involved in a case of blunt ocular trauma involving a high velocity racquetball. rupture of the ocular coat did not occur in either case.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Luxation of the globe.Emergency physicians encounter globe luxation, anterior dislocation of the eyeball beyond retracted lids, in a limited number of clinical circumstances. The authors present a case of spontaneous luxation followed by a general discussion of luxation. An understanding of the pathophysiology of various causes of luxation and the appropriate method and timing of reduction allows appropriate evaluation, treatment, and follow-up, thereby limiting patient discomfort, recurrence, and perhaps long-term visual impairment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Isolated medial orbital blow-out fracture with medial rectus entrapment.PURPOSE: The authors report on three cases of isolated medial orbital blow-out fracture with medial rectus entrapment which occurred in black males. Only a few similar cases have been reported in the literature. methods: The diagnosis was established with the help of tomography and CT scan of the orbit. RESULTS: The diagnosis could be expected from the clinical signs occurring after blow-out trauma mechanisms: eyelid emphysema, nasal subconjunctival haemorrhage, motility disturbance, enophthalmos. CONCLUSION: An ethnic anatomic hypothesis could explain the predominance of this fracture in blacks. This fracture often remains undiagnosed. The diagnosis was based on axial and especially coronal CT scan of the orbit. The physician should be alerted by some clinical signs that justify these radiographic techniques.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |