1/12. Delayed presentation of transorbital intracranial pen.A 13 year old Fijian boy sustained a stab wound to the left orbit 3 years ago. It was not appreciated by the treating physicians in fiji that the plastic pen had crossed from the left orbit, through the nose, right orbit and right optic nerve, into the right middle cranial fossa and lodged in the right temporal lobe and that the pen remained in situ for the past 3 years. The boy presented to australia with a discharge from the entry wound in his left lower eyelid. The retained foreign body was not detected on computed tomography imaging, but was detected on subsequent magnetic resonance image. A combined neurosurgery/plastic surgery craniofacial approach was undertaken with successful complete removal of the retained pen, and preservation of vision in his only seeing eye.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/12. Consequence of perforation during peribulbar anesthesia in an only eye.A patient with a blind fellow eye had cataract surgery in the right eye; anesthesia comprised an intraocular injection of lidocaine and bupivacaine. Forty-eight hours after surgery, visual acuity in the right eye was light perception (LP). Three days later, fundus examination showed inferotemporal hemorrhage, retinal whitening consistent with needle tracking, and a diffusely pale optic disc in the operated eye. Computed tomography showed an intact optic nerve in both eyes and high-density vitreal lesions in the right eye. Laser photocoagulation was applied to the retinal break. We believe that a jet stream of anesthetic agent may have transiently increased intraocular volume enough to occlude the central retinal artery. Although the retina remained attached, visual acuity failed to improve beyond LP.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/12. Severe visual loss caused by ocular perforation during chalazion removal.PURPOSE: To report two cases of ocular perforation during chalazion removal procedures leading to severe vision loss. DESIGN: Observational case series. methods: Two patients presented with unilateral decreased vision after chalazion removal procedures. Complete ophthalmologic examinations were performed. RESULTS: Examination revealed a cherry red spot and perforation site in the first patient. In the second patient, there was an intraocular gas bubble and ischemic retina. CONCLUSIONS: Local anesthetic injections for procedures such as chalazia removal can result in ocular perforation. We postulate that the intraocular injections led to extremely high pressures, compromising the blood supply to the retina and optic nerve. Anesthetic injections for all procedures, even chalazia removal, should be done with great caution. It is imperative to avoid injection if ocular perforation is suspected, as the high pressure may cause the majority of the visual morbidity.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/12. suicide-related perforating injury of globe with nail gun.A case is reported of nail gun injury due to suicide attempt involving both orbits, frontal lobe and abdomen, which resulted in an unusual posterior perforation of the left globe. Injury was inflicted with a total of eight nails. Three nails entered the left orbit, one of which perforated the posterior aspect of the left globe. One nail entered the right orbit involving the optic nerve and crossed the midline to finish in the left sphenoid sinus. Three nails entered the frontal lobe near the midline and the final nail pierced the left lobe of the liver. The left eye underwent primary repair, lensectomy and vitrectomy with silicone oil and achieved a visual acuity of 6/60, 3 months post removal of oil with sutured posterior chamber intraocular lens. The right eye suffered traumatic optic neuropathy and currently has a visual acuity of 6/36 due to senile cataract formation. No other serious sequelae resulted from the other injuries and the patient has recovered from his episode of depression.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/12. Potential applications of optical coherence tomography in posterior segment trauma.BACKGROUND AND OBJECTIVE: To describe potential clinical applications of optical coherence tomography (OCT) in diagnosis and surgical timing in eyes with posterior segment trauma. patients AND methods: In a noncomparative study, 7 consecutive patients who had open-globe or closed-globe injury and were found to have posterior abnormality that could also be detected by OCT are described. RESULTS: All patients had documented OCT abnormalities in the posterior segment. In one patient with a penetrating injury, two metal foreign bodies were located in the posterior segment, one in the vitreous compartment coupled with inflammatory reaction and localized posterior vitreous detachment and the other embedded in the retina. In a second patient with a penetrating injury, OCT revealed the appearance of posterior vitreous detachment 5 days after injury. A closed-globe injury in one patient resulted in anterior optic neuropathy, manifested as disc edema and thickening of the circumpapillary retinal nerve fiber layer. The other patients had received blunt trauma and were found to have either full-thickness macular holes (2 patients), retinal pigment epithelium detachment at the papillomacular bundle site (1 patient), or macular edema (1 patient). CONCLUSIONS: OCT may serve as an important adjunct imaging device in evaluation of injuries to the posterior segment, qualitatively and quantitatively. It has potential in diagnosing subtle key abnormalities and in follow-up of these injuries.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/12. Penetrating orbital trauma by stiletto causing complex cranial neuropathies.Penetrating orbital injuries pose a serious threat to vision, ocular motility, and in some cases, life. Long, sharp stiletto objects may penetrate deeply, causing catastrophic damage to orbital structures, despite seemingly trivial entry wounds. The authors present two cases of penetrating orbital injuries by stiletto objects, both entering via small eyelid wounds. Traumatic optic neuropathy occurred in both cases, and was treated with corticosteroids, however the globes escaped direct injury. Injuries to the IIIrd and VIth cranial nerves were also observed. Deep orbital injuries must be excluded in patients presenting with small eyelid wounds caused by sharp penetrating objects.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/12. Manual enucleation of both eyes during assault.Manual enucleation of the eyeball from the orbit during physical assault is rare. Management includes removal of such sightless eyeballs when the optic nerve and extraocular muscles are avulsed. However, other authors recommend replacement of these eyeballs even though visual prognosis is nil and phthisis bulbi is expected. A patient who had bilateral enucleation after assault is described.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/12. Prediction of postoperative vision in eyes with severe trauma.The single most important factor determining the potential for return of useful vision in severely injured eyes is the magnitude of damage incurred by the macula or optic nerve at the time of injury. Most gravely injured eyes have media opacities that prevent funduscopic examination. In such eyes, the flash visually evoked potential is the single best predictor of postoperative vision. The second most reliable predictor is the bright-flash electroretinogram. ultrasonography is an important part of the preoperative assessment of injured eyes with opaque media, but is of less value than electrophysiological testing in predicting postoperative vision in eyes with major trauma.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/12. Calcific phacolysis.BACKGROUND AND methods: The authors report the clinical and ocular histopathologic findings in three patients with longstanding unilateral post-traumatic blindness. After one or more decades, acute pain associated with conjunctival hyperemia and apparent keratoprecipitates or a hypopyon developed in the affected eye of each individual. Phacoanaphylaxis was diagnosed preoperatively in two patients. RESULTS: Calcified granular lens fragments were dispersed throughout all three eyes. The anterior chamber in all patients contained extracellular calcified lens particles, but only one eye contained conspicuous macrophages. Two eyes showed elevated intraocular pressure (IOP), and in one patient calcified particles extended into a glaucomatous optic nerve head. CONCLUSION: To the authors' knowledge, this is the first report describing a rare condition involving the intraocular dispersal of calcified lens particles after disruption of the lens capsule. The authors have designated this entity as calcific phacolysis.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/12. Anterior chiasmal optic nerve avulsion.In a case of traumatic avulsion of the optic nerve at the anterior chiasm, MR imaging provided highly specific images of the injury site, including the absence of the optic nerve within the optic canal and the point of transection at the anterior portion of the chiasm. This was confirmed clinically and histopathologically. MR imaging should be considered in cases of suspected chiasmal injury.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
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