1/15. Ocular explosion during cataract surgery: a clinical, histopathological, experimental, and biophysical study.INTRODUCTION: An increasing number of cases are being recognized in which a peribulbar anesthetic for cataract surgery has been inadvertently injected directly into the globe under high pressure until the globe ruptures or explodes. We reviewed the records of 6 such cases (one of which was reported previously by us), and one additional case has been reported in the literature. Surprisingly, 2 of these 7 cases went unrecognized at the time, and the surgeons proceeded with the cataract operation; all of the patients ultimately developed severe visual loss and/or loss of the eye. OBJECTIVES: To reproduce this eye explosion in a live anesthetized rabbit model and to perform a clinical, histopathological, experimental, biophysical, and mathematical analysis of this injury. methods: Eyes of live anesthetized rabbits were ruptured by means of the injection of saline directly into the globe under high pressure. The clinical and pathological findings of the ruptured human and animal eyes were documented photographically and/or histopathologically. An experimental, biophysical, and mathematical analysis of the pressures and forces required to rupture the globe via direct injection using human cadavers, human eye-bank eyes, and classic physics and ophthalmic formulas was performed. The laws of Bernoulli, LaPlace, Friedenwald, and Pascal were applied to the theoretical and experimental models of this phenomenon. RESULTS: The clinical and pathological findings of scleral rupture, retinal detachment, vitreous hemorrhage, and lens extrusion were observed. In the exploded human and rabbit eyes, the scleral ruptures appeared at the equator, the limbal area, or the posterior pole. In 2 of the 7 human eyes, the anterior segments appeared entirely normal despite the rupture, and cataract surgery was completed; surgery was canceled in the other 4 cases. In 4 of the 5 injected and ruptured rabbit eyes, the anterior segments appeared essentially normal. The experiments with human eye-bank eyes and the theoretical analyses of this entity show that the pressure required to produce such an injury is much more easily obtained with a 3- or 5-mL syringe than with a syringe 10 mL or larger. CONCLUSIONS: Explosion of an eyeball during the injection of anesthesia for ocular surgery is a devastating injury that may go unrecognized. The probability of an ocular explosion can be minimized by careful use of a syringe 10 mL or larger with a blunt needle, by discontinuing the injection if resistance is met, and by inspecting the globe prior to ocular massage or placement of a Honan balloon. When ocular explosion occurs, immediate referral to and intervention by a vitreoretinal surgeon is optimal. Practicing ophthalmologists should be aware of this blinding but preventable complication of ocular surgery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/15. Attempted bilateral manual enucleation (gouging) during a physical assault.OBJECTIVE: To report a rare, severe case of partial traumatic bilateral enucleation and its assessment and management. DESIGN: Case report and literature review. methods: A report of clinical and imaging findings, surgical procedure, medical treatment, and final outcome. RESULTS: Complete avulsion of the extraocular muscles and optic nerve resulted in total loss of vision in one eye. Partial visual recovery was achieved by operating on the fellow eye, which was partially avulsed. Both eyes underwent lateral canthotomy in the emergency room. This was followed by exploration, repair of all ruptured extraocular muscles, and anterior chamber tap under general anesthesia. The few previously reported cases of traumatic manual avulsion of the globe are reviewed and discussed in the context of the present case. CONCLUSIONS: Partial visual recovery can be achieved after severe orbital and optic nerve trauma. A multidisciplinary approach to the assessment and management of these patients is recommended.- - - - - - - - - - ranking = 0.66666666666667keywords = physical (Clic here for more details about this article) |
3/15. battered child syndrome simulating congenital glaucoma.A 9-week-old child with "congenital glaucoma" was later found to have, in addition to enlarged corneas and elevated intraocular pressure, subluxated and cataractous lenses, hyphema, iridodialysis, angle recession, and vitreous hemorrhage, along with signs of gross parental neglect and physical abuse. To our knowledge, this is the first report in which a battered child with bilateral "congenital glaucoma" (probably caused by trauma) is described.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
4/15. Blinding keratoconjunctivitis and child abuse.PURPOSE: To report an unusual, blinding inflicted eye injury in young children. DESIGN: Observational case report. methods: Retrospective study in an institutional clinical practice of two families in whom the probands had inferior half keratoconjunctivitis and additional signs of child abuse. RESULTS: Two unrelated infants presented with bilateral, asymmetrical, external eye disease affecting the lower half of the cornea and conjunctiva. One eye had perforated. All eyes recovered quickly while the patients were in the hospital with no specific treatment. There were other signs of child abuse detected by further studies on the patients, and in one case, the younger sibling was the subject of severely damaging physical abuse. CONCLUSIONS: Inflicted corneal injuries are nonspecific, and unexplained keratoconjunctivitis, especially in the lower half of the conjunctiva and cornea in infants should alert the clinician to the possibility child abuse, but, by itself cannot be taken as being pathognomonic of abuse.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
5/15. 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 = 0.83333333333333keywords = physical (Clic here for more details about this article) |
6/15. Gunshot wounds of the orbit.Five cases of ocular firearm injuries are presented. A physical analysis of the gunshot wound characteristics, with representative examples, is highlighted. The important early and late complications are completely discussed. Appropriate management sequence, including complete evaluation, diagnostic testing, and surgical intervention, is outlined and discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
7/15. 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 = 0.16666666666667keywords = physical (Clic here for more details about this article) |
8/15. Value of computed tomography for the diagnosis of a ruptured eye.The diagnosis of scleral perforation of the globe following ocular trauma is often obvious on physical examination, but occult perforations occur frequently. In addition to locating intraorbital foreign bodies and associated facial bone fractures, computed tomography of the orbit can suggest an occult scleral rupture. Posterior collapse of the sclera causes flattening of the posterior contour of the globe, the "flat tire" sign. Other associated findings that are suggestive of scleral rupture are intraocular foreign body or gas, thickening of the sclera posteriorly, and a blood-vitreous fluid-fluid level.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
9/15. Retinal complications after bungee jumping.Bungee jumping is becoming a popular sport in the western world with some cases of ophthalmic complications being reported in recent literature. The authors reported a case of a 23-year-old healthy female who presented retinal complications following a bungee jumping. Her fundi showed superficial retinal hemorrhages in the right eye and a sub-internal limiting membrane hemorrhage affecting the left eye. A general examination, including a full neurological examination, was normal and laboratorial investigations were all within normal values. More studies are necessary to identify risk factors and the true incidence of related ocular lesions, but until then, we think this sport activity should be desencouraged, especially to those that are not psychological and physically fit.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
10/15. Uncontrolled pain following physical injury as the core-trauma in post-traumatic stress disorder.Post-traumatic stress disorder (PTSD) is a psychiatric diagnostic category characterized by "the development of characteristic symptoms following a psychologically traumatic event that is generally outside the range of usual human experience". research shows that the prevalence of PTSD among injured survivors of stressful events is higher than that of survivors without physical injury, thus suggesting that secondary stressors (e.g., severe uncontrolled pain, a prolonged state of acute anxiety, uncertainty regarding the immediate future, loss of control, and inability to monitor contact with the environment) may play an important role in the formation of PTSD. However, pain has never been suggested or recognized as a direct cause of PTSD. We present the case of a patient who lost an eye under traumatic circumstances and was later diagnosed as suffering from PTSD. Upon evaluation in a psychophysiological laboratory, this patient's core-trauma was discovered to be 7 h of severe uncontrolled pain while waiting for surgery, rather than the moment when he lost his eye during military service. The case suggests that pain, although not "generally outside the range of usual human experience", may be a strong enough stressor in traumatic circumstances to cause the development of PTSD, thus highlighting the importance of prompt and adequate pain management in hospitalized survivors of traumatic injury.- - - - - - - - - - ranking = 0.83333333333333keywords = physical (Clic here for more details about this article) |
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