Ocular morbidity prevalence among school children in Shimla, Himachal, North India

Background

Data on eye diseases among school children is not readily available. Considering the fact that one-third of India''s blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, early detection and treatment of ocular morbidity among children is important.

Aim

To estimate the prevalence of ocular morbidity among school children of age 6-16 years.

Settings

Government and private coeducational schools in urban area of Shimla.

Design

Cross-sectional

Materials and Methods

Government and private coeducational schools selected by stratified random sampling. About 1561 school children, studying in elementary through secondary class in these schools were examined from August 2001 to January 2002 in Shimla. A doctor did visual acuity and detailed ophthalmic examination.

Statistical analysis

The Chi-square test was used to test differences in proportions. Differences were considered to be statistically significant at the 5% level.

Results

Prevalence of ocular morbidity was 31.6% (CI=29.9-32.1%), refractive errors 22% (CI=21.1-22.8%), squint 2.5% (CI=2.4-2.6%), color blindness 2.3% (CI=2.2-2.4%), vitamin A deficiency 1.8 % (CI=1.7-1.9%), conjunctivitis 0.8% (CI=0.79-0.81%). Overall prevalence of ocular morbidity in government and private schools did not show any statistical significant difference. Prevalence of conjunctivitis was significantly (P<0.5) more in government schools.

Conclusion

A high prevalence of ocular morbidity among high-school children was observed. Refractive errors were the most common ocular disorders.     

Characteristics and visual outcomes of patients hospitalized for ocular trauma in central China: 2006–2011

AIM

To complete the data of ocular trauma in central China, as a well-known tertiary referral center for ocular trauma, we documented the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in this region.

METHODS

A retrospective study of patients hospitalized for ocular trauma in central China from 2006 to 2011 was performed.

RESULTS

This study included 5964 eyes of 5799 patients. The average age was 35.5±21.8y with a male-to-female ratio of 2.8:1. The most common age was 45-59y age group. Most patients were farmers and workers (51.9%). The most common injuries were firework related (24.5%), road traffic related (24.2%), and work related (15.0%). Among the most common causative agents were firecrackers (24.5%), followed by metal/knife/scissors (21.4%). Most injuries occurred in January (14.2%), February (27.0%), and August (10.0%). There were 8.5% patients with ocular injuries combined with other injuries. The incidence of open ocular injuries (4585 eyes, 76.9%) was higher than closed ocular injuries (939 eyes, 15.7%). The incidences of chemical and thermal ocular injuries were 1.2% and 0.6%. Ocular trauma score (OTS) predicted final visual acuity at non light perception (NLP), 20/200-20/50 and 20/40 with a sensitivity of 100%, and light perception (LP)/hand motion (HM) and 1/200-19/200 with a specificity of 100%.

CONCLUSIONS

This study provides recent epidemiological data of patients hospitalized for ocular trauma in central China. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.     

Visual impairment and blindness among the students of blind schools in Allahabad and its vicinity: A causal assessment

Background/Aims:

Information on eye diseases in blind school children in Allahabad is rare and sketchy. A cross-sectional study was performed to identify causes of blindness (BL) in blind school children with an aim to gather information on ocular morbidity in the blind schools in Allahabad and in its vicinity.

Study Design and Setting:

A cross-sectional study was carried out in all the four blind schools in Allahabad and its vicinity.

Materials and Methods:

The students in the blind schools visited were included in the study and informed consents from parents were obtained. Relevant ocular history and basic ocular examinations were carried out on the students of the blind schools.

Results:

A total of 90 students were examined in four schools of the blind in Allahabad and in the vicinity. The main causes of severe visual impairment and BL in the better eye of students were microphthalmos (34.44%), corneal scar (22.23%), anophthalmos (14.45%), pseudophakia (6.67%), optic nerve atrophy (6.67%), buphthalmos/glaucoma (3.33%), cryptophthalmos (2.22%), staphyloma (2.22%), cataract (2.22%), retinal dystrophy (2.22%), aphakia (1.11%), coloboma (1.11%), retinal detachment (1.11%), etc. Of these, 22 (24.44%) students had preventable causes of BL and another 12 (13.33%) students had treatable causes of BL.

Conclusion:

It was found that hereditary diseases, corneal scar, glaucoma and cataract were the prominent causes of BL among the students of blind schools. Almost 38% of the students had preventable or treatable causes, indicating the need of genetical counseling and focused intervention.     

Ocular prostheses in the last century: a retrospective analysis of 8018 patients

Purpose

To analyze the clinical characteristics of patients with ocular prosthesis to assess the causes of eye loss in the different genders and age groups, and their incidence over the years.

Methods

We retrospectively examined the rates of ocular prosthesis application and related causes in the period from 1927 to 2011 in a referral center in Rome, Italy, and compared them over time. We also compared the results within the population in terms of age and gender.

Results

Of 8018 ocular prosthesis wearers, 63% were males and 37% were females, with a mean age of 29 years. The most frequent cause of ocular prosthesis application was a traumatic event (54%), with work-related eye injuries being the most frequent single cause of ocular trauma reported. Other frequent causes were end-stage ocular diseases, tumors, and malformations, without significant differences in gender. Tumors and malformations showed a slight increasing trend over time, while end-stage ocular diseases and work-related injuries remained unchanged, and other traumatic events decreased.

Conclusion

The constantly high frequency of ocular prosthesis application for work-related injuries and end-stage ocular diseases suggests that preventive measures for these events have not been addressed accordingly, and might represent a neglected public-health issue.     

Causes of childhood blindness in the northeastern states of India

Background:

The northeastern region (NER) of India is geographically isolated and ethno-culturally different from the rest of the country. There is lacuna regarding the data on causes of blindness and severe visual impairment in children from this region.

Aim:

To determine the causes of severe visual impairment and blindness amongst children from schools for the blind in the four states of NER of India.

Design and Setting:

Survey of children attending special education schools for the blind in the NER.

Materials and Methods:

Blind and severely visually impaired children (best corrected visual acuity <20/200 in the better eye, aged up to 16 years) underwent visual acuity estimation, external ocular examination, retinoscopy and fundoscopy. Refraction and low vision workup was done where indicated. World Health Organization′s reporting form was used to code anatomical and etiological causes of visual loss.

Statistical Analysis:

Microsoft Excel Windows software with SPSS.

Results:

A total of 376 students were examined of whom 258 fulfilled the eligibility criteria. The major anatomical causes of visual loss amongst the 258 were congenital anomalies (anophthalmos, microphthalmos) 93 (36.1%); corneal conditions (scarring, vitamin A deficiency) 94 (36.7%); cataract or aphakia 28 (10.9%), retinal disorders 15 (5.8%) and optic atrophy 14 (5.3%). Nearly half of the children were blind from conditions which were either preventable or treatable (48.5%).

Conclusion:

Nearly half the childhood blindness in the NER states of India is avoidable and Vitamin A deficiency forms an important component unlike other Indian states. More research and multisectorial effort is needed to tackle congenital anomalies.     

Ocular disorders in children with learning disabilities in special education schools of Pune, India

Aim:

The aim was to study and treat ocular disorders in children with learning disabilities (cLDs) and explore associations with their perinatal history.

Materials and Methods:

cLDs attending 11 special schools were examined by a team consisting of an ophthalmologist, optometrist, and a social worker in 2007 and followed up in 2008. The students‘ intelligence quotient (IQ) and their medical histories were noted. Distant visual acuities were measured using Kay pictures or Snellen''s tumbling E chart and complete ocular examination was performed. Students were assessed at the pediatric ophthalmology unit and low vision center, if needed. Statistical analysis was done with SPSS and the Chi-square test for ordinal data.

Results:

A total of 664 students were examined, 526 of whom were <16 years of age; 323 (61.4%) were male. A total of 326 (60%) had moderate-to-severe learning disabilities (IQs <50), and the mean IQ was 45.4. Two hundred and thirty-eight (45.3%) had ocular disorder; 143 (27.3%) had an uncorrected refractive error, followed by strabismus in 83 (15.8%), nystagmus in 36 (6.8%), optic atrophy in 34 (6.5%), and congenital anomalies in 13 (2.5%), 103 children had more than one abnormality. Only 12 of the 143 students with refractive errors were using spectacles. A total of 132 (48.7%) children with a history of perinatal insult had ocular problems. Ocular disorders were also common in those with a history of epilepsy, Down''s syndrome, and cerebral palsy.

Conclusion:

Nearly half the cLDs in this study had ocular disorders and one-fourth had their vision improved.     

Screening for visual impairment: outcome among schoolchildren in a rural area of Delhi

Background:

Uncorrected refractive errors are the main cause of vision impairment in school-aged children. The current study focuses on the effectiveness of school eye screening in correcting refractive errors.

Objectives:

1. To study the magnitude of visual impairment among school children. 2. To assess the compliance of students for refraction testing, procurement and use of spectacles.

Materials and Methods:

An intervention study was conducted in schools of the north- west district of Delhi, in the rural field practice area of a medical college. Students studying in five government schools in the field practice area were chosen as the study subjects.

Results:

Out of 1123 students enrolled, 1075 (95.7%) students were screened for refractive errors. Low vision (visual acuity < 20/60) in the better eye was observed in 31 (2.9%) children and blindness (visual acuity <20/200) in 10 (0.9%) children. Compliance with referral for refraction was very low as only 51 (41.5%) out of 123 students could be tested for refraction. Out of 48 students, 34 (70.8%) procured spectacles from family resources but its regular use was found among only 10 (29.4%) students. The poor compliance among students stems out of various myths and perceptions regarding use of spectacles prevalent in the community.

Conclusion:

Refractive error is an important cause of avoidable blindness among rural school children. Behavior change communication among rural masses by spreading awareness about eye health and conducting operational research at school and community level to involve parent''s teachers associations and senior students to motivate students for use of spectacles may improve utilization of existing eye health services in rural areas.     

The prevalence of ocular complications in leprosy patients seen in the United Kingdom over a period of 21 years

Objective

The objective of this study was to determine the prevalence of ocular complications and blindness among leprosy patients presenting in the United Kingdom.

Methods

Observational prospective study.

Results

A total of 126 consecutive leprosy patients attending their ophthalmic visit were examined, out of which 18 patients were blind in one eye (14.3%) and five patients were blind in both the eyes (4.0%). Visual acuity of ⩾6/18 was present in 96 patients (76.2%). A total of 65 patients (51.6%) had an ocular complication and 28 patients (22.2%) had a sight-threatening leprosy complication (lagophthalmos, severe corneal, or iris disease). The most common ocular complications were impaired lid closure (24 patients, 19%), impaired corneal sensation (20 patients, 15.9%), cataract (20 patients, 15.9%), mild corneal opacity (17 patients, 13.5%), and iris atrophy (17 patients, 13.5%). Impaired corneal sensation was associated with vision <6/18 (P<0.001, OR 13.5, 95% CI 5.14–35.44) and vision <3/60 (P=0.01 OR 6.42, 95% CI 2.15–19.15). Impaired lid closure was significantly associated with increasing age (P=0.029, OR 1.039, 95% CI 1.0–1.08) and vision <3/60 (P=0.03, OR 6.06, 95% CI 1.81–20.24).

Conclusion

There is a significant rate of ocular complications and blindness seen in leprosy patients in the United Kingdom, and over one in five had a potentially sight-threatening ocular complication. Health professionals and all leprosy patients, including those cured of the disease, need to be aware that new eye symptoms and signs require prompt ophthalmology review to prevent avoidable blindness, due to the life-long risk of sight-threatening ocular complications.     

Keratoconjunctivitis caused by an unusual retained conjunctival foreign body: A frequently unrecognized entity

Purpose:

The purpose of this study is to describe a case series of keratoconjunctivitis caused by a retained bindi (dot) in six children who presented to a tertiary eye care facility in Southern India.

Patients and Methods:

Over a period of 11 years (January 2000 and January 2012), six children (all female, ranging in age from 6 months to 3 years) were diagnosed with ocular manifestations subsequent to a retained bindi.

Results:

All patients presented with redness, photophobia, extensive lacrimation, and blepharospasm. Two patients presented with mucopurulent conjunctivitis, three patients with suppurative keratitis and one patient presented with corneal epithelial defect. After removal of the foreign body the response to topical antibiotics was good in five of six cases, whereas one patient required therapeutic keratoplasty.

Conclusions:

Young children presenting with unilateral keratitis and conjunctivitis should alert the clinician to the possibility of a retained foreign body in the eye.     

Visual impairment in the hearing impaired students

Background:

Ocular problems are more common in children with hearing problems than in normal children. Neglected visual impairment could aggravate educational and social disability.

Aim:

To detect and treat visual impairment, if any, in hearing-impaired children.

Setting and Design:

Observational, clinical case series of hearing-impaired children in schools providing special education.

Materials and Methods:

Hearing-impaired children in selected schools underwent detailed visual acuity testing, refraction, external ocular examination and fundoscopy. Ocular motility testing was also performed. Teachers were sensitized and trained to help in the assessment of visual acuity using Snellen''s E charts. Refractive errors and squint were treated as per standard practice.

Statistical Analysis:

Excel software was used for data entry and SSPS for analysis.

Results:

The study involved 901 hearing-impaired students between four and 21 years of age, from 14 special education schools. A quarter of them (216/901, 24%) had ocular problems. Refractive errors were the most common morbidity 167(18.5%), but only 10 children were using appropriate spectacle correction at presentation. Fifty children had visual acuity less than 20/80 at presentation; after providing refractive correction, this number reduced to three children, all of whom were provided low-vision aids. Other common conditions included strabismus in 12 (1.3%) children, and retinal pigmentary dystrophy in five (0.6%) children.

Conclusion:

Ocular problems are common in hearing-impaired children. Screening for ocular problems should be made mandatory in hearing-impaired children, as they use their visual sense to compensate for the poor auditory sense.     

The incidence of serious eye injury in Scotland: a prospective study

Purpose

Ocular trauma remains an important cause of visual morbidity worldwide. A previous population-based study in Scotland reported a 1-year cumulative incidence of 8.14 per 100 000 population. The purpose of this study was to identify any change in the incidence and pattern of serious ocular trauma in Scotland.

Methods

This study was a 1-year prospective observational study using the British Ophthalmological Surveillance Unit reporting scheme among Scottish ophthalmologists. Serious ocular trauma was defined as requiring hospital admission. Data were collected using two questionnaires for each patient 1 year apart.

Results

The response rate from ophthalmologists was 77.1%. There were 102 patients reported with complete data giving an incidence of 1.96 per 100 000 population, four times less than in 1992. In patients younger than 65 years, the age-adjusted incidence ratio (males/females) indicated a ninefold higher risk of trauma in males. In 25 patients (27.2%), the injured eye was blind (final visual acuities (FVA) <6/60), 24 being attributable to the eye injury. Standardised morbidity ratios suggested a threefold decrease in risk of poor visual outcome in 2009 compared with 1992.

Conclusions

The incidence of serious ocular trauma has fallen; this study has shown hospital admission for serious eye injury in Scotland has decreased fourfold in 17 years. Young adult males continue to be at highest risk, which needs to be specifically addressed in future health-prevention strategies. This study also observed a reduction in visual loss from serious ocular injuries, although the reasons for this require further exploration.     

Prevalence,causes of blindness,visual impairment and cataract surgical services in Sindhudurg district on the western coastal strip of India

Background:

Konkan coast of India is geographically distinct and its pattern of blindness has never been mapped.

Aim:

To study the prevalence and causes of blindness and cataract surgical services in Sindhudurg district of West Coast.

Subjects:

Individual aged > 50 years.

Materials and Methods:

Rapid assessment of avoidable blindness used to map blindness pattern in the district. Statistical analysis: SPSS version 19.

Results:

Amongst those examined 1415 (51.7%) had visual acuity (VA) >20/60, 924 (33.8%, confidence interval (C.I) 30.5%-36.8%) had VA 20/200-<20/60(visual impairment), 266 (9.7%, C.I. 6.1%-13.3%) had VA < 20/200-20/400 (severe visual impairment) and 132 (4.8%, C. I. 1.1%-8.5%) had VA < 20/400 (blindness by WHO standards). There was no significant gender difference in prevalence of blindness, but blindness and visual impairment was more in older and rural residing individuals. Amongst those with presenting vision < 20/200 in better eye, 309 (82.4%) had cataract, 36 (9.7%) had corneal scars, 13 (3.5%) had diabetic retinopathyand 3 (0.8%) had glaucoma. Cataract surgical coverage for the district was only 30.5%; 32% for males and 28.4% for females. Unable to afford, lack of knowledge and lack of access to services were the commonest barriers responsible for cataract patients not seeking care. Amongst those who had undergone cataract surgery, only 50% had visual acuity ≥ 20/60.46.9% of the population had spectacles for near, but only 53.3% of the population had presenting near vision < N10.

Conclusion:

Cataract, refractive errors and diabetes were significant causes of visual impairment and blindness.     

A survey of severe visual impairment in children attending schools for the blind in a coastal district of Andhra Pradesh in South India

Purpose

To identify the major causes of severe childhood visual impairment and blindness among students attending schools for the blind in a coastal district of Andhra Pradesh (AP) in South India.

Methods

Children ≤16 years of age attending six schools for the blind in the study area were interviewed and examined in the year 2009, and causes were classified according to the World Health Organization Program for Prevention of Blindness (WHO/PBL) childhood blindness proforma. A total of 113 children underwent a detailed eye examination by an experienced ophthalmologist.

Results

The major causes of blindness were congenital eye anomalies in 46 children (41.4; 95% confidence interval (CI): 32.3–50.6), followed by retinal disorders in 21 children (18.9% 95% CI: 11.6–26.2), cataract in 9 children (9.7% 95% CI: 2.9–12.9), and corneal conditions (scar and Staphyloma) in 8 children (7.1% 95% CI: 2.4–11.8). More than half the children (56.6%) were blind due to conditions that could have been treated or prevented.

Discussion

Congenital anomalies were found to be the most common cause of blindness. The majority of the cases were due to avoidable causes of blindness. Therefore, robust screening measures may help reduce the burden of visual impairment in children.     

Visual and anatomic outcomes of golf ball-related ocular injuries

Aims

To investigate the characteristics and prognoses of golf ball-related ocular injuries (GROIs) using standardized terminology, classification, and scoring systems.

Methods

Twenty-two GROI patients were assessed using the Birmingham Eye Trauma Terminology, Ocular Trauma Classification Group (OTCG) classification, and Ocular Trauma Score. Globe preservation and final visual acuity (FVA) were assessed according to the injury severity categorical designation.

Results

Fourteen patients were injured on golf courses and eight on driving ranges. Nine patients (40.9%) had open-globe injuries (five ruptures (22.7%), four penetrating injuries (18.2%)). All rupture cases required enucleation, whereas penetrating injury cases did not (the FVA ranged from 20/100 to no light perception). In open-globe injuries, wearing glasses protected against rupture (P=0.008). Thirteen patients sustained closed-globe injuries that were accompanied by lens subluxation (38.5%), choroidal rupture (30.8%), macular commotio retinae (38.5%), and traumatic optic neuropathy (7.7%). Twelve (54.5%) patients had orbital wall fractures. The mean number of related surgeries required was 1.5±1.7 across all patients.

Conclusion

Eyes with GROIs had devastating FVA and globe preservation status, especially those with open-globe injuries. Observing golf rules and improving driving-range facilities are essential for preventing GROIs. Protective eyewear may reduce ocular damage from GROIs, especially globe rupture.     

Relationship between systemic hypertension,perfusion pressure and glaucoma: A comparative study in an adult Indian population

Aims:

To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives.

Design:

Cross-sectional observational study.

Materials and Methods:

A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey''s central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2.

Statistical Analysis:

Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect.

Results:

There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1½ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13–45%, P = 0.001) and glaucoma suspect (95% CI = 2–21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP.

Conclusion:

Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.     

Diabetic retinopathy, visual impairment and ocular status among patients with diabetes mellitus in Yemen: A hospital-based study

Background:

We present a series of patients with diabetes mellitus (DM) who attended an eye hospital in Sana, Yemen during 2004.

Aim:

To determine the magnitude and risk factors of diabetic retinopathy (DR).

Design:

Cross-sectional study.

Materials and Methods:

Ophthalmologists assessed vision, ocular pressure, ocular media and posterior segment to note ocular manifestations among patients with DM. DR was graded by using bio-microscope and Volk lens. The prevalence and 95% confidence interval of ocular complications of DM were calculated. Risk factors of DR like age, sex, duration of diabetes and hypertension were evaluated.

Statistical Analysis:

Univariate and multivariate analysis.

Results:

Our series comprised 350 patients suffering from DM. The duration of diabetes was ≥15 years in 101 (29%) patients. Physician was treating 108 DM patients with insulin. The prevalence of DR was 55% (95% CI 49.6–60.1). The proportions of background diabetic retinopathy (BDR), preproliferative diabetic retinopathy (PPDR), proliferative diabetic retinopathy (PDR) and diabetic macular edema were 20%, 13%, 17% and 22% respectively. The prevalence of blindness among DM patients was 16%. The prevalence of cataract and glaucoma was 34.3% and 8.6%. Duration of DM was the predictor of DR. One-fifth of the patients had sight-threatening DR and needed laser treatment.

Conclusions:

DR was of public health magnitude among our patients. An organized approach is recommended to address DR in the study area.     

Prognostic factors for open globe injuries and correlation of Ocular Trauma Score at a tertiary referral eye care centre in Singapore

Objective:

To evaluate the factors influencing final vision outcome after surgical repair of open globe injuries and to correlate the Ocular trauma score.

Materials and Methods:

Retrospective case analysis of patients with open globe injuries at a tertiary referral eye care centre in Singapore was performed. Pre-operative factors affecting final vision outcome in patients with open globe injury and correlation of ocular trauma score in our study with international ocular trauma scoring system was performed.

Results:

Case records of 172 eyes with open globe injury were analyzed. Mean age was 36. 67 years. Mean follow up was 12.26 m. Males were pre-dominantly affected. Initial visual acuity was ≥20/40, 20/50 < 20/200, 20/200- CF, HM– PL and NLP in 24 (14%), 39 (22.7%), 16 (9.3%), 66 (38.4%) and 27 (15.7%) eyes respectively. Final visual acuity was ≤20/40, 20/50 < 20/200, 20/200- 1/200, HM– PL and NLP in 76 (44.2%), 28 (16.3%), 11 (6.4%), 30 (17.4%) and 27 (15.7%) eyes respectively. Ocular trauma score in our study correlates with international ocular trauma scoring system.

Conclusion:

The present study showed pre-operative variables such as mode of injury, pre-operative visual acuity, traumatic cataract, hyphaema, relative afferent papillary defect, vitreous lossand vitreous hemorrhage to be adversely affecting the final vision outcome. Our study showed a good synchrony with international ocular trauma score (OTS) and based on this study we were able to validate application of OTS in Singapore population. Recognizing these factors can help the surgeon in evidence based counseling.     

Central Retinal Artery Occlusion and Third Cranial Nerve Palsy Following Nasal Septoplasty

Background

Postoperative vision loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to central retinal artery occlusion associated with third cranial nerve following septoplasty.

Case Report

We report a patient who developed an unusual central retinal artery occlusion with unilateral blindness following nasal surgery under general anesthesia. A 45-year-old man underwent a nasal septal surgery for severe epistaxis. Soon after recovery, the patient noticed loss of vision in his right eye and was unable to lift his upper eyelid. Upon ophthalmic examinations, we determined that he had right-sided third cranial nerve palsy with central retinal artery obstruction and ptosis of right upper eyelid, restriction of ocular movements, and no perception of light in the right eye. Postoperative computerized tomography scan revealed multiple fractures of the left medial orbital wall, including one near the optic canal. Ptosis and ocular defects were recovered partially, but visual loss persisted until the last follow-up.

Conclusion

This paper highlights one case of complete unilateral blindness from direct central retinal artery occlusion associated with third cranial nerve palsy following an apparently uneventful septorhinoplasty. Ophthalmologists and otolaryngologists should therefore be aware of the possible occurrence of such complications.Key Words: Central retinal artery occlusion, Third nerve palsy, Septoplasty, Nasal polypectomy, Visual loss     

A new ocular trauma score in pediatric penetrating eye injuries

Purpose

To assess the prognostic value of a new ocular trauma score (OTS) in pediatric penetrating injuries.

Methods

Children ≤15 years of age that presented to the emergency room with penetrating eye injuries between April 2007 and August 2008 were evaluated prospectively. All patients were reviewed on the basis of age, gender, time of injury and how it happened, time of admission, time of surgery, type of penetrating injury, initial and final visual acuity (VA), and concomitant eye pathology. Injuries were classified based on a new OTS, and we assessed the relationship with final VA and the new OTS.

Results

In total, 30 eyes in 29 patients (41.38% female, 58.62% male) with a mean age of 6.83±4.00 years (range: 1–15 years) were included in the study. Initial VA, which was evaluated in 22 patients, was as follows: no light perception (NLP) in 2 (9.09%) patients, light perception (LP) to hand motion (HM) in 8 (36.36%) patients, counting fingers in 6 (27.27%) patients, 0.1–0.5 in 4 (18.18%) patients, and ≥0.6 in 2 (9.09%) patients. Final VA, which was evaluated in 27 patients, was as follows: NLP in 3 (11.11%) patients, LP to HM in 3 (11.11%) patients, counting fingers in 2 (7.41%) patients, 0.1–0.5 in 11 (40.74%) patients, and ≥0.6 in 8 (29.63%) patients. The relationship between initial VA and final VA was statistically significant (P<0.001).

Conclusions

The new OTS calculated at initial examination may be of prognostic value in children with penetrating eye injuries.