Incidence and causative agents of chemical eye injuries in Switzerland

Context: Chemical eye injuries are ophthalmological emergencies with a high risk of secondary complications and severe visual loss. Only limited epidemiological data for such injuries are available for many countries. Patients and methods: We performed two independent studies. The cause of chemical eye injuries was assessed with a prospective questionnaire study. Questionnaires were sent to all ophthalmologists in Switzerland. A total of 163 patients (205 eyes) were included, between December 2012 and October 2014. Independent of the questionnaire study, the incidence of chemical eye injuries was assessed with a retrospective cohort study design using the database of the mandatory accident insurance. Results: Ophthalmological questionnaires revealed that plaster/cement (20.5%), alkaline (12.2%) and acid (10.2%) solutions caused the highest number of chemical injuries. Only 2% of all injuries were classified as grade III and none as grade IV (Roper-Hall classification). The official toxicological information phone-hotline was contacted in 4.3% of cases. Using data from the accident insurance, an incidence of chemical eye injuries of about 50/100 000/year was found in the working population. Conclusion: Here, we present data on the involved agents of chemical eye injuries in Switzerland, and also the incidence of such injuries in the working population. This may also help to assess the need for further education programs and to improve and direct preventive measures.     

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.     

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.     

Comparison of Crashes Involving Ambulances with Those of Similar-Sized Vehicles

Objective. To describe the characteristics andassociated occupant injuries of motor vehicle collisions (MVCs) involving ambulances as compared with MVCs involving similar-sized vehicles. Methods. Motor vehicle crash data in Pennsylvania from 1997–2001 were analyzed to compare the characteristics of crashes involving ambulances with those involving vehicles of a similar size. Crash demographics (e.g., location of crash, roadway conditions, intersection type) andassociated injuries were examined andcompared using chi-square tests andFisher's exact test. Results. 2,038 ambulance MVCs and23,155 crashes involving similar-sized vehicles were identified. Weather androad surface conditions were similar, but ambulance MVCs occurred with increased frequency on evenings andweekends. Ambulances were more likely to be involved in four-way intersection crashes (43% vs. 23%, p = 0.001), angled collisions (45% vs. 29%, p = 0.001), andcollisions at traffic signals (37% vs. 18%, p = 0.001). More people were involved in ambulance MVCs (p = 0.001), with 84% of ambulance MVCs involving three or more people and33% involving five or more people. Injuries were reported in more ambulance MVCs (76% vs. 61%, p = 0.001). Pedestrian involvement was rare (< 5% in both groups). Conclusion. Ambulance crashes occur more frequently at intersections andtraffic signals andinvolve more people andmore injuries than those of similar-sized vehicles.     

Crash Scene Photography in Motor Vehicle Crashes without Air Bag Deployment

OBJECTIVE: To determine whether vehicle characteristics, measured using crash scene photography, are associated with anatomic patterns of injury and severity of injury sustained in motor vehicle crashes (MVCs) without air bag deployment. METHODS: A prospective observational study was conducted over 22 months, using 12 fire departments serving two hospitals. Two vehicle photographs (exterior and interior) were taken at each MVC. Vehicular variables were assigned by grading the photographs with a standardized scoring system, and outcome information on each patient was collected by chart review. RESULTS: Five hundred fifty-nine patients were entered into the study. Frontal crashes and increasing passenger space intrusion (PSI) were associated with head, facial, and lower-extremity injuries, while rear crashes were associated with spinal injuries. Restraint use had a protective effect in head, facial, and upper and lower extremity injuries, yet was associated with higher odds of spinal injury. Lack of restraint use, increasing PSI, and steering wheel deformity were associated with an increased hospital length of stay and hospital charges, yet only steering wheel deformity was associated with increasing injury severity when adjusting for other crash variables. CONCLUSIONS: Out-of-hospital variables, as obtained from crash vehicle photography, are associated with injury site, injury severity, hospital length of stay, and hospital charges in patients involved in MVCs without air bag deployment.     

小儿眼球穿通伤的护理

眼球穿通伤是由锐器刺入、切割造成眼球壁的全层裂开，伴有或不伴有眼内损伤或组织脱出，是严重的眼外伤[1]。近年来，由于留守儿童增多，家庭中老人对小儿的照顾能力有限，发生眼球穿通伤的小儿也随之增加。对眼球穿通伤的及时正确处理和术后的精心护理，是促进伤口愈合，预防并发症，保护眼球，提高视力的重要保证。我院2004年3月～2007年4月共收治眼球穿通伤患儿45例，现将护理报告如下。     

Catastrophic Globe Disruption as a Result of a TASER Injury

Background

Injuries caused by the TASER^® (TASER International, Inc., Scottsdale, AZ) have been well documented, and both direct and indirect ocular injuries have been reported. We present a case of severe perforating injury to the globe from a TASER dart with central cornea penetration.

Objectives

To describe the presentation and management of a penetrating ocular injury from a TASER dart.

Case Report

A 47-year-old woman presented with a TASER dart injury penetrating through the central cornea. The injury resulted in a stellate corneal laceration, which was repaired with a final visual acuity of light perception without projection.

Conclusion

This is a case of a severe TASER-related ocular injury resulting in significant vision loss. Although mechanical trauma seemed to be the main etiology for vision loss, electrical shock injury may also be contributory. Direct injury to the eye from a TASER dart is similar to other perforating projectile injuries and can have a devastating visual outcome.     

Penetrating eye injuries in road traffic accidents.

A review of all penetrating eye injuries treated by the Manchester Eye Hospital over four years (1 February 1982-31 January 1986) was undertaken. One hundred and ninety-six penetrating eye injuries were seen, of which 16 (8.2%) were due to road traffic accidents. Eight patients (nine eyes) were seen in the 12 months prior to the introduction of the seat-belt legislation on 1 February 1983. None of these patients was wearing a seat-belt whereas two of the eight patients (10 eyes) seen after the seat-belt legislation were. Both these patients suffered severe visual loss due to intraocular glass from shattered windscreens. Three patients had bilateral penetrating eye injuries, one before and two after the seat-belt legislation. Two of the nine eyes involved prior to the legislation and three of the 10 eyes after the legislation had an eventual visual acuity of 6/12 or better. In the majority of patients, failure to wear seat-belts or defective use is to blame. Flying glass from shattered toughened windscreens is a preventable danger. Nine of the 16 patients were first seen in the general accident and emergency department and, of these, seven did not have visual acuities recorded prior to referral to an ophthalmologist. The importance of measurement of the visual acuity and detection of an afferent pupillary defect is stressed based on these findings.     

The epidemic of penetrating trauma: A national dilemma

Available literature on penetrating trauma in the USA was reviewed to determine the prevalence, etiological factors, and societal cost of penetrating trauma. Penetrating injuries accounted for 39,888 deaths in 1989 and was the eighth leading cause of death. Etiological factors include increasing ownership of firearms, alcohol consumption, recreational drug use and trafficking, occupational risks, and socioeconomic factors. These injuries account for the fourth leading cause of estimated years of potential life lost. Corrective strategies and research are severely limited by the disproportionately low research funding.     

心理护理在眼球穿通伤病人中的应用

[目的]探讨心理护理在眼球穿通伤病人护理中的应用效果。[方法]对于眼球穿通伤病人,心理治疗贯彻始终,总结458例眼球穿通伤病人的护理经验与效果。[结果]本组病人情绪稳定,保持良好的心理状态,积极配合医护人员手术及治疗,提高了治愈率,康复效果较好。[结论]心理治疗贯彻始终、调动积极情绪,使病人正确对待人生中突如其来的挫折,缓解焦虑及抑郁情绪,使病人身体和心理健康共同恢复。     

Military and civilian penetrating eye trauma: anesthetic implications.

In 20th century warfare, wounds from fragmentation weapons have become the number 1 cause of military hospital admissions during combat. Specifically, grenades, landmines, mortars, and artillery weapons have replaced guns and bullets. Consequently, penetrating eye injuries and maxillofacial injuries in the military have escalated dramatically. In the civilian sector, pipe bombs, explosive bottles used in gang warfare, and terrorist bombs, which are all fragmentation weapons, have generated new studies in the care of patients with penetrating eye injury. This change in the wounding pattern is, documented internationally in military-medical literature and in civilian-medical literature of relief agencies such as the International Committee of the Red Cross and the Red Crescent. The anesthetic management of open eye injuries has been a running controversy for 40 years in terms of the use of muscle relaxants. Nondepolarizing agents carry the risk of aspiration and increased intraocular pressure when trauma patients are intubated prematurely during rapid-sequence induction for "full stomachs." Succinylcholine would be the logical relaxant of choice for a rapid-sequence induction, but succinylcholine raises intraocular pressure. In many cases, the literature specifically contraindicates succinylcholine in the open eye injury for fear of extruding the content of the eye. A review of the vital assessment for the patient with a penetrating eye injury, as well as a comparative analysis of the literature, is presented. The conclusion favors pretreatment with a nondepolarizing agent and the use of succinylcholine during rapid-sequence induction. The eye injury itself is not the primary concern of this article. The primary concern is that open eye injuries serve as hallmarks for for more dangerous injuries. Penetrating open eye injuries merit extensive clinical assessment that can be life saving.     

穿透性角膜移植术治疗真菌性角膜炎的临床观察

目的 观察穿透性角膜移植术治疗真菌性角膜炎的临床疗效.方法 对真菌性角膜炎49例49眼进行穿透性角膜移植术,观察其临床特点及手术效果.结果 术后49例患者中除4例眼球摘除、3例放弃治疗外,其余视力均较术前提高.术后视力0.01～0.3.15例术后出现真菌复发,5例患者在术后3 d内眼压暂时升高,27例出现排斥反应.结论 穿透性角膜移植术是治疗真菌性角膜炎的有效方法.     

Eye injury: prevalence and prognosis by setting

Although an estimated 1 million Americans suffer ocular injuries each year, the setting of injury and its prognostic implications have not been closely examined. Using data compiled by the Eye Injury Registry of Alabama (EIRA) from 514 cases of serious eye injury, we examined the demographics and prognosis of ocular injury by setting of injury. Work-related injuries accounted for only 28% of total injuries, and injuries occurring at home accounted for 27%, followed by situations related to recreation (25%), assault (11%), travel (5%), and "other" (school, unknown, etc) (4%). The poorest initial vision, poorest final vision, and highest rate of enucleation occurred in patients injured by assault, whereas the lowest rate of enucleation and loss of light perception was found in patients who had work-related injuries. Patients in the "other" category had the highest rate of return to 20/100 or better vision.     

Emergency department management of penetrating eye injuries

Penetrating injuries are rare but important for the patient both visually and socioeconomically. This guide intends to provide a structure for emergency department personnel to enable targeted history taking, effective examination, appropriate investigation and timely referral for those presenting with penetrating eye trauma.     

A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years

OBJECTIVE: To evaluate epidemiologic trends in new spinal cord injuries (SCIs) in the United States over 3 decades. DESIGN: Consecutive case series. SETTING: Model Spinal Cord Injury Systems (MSCIS) facilities. Participants: Persons (N=30,532) admitted to MSCIS facilities within 365 days of injury between 1973 and 2003, and enrolled in the National Spinal Cord Injury Database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data were collected at MSCIS admission and rehabilitation discharge. Variables included age, gender, race and ethnic group, year of injury, and level and extent of injury. Specific etiologies were grouped as motor vehicle collisions (MVCs), violence, falls, sports, and other. Demographic and injury severity trends were analyzed by year of injury groupings according to decades (1973-1979, 1980-1989, 1990-1999, 2000-2003.) Chi-square tests assessed statistical significance. One-way analysis of variance compared mean ages. RESULTS: The male/female ratio remained fairly stable at 4:1, but the percentage of women increased slightly over time, especially from MVC etiologies ( P <.001). Over time, the mean age at injury increased significantly ( P <.001); it was 37.7+/-17.5 years in 2000-2003. The majority of cases were white (66.1%). Tetraplegia (54.1%) and complete injuries (55.6%) occurred more than paraplegia and incomplete injuries, respectively. MVCs (45.6%) remained the most common etiology; falls (19.6%) held the second position over violence (17.8%), except for the 1990-1999 period when the positions were reversed. Significantly increasing percentages of new injuries were seen for SCI due to automobile, motorcycle, bicycle, and all-terrain vehicle crashes, blunt object attacks, snow skiing, and medical and surgical mishaps. CONCLUSIONS: Many previously seen SCI demographic trends continued into the 2000 decade.     

Airbag safety: Deployment in an automobile crash with a fall from height

Airbag restraint systems have demonstrated a significant reduction in mortality in motor vehicle crashes (MVCs). While airbag devices are effective primarily in frontal or near-frontal impacts, little is known about the efficacy of these devices in nonfrontal types of collisions. Moreover, there are reports of injuries specific to airbag deployment that have led some investigators to question the benefit of such devices. This article reports a rollover MVC with a considerable fall from height in which lap/shoulder belts were used in addition to airbag deployment that resulted in protection of the driver from injury. The outcome of this case continues to support the combination of belt and airbag restraint systems as the most effective occupant protection in both frontal and nonfrontal types of MVCs.     

Ocular trauma in Turkey: A 2-year prospective study

This 2-year prospective study was conducted to identify those at risk for ophthalmologic emergencies, to define the risk factors and reasons for eye injuries, to analyze treatment options, and to compare findings with those of previous studies. A total of 203 patients (74% male, mean age 27.3±13.9 y, 51% right eye injuries, 44% left eye injuries, 5% bilateral injuries) with injury to 208 eyes who presented to the emergency department for treatment were included in this study. All patients were evaluated by an ophthalmologist, who completed a formal questionnaire. Information recorded included demographic data, details of the eye injury, whether eye protection was used, and the type, location, and mechanism of injury to the eye. Mechanism of injury was categorized as blunt, sharp, or a combination. The ophthalmologist reported the time that had passed between occurrence of injury and presentation for treatment. Each patient was examined by the ophthalmologist, and findings, diagnosis, and treatment were documented. Of treated patients, 93% were hospitalized, most of whom required surgical treatment. One hundred (48%) injuries were related to blunt trauma and 86 (41%) to sharp device trauma. Only 10 (4%) patients were wearing protective eyewear when injured. Ruptured globe was the most common diagnosis of hospitalized patients and the most frequent cause of this was corneal lesions; subconjunctival hemorrhage was the most common diagnosis among nonhospitalized patients. In this study, the leading cause of eye injury was workplace accidents, probably attributable to growing industrialization in the region. Ocular trauma continues to be an important health problem in Turkey. Investigators believe that with education about and use of proper eye protection, 90% of eye injuries could be prevented.     

Underappreciation of sleep disorders as a cause of motor vehicle crashes

Despite an increased risk of motor vehicle crashes (MVC) in patients with obstructive sleep apnea (OSA), we hypothesized that OSA was not considered in drivers admitted to trauma centers after an injury-producing MVC. A retrospective study on drivers involved in MVCs admitted to a level 1 trauma center was performed, with crash cause determined and the frequency of sleep studies recorded. A questionnaire was also mailed to 240 trauma centers seeking information on evaluation of patients with unexplained causes for MVCs, including screening for OSA. There were 122 drivers of MVCs admitted to our hospital, 60/122 (49%) had unexplained crashes and no sleep studies were performed. There were 70 survey respondents (30% return rate), 35/70 (50%) centers routinely screened for syncope after unexplained MVC, however, no center screened for OSA. US trauma centers do not screen for sleep disorders despite the associated increased crash risk and the high prevalence of crashes that can not be explained by other causes. We believe this reflects a lack of awareness of sleep disorders by health care professionals caring for trauma victims and education is of utmost importance.     

Reducing complications of thoracic gunshot wounds

With the persistent presence of violence in our urban areas and the availability of guns, penetrating injuries as a result of firearm use continue to be a challenge for the emergency, surgery, and operating room nurse. Because gunshot wounds may be rapidly fatal, an understanding of firearms and the injuries they produce, as well as their possible complications, can assist the critical care nurse in caring for patients with gunshot wounds to the chest. Thoracic trauma is present in 50% of all trauma patients and is the cause of death in 25% of these victims. Penetrating trauma from violent episodes accounts for approximately 50% of cases of chest trauma in the urban setting.     

Initial management of penetrating neck wounds--a selective approach

The management of anterior penetrating neck injuries remains highly controversial. This is a review of our treatment of such injuries over the preceding decade. During the first 6 years all injuries were explored. Of 75 patients explored, only 33 (44%) had significant injuries. During the last 4 years, patients were managed selectively. Patients with bleeding, crepitation, dysphagia, compromised airways, or for whom full clinical evaluation was not possible underwent prompt formal operative exploration. All other patients were observed. Of 48 patients who underwent explorations, 41 (85%) had significant injuries. Thirty-six patients were observed with no adverse sequelae. Ancillary diagnostic testing was only routinely done in level I injuries. Over the last 10 years we evolved from mandatory exploration to selective exploration of anterior penetrating neck injuries. Our experience confirms the safety and cost-effectiveness of a selective exploration policy. Furthermore, observation does not mandate extensive ancillary diagnostic testing for level II and level III injuries.