Penetrating eye injury from a rigid infant pacifier

Background: The use of infant pacifiers (dummies) is common in Australasian communities and has been reported to be associated with various injuries, but to date ocular trauma has not been reported.
Case report: A 14-month-old child sustained a penetrating eye injury from the infant pacifier that was in his mouth during a minor fall. Only a lid laceration was detected at the time. One week later he presented with mydriasis, heterochromia and a poor red reflex. Diagnosis of a penetrating eye injury was made by examination under anaesthesia, with B-scan ultrasonography demonstrating hypotony but no retinal detachment or intraocular foreign body. Funduscopy revealed a small inferior vitreous haemorrhage. Exploration of the globe adjacent to the lid wound showed a 6 mm laceration through the sclera plugged with prolapsed vitreous.
Conclusion: Serious ocular injury may result after a minor fall with some designs of rigid infant pacifiers. Heterochromia and anisocoria noted by the mother heralded more serious ocular injury in this case. The delay in diagnosis of this injury emphasises the importance of ocular examination to exclude eye trauma when injuries occur around the orbit.     

A fishy eyelid injury

A 9-year-old girl was reviewed by a tertiary ophthalmology service after being hit in her right upper eyelid by a fish whilst swimming. Initial wound exploration demonstrated fish scales in the wound. She was first treated conservatively with washout of the 5-mm wound and was discharged with oral ciprofloxacin. Five days later, the patient re-presented with a worsened ptosis due to periorbital swelling. Ultrasound of the upper lid demonstrated a foreign body in the upper lid. The patient was taken to theatre and, with the assistance of intraoperative ultrasound, the jaws of a needle fish were removed from the upper lid. The case highlights the importance of ultrasound and its intraoperative utility in cases of trauma and a suspicion of retained foreign bodies as well as the potential danger of fish injuries off the West Australian coast.     

Orbitocranial wooden foreign body diagnosed by magnetic resonance imaging. Dry wood can be isodense with air and orbital fat by computed tomography.

In computed tomographic (CT) scans, a wooden foreign body can appear as a lucency with nearly the same density as air or fat, and it can be indistinguishable from orbital adipose tissue. Magnetic resonance imaging (MRI) can localize these wooden foreign bodies in the orbit. We studied a case in which a wooden golf tee lodged in the right optic canal of a nine-year-old boy. The head portion lodged in the orbital apex and the tip entered the interpeduncular fossa. Clinical examination revealed a right paranasal laceration; the right eye had no light perception and a peripapillary hemorrhage, but was otherwise normal. Surgical exploration and evaluation by CT failed to locate the foreign body. However, the golf tee was demonstrated by MRI as a low intensity image. Although it was removed by craniotomy with good neurological results, bacterial panophthalmitis led to enucleation of the eye. This case emphasizes the diagnostic value of MRI and the hazards of retained wooden foreign bodies.     

Corneal ulcer caused by a wooden foreign body in the upper eyelid 6 months after minor injury

PURPOSE: To describe a case of a wooden foreign body in the upper eyelid that remained asymptomatic for 6 months. CASE REPORT: A 9-year-old boy was presented with moderate upper lid swelling. Medical history was positive for trauma with a wooden stick 6 months ago. At first, the condition resolved under local antibiotic treatment. Three weeks later, the inflammation recurred and a corneal ulcer developed. Examination under general anesthesia revealed a wooden foreign body which had remained in the upper eyelid since the first injury. CONCLUSION: Organic foreign bodies in the eyelid can remain asymptomatic for a long period of time and can play a role in periocular inflammation. In case of doubt, children and other less cooperative patients should be examined under general anesthesia.     

Necrosis and reconstruction of the inferior oblique muscle after removal of a wooden intra-orbital foreign body

A 39-year-old patient presented 3 days after a bicycle accident with a progressive left periorbital inflammatory swelling and diplopia in upgaze. On the day of the accident, a cranial x-ray did not reveal a fracture or an orbital foreign body, and the 2.5 cm skin wound on the left lower eyelid was sutured. For further evaluation, computer tomography) was performed. This did not show a radio-opaque, orbital foreign body. An explorative orbitotomy was carried out and revealed a 3.7 cm long wooden fragment medial to the inferior oblique muscle (OI). The extraconal portion of OI was found to be necrotic. Complete reconstruction of the OI was not possible due to the extent of the necrosis. The residual muscle was fixated to the orbital septum. Recovery was good and the diplopia resolved after 6 months. This case emphasizes the importance of a meticulous inspection of skin wounds with a high risk of remaining wooden foreign bodies and shows the possibility of functional recovery of extraocular muscles following partial reconstruction.     

M. obliquus-inferior-Nekrose mit Rekonstruktion bei intraorbitalem Holzfremdkörper

A 39-year-old patient presented 3 days after a bicycle accident with a progressive left periorbital inflammatory swelling and diplopia in upgaze. On the day of the accident, a cranial x-ray did not reveal a fracture or an orbital foreign body, and the 2.5 cm skin wound on the left lower eyelid was sutured. For further evaluation, computer tomography) was performed. This did not show a radio-opaque, orbital foreign body. An explorative orbitotomy was carried out and revealed a 3.7 cm long wooden fragment medial to the inferior oblique muscle (OI). The extraconal portion of OI was found to be necrotic. Complete reconstruction of the OI was not possible due to the extent of the necrosis. The residual muscle was fixated to the orbital septum. Recovery was good and the diplopia resolved after 6 months. This case emphasizes the importance of a meticulous inspection of skin wounds with a high risk of remaining wooden foreign bodies and shows the possibility of functional recovery of extraocular muscles following partial reconstruction.     

New views on treatment of intraocular foreign bodies]

The authors evaluated the results of surgery in 130 patients operated at the Second Ophthalmological Clinic in 1983-1989 on account of intraocular foreign bodies. Extraction of the body was successful in 126 patients (96%), the function of the eye was preserved in 102 of 126 extracted foreign bodies (81%), a visual acuity of 0.5 to 1.0 was recorded in 78 eyes (60%). The authors investigated the relationship of functional results on the type, size and site of the intraocular foreign body, the way of extraction, interval between the injury and operation and previous attempted extractions. Analysis of results revealed the advantages of extraction of intraocular foreign bodies under visual control in the majority of foreign bodies. Intraocular foreign bodies are not an indication for immediate but for early operation. After careful treatment of the wound where the foreign body penetrated extraction may be delayed for several days before optimal conditions for surgery are created.     

Pentacam三维眼前节分析仪在晶状体异物诊断中的应用价值

目的 探讨Pentacam在晶状体异物诊断及定位中的应用价值.方法 为比较性研究.收集经手术证实的晶状体异物病例9例,所有患者术前均完成裂隙灯显微镜、普通B超、UBM、CT及Pentacam三维眼前节分析仪检查.结果 9例晶状体异物病例中,通过裂隙灯显微镜直接检出者为4例,怀疑1例;通过B超检出5例;通过UBM、CT、Pentacam检出者均为6例.本组9例病例中,异物均经角膜穿通伤口达到并存留于晶状体,Pentacam能检出所有病例的角膜穿通伤口,晶状体前囊膜破口或机化,晶状体皮质溢出,外伤性白内障等晶状体异物相关体征.对于检出的晶状体异物病例,Pentacam可实现异物所在径线和异物与周围组织关系的精确定位;Pentacam在判定异物性质方面存在一定困难;Pentacam的异物测量值比实际测量值偏小.结论 Pentacam在晶状体异物诊断及异物相关体征检出中具有实用价值;Pentacam可实现所检出异物的精确定位;联合应用其他检查方法可为晶状体异物的诊断和定位提供更为准确和详尽的信息.     

"Masquerade foreign body" of the conjunctiva

CASE REPORT: An eight months old child presented with a "red eye" and a corneal erosion since a week. The parents reported on a "hair" which was invisible most of the time but appeared intermittently at the lid margin. The medical history was otherwise unremarkable. In general anaesthesia, a long structure could be easily extracted. The tapering structure disclosed several tiny hair-like filaments sprouting from the thickened end. This end was embedded within a fold of conjunctiva, thus giving the impression of a hair sheath. Clinically, an ectopic "giant hair" was supposed. Histology, however, revealed plants cells and a birefringence too high for a hair so that a diagnosis of a plant foreign body was established. CONCLUSION: Conjunctival foreign bodies may be overlooked especially in young children with no history of foreign body acquisition. They may occur as a "masquerade foreign body".     

前节相干光断层扫描技术在角膜外伤中的应用研究

目的评估前节相干光断层扫描技术（AS-OCT）在角膜外伤诊疗中的应用价值。方法回顾性分析85例（91只眼）各类角膜外伤：穿通伤56只眼,钝挫伤18只眼,角膜异物10只眼,化学伤7只眼。所有患者在诊疗过程中除常规裂隙灯显微镜等检查外,均以AS-OCT观察了角膜形态结构,部分患者进行了角膜厚度测量。结果所有病例均获得清晰AS-OCT角膜图像,8只眼角膜穿通伤病例清创缝合术后患眼发现严重角膜伤口内口对合不佳,3只眼LASIK术后眼球钝挫伤发现角膜层间积液,对于透明/半透明角膜异物病例,AS-OCT可显示异物在角膜内具体位置。但对于金属异物,在AS-OCT检查所获图像中异物后的部分呈现为无反射区,故而无法判断异物深度。AS-OCT可清晰显示急性期角膜化学伤患者角膜水肿情况并可进行厚度测量。1只眼因陈旧性化学伤导致的角膜白斑,裂隙灯显微镜下无法窥见眼内结构,AS-OCT显示前房、虹膜结构基本正常。结论 AS-OCT可清晰显示外伤后角膜的形态结构,对于角膜外伤的诊断和疗效评估具有很好的应用价值。     

The history of neuro-ophthalmology in Europe

Orbitocranial injuries caused by a wooden foreign body are rarely encountered.We present a 17-year-old boy who sustained an intracerebral injury from a wooden foreign body via the transorbital route. Almost all neuro-ophthalmological signs were present due to penetration of the material into the optic canal and superior orbital fissure.There was a minute laceration on the upper eyelid, whereas the eye bulb was macroscopically intact.The wooden foreign body (6.5cm in length) was removed via the upper eyelid. The diagnostic and therapeutic modalities of intracranial injuries caused by a wooden foreign body through the transorbital route are discussed in this paper.     

Surgical treatment of eye wounds with retinochoroidal metal foreign bodies. Apropos of 6 cases

Six cases of intra-ocular metallic foreign bodies located into the retino-choroidal wall are presented. A surgical treatment was performed, and included a vitrectomy, a foreign body extraction with intraocular forceps, a primary or a secondary scleral buckling for the peripheral wound, and a retino-choroidectomy for one of the posteriorly located foreign bodies. In all the cases, we observed a cicatricial retraction of the retino-choroidal wound. When the wound was peripheral, the retina detached in the cases without buckling and it was necessary to do a secondary scleral buckling procedure. When the wound was located at the posterior pole, the retina remained flat in one case, with a 6 mm metallic body, probably because of the relaxing retinotomy performed to extract the foreign body. We think that it is better to perform a primary scleral buckle of the peripheral wounds. The various aspects of the treatment are discussed.     

A case of an intraocular foreign body due to graphite pencil lead complicated by endophthalmitis

We report a case of an 8-year-old boy who presented with an intraocular foreign body composed of graphite pencil lead. The patient had been accidentally poked in the right eye with a graphite pencil. Primary care consisted of corneal suturing and lens extraction. Two pieces of the pencil lead remained in the vitreous cavity following surgery, and 2 days later the patient developed endophthalmitis. Pars plana vitrectomy was performed immediately and the intraocular foreign bodies were removed through the scleral wound. Cultures of the vitreous fluid revealed no bacterial organisms. X-ray fluoroscopic analysis of the vitreous detected 1 ppm of aluminum (a constituent of the pencil lead). Although the clinical presentation indicated probable bacterial endophthalmitis, the detection of elemental aluminum within the vitreous cavity also suggested the possibility of further retinal toxicity due to some dissolving of the pencil lead.     

玻璃体切割术治疗眼球壁异物的临床观察

目的评价玻璃体切割术治疗眼球壁异物的效果。方法对我院2007年1月至2010年6月21例（21眼）眼球内壁异物行玻璃体切割联合异物取出的临床资料进行回顾分析。结果 21例（21眼）均一次手术成功取出异物,伴有角膜裂伤、白内障、视网膜脱离及眼内炎者,均得到治愈。术后视力较术前增加者6眼（占28.6%）,不变者8眼（占38.1%）。术后1眼出现脉络膜脱离,1例出现视网膜脱离。结论玻璃体切割联合球壁异物取出,异物取出成功率高,同时治疗并发症,是治疗眼球内壁异物的较好选择。     

Intraorbital organic foreign body--a diagnostic challenge

Intraorbital organic foreign bodies pose a diagnostic and management challenge to ophthalmologists. A high degree of suspicion of an orbital foreign body is needed when patients present with injuries to the eyelids and orbit. We present a case of retained intraorbital wooden foreign body which was initially undetected. A 10-year-old boy presented to the eye casualty with signs and symptoms suggestive of orbital cellulitis. He was started on intravenous antibiotics and urgent CT of the orbits did not reveal any foreign bodies. There was spontaneous extrusion of a wooden foreign body through the upper lid two days later, followed by spontaneous resolution of symptoms. Wood has a density similar to air and fat and can be difficult to distinguish from soft tissue in both a plain X-ray film and a computed tomogram. Clinicians should be alerted to the possibility of retention of an intraorbital foreign body in all patients presenting with periorbital trauma. The clinician should also obtain a careful history of the type of injury and should examine the patient in detail. In cases where a wooden foreign body is suspected, investigation by magnetic resonance imaging is preferred.     

Wooden spike orbital injury

A 71-year-old female patient fell in her garden, inducing a skin wound on the temporal left eyebrow. Skin disinfection and wound closure were performed elsewhere, an X-ray image did not reveal a foreign body. She was referred to our service three days later with a progressive left periorbital swelling. Clinical inspection demonstrated a painfully, fluctuant swelling around the wound with an inflammatory pseudoptosis of the left eye. Vision was reduced on the left eye; anterior and posterior segments of both eyes were unharmed. After opening the wound sutures a purulent liquid was drained and a wooden fragment was found, measuring 22 x 0.5 mm. Because of restriction of abduction of the left eye, magnetic resonance imaging (MRI) was performed, detecting another organic intraorbital foreign body and a fracture of the left medial orbital wall. Anterior orbitotomy was performed and a wooden fragment was removed, measuring 47 x 0.6 mm. Under administration of intravenous antibiotics vision and ocular motility recovered uneventfully. This case emphasizes the value of MRI in the diagnostics of retained wooden foreign bodies as well as the importance of a soigneuse inspection of skin wounds with a high risk for remaining foreign bodies.     

玻璃体切割术治疗异物引起的眼球贯通伤

目的评价异物引起的眼球贯通伤行玻璃体切割术的治疗效果,探讨异物取出的手术路径和玻璃体切割手术时机的选择。方法回顾性系列病例研究。由异物导致的眼球贯通伤56例（56眼）。根据CT和B超检查结果联合定位,分为球壁异物组（24例）和眶内异物组（32例）。24例球壁异物在伤后1周内均通过玻璃体视网膜手术取出异物。32例眶内异物中有22例先行眶内异物取出联合后巩膜伤口缝合术。10例因异物位于后极部或眶深部未行取出术。所有眶内异物组患眼均于伤后2周左有行玻璃体视网膜手术修复眼内组织。随访3-12个月,观察术后视力和并发症。以卡方检验分析影响术后视力的冈素。结果玻璃体切割术后,50例（89％）患者视力较术前提高,34例（61％）术后最佳矫正视力≥0．05。异物人口位置（X^2=7．69,P=0．01）、出口位置（X^2=21．83,P〈0．01）、视网膜脱离（X^2=-16．64,P〈0．01）、脉络膜脱离（X^2=7．73,P=0．01）以及眼内感染（X^2=6．89．P=0．01）对术后视力影响较大。术后6例发生视网膜脱离,2例低眼压,12例发生黄斑前膜或皱褶。结论根据异物的位置和眼内情况选择恰当的手术路径和玻璃体切割的手术时机,最大限度地减少手术对视网膜组织的损伤及预防增殖性玻璃体视网膜病变是成功治疗眼球贯通伤的关键。     

眼内异物伤眼内炎的临床观察

目的:探讨眼内异物伤眼内炎的感染因素、诊治情况.方法:收集256例眼内异物伤中42例发生眼内炎病例,从致病因素、微生物学检测及诊断治疗进行回顾性分析.结果:眼内异物伤眼内炎发生率为16.4%.眼后节异物及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素(P＜0.05).眼内异物伤Ⅰ期给予玻璃体腔注射盐酸去甲万古霉素及头孢他啶可以减少眼内炎的发生率(P<0.05).异物性质及大小、取出时间及伤口情况对眼内炎发生率无明显影响(P＞0.05).眼内异物伤眼内炎手术分级Ⅲ级最多.玻璃体切除手术是治疗眼内炎的主要手术方式.结论:眼后节异物伤及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素,Ⅰ期手术需处理白内障时尽量保留完整的晶状体后囊膜.建议眼后节异物伤Ⅰ期行玻璃体腔注射万古霉素及头孢他啶.一旦确诊眼内炎,尽早进行玻璃体切除手术.     

Laceration and partial dislocation of LASIK flaps 7 and 4 years postoperatively with 20/20 visual acuity after repair

PURPOSE: To report two cases of late ocular trauma resulting in laceration of corneal flaps 7 and 4 years (cases 1 and 2, respectively) after LASIK. METHODS: A 49-year-old man sustained laceration of the flap and interface foreign body debris from construction material in the right eye 7 years after uneventful LASIK (case 1). A 33-year-old man had partial dislocation of the flap 4 years after LASIK in the left eye (case 2) due to a penetrating wood chip accident. Surgical procedures were performed to remove the foreign bodies and reposition the flaps. RESULTS: In case 1, postoperative uncorrected visual acuity (UCVA) was 20/25 with manifest refraction of -0.50 -0.50 x 110 corrected to 20/20. In case 2, UCVA was 20/20 with piano refraction after LASIK retreatment. CONCLUSIONS: Corneal LASIK flaps are susceptible to penetrating trauma, which can occur >7 years after the procedure. Proper everamanage ment of the trauma and LASIK flap can restore excellent visual acuity.