Air bag-associated ocular trauma in children

OBJECTIVE: To describe a series of children with ocular injuries related to air bag deployment. DESIGN: Retrospective, observational case series. PARTICIPANTS: Seven patients with ocular injuries sustained in motor vehicle accidents in which air bags were deployed. METHODS: Review of medical records. RESULTS: All patients had periocular contusions. Minor injuries included corneal abrasions (n = 5), superficial eyelid laceration (n = 1), and traumatic iritis (n = 2). Serious injuries included corneal edema (n = 1) and a traumatic hyphema with secondary glaucoma and cataract (n = 1). The latter patient required surgery. All other injuries resolved with medical therapy. All patients recovered normal visual acuity. CONCLUSIONS: Serious ocular injuries in children may result from air bag deployment. Most such injuries are minor and resolve without sequela. It is recommended that infants and children travel in the rear seat of automobiles to minimize their risk of injury.     

A case of air-bag associated severe ocular injury

Air-bags have received widespread support as an effective means of enhancing automotive safety, and they are becoming more common as standard automobile equipment on many cars. Although air-bag induced ocular injuries are rare, they present a serious concern because of the possibility of permanent damage or visual impairment. To date, most reports have investigated ocular injury from high velocity motor vehicle accidents and reports of ocular injury from low speed motor vehicle accidents have been rare. We describe a patient who sustained severe ocular injury, including periorbital fracture, hyphema, vitreous hemorrhage, and choroidal rupture of the macular area, due to an inflated air-bag in a low speed motor vehicle accident.     

Airbags and Eye Injuries: Epidemiology, Spectrum of Injury, and Analysis of Risk Factors

Although airbags measurably reduce the overall risk of injury to adults (including eye injury), and death from motor vehicle accidents, injuries attributed to airbag deployment have been reported. To identify reported cases of ocular trauma related to airbag deployment, a MEDLINE search from 1991 to 2000 was performed. A total of 263 injuries in 101 patients were identified. Patient demographics, details of the accident, specific ocular structures injured, and visual outcomes when available where tabulated and analyzed. The most common of these affect the eyes. Damage to the orbit and virtually every ocular and adnexal structure has been seen. Although most injuries are self-limited and do not significantly compromise vision, some result in severe, permanent visual loss. Most common is damage to anterior structures due to either blunt, contusive forces and/or chemical injury. Posterior segment trauma is less common but generally more visually devastating because of the involvement of the retina or optic nerve. Data are not available to determine whether the wearing of eyeglasses or previous intraocular surgery affects the nature, severity, or outcome of these injuries. Awareness of the spectrum of airbag-associated ocular trauma will help physicians recognize these problems early and optimize their management. Data derived from analyses of these injuries will be critical to the development of safer, more effective devices.     

Orbital roof fractures: management of ophthalmic complications

PURPOSE: To review the clinical features and management of patients with orbital roof fractures. METHODS: Non-comparative, retrospective case review of 21 patients presenting with orbital roof fractures. RESULTS: The orbital roof fractures in our series resulted from motor vehicle accidents, blunt trauma, head injuries, and penetrating orbital injuries. Associated orbital and ocular injuries included other ipsilateral orbital fractures (16 cases), traumatic optic neuropathy (3 cases), ptosis (2 cases), perforating eye injuries (2 cases), intraorbital foreign bodies (2 cases), and oculomotor nerve palsy (1 case). Six patients required surgical intervention for ophthalmic sequelae, which included motility problems (4 cases), lagophthalmos (1 case), and a retained intraorbital foreign body with a cerebrospinal fluid leak (one case). The outcome of surgery was favorable in all cases, with complete resolution of symptoms in five of six patients. CONCLUSIONS: Orbital and ocular injuries are common in association with orbital roof fractures. A multidisciplinary approach to management is required because facial and cerebral injuries are also common. Most patients can be managed conservatively. The specific ophthalmic indications for surgical intervention are limited, but the outcome in these cases is gratifying.     

Four-year review of open eye injuries at the Royal Adelaide Hospital

Purpose: To review the epidemiology of penetrating eye injuries and ruptured globes presenting to the Royal Adelaide Hospital, South Australia. Methods: A retrospective case review over a 4‐year period. Results: There were 109 penetrated or ruptured globes in 105 patients. The average age was 41 years and 80.2% were men. Over half were from rural areas. The commonest cause of injury was hammering metal followed by motor vehicle accidents. Falls in the elderly were the commenest cause of globe ruptures. A final visual acuity of 6/12 or better was found in 40% of eyes and no perception of light in 27%. Conclusions: At the Royal Adelaide Hospital, the predominant referral centre for serious ocular injury in South Australia, approximately 25 open globe injuries are encountered a year. Although the epidemiology of these injuries was found to be similar to those previously reported in Victoria and rural New South Wales, differences were thought to reflect to the ageing population of South Australia. Rupture of an old, healed large‐incision cataract extraction wound was the commonest cause of ruptured globe. An effective preventive strategy to reduce the incidence of severe ocular trauma has yet to be implemented. The concept of a national population‐based severe ocular trauma database is considered.     

Incidence of ocular injuries in motor vehicle crash victims with concomitant air bag deployment

OBJECTIVE: To report the incidence of ocular and nonocular trauma in patients admitted to the Henry Ford Hospital via the emergency room since 1994 after a motor vehicle crash (MVC) with and without air bag deployment. DESIGN: A retrospective cohort study. METHODS: The Henry Ford Hospital Trauma Registry database was reviewed for patients involved in MVCs with and without air bag deployment since 1994. RESULTS: From 1994 to 1999, there were only seven air bag-related ocular injuries, representing 4.4% of all MVC-related ocular injuries. From 1997 to 1999, MVC-related ocular injuries with and without air bags represented 5.0% and 12.7%, respectively, of all MVC-related injuries. For that same period, the death rate and average Injury Severity Score for MVCs with air bag deployment were 3.4% and 10.75, compared with 8% and 14.5, respectively, for MVCs without air bag deployment. CONCLUSIONS: MVC-related ocular injuries associated with air bag deployment are rare, and the incidence of ocular injuries associated with MVCs was lower when air bags were deployed.     

Eye injury and the air bag

Although traffic-related mortality and morbidity figures have improved in recent years in the United States, motor vehicle crash remains a leading source of death and injury, requiring additional efforts to reduce its toll. The rationale for equipping passenger vehicles with air bags was to introduce a mechanical cushion between occupants and the car's hard interior surfaces. Although air bags have proven to be effective in saving lives and preventing injuries, a growing number of reports indicate that the air bag is also a potential source of ocular trauma. This article analyzes 24 eye injuries alleged to be air bag-related. The posterior segment was injured in less than half of cases, and only one eye sustained severe visual impairment. Although such reports may help to improve air bag design, the air bag should remain "innocent until proven guilty." We report that in motor vehicle crashes, the rate of ocular trauma increases 2.5 times if the car is not air bag-equipped. In contrast to injuries seen in vehicles without air bags, eye trauma sustained in vehicles with air bags is typically closed globe.     

Ocular injuries secondary to motor vehicle accidents

PURPOSE: Ocular trauma is one of the main causes of visual reduction or loss, particularly in the younger population. METHODS: In this prospective study the authors included 67 consecutive patients with ocular trauma secondary to motor vehicle accidents who were hospitalized in the Athens University Eye Clinic from September 1993 to December 1996. The mean follow-up time was 31 months, the mean age was 31.7 years, and the ratio between men and women was 2.7:1. RESULTS: Thirty-two of the accidents (47.76%) took place in populated areas. Among the 67 injured persons, 58 (86.56%) were car passengers, 8 (11.95%) were on motorcycles, and 1 (1.49%) was a pedestrian. Only 3 (5.2%) of the 58 persons injured inside automobiles used safety belts and none of the motorcyclists used crash helmets during the accidents. Fifty-three (79.1%) ocular traumas were penetrating in nature, with glass fragments being the main cause in 36 of them (67.9%). Among the 53 injured persons experiencing penetrating ocular trauma, 49 had a follow-up time of more than 6 months. Twenty of them (40.8%) underwent one surgical procedure, 22 (44.9%) were submitted to two surgical procedures, and the remaining 7 persons (14.3%) needed three or more operations. Eighteen (36.7%) of the 49 patients with penetrating ocular trauma and with 6 months follow-up had a final visual acuity of less than 1/20, 21 (42.9%) had a visual acuity of more than 5/10, and 3 (6.1%) underwent enucleation. Among the 67 patients, 61 had a follow-up time of more than 6 months, regardless of their history of penetrating ocular trauma. Eighteen of them (29.5%) had a final visual acuity of less than 1/20, 8 (13.1%) had a visual acuity between 2/10 and 4/10, and 22 (52.5%) had a visual acuity of more than 5/10. CONCLUSIONS: Because motor vehicle accidents can cause severe ocular trauma, it would be helpful for drivers to be more careful and aware of motor vehicle regulations. There seems to be a great need of enforcement of seatbelt laws in Greece.     

Ocular morbidity associated with airbag deployment: a report of seven cases and a review of the literature

PURPOSE: To review ocular injuries secondary to airbag deployment that were seen in our institution and were reported in the literature. METHODS: Patients examined at our institution between 1997 and 2000 were evaluated for ocular injuries caused by airbags. A review of the medical literature using Medline was performed. All reports involving ocular injuries secondary to airbags were included in this study. RESULTS: Seven cases from our medical center were identified to involve airbag-related eye injuries. The ages of the patients ranged from 4 to 73 years. Ocular injuries included corneal abrasion, corneal decompensation, corneal alkali injury, hyphema, iris sphincter tears, vitreous hemorrhage, macular retinal pigment epithelium disruption, dislocated posterior chamber intraocular lens, and commotio retinae. A review of the medical literature showed 74 cases involving 80 eyes. The ages of the patients ranged from 2 to 81 years. Males slightly outnumbered females by a ratio of 1.1 to 1.0. The speed of the vehicles ranged from 0 to 65 miles per hour, with an average reported speed of 31 miles per hour. Reported injuries ranged from mild corneal abrasions to open globes. CONCLUSIONS: Ocular morbidity secondary to airbag deployment must be recognized as a significant risk for motor vehicle drivers and passengers. Improvements in airbag safety will include increased consumer awareness and manufacturer design modification.     

New investigations concerning the relationships between congenital colour vision defects and road traffic security

New extentive experiments demonstrated that: (a) protan observers are more deficient than deutan ones with regard to perception distances of some traffic panels, of vehicle red stop lights, of vehicle red rear-position lights and of white, yellow and red reflectors. Contrarily, deutan observers are more deficient than protan ones for the distinction of differently coloured traffic lights and vehicle rear lights; (b) protan and deutan drivers are nevertheless not responsible for more traffic accidents than drivers with normal colour vision; (c) this apparent contradiction is due to psychological compensation mechanisms. The practical conclusions are: (a) that persons with defective colour vision need not to be excluded from non professional road traffic; (b) that it is nevertheless useful that they should be aware of their handicap; (c) that the red traffic signal has to be larger than the other ones; and (d) that the stop and red position lights of vehicles must be sufficiently intense and that the filters transmitting only pure red should be avoided in them.     

Ophthalmic complications among cases of head trauma in north-eastern Iran

The aim of this study was to investigate the prevalence and pattern of ocular complications in patients with head trauma admitted to the main trauma centre in north-eastern Iran. A total of 459 head-injured patients (36.56 ± 19.30 years of age) with at least one ocular manifestation were recruited. Each individual patient was examined by a neurosurgeon and an ophthalmologist to confirm the type of ocular complication. In addition, all patients were analysed for age, gender, and cause of head injury in addition to the ophthalmic and neurosurgical examinations. Of the 459 patients, 142 (31 %) were female and 317 (69 %) were male. The maximum rate of ocular complications was during the third decade of life and minimum during childhood and in the elderly (>71 years) population. The leading cause of head trauma was motor vehicle accidents, predominant in male adults aged 21–40 years. Ocular complications observed were classified into three major groups: soft-tissue injuries to the globe and adnexae (n = 434), orbital complications (n = 45) and neuro-ophthalmic complications (n = 152). In conclusion, our data provides a useful estimation of the rate and pattern of ocular complications among patients with head injuries seen in trauma centres in north-eastern Iran. Understanding the pattern of ocular complications helps us to design more appropriate preventive methods.     

MOTOR VEHICLE ACCIDENT EYE INJURIES IN CHILDREN

An analysis of 32 eye injuries in 30 children who survived motor vehicle accidents and were admitted between 1971 and 1978 to the Royal Alexandra Hospital for Children and Sydney Eye Hospital. Each child was an unrestrained passenger in a motor vehicle involved in the accident. 70% lost the sight in one eye.     

Automobile air bags: friend or foe? A case of air bag-associated ocular trauma and a related literature review.

BACKGROUND: Although air bags are placed in automobiles to act as safety devices, they have been shown to carry a risk of injury themselves. Ocular injury, in particular, can often be a direct consequence of air bag deployment. A case of ocular air bag injury is presented. A discussion and review of the current literature on this issue follows. CASE REPORT: A 63-year-old man was transferred to our clinic after sustaining injuries related to a motor vehicle accident, during which the automobile's air bag was deployed. Initial examination revealed many signs of blunt ocular trauma of the O.D., including iridodialysis, dislocated lens with traumatic cataract, and traumatic/inflammatory glaucoma. Initial B-scan showed an attached retina O.D. One month later, the patient underwent an attempted pars plana vitrectomy with lensectomy, iris repair, and insertion of an anterior chamber intraocular lens. Complications arose during the procedure, and a total retinal detachment developed. Resultant acuity is no light perception O.D. CONCLUSIONS: Although ocular morbidity can be a direct consequence of air bag deployment, most eye injuries are minimal, and seem to be outweighed by the benefits of air bags. Drivers, as well as passengers, can minimize associated injuries by adhering to specific safety guidelines. This, as well as continual modification and improvement in air bag design, will maximize the safety of air bags and decrease the incidence of vision-threatening ocular injury caused by air bag deployment.     

Ocular injury caused by an air bag for a driver wearing eyeglasses.

BACKGROUND: Although air bags have been shown to reduce the number of fatalities and serious injuries caused by motor vehicle accidents, there have been many reports of air bag-related ocular injuries. We recently treated air bag-related corneal laceration in a patient wearing eyeglasses at the time of a motor accident. CASE: A 38-year-old Japanese man was driving a car at approximately 40 km per hour when he struck a stopped 2-ton truck. He was wearing a three-point lap-shoulder seat belt. At impact, the driver's-side air bag deployed and struck the man on the left side of his face. He was wearing eyeglasses with glass lenses, and the air bag broke the left lens of his eyeglasses, and glass fragments lacerated his cornea. OBSERVATIONS: External examination showed multiple superficial abrasions of the skin and ecchymosis of the left side of his face. Slit-lamp examination of his left eye showed corneal laceration and hyphema. The lens had opacities and was covered with fibrin membrane. Repair of the corneal laceration and phacoemulsification of the lens were performed. Six months later, his best corrected visual acuity was 20/20 in the left eye. CONCLUSIONS: As cars are increasingly equipped with air bags, reports of air bag-related eye injuries have increased. To our knowledge, this is the first reported case of corneal laceration caused by a shattered lens in an air bag-related injury. Ophthalmologists should caution patients about the danger of eye injuries in air bag-equipped cars, and thought should be given to improving the materials for eyeglasses.     

外伤性眶内血肿的临床表现及治疗

目的 探讨外伤性眶内血肿的临床特点和治疗方法。方法 回顾分析23例23眼外伤性眶内血肿的临床表现，探讨了外伤性眶内血肿的发病原因、影像学特征和治疗方法。结果 外伤性眶内血肿引起视力下降、眼眶压增高、眼球突出、复视及眼部运动神经损害。视力恢复较血肿消退快。血肿消退速度从2周后加快。视力恢复≥0．3者19眼占82．61％，眼运动神经损伤恢复者18例占78．26％。结论 外伤性眶内血肿对眼组织损害较大，应早期采取综合治疗：溶解血肿、降低眶压、促进吸收并改善循环。     

Facial and ocular injuries associated with methamphetamine production accidents

PURPOSE: To evaluate the relative contribution of methamphetamine production-related accidents to facial and ocular injuries admitted to a regional burn unit. DESIGN: Retrospective observational case series. METHODS: Chart review of all patients admitted to the Burn Unit at the University of Iowa Hospitals and Clinics (UIHC) over a 16-month interval. RESULTS: Methamphetamine related accidents were responsible for thirteen (9.8%) of 132 patients admitted with facial burns to UIHC during the study period. All victims were male. In addition to facial burns, eight patients (14 eyes) suffered chemical or thermal burns of the ocular surface of Hughes grade I or worse. One patient required full-thickness skins grafts for cicatricial ectropion of all four eyelids. CONCLUSION: In endemic areas such as Iowa, methamphetamine production accidents contribute to as many as 10% of admissions to burn care units for facial and ocular injuries.     

Airbag induced facial and bilateral ocular injuries in a 14-year-old child

Although air bags have reduced the incidence of fatal and severe injuries in automobile collisions, they have been shown to carry a risk of injury themselves. Ocular injury in particular can often be a direct consequence of air bag deployment.We report a 14-year-old child who sustained facial burn and bilateral ocular injuries affecting both the anterior and posterior segments due to an inflated air bag in a low speed motor vehicle accident.     

Corneal manifestations in chemical injury with stannous chloride

Chemical injuries are potentially devastating ocular accidents that can lead to permanent damage to the ocular surface and visual loss. The majority of serious chemical injuries occur in factory workers who are exposed to hazardous chemicals in their day-to-day life. The ocular effects of commonly encountered acids and alkalis are well documented in the literature. Here we report briefly on the corneal and other ocular effects of stannous chloride, which is sparsely reported in the currently available literature.     

Eye injuries in childhood: a retrospective investigation of 88 cases from 1988 to 2000

PURPOSE: To assess the frequency, causes, mechanisms, and functional outcomes of eye injuries in childhood. METHODS: A retrospective analysis of the hospital files of patients younger than 12 years admitted to the Institute of Ophthalmology of Verona University for eye injuries from January 1, 1988, to December 31, 2000. RESULTS: Eighty-eight cases of eye injuries (69 [78%] boys, 19 [22%] girls) were identified. The mean age at admission was 7.2 years. The most frequent causes of eye injuries were domestic accidents in patients younger than 6 years (25%) and accidents at play in those older than 6 years (35%). Scissors were the most frequent causative agents in children under 6 and toys, stones, and ball injuries in those over 6. Diagnoses, therapies implemented, ocular complications, and outcomes are reported. CONCLUSIONS: The major causes of eye injuries in childhood are preventable; thus more adequate adult supervision and educational and legislative measures are necessary and useful in order to reduce prevalence and morbidity of these accidents.