Fishhook Injury of the Anterior Chamber Angle of the Eye.

A 36-year-old man presented with a corneal penetrating fishhook injury with the tip embedded in the inferior anterior chamber angle of the eye. Complete removal was achieved with extension of the wound at the limbus using the "cut-out" technique. Intraocular fishhook injuries are common in fishing communities and effective surgical removal may involve modified techniques previously described for skin or mucosal tissue.

Intranasal Corticosteroids and Central Serous Chorioretinopathy: A Report and Review of the Literature.

A 43-year-old male with a history of allergic rhinitis on chronic intranasal corticosteroids presented with complaints of a "black band" in his right eye visual field. On examination, he had subretinal fluid and lab tests and imaging studies including optical coherence tomography (OCT) and fluorescein angiography (FA) did not show any evidence of inflammatory, degenerative, or malignant process. He was diagnosed with central serous chorioretinopathy (CSCR). Symptoms improved and the subretinal fluid resolved after the discontinuation of intranasal corticosteroid medication. Intranasal corticosteroids are rarely associated with CSCR. Patients and providers should be aware of the potential risk of vision loss caused by intranasal corticosteroids.

Isolated trochlear nerve (cranial nerve IV) palsy in a patient with carotid-cavernous fistula.

Isolated fourth cranial (trochlear) nerve palsy is an uncommon occulomotor nerve palsy typically secondary to ischemia, inflammation/infection, or mass effect. Due to its positioning within the cavernous sinus, pathology of the deep cerebral venous system would theoretically predispose to palsy of this nerve. We present a case of a patient presenting with isolated trochlear nerve palsy in the setting of angiographically-confirmed direct carotid-cavernous fistula.

High School Football Players Use Their Helmets to Tackle Other Players Despite Knowing the Risks.

There is greater attention to head-related injuries and concussions in American football. The helmet's structural safety and the way that football players use their helmets are important in preventing head injuries. Current strategies include penalizing players for high-risk behavior such as leading with their helmet or hitting an opposing player above the shoulder. Passive strategies include helmet modification to better protect the head of the players or to change the playing style of the players. Hawai'i high school varsity football players were surveyed to determine how they use their helmets and how a new helmet design would affect their style of play. One hundred seventy-seven surveys were completed; 79% said that they used their helmet to hit an opposing player during a tackle and 46% said they made this contact intentionally. When asked about modifying helmets with a soft material on the outside, 48% said they thought putting a soft cover over a regular helmet would protect their head better. However, many participants said that putting a soft cover over their regular helmet was a bad idea for various reasons. Most young football players use their helmets to block or tackle despite being taught they would be penalized or potentially injured if they did so. By gaining a better understanding of why and how players use their helmets and how they would respond to new helmet designs, steps can be taken to reduce head injuries for all levels of play.

A Rare Case of Lateral Canthal Gouty Tophus Presenting as an Eyelid Mass.

A 41-year-old man with a history of gout presented with an enlarging eyelid growth. Clinical examination revealed a mildly indurated nodule at the lateral canthus. Following resection, histopathological examination revealed needle-shaped, crystalline material surrounded by multinucleated giant cells, findings consistent with gouty tophus. This represents just the sixth case of gouty tophus of the eyelid reported in the literature.

External foam layers to football helmets reduce head impact severity.

Current American football helmet design has a rigid exterior with a padded interior. Softening the hard external layer of the helmet may reduce the impact potential of the helmet, providing extra head protection and reducing its use as an offensive device. The objective of this study is to measure the impact reduction potential provided by external foam. We obtained a football helmet with built-in accelerometer-based sensors, placed it on a boxing mannequin and struck it with a weighted swinging pendulum helmet to mimic the forces sustained during a helmet-to-helmet strike. We then applied layers of 1.3 cm thick polyolefin foam to the exterior surface of the helmets and repeated the process. All impact severity measures were significantly reduced with the application of the external foam. These results support the hypothesis that adding a soft exterior layer reduces the force of impact which may be applicable to the football field. Redesigning football helmets could reduce the injury potential of the sport.