Nonsurgical Management of Retained Needlefish Jaw.

While scuba diving, the left medial canthus of a 53-year-old man was pierced by a needlefish. He immediately lost vision in his left eye. An orbital computed tomographic scan showed the needlefish jaw in the left optic canal. The left medial orbit was explored surgically but no foreign object was removed. One month later, MRI confirmed the presence of the retained needlefish jaw. A conservative approach was taken and the patient remained stable over 3 months of follow-up.

[Classical Medical Mistakes - Lack of Appreciation of Psychological Components]. / Klassische ärztliche Fehlleistungen ­ die Verkennung psychologischer Komponenten.

Detailed evidence for psychogenic effects after an accident: evidence from 3 expert reports.

First identification of Gordonia sputi in a post-traumatic endophthalmitis patient - a case report and literatures review.

BACKGROUND: We present a case of post-traumatic endophthalmitis with relatively good prognosis caused by Gordonia sputi, which, to our knowledge is the first case in the literature. CASE PRESENTATION: A 24 year old man, who underwent an intraocular foreign body extraction half a month before presentation in the left eye, was referred to us complaining of blurred vision and slight pain for 5 days. His first presentation showed moderate intracameral and intravitreous purulent inflammation with a best corrected vision of counting fingers. After gram staining of the intravitreous samples revealed a gram-positive bacilli infection, a combination of amikacin and vancomycin was initially injected intravitreously. The left eye kept stable for three days but deteriorated on the 4th day. On the 5th day after presentation conventional culture characterized the bacterium as an Actinomyces sp. while 16S ribosomal RNA gene sequencing confirmed it as Gordonia sputi. Thereby a complete pars plana vitrectomy combined with lensectomy and silicone oil tamponade was performed. During the surgery an intraocular irrigation with penicillin G was adopted, followed by administration of intravenous penicillin G twice one day for a week. A relatively normal fundus with slight intracameral inflammation was observed a week after the operation, and the best corrected vision recovered to 0.15. One year later his vision remained 0.1. CONCLUSION: Gordonia sputi should be taken into consideration in patients with post-traumatic endophthalmitis especially due to foreign body penetration. Compared to conventional laboratories, molecular methods are recommended for an accurate diagnosis. A comprehensive strategy of antimicrobial agents and vitrectomy may render a satisfactory result.

Managing corneal foreign bodies in office-based general practice.

BACKGROUND: Patients with a corneal foreign body may first present to their general practitioner (GP). Safe and efficacious management of these presentations avoids sight-threatening and eye-threatening complications. Removal of a simple, superficial foreign body without a slit lamp is within The Royal Australian College of General Practitioners' (RACGP's) curriculum and scope of practice. Knowing the rele-vant procedural skills and indications for referral is equally important. OBJECTIVE: The objective of this article is to provide an evidence-based and expert-based guide to the management of corneal foreign bodies in the GP's office. DISCUSSION: History is key to identifying patient characteristics and mechanisms of ocular injury that are red flags for referral. Examination tech-niques and methods of superficial foreign body removal without a slit lamp are outlined, as well as the procedural threshold for referral to an ophthalmologist.

Localization and Retrieval of an Eyelid Metallic Foreign Body With an Oscillating Magnet and High-Resolution Ultrasonography.

A patient was found to have a metallic foreign body in the left anterior orbit on CT imaging, but the foreign body was not evident on clinical examination. On high-resolution ultrasonography, an object was identified in the left upper eyelid; however, the typical shadow with metallic foreign bodies was not seen. A high-power oscillating magnet was then applied to the eyelid, which revealed a subcutaneous metallic foreign body in the left upper eyelid. When used in conjunction, the high-resolution ultrasound and oscillating magnet successfully localized and facilitated retrieval of the metallic foreign body from the left upper eyelid.

Orbital cellulitis and corneal ulcer due to Cedecea: First reported case and review of the literature.

Cedecea is a gram-negative bacterium from the family Enterobacteriaceae, rarely associated with human infection. We report the first case of an orbital cellulitis and corneal ulcer due to Cedecea in a patient who sustained a motor vehicle accident and was then found to have a retained wooden orbital foreign body.

[EPIDEMIOLOGY, CLINICAL CHARACTERISTICS, PROGNOSTIC FACTORS, AND VISUAL OUTCOMES IN PATIENTS WITH OPEN OCULAR INJURIES AND INTRAOCULAR FOREIGN BODIES].

AIMS: To describe and identify clinical characteristics, prognostic factors and visual outcome in patients with intraocular foreign bodies (IOFB) in southern Israel. METHODS: We conducted a retrospective review of all cases of open globe injury with IOFB treated and followed-up for at least 6 months in the Ophthalmology Department at Soroka University Medical Center, Beer Sheva, Israel, from 1995-2011. The study population was subdivided into two groups: 1. Patients whose difference in visual acuity (VA) between presentation and end of follow-up was considered "successful" (n = 54); 2. Patients whose difference in VA between presentation and end of follow-up was considered "non-successful"(n = 14). Comparing these two groups, we analyzed the following: time from trauma to admission, time from admission to operation, location of IOB, wound zone, best corrected VA at admission. RESULTS: A total of 97.1% of the study group were males and the mean age was 28.7 ± 15.3 years. Metallic IOB were found in 73.5% of cases. The IOFB penetrated at Zone 1 in 61.8% cases, and were located at the posterior segment in 65.2 % of cases. The two subgroups differed in their best corrected VA (by LogMAR) at presentation (p value = 0.02): the patients who were defined as "successful" (n = 54) had.a higher mean VA (1.2 ± 1.3) than those (n = 14) who were defined as "non-successful" (1.1 ± 0.6). The duration of time from trauma to admission was not found to be of statistical significance (p value = 0.361, and neither did the time from admission to operation (P value = 1). CONCLUSION: We present an innovative definition of VA changes during the follow-up period in patients with open globe injuries involving IOFB. Our study showed that patients who presented with worse VA had a better chance of a "successful" outcome.

Intraorbital wooden foreign body: clinical analysis of 32 cases, a 10-year experience.

BACKGROUND: We aimed to describe herein the clinical features, diagnosis and treatment of intraorbital wooden foreign body injuries. METHODS: A case series review of orbital injuries managed at Trakya University Faculty of Medicine between 2002 and 2012 was performed retrospectively. The clinical analysis of 32 intraorbital wooden foreign body injuries was reviewed. RESULTS: Among the 32 cases, injuries in 16 were caused by a tree branch, in 10 by a pencil, in 5 by a stick, and in 1 by a bush. With respect to preoperative vision, postoperative vision was improved in 69% of patients. Time lapse from injury to presentation was correlated with the size of the foreign body. The subjects were comparable in etiological factor, and distribution of injury according to orbit was as follows: superior 28%, medial 25%, lateral 22%, inferior 16%, and posterior 9%. Computerized tomography (CT) for foreign body was definitive in 72% (n=23) and suggestive in 28% (n=9). CONCLUSION: The diagnosis of orbital wooden foreign body is difficult because it may be missed clinically and from the imaging perspective. If a foreign body is suspected, optimal patient management should be done. Prior to the surgery, imaging modalities should be maximally utilized. A careful preoperative evaluation, imaging studies, which are event-specific, a high index of suspicion, and rigorous surgery and postoperative care are the keys in the management of orbital wooden foreign body injuries.

Spectrum of intra-ocular foreign bodies and the outcome of their management in Brunei Darussalam.

To review the etiologies, prognostic factors and treatment outcomes of intraocular foreign bodies (IOFBs) occurring in the population of Brunei Darussalam, and provide guidelines to prevent and manage such injuries. A retrospective review was performed for all cases of traumatic IOFBs managed in our centre during a 3-year period between May 2008 and April 2011. The mechanism of injury, management, complications and visual outcomes were analyzed. Majority of the patients were males (93 %) and the mean age was 36 years. The main causes of trauma were metal hammering and grass cutting (43 % each). Other causes include road traffic accidents and firecracker explosion (7 % each). The visual outcome was ≥6/18 in 50 % and 'No perception of light' in 29 %. Causes of poor visual outcome were retinal detachment with proliferative vitreoretinopathy (21 %), endophthalmitis (21 %) and globe maceration (7 %). Prognostic factors associated with significantly worse final visual outcome included posterior location of the IOFB (p = 0.05) and larger IOFB size (p < 0.001). The time from injury to surgery did not correlate with a worse visual prognosis. In Brunei Darussalam, the commonest causes of IOFBs are hammering metal and cutting grass using power tools. The visual outcome varies between 6/6 and NPL. Poor visual outcome is related to the severity of the initial ocular injury, posterior segment IOFB and endophthalmitis.

The management of open globe eye injuries: a discussion of the classification, diagnosis and management of open globe eye injuries.

Eye injuries occurred in 10% of UK military major trauma cases in Iraq and Afghanistan between 2004 and 2008, with 33% of these eye injuries open globe in nature(1). This article will consider the diagnosis, classification and management of open globe injuries in the role 1/ pre-hospital environment.

Contact lens removal: the "chopstick" approach.

A case of adherent soft contact lenses in an apprehensive adolescent patient is described, along with a description of a novel technique for contact lens removal. After topical anesthesia and saline irrigation, the lenses were successfully removed, atraumatically, using a pair of saline-soaked cotton-tipped applicators held in a chopstick fashion.

Visual outcome and prognostic factors in posterior segment intraocular foreign bodies.

OBJECTIVE: To identify the prognostic factors that predict visual outcome in eyes with penetrating ocular injuries with retained intraocular foreign bodies (IOFBs). DESIGN: Retrospective cases series MATERIAL AND METHOD: The authors reviewed the records of 228 patients who had penetrating eye injuries with retained posterior segment IOFBs managed at Siriraj Hospital between June 1995 and February 2008. One hundred and forty-one patients (61.8%) were included in the present study. Associations between final visual outcome and various pre-operative and post operative variables were statistically analyzed. RESULTS: After a mean follow-up of 10.4 +/- 7.7 months, 68 eyes (48.2%) achieved visual acuity of 6/18 or better The final visual acuity ranged between 6/24 and 6/60 in 22 eyes (15.6%) and 51 eyes (36.2%) had visual acuity less than 6/60. Final visual acuity significantly depended on initial visual acuity (p = 0.002), size of entry wound (p = 0.020), size of foreign body (p = 0.018), presence of vitreous hemorrhage (p = 0.014), retinal detachment (p = 0.026) and endophthalmitis (p < 0.0001). CONCLUSION: Visual outcome in penetrating ocular injuries with retained IOFBs was affected by initial visual acuity, size of entry wound, size of foreign body, vitreous hemorrhage, retinal detachment and endophthalmitis. These factors may be helpful for pre-operative counseling and predicting the final visual outcome.

Foreign body traumas of the eye managed in an emergency department of a single-institution.

BACKGROUND: Superficial corneal foreign bodies (SCFB) are common injuries seen in the ED. The aim of this study was to describe the eye injuries caused by FBs and to determine clinical strategies for the prevention and management of ocular trauma. METHODS: This was a retrospective chart review of the previous two years. Demographic data, timing of the injury, injury type (open- or closed-globe injuries), source of the FB, hospital admission and ophthalmology consultation, treatments, and the long-term complications were recorded for each patient. RESULTS: There were 476 patients, and 83% were male, with an average age of 34.16±14.02 years. 9.7% of the eyes had an open-globe injury, while the rest were closed-globe injuries with or without SCFB. The most common FBs were metal fragments (37.6%) and dust (31.1%). The majority of the patients (72.1%) sustained work-related injuries. 42.4% of the patients were consulted to ophthalmology, and the remaining were treated by the emergency physicians. Only 10% of the patients required hospitalization, and complications were seen in 2.3% of the patients. CONCLUSION: Ocular FB involved mainly young healthy males who had sustained work-related injuries. In view of the large number of eye injuries seen in Eds, ED colleagues should train themselves in order to appropriately recognize, treat and refer the SCFB injuries seen in the ED.

Adult Eye Conditions: Common Eye Conditions.

In primary care practices and emergency departments, approximately 2% to 3% of visits are related to eye conditions. The most common diagnoses are corneal abrasion, corneal foreign body, conjunctivitis, external hordeolum (stye), and subconjunctival hemorrhage. This section addresses hordeolum, chalazion, conjunctivitis, corneal abrasion, and corneal foreign body. A thorough history and physical examination are crucial for patients with these conditions, and frequently are sufficient for diagnosis. Conservative therapies are first-line treatments for hordeolum and chalazion, including application of warm compresses, eyelid scrubs, and eyelid massage. Conjunctivitis is the most common etiology of red eye and has infectious and noninfectious causes. Bacterial conjunctivitis typically resolves in 1 to 2 weeks, but can be managed with topical antibiotic solutions or ointments. Viral conjunctivitis management involves frequent handwashing and use of cool compresses and artificial tears. Corneal abrasion is the most common eye injury seen in emergency departments, and corneal foreign body is the second most common. Topical antibiotics and cycloplegics are mainstay therapies for corneal abrasion, with consideration of topical nonsteroidal anti-inflammatory drugs for pain management. Follow-up visits are recommended for select patients. Management of corneal foreign body requires prompt removal of the object, pain management, consideration of prophylactic antibiotics, and follow-up when appropriate.

Eye irrigation as a first-line treatment and diagnostic method for emergency department patients who complain of ocular foreign bodies.

This prospective study aimed at determine whether eye irrigation removes ocular foreign bodies (FBs) and whether ocular pain predicts FBs. Emergency department patients complaining of ocular FBs were enrolled. In the irrigation group (n = 52), pain was evaluated with a visual analog scale before and after irrigation, and the presence of FBs was determined under a slit-lamp. In the nonirrigation group (n = 27), the evaluations were performed upon arrival. The corneal FB retention rate was found significantly lower in the irrigation (13/52, 25%) than in the nonirrigation groups (13/27, 48%; P = 0.04). After irrigation, those without FBs had more patients experiencing pain reduction (67%) compared to those with retained FBs (46%; P = 0.14) and had a greater magnitude of change in pain score (mean ± SD, - 2.6 ± 2.7 vs. - 0.7 ± 1.4; P = 0.02). An improvement in ocular pain score ≥ 5 points after irrigation predicted the absence of FBs with a negative predictive value of 100%. Eye irrigation significantly lowered corneal FB retention; if ocular pain decreased considerably, the probability of retained FBs was low, making irrigation-associated pain score reduction a feasible diagnostic method to exclude FB retention without needing specialized ophthalmic examinations.

Skull base osteomyelitis with secondary cavernous sinus thrombosis: a rare presentation of an animate foreign body in the ear.

A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.

Treatment and outcome of traumatic endophthalmitis in open globe injury with retained intraocular foreign body.

PURPOSE: Our aim was to evaluate the incidence, risk factors, pathogens, use of systemic and intravitreal antibiotics, and outcome of traumatic endophthalmitis after open globe injury with retained intraocular foreign body (RIOFB). METHODS: Patients with open globe injury and RIOFB complicated by endophthalmitis were enrolled and retrospectively studied in Taiwan over a 20-year-period from 1981 to 2002. RESULTS: There were 125 patients, who sustained open globe injury and RIOFB, which required surgical management. In 15 patients (12%) traumatic endophthalmitis was identified. Thirteen (87%) of these 15 cases had signs of endophthalmitis at their initial presentation. The patients' mean age was 41 years; all of them were male. Invading micro-organisms were isolated in 8 patients, and the positive culture rate was 53%. Gram-negative bacteria were the most commonly isolated organisms in 6 patients and 1 eye with multiple organisms. One eye with culture-proven Bacillus cereus had a very fulminant course and ended with phthisis bulbi. All 15 patients received topical and systemic intravenous antibiotic treatment; 9 eyes (60%) were given intravitreal antibiotic injection with broad-spectrum combined vancomycin and ceftazidime in 5 eyes. Pars plana vitrectomy was performed in 9 patients, with successful removal of RIOFB. The final visual acuity improved in 8 patients (53.5%), was unchanged in 1 (6.7%) and worse in 6 (40.0%). Five patients (33%) got a visual outcome of 6/60 or better. There were also 5 patients (33%) with a poor outcome of no light perception. Eleven (73%) of 15 patients had treatment delayed for >24 h after injury, and 5 out of these 11 patients had a very poor visual outcome (1 hand motion, 4 no light perception). Delay of presentation for >24 h after injury was associated with a tendency to increased risk of endophthalmitis [11/71 (15.5%) vs. 4/54 (7.4%)]. CONCLUSIONS: Early intravitreal antibiotics and prompt vitrectomy to remove the contaminating IOFB may salvage useful vision in some patients with traumatic endophthalmitis with RIOFB. Delay of treatment for >24 h was associated with increased risk of traumatic endophthalmitis.

Diagnosis and management of red eye in primary care.

Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. Allergies or irritants also may cause conjunctivitis. The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.