Benign hemangioendothelioma of the lacrimal gland fossa.

A mass was surgically removed from a patient who complained of a swelling in the lacrimal gland fossa. Histopathologic evaluation of the mass showed an unusual variant of the benign capillary hemangioma that exhibited abundant endothelial cell proliferation, and that could alternatively be classified as a benign hemangioendothelioma.

Anterior segment consequences of blunt ocular injury.

The anterior segments of 212 eyes (205 patients) were evaluated one to 14 years after contusional eye injuries. Anterior chamber angle recession was the commonest complication, occurring in 153 of 190 eyes examined (80.5%). However, only one patient developed ocular hypertension. Iris abnormalities were found in 37.3% of eye injured, the most common abnormalities being marginal tears and pupillary defects. Cataract or lens dislocation attributable to trauma occurred in 24.5% of eyes, but most lens opacities were localised, stationary, and not associated with significant loss of vision. 15.4% of eyes developing lens opacities had cataract extraction within 18 months of the injury. Functional corneal sequelae were rare, but occasionally corneal opacities masked perforating injuries.

A 10-year survey of eye injuries in Northern Ireland, 1967-76.

Ocular injuries of sufficient severity to necessitate admission to the Eye and Ear Clinic, Royal Victoria Hospital, Belfast, were sustained by 1707 male patients and 325 female patients. Blunt injury occurred in 1063 eyes (49.2%), perforating injury in 1037 (48%), and intraocular or intraorbital foreign bodies in 181 eyes (8.4%). More than three-quarters of the patients (77.4%) were less than 36 years of age and 84% of all injuries occurred in males. Normal visual acuity (6/6 or better) was regained by 41.2% of the patients in whom the final visual outcome was known. The benefit of wearing seat belts in road vehicles and protective goggles in industry and sport should receive more publicity on radio and television and via poster campaigns. Compulsory fitting of laminated windscreens in all road vehicles is recommended. The vulnerability of children to ocular injury should be highlighted through the mass media, schools, and health centres.

Visual impairment in Northern Ireland.

Statistics on the registration of blind and partially-sighted patients in Northern Ireland underestimate the true extent of visual impairment within our community. In comparison to other UK regions, where between 0.53% and 0.59% of the population avail of blind or partial sight registration, only 0.35% of residents in Northern Ireland appear on the respective registers. Most patients on the combined registers are in the older age groups and many also suffer from other disabilities. Regional discrepancies may be attributed to a combination of factors including: patient attitudes to the registration process, medical attitudes to registration and local anomalies in the way in which social services departments both record and present annual registration returns. Better liaison is necessary between the community, hospital and voluntary sector providers to improve identification and support services for the visually impaired in the future.

Contusional eye injuries: retinal and choroidal lesions.

The fundi of 114 patients were evaluated one to 14 years following contusional eye injury. Most injuries to children occurred at sport and play. Domestic and civil assaults, sporting injuries and industrial accidents were common. Males in the second and third decades of life were predominantly affected. Iris tears, pupillary abnormalities and angle recession were typically associated with the fundal lesions. Contusional injuries of the retina and choroid were found in 92 patients and were graded according to their location, extent and severity. Twenty-six patients (grade 1) had focal or diffuse disturbances of the inner or outer retina. In 15 patients the lesions predominantly affected the receptor-retinal pigment epithelial layers and in six patients there were associated breaks in Bruch's membrane. Five further patients had atrophic inner retinal alterations and lamellar holes at the macula. Most patients in this group retained good visual function. Thirty-six patients (grade 2) had single or multiple choroidal tears. In 21 instances the outer retina was primarily involved; however, in 15 cases there was associated inner retinal damage. Only three patients developed subretinal neovascularisation. Sixteen patients (grade 3) had extensive areas of chorioretinal atrophy associated with retinal pigment epithelial atrophy, proliferation, plaque and membrane formation. Fourteen patients (grade 4) developed retinal holes or tears and 10 proceeded to retinal detachment two weeks to 14 years following injury. Contusional retinal and choroidal lesions have an unfavourable visual prognosis, only 38.6% of patients regaining a visual acuity of 6/12 or better.

Long-term review of injuries to the lacrimal drainage apparatus.

A series of 57 patients with injuries to the proximal lacrimal drainage apparatus was reviewed to assess the long-term sequelae. The lower canaliculus was involved in 33 patients, the upper in ten, and both upper and lower in twelve, while the common canaliculus and lacrimal sac were each involved in one patient. It was found that either the upper or the lower canaliculus could cope independently with basal lacrimal secretions and that patients with at least one canaliculus intact had no symptoms under normal conditions. In seven patients with lower canalicular lacerations it was found that spontaneous functioning fistulae had developed nasal to the site of canalicular obstruction. The management of canalicular lacerations is discussed and it is recommended that the function of an intact canaliculus should not be jeopardized by surgical manipulations in an attempt to repair a damaged fellow canaliculus.

The traumatized eye.

Injuries to the eye, both contusional and perforating, have a considerable visual morbidity not the least of which is a cosmetically unacceptable eye. Meticulous primary surgical repair and judicious secondary reconstruction of the eye may not only preserve visual functions but substantially improve the patient's appearance. Most cosmetic problems follow perforating eye injuries and include corneal leucomata, iris and pupillary abnormalities, cataract, phthisis bulbi and enucleation. Oculo-motor abnormalities, particularly divergent squint, are common where substantial loss of vision has occurred in one or both eyes. In the series reported 215 eyes were enucleated secondary to ocular trauma over a 10 year period (2,162 injured eyes), the vast majority following perforating injury. The risk of sympathetic ophthalmia was the reason for enucleation in 50.7 per cent of cases although sympathetic ophthalmia was identified in only two instances. Cosmetic defects secondary to contusional injuries are uncommon and mostly due to iris abnormalities and cataract.

The provision of ophthalmic services for a rehabilitation day care centre population with multiple physical handicaps.

The provision of the wide variety of support services necessary for patients with multiple handicaps is often poorly coordinated. In this study a group of 108 adults, aged from 19 to 90 years, who suffered from multiple physical handicaps and attended a rehabilitation day care centre, had their visual functions and requirements assessed by a multidisciplinary team. The programme consisted of five stages. Each patient was initially screened and subsequently referred for more detailed optometric, ophthalmological, low vision or rehabilitation assessments, where appropriate. Results indicated that many of the patients had not been receiving regular ocular assessments and would benefit from the provision of an optical appliance or ophthalmological treatment. The survey provided staff at the rehabilitation centre with information on the visual status of individual patients and enhanced general eye-care awareness.