The ABCs of Ocular Trauma: Adapting a Familiar Mnemonic for Rapid Eye Exam in the Pre-Ophthalmic Zone of Care.

Evaluation and management of eye trauma is daunting to many practitioners. For general medical emergencies, the familiar ABCs mnemonic serves to both recompose the provider as well as provide a logical order for evaluation and action. We recently adapted an ABCs mnemonic to provide non-ophthalmologists with a familiar method for systematically evaluating and managing eye trauma. A = ACUITY. Visual acuity is the most importance piece of information in eye trauma. B = BEST exam of BOTH eyes. Starting with acuity, examination proceeds from the front to the rear of the eye. Examine the uninjured eye first. C = CONTIGUOUS STRUCTURES and CONTACT LENSES. Examine structures contiguous to the apparent injury. Inspect for contact lens wear. D = DRUGS, DIAGNOSTIC IMAGING, and the DON'TS. Start antibiotics, antiemetics, and analgesics. Administer tetanus. Obtain computerized tomography if available. Do not attempt ocular ultrasound or magnetic resonance imaging. Do not apply pressure to the eye. Do not patch the eye or apply any medication. E = EYE SHIELD and EVACUATE. Shield and ship to ophthalmology. The mnemonic was adapted to reflect current Joint Trauma Services and Tactical Combat Casualty Care practice guidelines. We believe this familiar mnemonic will serve as a useful tool in allowing non-ophthalmologists to comfortably and safely evaluate an eye for trauma.

Incident and recurrent cases of central serous chorioretinopathy, active component, U.S. Armed Forces, 2001-2018.

Central serous chorioretinopathy (CSCR) is a condition that affects central visual function. It can produce blurred and/or distorted vision that can impact the performance of military duties. CSCR can recur in susceptible individuals. Incident cases of CSCR among active component service members were found to average 18.3 per 100,000 person-years (p-yrs) during 2001-2018. Incidence rates increased during the surveillance period by 60.7% and were more common with increasing age. Overall rates of incident CSCR diagnoses were highest among Air Force (20.7 per 100,000 p-yrs) and Navy members (19.9 per 100,000 p-yrs) and lowest among Marine Corps members (12.5 per 100,000 p-yrs). Pilot/air crew occupational groups had rates almost twice that of other groups. Annual recurrence rates increased 71.4% over the course of the 18-year period.

Simplified Method for Rapid Field Assessment of Visual Acuity by First Responders After Ocular Injury.

Objective: Initial visual acuity after ocular injury is an important measure, as it is an accurate predictor of final visual outcome and gives a rapid estimation of the overall severity of the injury, thereby aiding evacuation prioritization. We devised a simple method for rapidly assessing visual acuity in the field without having to rely on formal screening cards. Methods: Using common objects, icons, and text found in the injury zone - for example, common military name tapes, rank insignias, patches, emblems, and helmet camouflage bands, which will be known collectively as the Army Combat Optotypes (ACOs) - a Snellen-equivalent method of assessing visual acuity was devised and correlated to the ocular trauma score (OTS). Results: Ability to read the ACOs at 2, 3, and 5 ft correlates with acuities in the range from 20/20 to 20/400. Identification of ACOs with visual acuity of 20/50 and 20/200 approximates important inflection points of severity for the OTS. Conclusion: Accurately assessing visual acuity in the field after ocular injury provides essential information but does not require sophisticated screening equipment. Pertinent and accurate acuities can be rapidly estimated using commonly available text or graphical icons such as standard name tapes, patches, and rank insignias.

Ocular Manifestations of Mosquito-Transmitted Diseases.

Of the 3,548 known mosquito species, about 100 transmit human diseases. Mosquitoes are distributed globally throughout tropical and temperate regions where standing water sources are available for egg laying and the maturation of larva. Female mosquitoes require blood meals for egg production. This is the main pathway for disease transmission. Mosquitoes carry several pathogenic organisms responsible for significant ocular pathology and vision loss including West Nile, Rift Valley, chikungunya, dengue viruses, various encephalitis viruses, malarial parasites, Francisella tularensis, microfilarial parasites, including Dirofilaria, Wuchereria, and Brugia spp., and human botfly larvae. Health care providers may not be familiar with many of these mosquito-transmitted diseases or their associated ocular findings delaying diagnosis, treatment, and recovery of visual function. This article aims to provide an overview of the ocular manifestations associated with mosquito-transmitted diseases.

Case Report of an Anthrax Presentation Relevant to Special Operations Medicine.

Special Operations Forces (SOF) medical personnel function worldwide in environments where endemic anthrax (caused by Bacillus anthracis infection) may present in one of three forms: cutaneous, pulmonary, or gastrointestinal. This report presents a rare periocular anthrax case from Haiti to emphasize the need for heightened diagnostic suspicion of unusual lesions likely to be encountered in SOF theaters.

A clinicopathologic case study of two patients with pediatric orbital IgG4-related disease.

The purpose of this report is to describe the clinical, radiographica, and histopathologic findings in two pediatric patients with orbital IgG4-related disease.

CyberKnife radiosurgery and rituximab in the successful management of sclerosing idiopathic orbital inflammatory disease.

A 26-year-old man presented with symptoms suggesting idiopathic orbital inflammatory disease. After a poor initial response to oral steroids, an orbital biopsy confirmed the diagnosis. A paucicellular lymphocytic infiltrate with areas of fibrosis was seen to replace normal tissue. With the development of exposure keratopathy and diplopia associated with eyelid retraction, lagophthalmos, and decreased motility, increasing doses of steroids and intralesional steroid injections were instituted without effect. On the basis of successful treatment of malignant lymphocytic lesions, he was treated with CyberKnife radiosurgery and rituximab. This resulted in symptom resolution with improved eyelid closure and motility. Eighteen months after treatment, he is essentially symptom-free, with almost complete radiographic regression of his disease process.

Medial rectus muscle injuries associated with functional endoscopic sinus surgery: characterization and management.

OBJECTIVE: To characterize and evaluate treatment options for medial rectus muscle (MR) injury associated with functional endoscopic sinus surgery (FESS). DESIGN: Retrospective interventional case series. PARTICIPANTS: A total of 30 cases were gathered from 10 centers. METHODS: Cases of orbital MR injury associated with FESS surgery were solicited from members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) through an e-mail discussion group. MAIN OUTCOME MEASURES: Variables assessed included patient demographics, computerized tomography and operative findings, extent of MR injury and entrapment, secondary orbital/ocular injuries, initial and final ocular alignment and ductions, and interventions. RESULTS: A spectrum of MR injury ranging from simple contusion to complete MR transection, with and without entrapment, was observed. Four general patterns of presentation and corresponding injury were categorized. CONCLUSIONS: Medial rectus muscle injury as a complication of FESS can vary markedly. Proper characterization and treatment are important, particularly with reference to the degree of direct MR injury (muscle tissue loss) and entrapment. Patients with severe MR disruption can benefit from intervention but continue to show persistent limitation of ocular motility and functional impairment. Prevention and early recognition and treatment of these injuries are emphasized.