Correlation analysis of the clinical features and prognosis of acute ocular burns-exploration of a new classification scheme.

PURPOSE: To explore a new classification scheme for acute ocular burns. METHODS: Medical records of 345 patients (450 eyes) with acute ocular burns treated at Shandong Eye Institute between January 2013 and January 2018 with a 12-month minimum follow-up were retrospectively reviewed. A total of 8 parameters in the acute phase were evaluated and graded on a scale from 0 to 3 according to their severity. RESULTS: The key factors affecting the prognosis of acute ocular burns were conjunctival involvement (386 eyes, 85.8%), corneal epithelial defect (349 eyes, 77.6%), and limbal ischemia (244 eyes, 54.2%). Visual acuity in 181/450 eyes (40.2%) was worse than 6/60. The injury severity of the cornea, limbus, bulbar conjunctiva, eyelid, and fornix and intraocular signs in the acute phase was significantly correlated with the logarithm of the minimum angle of resolution (logMAR) visual acuity (correlation coefficient [R] 0.481-0.933, P < 0.0001) and corneal opacification, neovascularization, and symblepharon scores in the stable phase (R 0.513-0.855, P < 0.0001). The mean total score for the 8 parameters in the acute phase was 5.34 ± 4.04 (range 0-14); higher scores indicated worse visual acuity (R = 0.899, P < 0.0001). The total score for acute-phase parameters was significantly correlated with that for the stable-phase parameters (R = 0.872, P < 0.0001). CONCLUSIONS: The severity of acute-phase parameters is significantly correlated with the final visual outcome and prognosis. The new grading scheme can help clinicians more accurately analyze the degree of ocular burns, determine a reasonable treatment protocol, and rationally evaluate the prognosis.

Corneal and conjunctival injury seen in urgent care centres in Israel.

PURPOSE: Corneal and conjunctival injuries (CCI) comprise a large portion of the cases presenting to hospital-based emergency departments (ED) with ocular involvement. Urgent Care Centres (UCC) offer community based emergency care at lower cost than hospital-based emergency departments (ED) and with greater temporal convenience than primary care office settings. While CCI prevalence and treatment at hospital-based EDs has been well studied, this is the first report, to our knowledge, on CCI demographics and aetiology presenting to UCCs. METHODS: This retrospective study was approved by the institutional ethics committee. The setting is a UCC system in Israel, modelled on USA urgent care facilities, consisting of 17 branches at the time of the study. Electronic medical record data (between November 1, 2015 and October 31, 2016) of patients diagnosed with corneal disorder, foreign body or eye disorder were retrieved and reviewed for inclusion/exclusion criteria. Data collected included gender, age, chief complaint, diagnosis, treatment and discharge status (sent home or referred to ED). International Classification of Diseases, Ninth Revision (ICD-9) codes were assigned to each record based on a review of all fields. UCC results were compared to all ED patients in Israel using data from a public report. Data were analysed by descriptive statistics and logistic regression analysis. RESULTS: Of the 602 074 charts screened, 4797 patients presented with CCI (0.8%). The average age was 32.6 ± 18.2 years and 71.3% were male. Among these, 26.4% were referred to the ED compared to 6.8% from the entire UCC cohort. ICD-9 code Foreign body (FB) of the eye was the most common cause of CCI (56.5%) followed by the following ICD-9 codes: trauma (18.1%), chemical in the eye (11.1%) and corneal disorder due to a contact lens (5.1%). Logistic regression analyses showed the following risk factors for ED referral: age (22-64), male gender, ICD-9 code FB, work-related injury and the presence of a clinical abrasion in the eye. CONCLUSIONS: The aetiology of ocular injury at UCC is similar to previous studies of ED. Most CCI can be treated at UCC saving ED resources and underscores the importance of this mode of health care delivery in the overall health system.

Ant Bites Conjunctival Tissue: The ABCs of Removing an Ocular Ant Foreign Body.

BACKGROUND: A variety of insect-related ocular injuries have been reported in the literature. However, no reports have been published documenting injuries resulting from exposure of the ocular surface to ants. This is surprising, given the relatively ubiquitous presence of ants. This is the first known case report to describe various techniques utilized in the removal of ants from the ocular surface. CASE REPORT: This case report details the presentation of a distressed 24-year-old woman who presented to the Emergency Department with an ocular foreign body associated with pain and increased lacrimation. She was identified to have an ant adherent to her conjunctiva. Various techniques of removal were performed, with the ant finally removed without any trauma to underlying tissues. CONCLUSION: This is the first case report to detail various techniques utilized in the removal of ants from the ocular surface, and discusses salient features that treating physicians should be aware of in managing patients presenting with ant bites.

Prospective study of the sensitivity of the Wood's lamp for common eye abnormalities.

OBJECTIVE: The Wood's lamp, a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2-3 times, is commonly used by non-ophthalmologists for examining patients with eye complaints. The goal of current research was to determine the sensitivity and specificity of the Wood's lamp for common eye abnormalities. STUDY DESIGN: We examined a convenience sample of patients, 18 years of age and older, who presented for eye complaints to an urgent clinic of a large ophthalmology practice. This prospective observational trial was performed from December 2016 until July 2017. An ophthalmologist examined the patient's eyes with a Wood's lamp, followed by examination of the eyes using a slit lamp. The Wood's lamp was compared with the slit lamp, which served as the gold standard. RESULTS: There were 73 patients recruited. The mean age of study subjects (29 female and 44 male) was 49 years. The overall sensitivity of the Wood's lamp was 52% (38/73; 95% CI 40% to 64%). Based on the principal final diagnosis made with the slit lamp, the Wood's lamp only detected 9 of 16 corneal abrasions, 5 of 10 corneal ulcers, 5 of 9 corneal foreign bodies, 0 of 4 cases of non-herpetic keratitis, 1 of 2 cases of herpes keratitis, 1 of 5 rust rings and 18 of 28 other diagnoses. CONCLUSIONS AND RELEVANCE: Examination using the Wood's lamp fails to detect many common eye abnormalities. Our findings support the need for a slit lamp examination of patients with eye complaints whenever possible.

Self-insertion of foreign bodies into the orbit and periocular tissue.

We describe six patients with 12 separate episodes of self-inflicted periocular foreign body injuries, which presented to our institution recently. All patients were male, relatively young (mean 28.5 years old), incarcerated, and had significant underlying psychiatric conditions. The subjects had inserted staples (6), paperclips (2), or other small metallic wire segments (4) into the periocular region. Most cases (9/12) involved concurrent self-inflicted injury to other body parts. Ten cases involved foreign bodies inserted through the palpebral conjunctiva into the upper eyelid, while two cases involved insertion into the orbit. Identification and surgical retrieval of foreign bodies was successful in most cases (9/11) but was not attempted in one case. Self-inflicted periocular injuries, while rare, are challenging cases for which the ophthalmologist should be prepared. A multidisciplinary approach, including psychiatric assessment and treatment, is important for optimal care.

Conjunctival repair after glaucoma drainage device exposure using collagen-glycosaminoglycane matrices.

BACKGROUND: To report the results of the repair of conjunctival erosions resulting from glaucoma drainage device surgery using collagen-glycosaminoglycane matrices (CGM). METHODS: Case series of 8 patients who underwent revision surgery due to conjunctival defects with exposed tubes through necrosis of the overlying scleral flap and conjunctiva after Baerveldt drainage device surgery. The defects were repaired by lateral displacement of the tube towards the sclera, with a slice of a CGM as a patch, covered by adjacent conjunctiva. RESULT: Successful, lasting closure (follow-up of 12 to 42 months) of the conjunctival defects was achieved without any side-effects or complications in all eight cases. CONCLUSIONS: Erosion of the drainage tube, creating buttonholes in the conjunctiva after implantation of glaucoma drainage devices, is a potentially serious problem. It can be managed successfully using a biodegradable CGM as a patch.

Histopathologic Clues in Diagnosing Oral Mucosal Grafts to the Conjunctiva.

Excised redundant, forniceal "conjunctival" tissue from a 67-year-old man who experienced a chemical injury to his OS 25 years earlier was evaluated histopathologically with the hematoxylin-eosin, periodic acid Schiff (PAS) with and without diastase, mucicarmine, and Alcian blue methods. Additional immunoperoxidase testing for gross cystic disease fluid protein-15 (GCDFP-15) was undertaken. Non-keratinizing squamous epithelium composed of 8 to 10 layers of swollen keratinocytes without goblet cells surmounted a variably dense and well-vascularized collagenized lamina propria deep to which, in submucosal fibroadipose tissue, was embedded an accessory gland. The acini of the gland were composed of both GCDFP-15-positive serous cells and mucicarmine-positive goblet cells, indicating they were seromucinous rather than entirely serous, as is characteristic of normal lacrimal glandular tissue. Different features of the surface epithelium, the lamina propria, and the submucosa can separate the conjunctival and oral mucous membranes. A close analysis of the cytologic composition of associated accessory glands can reinforce the correct diagnosis of an oral mucous membrane graft when the past surgical history is unclear, because only serous cells but not mucocytes comprise the lacrimal glandular units.

[Severe Eyeball and Facial Skeletal Injuries Caused by Firefighting Sport]. / Schwerwiegende Augen- und Gesichtsskelettverletzungen beim Feuerwehrsport.

The aim of this work is to draw attention to possible injuries of the eye and the facial skeleton caused by firefighting sport. There was a group of 9 patients presented who were treated from 2006 to 2015 in the Department of Ophthalmology at the University Hospital in Pilsen and diagnosed with severe eyeball contusion after being hit by a jet of water and/or a water pipe. Three cases are presented in detail.

The Paradoxical Predominance of Medial Wall Injuries in Blowout Fracture.

PURPOSE: To evaluate the type and cause of orbital blowout fractures in Korea. DESIGN: Retrospective, observational case series. METHODS: Patients who underwent reconstruction for blowout fracture from March 2004 to April 2013 at Korea University Guro and Ansan Hospitals were included in this study. Patient demographics and orbital computed tomography (CT) scans were reviewed. On CT, ethmoid air cell septa, blowout fracture type, and other combined fractures were analyzed. Blowout fracture was classified as affecting up to 4 areas: the floor lateral to the infraorbital canal, the floor medial to the canal, the maxilla-ethmoidal strut ("inferomedial" strut), and the medial wall. Furthermore, trauma type and associated injury were reviewed. The results of adolescent patients and adult patients were compared, as were those of males and females. RESULTS: The study included 659 eyes of 659 patients; mean patient age was 31.01 ±â€Š14.27 years. In total, 513 (77.85%) patients were male and 146 (22.15%) were female. The most common blowout fracture type was medial wall fracture, followed by floor wall, floor and medial wall without inferomedial strut, and floor and medial wall fracture with inferomedial strut, in that order. Interestingly, patients with floor wall blowout fracture were younger (26.87 ±â€Š12.90 y) than other groups: medial wall fracture (32.35 ±â€Š14.64 y, P < 0.0001), floor and medial wall fracture (35.22 ±â€Š14.49 y, P < 0.0001), and floor and medial wall fracture involving the maxillaethmoidal strut (32.62 ±â€Š13.75 y, P = 0.002). The number of ethmoidal air cell septa was lowest in the medial wall fracture group (3.62 ±â€Š0.67): floor wall fracture (4.07 ±â€Š0.69, P < 0.0001), floor and medial wall fracture (3.90 ±â€Š0.78, P < 0.0001), and floor and medial wall fracture involving the maxilla-ethmoidal strut (4.05 ±â€Š0.72, P = 0.001). CONCLUSIONS: Our study demonstrated that the blowout fracture type distribution in Korea varied from the results of many other studies. Medial wall fracture is the most common among the 4 types, and anatomic variance, such as number of ethmoid air cell septa, could influence blowout fracture type, especially in medial wall fracture.

Closed-globe injuries of the ocular surface associated with combat blast exposure.

PURPOSE: To describe closed-globe conjunctival and corneal injuries and endothelial cell abnormalities associated with blast exposure and their relationships to other closed-globe injuries and blast-event characteristics. DESIGN: Observational cross-sectional study. PARTICIPANTS: Veterans with a history of blast-related traumatic brain injury (TBI). METHODS: History and ocular examination, including slit-lamp biomicroscopy, gonioscopy, specular microscopy. MAIN OUTCOME MEASURES: Type and location of blast injuries to the conjunctiva and cornea. RESULTS: Ocular surface injuries were present in 25% (16 of 65) of blast-exposed veterans with TBI. Injuries included partial-thickness anterior stromal corneal scars (15 eyes), Descemet membrane ruptures (6 eyes), and conjunctival or corneal foreign bodies (7 eyes). Based on normative information from an age-matched comparison group, endothelial cell abnormalities were identified in 37% of participants. Eyes with ocular surface injury were more likely to have lower endothelial cell density, higher coefficient of variation of cell area, and lower percentage of hexagonal cells compared with eyes without injury. Presence of ocular surface injury or endothelial cell abnormalities was associated with elevated rates of other anterior and posterior segment injuries, as well as impairment of visual acuity. We found no relationship between ballistic eyewear use or severity level of TBI and presence of ocular surface injuries from blast. CONCLUSIONS: Independent of TBI severity or use of protective eyewear, ocular surface injuries and endothelial cell abnormalities were found in significant numbers of veterans with blast-related brain injury. Descemet membrane ruptures from blast exposure were described. Ocular surface trauma was associated with other ocular injuries throughout the globe. Potential mechanisms for the types and locations of ocular injuries seen were discussed. Any corneal or conjunctival injury in a blast survivor should prompt a thorough ocular trauma examination, including gonioscopy and specular microscopy, with appropriate follow-up for associated injuries. Longitudinal studies are required to determine long-term visual outcomes after blast exposure.

Severe ocular injury after button battery exposure.

BACKGROUND: Button batteries can cause local tissue necrosis within 2h of exposure due to hydrolysis of tissue fluid and generation of hydroxide ions. Tissue damage resulting from battery exposure has been associated with acute and chronic complications via several routes, however, previous experience with ocular battery exposures is predominantly limited to batteries that have exploded or penetrated the eye. OBJECTIVES: A case is presented of an intact battery causing significant damage after ocular exposure without penetrating the eye. CASE REPORT: An 18-year-old woman presented to the Emergency Department after a toy balloon propelled a button battery into the patient's eye. The battery did not penetrate the orbit and was intact upon removal from the inferior fornix in the operating room 4h later. The patient had severe conjunctival ulceration, subconjunctival hemorrhage, vitreous opacification, and a partially dilated pupil, with the greatest area of injury adjacent to the negative pole of the battery. The eye was extensively irrigated and the patient was treated with topical antibiotics, steroids, and a daily rodding procedure to prevent conjunctival adhesions. The eye ultimately healed over the subsequent 6 months, with normal visual acuity on follow-up. CONCLUSION: Prolonged ocular exposure to an intact battery can cause significant tissue necrosis, which may threaten sight. Early removal is critical to prevent significant ocular damage and visual compromise.

[An experimental study on inhibition effects of KH902 on rat corneal neovascularization].

OBJECTIVE: To observe the inhibition effect of subconjunctival injection of KH902 on rat corneal neovascularization (CNV)induced by alkaline burn. METHODS: Alkaline burn was adopted to make rat corneal neovascularization models. The rats were randomly divided into four groups: (1) Experimental group, subconjunctival injection of KH902 (30 mg/mL); (2) Masculine comparison group, subconjunctival injection of dexamethasone (1 mg/mL); (3) Comparison group I, subconjunctival injection of solvent of KH902; (4) Comparison group II, subconjunctival injection of saline. At the 28th day after the treatments, the maximal length, area of corneal neovascularization, and the average optical density value of vascular endothelial cell growth factor (VEGF) immunohistochemical staining in the four groups were measured. RESULTS: On the 28th day after molding, the corneal neovascularization area of KH902 experimental group was distinctly smaller than that of dexamethasone group, solvent group and saline group (P < 0.05 or P < 0.01). The expression of VEGF in the experimental group was distinctly lower than that of other groups (P < 0.01). CONCLUSION: Subconjunctival injection of KH902 (30 mg/mL) may inhibit rat corneal neovascularization.

Isolated tarso-conjunctival superior eyelid traumatic laceration.

To report a unusual case of an isolated traumatic stellated tarso-conjunctival laceration located in the upper left eyelid without eyelid margin involvement and with normal ocular examination. A 19 year-old male wounded by a bokken (wooden katana) while practicing a sham duel had an isolated eyelid tarso-conjunctival laceration, without any other eyelid layer damage, neither skin nor muscle. Treatment was conservative without suture, by means of compressive occlusion fixing the pieces of broken tarsus in the correct position. The aim of the treatment was to avoid any wrong eyelid position secondary to healing. The eyelid maintained normal structure and movement in the follow-up at 8 months. Tarsal plate rupture is usually combined with other eyelid layer damage, which usually requires suture by layers. If eyelid skin and muscle are intact, we may choose conservative management.

Orbital fracture due to high-pressure air injection.

We present a case of orbital fracture associated with emphysema and pneumocephalus caused by a high-pressured air injection in the eyeball. A 49-year-old man injured his right eye while working with a high-pressure (compressed) air jet in a workshop. The periorbital area was swollen and ecchymotic. The bulbar conjunctiva sustained multiple lacerations around the pupil: 9 mm at 12 o'clock in direction, 6 mm at 3, 8 mm at 6, and 6 mm at 9, respectively. Computed tomography showed crisp emphysema around the right orbit, and a fracture of the medial wall of the orbit. Free air was also seen near the basal cistern and sylvian fissure, indicating a pneumocephalus. Our case proved a high pneumatic pressure could induce a fracture of the medial wall of the orbit. Green et al (Ophthal Plast Reconstr Surg 1990;6:211-217) suggested that a consistent force of more than 2.08 J is enough to inflict injury on the orbital wall.

Ocular acid burn due to 20% concentrated salicylic acid.

This is a case report of severe conjunctival and corneal epithelial defects resulting from accidental exposure to salicylic acid that was mistakenly used instead of artificial tears (eye drops). The patient was treated with tobramycin 0.3%-dexamethasone 1% 3 times a day, cyclopentolate 1% twice a day, and artificial tears 6 times a day and underwent daily examinations until the corneal and conjunctival epithelial defects resolved. The corneal and conjunctival epithelial defects slowly resolved over 14 days. Visual acuity improved to its preinjury level of 20/40 in the affected eye. No residual corneal scarring was evident. Slowly resolving corneal and conjunctival epithelial defects can occur from direct contact with salicylic acid; therefore, this medication should be packaged and labeled differently from eye drops.

[A case of button battery-induced corneal and conjunctive burn injury and experimental findings of local damage].

PURPOSE: To report a case of button battery-induced alkaline burn injury of the cornea and conjunctiva, with experimental findings of local damage. CASE: A three-year-old girl had a hard and polished white opacity on the nasal lower cornea and conjunctival injection, caused by a button battery remaining in the conjunctival sac for several hours. The ocular surface was washed carefully with distilled water. The opacity improved gradually over several months and scarring was replaced by secondary pterygium. EXPERIMENT: A button battery was placed on an eyeball of a pig, with the cathode directed toward the cornea. Corneal opacity developed in five minutes and increased thereafter. Another battery was sanded with saline-soaked gauze and the gauze near the cathode turned dark brown. This change intensified when the gauze was in contact with the side of the battery. CONCLUSIONS: The cornea and conjunctiva of the patient were damaged by continuous exposure to alkaline solution (concentrated NaOH) after the button battery had entered the lacrimal sac causing fixation by chemosis. The recent development of smaller batteries increases the risk of similar accidents. Button battery-induced burn injuries may be severe and require immediate correct diagnosis and treatment, especially in small children who may be difficult to examine.

Asymptomatic subconjunctival entrapment of a cilium.

We report an unusual case of asymptomatic subconjunctival entrapment of a cilium. A 64-year-old man presented with a 3 month history of a painless black line in the conjunctiva of the left eye, and slit-lamp examination revealed a cilium under the conjunctiva. The patient remained asymptomatic without conjunctival edema or hyperemia during a 2 week follow-up. To the best of our knowledge, this is the first report of an asymptomatic cilium inside the subconjunctival space.

Management of ocular thermal and chemical injuries, including amniotic membrane therapy.

PURPOSE OF REVIEW: To provide a concise review of the literature regarding potential management strategies of ocular thermal and chemical injuries. RECENT FINDINGS: After experiencing a serious ocular surface burn, either thermal or chemical, the goal of therapy is to restore a normal ocular surface and corneal clarity. If extensive corneal scarring and/or limbal stem cell deficiency are present, techniques such as limbal stem cell grafting, amniotic membrane transplantation and possibly a keratoprosthesis can be employed to help restore vision. This article will review the literature available and discuss how these techniques have improved the prognosis of patients with serious thermal and chemical injuries. SUMMARY: Ocular thermal and chemical injuries are a true ocular emergency and require immediate and intensive evaluation and treatment. The sequelae of an ocular burn can be severe and particularly challenging to manage. Improvements in the understanding of the pathophysiology of a radiant energy or chemical injury as well as advancements in ocular surface reconstruction have provided hope for patients in whom would otherwise have a dismal visual prognosis.