Eye Trauma in Mixed Martial Arts and Boxing.

PURPOSE: To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN: Retrospective cohort study. METHODS: Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS: In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION: Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.

Subconjunctival hemorrhage and vision loss after regional ocular anesthesia.

PURPOSE: To report two cases of retinal vascular occlusion and associated subconjunctival hemorrhage in needle optic nerve injury during local bulbar anesthesia. METHODS: Surgical records of these two subjects who presented with acute vision loss after cataract extraction were studied, and systemic workup and ocular imaging were carried out to establish the cause. RESULTS: Computerized tomography showed evidence of optic nerve injury. CONCLUSION: Subconjunctival hemorrhage could be an associated clinical finding in hypodermic needle injury-related retinal vascular occlusion during ocular anesthesia.

Isolated traumatic aniridia after trabeculectomy in a pseudophakic eye.

This is a single case report of an elderly patient who had blunt trauma in an eye that had phacoemulsification and two trabeculectomies. She had good vision with a well-functioning bleb before the trauma. She presented during her routine follow-up visit for glaucoma with isolated aniridia and an intact globe. The capsular bag, zonules, and the intraocular lens were intact. The cupping was 0.8, and the rest of the fundus and macula were normal. Pigments were seen over the sclera extending posteriorly upto the fornix. Gonioscopy revealed only faint pigments at the fistula. Following the trauma, the intraocular pressure had increased to 26 mm Hg. The mechanism and the management of the glaucoma are discussed.

Anesthesia for ophthalmic procedures in the standing horse.

Effective delivery of local anesthesia is essential for successful standing surgical procedures in the horse. Local anesthesia can be used to facilitate examination of the eye, diagnostic procedures, therapeutic techniques, and surgical procedures. Understanding the relevant clinical anatomy and techniques for performing local anesthesia is critical to delivering successful local and regional anesthesia and analgesia.

Development of a surgical approach for a wide-view suprachoroidal retinal prosthesis: evaluation of implantation trauma.

BACKGROUND: Our research goal is to develop a safe, reproducible surgical approach for implantation of a wide-field retinal stimulating array. The aim of this study was to evaluate the pathological response to acute implantation of a functional prototype electrode array in the suprachoroidal space. METHODS: The surgical techniques to implant a 72 platinum electrode array fabricated on 8 × 13 × 0.4 mm polyimide and silicone substrate were developed in a pilot study in anesthetized cats. For the main study, nine eyes were implanted in vivo and unoperated eyes were used as controls. Surgery consisted of a temporal approach with a full-thickness scleral incision 5 mm posterior to the limbus. A suprachoroidal "pocket" was created, the electrode array inserted to sit beneath the area centralis, and placement was confirmed visually. The eyes were collected subsequently for histopathology. RESULTS: The array was consistently inserted into the suprachoroidal space beneath the area centralis in nine eyes. There was a significant hemorrhage in two cases where implantation was complicated by choroidal congestion. Retinal folding occurred only when the array tip was within 2.6 mm of the optic disc (p < 0.01). There was choroidal incarceration at the incision in six eyes and scleral distortion at the array edges in five. No cases were found where the implant breached the retina, choroid, or sclera. CONCLUSIONS: A large stimulation array can be reliably inserted into the suprachoroidal space without trauma to the neuroretina. These findings suggest that this is an appropriate surgical approach for the placement of an electrode array for use in retinal stimulation.

Web-based training on weapons of mass destruction response for emergency medical services personnel.

OBJECTIVE: To develop, implement, and assess a web-based simulation training program for emergency medical services (EMS) personnel on recognition and treatment of ocular injuries resulting from weapons of mass destruction (WMD) attacks. DESIGN: The training program consisted of six modules: WMD knowledge and event detection, ocular anatomy, ocular first aid (ie, flushing, cupping, and patching), and three WMD simulations (ie, sarin gas release, anthrax release, and radioactive dispersal device). Pretest, post-test, and 1-month follow-up test and a program evaluation were used to measure knowledge gain and retention and to assess the effectiveness of the program. SETTING: New York State EMS. PARTICIPANTS: Four hundred and sixty-four individuals participated in the training program and all waves of the testing (86 percent retention rate). MAIN OUTCOME VARIABLES: The effectiveness of the training intervention was measured using pretest and post-test questionnaires and analyzed using dependent t-tests. RESULTS: Assessment scores for overall knowledge increased from the pretest (mean = 15.7, standard deviation [SD] = 2.1) to the post-test (mean = 17.8, SD = 1.3), p < 0.001, and from pretest (mean = 15.7, SD = 2.1) to 1-month follow-up test (mean = 16.6, SD = 2.0), p < 0.001. Ninety-two percent of respondents indicated that the program reinforced understanding of WMDs. CONCLUSIONS: This training method provides an effective and low-cost approach to educate and evaluate EMS personnel on emergency treatment of eye trauma associated with the use of WMD. Online training should also be supplemented with hands-on practice and refresher trainings.

Jellyfish sting injury to the cornea.

A 25-year-old woman presented to the emergency room 2 hours after a jellyfish sting to the left eye. Centrally located linear epithelial defects were observed on slit-lamp evaluation. The epithelial defects improved but did not heal totally after meticulous patching with antibiotic ointment and cycloplegic drops. Small, subepithelial negative staining areas within the epithelial defects were observed on day 3. Confocal microscopy was performed and revealed thread-like hyperreflective structures, mainly located at the basal epithelial layer. Following debridement of the traumatized areas, the corneal epithelium healed completely in 24 hours, resulting in increased visual acuity and decreased foreign body sensation. Jellyfish stings to the eye may involve the intrusion of the nematocysts, thread-like venomous structures, into the cornea. Debridement of these foreign bodies can be helpful in the treatment of resistant cases.

Posterior segment injury developed after injection of anesthetics on eyelids with needleless jet injection device.

BACKGROUND: Though a needleless jet injection device (NJI device) has advantages over a conventional needle attached syringe for injecting anesthetics, safety of using it for lid surgery is not proved. We report a case of posterior segment injury suspected caused by a NJI device. METHODS: A 47-year-old woman presented with decreased visual acuity after regional anesthesia at the lower eyelids with a NJI device. RESULTS: Vitreous and subretinal hemorrhage was found associated with retinal edema adjacent to the optic disc of the right eye and around the inferior temporal arcade of the left eye. Fluorescein angiography revealed choroidal rupture in the both eyes. By 2 months, although the hemorrhage resolved, subretinal fibrosis and chorioretinal atrophy developed. Her vision decreased to 20/60 in the right eye and 20/40 in the left eye. CONCLUSION: The energy generated by the NJI device seemed to have reached the eyeballs to cause the blunt-typed posterior segment injuries. As choroidal rupture may result in a permanent visual loss, the risks associated the off-labeled use of the device for lid surgeries should be awakened.

Chemical and thermal injuries of the eyes. Surgical and medical treatment based on clinical and pathophysiological findings.

Light burns heal well within a few days. Severe chemical and thermal injuries of the eyes destroy surface epithelia and cause ischemic necroses of conjunctiva, cornea, sclera, iris, ciliary body, and lids. An inflammatory response follows with leucocyte infiltration and release of inflammatory mediators. Prostaglandins, lipoxygenase products, cytokines, superoxide radicals and Iysosomal enzymes are known to be active in eye burn disease. Their activities result in corneal, scleral and conjunctival ulceration, tissue proliferation and scarification, which develop within weeks, months and even years after the accident. Pathophysiological events produce defined clinical pictures. Some agents take special actions, e.g. alkali penetrates within seconds into the anterior chamber, sulfuric acid burns as well as quick lime burns forming slaked lime produce considerable heat. Hydrofluoric acid is highly toxic and induces early necroses. Heat causes deep ischemic necroses and lateron strongly shrinking scars. Onset and intensity of first aid decided on the outcome. Immediate rinsing is essential. Cool water, saline, Ringers lactate solution and BSS are good rinsing media. For first aid, buffered Previn seems suitable. Major chemical and thermal injuries need a variety of medical and surgical treatments: Necroses must be excised surgically. Tenon plasty is performed to reconstruct conjunctiva. Amnion-, limbus- and early keratoplasty or artificial epithelium are applied, initially to save the cornea from melting, and later to restore vision. Conjunctical, lid and intraocular surgery may be necessary. The aim of medical treatment is to suppress the inflammatory response and to prevent infection. Corticosteroids, antibiotics, ascorbate and inhibitors of proteolytic enzymes are used. Secondary glaucoma must not be forgotten. Extensive therapy is sometimes rewarding, results are presented.

Blinding choroidal rupture in a karateka.

A case of uniocular visual loss secondary to trauma sustained during a competitive karate bout is reported.

Ophthalmologic procedures in the emergency department--Part II: Routine evaluation procedures.

The emergency physician (EP) must be familiar with performance of ophthalmologic procedures for evaluation and treatment of a multitude of eye complaints. This article is the second of three articles addressing ophthalmologic procedures potentially of use by the EP. This article reviews the indications and the techniques for the following routine procedures: visual acuity testing, pupil dilatation, topical anesthesia use, and tonometry. Criteria for consultation also are addressed.