Globe trauma associated with falls at Australian tertiary centres.

OBJECTIVE: Falls frequently cause globe and adnexal trauma, particularly in the elderly. The morbidity decreases confidence, independence and quality of life. We aimed to improve the understanding of fall-related globe and adnexal trauma and the involvement of ophthalmology at two tertiary trauma centres. METHODS: A retrospective medical record review was conducted at Royal North Shore Hospital and Royal Prince Alfred Hospital of patients admitted with fall-related globe and/or adnexal trauma between January 2015 and December 2019. International Classification of Disease Tenth Revision codes were used to identify patients for inclusion. Medical records were reviewed to extract data on demographics, trauma, ocular examination and referrals to ophthalmology. RESULTS: From January 2015 to December 2019, 346 patients, 186 were female (54%) and median age 76 years (interquartile range 24 years), were admitted to Royal North Shore Hospital and Royal Prince Alfred Hospital with fall-related globe and/or adnexal trauma. One hundred and twenty-five (36%) suffered globe trauma with 48 (14%) classified as severe. Patients over 65 years old had at least three risk factors contributing to falls. Alcohol and illicit substances were involved in 20% of falls and occurred predominantly in younger populations. There were significantly more patients with globe trauma if orbital/mid-facial fractures were present (55% vs 36%, P < 0.001). CONCLUSION: Fall-related globe and adnexal trauma were more common in the elderly. Alcohol and illicit substances have a role in falls in younger populations. Thorough ocular assessment is required especially in mid-facial/orbital trauma to exclude globe trauma. Further, research is required to determine the effect of fall prevention strategies in preventing globe trauma.

Burn related globe and adnexal trauma at trauma centres.

INTRODUCTION: Prompt management of burn-related globe trauma can prevent long term complications. Delays in diagnosis may occur when globe trauma is associated with life-threatening injuries. We aimed to improve the understanding of the epidemiology, acute assessment and management of burns-related globe and adnexal trauma admitted to two trauma centres in Sydney, Australia. METHOD: Admitted patients with burns-related globe and/or adnexal trauma were retrospectively reviewed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) between January 2015 and December 2019. The International Classification of Disease, Tenth Revision codes was used to search and identify patients. Medical records were reviewed to extract data on demographics, injuries, ocular examination and ophthalmology involvement. RESULTS: Over the 5-years, 101 patients with globe and/or adnexal burns-related trauma were admitted to RNSH or RPAH. Median age was 37years. Most patients were male (76%) and were injured while at home or work (74%). Patients with chemical exposure were more likely to have globe trauma (100% vs 72%, p < 0.001) and severe globe trauma (54% vs 32%, p = 0.028). On initial review by emergency staff, 14 patients were not referred to ophthalmology, of these there were 2 patients where the diagnosis was delayed. CONCLUSION: Globe trauma is common in patients with chemical exposure. Thorough ocular assessment within the acute setting is vital to diagnose globe trauma. We investigated hospitals with specialised burn staff, further research is required to understand the management of globe trauma in hospitals without such resources. SYNOPSIS: Chemicals in household-products can cause severe globe trauma. Globe trauma can occur alongside large burns leading to delay in its diagnosis and management. Ophthalmology can assist in the early diagnosis and management of globe trauma.

Reactivation of Multifocal Choroiditis Associated with Treatment in Latent Tuberculosis.

Tuberculosis (TB) causes significant morbidity and mortality worldwide. Ocular manifestations of TB can lead to severe and sight-threatening complications. Initiating treatment in ocular TB with anti-tubercular therapy (ATT) may be necessary to prevent long-term visual complications. We present a case of the reactivation of bilateral multifocal choroiditis (MFC) in a patient with latent TB after commencing ATT. An asymptomatic 36-year-old Indian male was referred to an ophthalmologist with extensive inactive bilateral MFC close to his fovea despite no previous medical or ocular history. Latent TB was subsequently diagnosed via TB specific antigens and antibodies. After a period of stable observation without evidence of active eye or systemic disease, the patient was commenced on quadruple ATT with the aim of reducing the risk of visual loss with the MFC. However, after commencing treatment, MFC reactivation was observed. This settled with the addition of high-dose oral prednisone. The steroid was slowly weaned and ceased with the cessation of ATT. There have been no further episodes of active choroiditis since treatment was ceased. TB is a significant cause of mortality worldwide, and ocular manifestations can cause severe and sight-threatening complications in active and latent TB. The treatment of TB, however, may lead to further complications. We present the case of a visually asymptomatic patient with latent TB, with before and after fundal images, demonstrating the reactivation of the MFC after commencing ATT.

Asymptomatic occlusive retinal vasculitis in newly diagnosed active tuberculosis.

INTRODUCTION: Worldwide, tuberculosis is the leading cause of death from an infectious disease. Ocular involvement can cause significant and permanent vision loss. Ocular manifestations of tuberculosis often present with visual symptoms. Asymptomatic ocular tuberculosis is uncommon and yet can have serious consequences if missed. CASE REPORT: An immunocompetent 26-year-old Filipino man living in regional Australia who was diagnosed with active pulmonary tuberculosis and started on antitubercular therapy. He was referred to an ophthalmologist for baseline ethambutol screening to exclude pre-existing optic neuropathy. Despite having no visual symptoms, when examined, the patient had vision threatening occlusive retinal vasculitis. He was initially commenced on localised therapy via bevacizumab intravitreal injections and retinal photocoagulation. Following completion of antitubercular therapy, high dose prednisone was commenced and slowly tapered. CONCLUSIONS: We present the case of an asymptomatic sight threatening occlusive vasculitis that was discovered on pre-treatment ophthalmology review. This case emphasises the need for referral for full ophthalmic screening in newly diagnosed tuberculosis to exclude vision-threatening complications.