Demographic, Clinical Profile and Management Outcomes of Ocular Chemical Injuries in Saudi Children.

Background: Eye injuries in children due to chemicals constitute a medical emergency since they result in severe ocular damage. Objective: To determine the factors and management outcomes of chemical burns in the eyes of Saudi children. The study was performed at a tertiary eye center in the Kingdom of Saudi Arabia. Methods: Children aged 16 years and under who had ocular chemical burns from 2009 to 2021 were enrolled in a single-armed cohort study. Data collection was done on patient demographics, injury type, and previous treatment. A modified Roper-Hall classification was used to grade the ocular injuries. The research study revealed the outcome to be best-corrected visual acuity (BCVA), one year after presentation and management. Results: This study included 185 eyes from 147 children with chemical burns. The main profile of this study comprised the following categories: male (72.1%), grade 4 injury (27.6%), injury by acid (57.1%), burns at home (66%), and first aid was given to (35.4%) of the children. One year after treatment, there were 58 (31.4%) eyes with BCVA from 20/20 to 20/60, 31 cases (16.8%) with BCVA from 20/60 to 20/200, and 86 (46.5%) cases with severe visual impairment (SVI). Treatments included the release of symblepharon in 34 (18.4%) eyes and amniotic membrane transplantation (AMT) in 27 (14.6%) eyes. Poor visual outcomes were correlated with chemical burn severity (RR = 1.45, P=0.04). First aid administration (P = 0.86) and type of chemical (acid vs non-acid) (P = 0.83) did not differ significantly in association with SVI at the one-year follow-up. Conclusion: Visual outcomes of chemical burns in children were not promising even after one year of treatment. Public health initiatives are critical to prevent chemical burns in mitigating the poor visual prognosis.

Ocular Complications Resulting from the Use of Traditional Herbal Medicine in Central Saudi Arabia: A Review.

The present paper reviewed the ocular complications resulting from the use of traditional eye medicine in Central Saudi Arabia. We performed a literature search of the PubMed database using the keywords "traditional medicine," "herbal medicine," "ocular injuries," and "visual impairments," covering all years available for peer-reviewed full-text articles, letters, and review chapters of books. An additional search was performed in Google Scholar. All published materials were in English. Several ocular symptoms and disorders, including conjunctival cicatrization, symblepharon formation, obliteration of the fornices and the canaliculi, keratinization of the cornea, dryness, central corneal thinning, and corneal epithelial defect, have been associated with the use of traditional herbal medicine. In addition, the use of traditional eye medicine may result in corneal edema, opacity, ulceration, and perforation. Early recognition of ocular injuries could avoid or at least delay long-term sequelae. Ophthalmologists should be aware of the side effects of traditional remedies. Furthermore, public education, early detection of symptoms, and timely intervention may prevent permanent damage to the eyes.

Bee sting presumed endophthalmitis: a devastating ocular outcome.

BACKGROUND: To report a rare case of bee sting presumed endophthalmitis that resulted in a devastating ocular outcome. CASE PRESENTATION: A 43-year-old patient presented 24 h after bee sting ocular injury in his left eye. He had a mild inflammatory sign at presentation, and he underwent surgical exploration to rule out a scleral defect, which revealed a sealed defect. During his hospital course, he developed signs of endophthalmitis 48 h following trauma for which he received vitreous tap and intravitreal antibiotic. Microbial culture revealed gram-negative rods, Pseudomonas aeruginosa, and Aeromonas veronii. Condition escalated to reach the panophthalmitis stage and cellulitis like picture with visual acuity of no light perception. Visual evoked response (VER) demonstrated a flat response. Infection was controlled by evisceration of the globe at the end as salvage therapy against the spreading of infection CONCLUSIONS: Bee sting ocular injury is an exceedingly rare type of ocular trauma. Concomitant infection can happen, and severity depends on the pathogen involved. It is crucial to have insight and start appropriate treatment based on to the patient presentation.

Corneal Thinning Induced by Self-administered Alum Substance: A Case Report and Analysis of the Active Components.

We report a case of severe ocular injury and impaired vision after self-administration of alum. A 56-year-old female administered an alum substance in the left eye and experienced severe corneal thinning, a scar, and decreased vision. The active compounds in the alum substance were analyzed using scanning electron microscopy. When topically administered, alum may cause severe ocular injury. Public awareness, early recognition of the injuries, and timely intervention may prevent permanent ocular damage.

Isolated traumatic optic nerve avulsion in a boy who suffered a horse kick.

We report a case with traumatic avulsion of optic nerve caused by a horse kick in a child that caused loss of vision. Optic nerve avulsion is a rare injury usually associated with maxillofacial structures. Our patient had no light perception in the left eye. The left pupil was dilated and unreactive to light. The left globe was intact. A non-contrast axial computed tomography scan of the orbit demonstrated a widened and altered nerve globe junction with periorbital soft tissue edema. At six month following the injury, subsequent magnetic resonance imaging of the orbit showed that the preseptal soft tissue thickening dispersed spontaneously with total avulsion of the optic nerve and variable severity of surrounding hemorrhage. The patient did not develop phthisis bulbi during three years of follow up. Traumatic optic nerve avulsion presents with a dramatic clinical picture, and can lead to the development of severe visual loss.

Infectious Crystalline Keratopathy After Corneal Cross-linking.

To report a rare case of infectious keratitis after collagen cross-linking (CXL) for keratoconus. A 20-year-old male patient underwent CXL for keratoconus in his right eye. Four weeks after the procedure, he reported blurred vision and redness with increasing pain in the treated eye. Ophthalmic examination revealed a corneal epithelial defect with corneal infiltrates that exhibited branching needle-like opacities. The patient was diagnosed with infectious crystalline keratopathy (ICK). Corneal scrapings and culture indicated the presence of Streptococcus sanguinis. The patient was successfully treated with fortified vancomycin and ceftazidime over several weeks. ICK is a potential post-operative complication of CXL that can lead to corneal scarring with a permanent reduction in visual acuity.

Ocular injuries secondary to alexandrite laser-assisted hair removal.

PURPOSE: The aim of this study was to describe the clinical manifestations and outcomes of 4 patients who had sustained eye injury during alexandrite laser-assisted hair removal. METHODS: This was a retrospective case series of 4 patients who presented to 2 tertiary eye care hospitals over 2 years. Data on ophthalmic examination, spectral domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany), and fundus fluorescein angiography were collected. RESULTS: Four female patients sustained injuries during alexandrite laser hair removal. One patient presented with acute anterior uveitis, 2 patients with subfoveal choroidal neovascularization, and 1 patient with intraretinal foveal hemorrhage. Visual acuity at last follow-up (range 3-6 months) was 20/15 to 20/20. CONCLUSIONS: Ocular injuries can occur as a result of incorrect use of laser-assisted hair removal devices. Ophthalmologists should be aware of ocular damage caused by these devices.

Severe bilateral paralimbal sterile infiltrates after photorefractive keratectomy.

This study presents a case report of the clinical presentation and management of a 47-year-old male myope who underwent photorefractive keratectomy (PRK) and developed bilateral sterile corneal infiltrates at 1 day post-operatively. The patient was successfully treated with aggressive topical antibiotic and topical steroid therapy. The final corrected distance visual acuity (CDVA) was 20/25 with faint corneal scarring. Peripheral sterile corneal infiltrate can occur after PRK with excellent prognosis. Infectious causes should be suspected in all cases of corneal infiltrate. The most likely cause of peripheral sterile corneal infiltrate in this case was pooling of the tear film containing antigens under the bandage contact lens.

Unilateral posterior polymorphous corneal dystrophy associated with ipsilateral anisometropic amblyopia.

Posterior polymorphous corneal dystrophy is typically considered asymptomatic unless visual opacity develops. However, some have suggested that asymmetric disease without visual opacity might be associated with asymmetric refractive error, which would have the potential to be the cause of amblyopia in young children. In support of this concept, a case of unilateral posterior polymorphous dystrophy with ipsilateral anisometropic amblyopia is reported.

Corneal endothelial cytotoxicity of the Calotropis procera (ushaar) plant.

PURPOSE: To report 6 eyes of 5 patients with transient corneal edema after exposure to the milky latex of Calotropis procera (ushaar). METHODS: Interventional case series. RESULTS: Intracorneal penetration of ushaar latex can lead to permanent endothelial cell loss with morphologic alteration. Corneal edema resolved completely in approximately 2 weeks in all cases, despite reduced endothelial cell count and abnormal morphology. CONCLUSIONS: Corneal endothelial toxicity of ushaar latex is caused by its ability to penetrate the corneal stroma and induce permanent loss of endothelial cells. Corneal edema resolves if sufficient endothelial cell viability is still present after resolution of ushaar keratitis.

Initial diagnosis of leprosy in patients treated by an ophthalmologist and confirmation by conventional analysis and polymerase chain reaction.

PURPOSE: To report the initial diagnosis of leprosy in patients seeking treatment from an ophthalmologist in a tertiary eye care center, its confirmation by histopathologic and polymerase chain reaction analysis, and review of literature. DESIGN: Noncomparative retrospective case series. PARTICIPANTS: Patients with no known history of leprosy who were selected based on either a clinical suspicion or a histopathologic diagnosis and were found to have ocular or periocular lesions suggestive of leprosy. METHODS: Review of clinical records of patients with no known history of leprosy seen by an ophthalmologist at a tertiary eye care referral center. MAIN OUTCOME MEASURES: Patient demographics, presenting symptoms and signs, diagnostic studies, complications, and treatment. RESULTS: Among the 6 patients (5 women and 1 man; average age, 55 years), only 2 were found to have leprosy from clinical examination alone. Histopathologic characteristics or demonstration of acid-fast bacilli, suggestive of leprosy, were found in 5 patients. Definite confirmation of leprosy was made by polymerase chain reaction performed on formalin-fixed, paraffin-embedded tissues of 4 patients having suspected leprosy based on clinicohistopathologic examination results. CONCLUSIONS: The diagnosis of leprosy relies on the clinical symptom complex, epidemiologic factors, and demonstration of acid-fast bacilli in the tissue sample. Considering that the global leprosy population is 12 million, a patient with leprosy may be found anywhere. The ophthalmologist may be the first one to encounter such patient, in which case suspicion and detection of ocular findings may lead to early treatment of the infection. Polymerase chain reaction may be a new tool in the definite diagnosis of leprosy when suspicion of the diseases is raised by clinicohistopathologic studies.