Ординатура / Офтальмология / Учебные материалы / Clinical Diagnosis and Management of ocular trauma
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Preface
Ocular Trauma is an important and vast subject and has assumed greater significance in this present era of Modern Technology when greater industrial and vehicular revolution have taken place. As a result of this incidence, ocular trauma has increased sharply and now it is one of the leading causes of monocular blindness specially in children and in young generation. Early and effective treatment of ocular trauma is mandatory to achieve best possible outcome thus decreasing blindness. With latest technologies, equipment and techniques, it is possible to manage traumatized eyes in a better way. Very few International quality books are available on this important subject for the Ophthalmologists.
Present book has been conceived and written to provide latest uptodate information on this vast subject. 56 chapters of this book have been written by International experts on this field covering both anterior and posterior segment ocular trauma. We have tried to cover all clinical aspects of ocular trauma in both segments. Accompanying video DVD ROM shows surgical skills by International Masters for Ocular Trauma Management.
We are grateful to Shri Jitendar P Vij (CEO), Mr. Tarun Duneja (Director Publishing) and all staff members of M/s Jaypee Brothers Medical Publishers Pvt. Ltd. who took extraordinary efforts in the preparation of this book.
We are sure that present book shall provide deep insight into state of art ocular trauma management in a simplified and comprehensive manner. This book shall be an integral part of shelf of every Ophthalmologist clinical chamber who have to encounter ocular trauma cases in their professional practice.
Editors
Contents
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SECTION I |
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PRELIMINARY AND BASIC CONSIDERATIONS |
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IN OCULAR TRAUMA |
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1. |
Epidemiology and New Classification of Ocular Trauma ............................................................. |
3 |
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João J Nassaralla Jr, Belquiz A Nassaralla (Brazil) |
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2. |
New Classification of Ocular Trauma.......................................................................................... |
7 |
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B Shukla, D Shukla (India) |
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3. |
Clinical Evaluation of Ocular Trauma ....................................................................................... |
10 |
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B Shukla (India) |
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4. |
Evaluation and Initial Management of a Patient with Ocular Trauma ....................................... |
13 |
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Rupesh V Agrawal (India) |
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SECTION II |
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ANTERIOR SEGMENT OCULAR TRAUMA |
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5. |
Role of Ultrasound Biomicroscopy in Evaluation of the Anterior |
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Segment in Closed Globe Injuries ........................................................................................... |
25 |
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Ritika Sachdev, Mahipal S Sachdev, (India) |
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6. |
Management of Eyelid Inju0ries ............................................................................................... |
28 |
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Rania Abdel Salam, Essam El Toukhy (Egypt) |
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7. |
Management of Lacrimal Injuries ............................................................................................. |
33 |
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Rania Abdel Salam, Essam El Toukhy (Egypt) |
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8. |
Hyphema ................................................................................................................................. |
35 |
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Earl Crouch, Eric Crouch (USA) |
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9. |
Management of Corneal Injuries .............................................................................................. |
41 |
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Ashok Sharma (India) |
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10. |
Chemical Injuries of the Eye ................................................................................................... |
50 |
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Quresh B Maskati (India) |
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11. |
Injuries of the Eye due to Physical Agents (Thermal, Ultrasonic and Electrical Injuries) .......... |
55 |
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Rupesh V Agrawal (India) |
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12. |
Radiational Injuries to the Eye ................................................................................................ |
59 |
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Rupesh V Agrawal (India) |
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13. |
Traumatic Angle Recession GlaucomaL An Overview ............................................................... |
64 |
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Cyres K Mehta, Keiki R Mehta (India) |
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14. |
Management of Blunt Trauma of Anterior Segment ................................................................. |
67 |
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Ashok Sharma (India) |
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15. |
Management of Traumatic Cataract .......................................................................................... |
74 |
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Rupesh V Agrawal, Satish Desai (India) |
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16. |
Management of Traumatic Luxation of the Crystalline Lens ..................................................... |
80 |
Arturo Pèrez-Arteaga, Yuri Flores (Mexico)
xvi |
Clinical Diagnosis and Management of Ocular Trauma |
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17. |
Traumatic Cataract in Children ................................................................................................ |
86 |
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Rupal H Trivedi, M Edward Wilson (USA) |
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18. |
Scleral Fixated IOL in Trauma ................................................................................................. |
94 |
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Rupesh V Agrawal (India) |
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19. |
Iris Trauma ............................................................................................................................ |
100 |
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Rupesh V Agrawal (India) |
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20. |
Post-traumatic Strabismus ...................................................................................................... |
106 |
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B Shukla, P Bhasin (India) |
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21. |
Management of Orbital Trauma and Fractures ........................................................................ |
108 |
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Rania Abdel Salam, Essam El Toukhy (Egypt) |
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22. |
Management of Anterior Segment Trauma: An Update ........................................................... |
125 |
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CS Dhull, Sumit Sachdeva (India) |
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23. |
Glued IOL ............................................................................................................................. |
132 |
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Amar Agarwal, Dhivya A, Soosan Jacob, Athiya Agarwal, Chandresh Baid, Ashok Garg (India) |
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SECTION III |
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POSTERIOR SEGMENT OCULAR TRAUMA |
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24. |
Management of Traumatic Hemorrhages to the Posterior Segment ......................................... |
139 |
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Javier A Montero, Jose M Ruiz-Moreno (Spain) |
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25. |
Traumatic Retinal Detachments ............................................................................................. |
149 |
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Neeraj Sanduja, Ajay Aurora, Gaurav Luthra (India) |
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26. |
Retained IOFB ....................................................................................................................... |
155 |
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Neeraj Sanduja, Ajay Aurora, Gaurav Luthra (India) |
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27. |
Penetrating Posterior Segment Trauma ................................................................................... |
160 |
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T Mark Johnson (USA) |
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28. |
Traumatic Retinopathies ......................................................................................................... |
167 |
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Scott Pfahler, T Mark Johnson (USA) |
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29. |
Management of Endophthalmitis ............................................................................................ |
174 |
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Pei-Chang Wu, Hsi-Kung Kuo (Taiwan) |
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30. |
Management of Pediatric Ocular Trauma ................................................................................ |
181 |
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Yog Raj Sharma, Ritesh Gupta, Rajni Sharma (India) |
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31. |
Management of Blunt Retinal Trauma .................................................................................... |
189 |
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Arturo Pérez-Arteaga, Yuri Flores (Mexico) |
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32. |
Applications of Stem Cell Therapy in Ophthalmology............................................................ |
200 |
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Rajpal Vohra (India) |
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33. |
Primary Globe Repair ............................................................................................................ |
214 |
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Rupesh V Agrawal (India) |
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SECTION IV |
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IATROGENIC OCULAR TRAUMA AND ITS |
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COMPLICATIONS MANAGEMENT |
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34. |
Management of Iatrogenic Inflammation of the Eye ............................................................... |
223 |
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NR Biswas, GK Das, Viney Gupta (India) |
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35. |
Management of Postrefractive Keratitis ................................................................................... |
229 |
Eric D Donnenfeld (USA)
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Clinical Diagnosis and Management of Ocular Trauma |
xvii |
36. |
Optimized NSAIDs and Antibacterial Prophylaxis in Cataract Surgery ................................... |
232 |
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Ashok Garg (India), Ian Bell (USA) |
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37. |
Optimizing Visual Outcomes with NSAIDs Therapy in Cataract and Refractive Surgery ......... |
235 |
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Eric D Donnenfeld, Henry D Perry (USA) |
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38. |
Management of Cystoid Macular Edema ................................................................................ |
242 |
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Arturo Pérez-Arteaga, René Cano-Hidalgo (Mexico) |
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39. |
Managing Intraoperative Floppy Iris Syndrome ...................................................................... |
250 |
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David F Chang (USA) |
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40. |
Toxic Anterior Segment Syndrome ......................................................................................... |
254 |
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Simon P Holland, Douglas W Morck, Richard Mathias, |
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Tracy L Lee, Gina Chavez, Yumi G Ohashi (Canada) |
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41. |
Small Pupil Phaco: An Innovative Technique ......................................................................... |
259 |
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Boris Malyugin (USA) |
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SECTION V |
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CURRENT CONCEPTS AND RECENT ADVANCES IN |
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MANAGEMENT OF OCULAR TRAUMA |
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42. |
Trauma after Refractive Surgery ............................................................................................. |
269 |
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D Ramamurthy, Chitra Ramamurthy (India) |
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43. |
Complication and Contusion after Phakic IOL ....................................................................... |
273 |
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Jerome Jean Bovet (Switzerland) |
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44. |
Management of Corneal Lacerations....................................................................................... |
279 |
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Shui Lee (Canada) |
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45. |
Sports Injuries in Eye ............................................................................................................ |
283 |
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B Shukla, Binoo Nayar (India) |
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46. |
Management of Travel Eye Injuries ........................................................................................ |
286 |
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Leonardo Toledo Netto, Belquiz A Nassaralla (Brazil) |
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47. |
Ocular Injuries after Vehicular Accident and Possible Prevention ........................................... |
290 |
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Bojan Pajic, Brigitte Pajic-Eggspuehler, Jasna Ljubic (Switzerland) |
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48. |
Bottle Cork Injury to the Eye................................................................................................ |
296 |
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Gian Maria Cavallini, Matteo Forlini, Cristina Masini, Luca Campi, Simone Pelloni (Italy) |
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49. |
Ocular War Injuries................................................................................................................ |
300 |
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Jaroslaw Kulinski, Karol Stasiak, Marek E Prost (Poland) |
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50. |
Trauma of Anterior Eye Segment: An Update ........................................................................ |
311 |
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Boris Malyugin (Russia) |
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51. |
Management of Ocular Trauma with Plasma (Fugo) Knife ...................................................... |
319 |
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Ranjit Singh, Indu R Singh, Kiranjit Singh, Harmit Kaur, KK Bhalla, Daljit Singh (India) |
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52. |
Chandelier Illumination and Bimanual Vitrectomy Used to Remove a Dislocated IOL ........... |
328 |
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Amar Agarwal, Soosan Jacob, Athiya Agarwal, Sunita Agarwal, Ashok Garg (India) |
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53. |
Principles and Management of Ocular Trauma........................................................................ |
331 |
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Syed Asghar Hussain, Amol Mhatre, Kanupriya Mhatre, Supriya Dabir, |
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Saumil Sheth, Vandana Jain, S Natarajan (India) |
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54. |
Eyelid Injuries and Reconstruction: An Update ...................................................................... |
345 |
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Quresh Maskati, Sunil Vasani (India) |
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55. |
Prevention of Ocular Trauma ................................................................................................. |
349 |
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B Shukla, P Dutta (India) |
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56. |
Endophthalmitis Preventiion Strategies .................................................................................. |
352 |
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John D Sheppard (USA) |
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Index ................................................................................................................................................. |
355 |
Preliminary and
Basic Considerations in
Ocular Trauma
C H A P T E R
1 Epidemiology and
New Classification of
Ocular Trauma
João J Nassaralla Jr, Belquiz A Nassaralla (Brazil)
Introduction
An injury to the eye or its surrounding tissues is the most common cause for attendance at an eye hospital emergency department. The extent of trauma may range from simple superficial injuries to devastating penetrating injuries of the eyelids, lacrimal system, and globe. The surgical management of such injuries is directed primarily at the restoration of normal ocular anatomy; the ultimate goal is to prevent secondary complications and maximize the patient’s visual prognosis. Dramatic improvements in the surgical management of ocular trauma have evolved over the past two decades. However, persistent inadequacy in the standardized documentation of eye injury morbidity and treatment outcome limits the development and widespread introduction of techniques for preventing and improving the prognosis of serious eye trauma.
Professional associations like the International Society of Ocular Trauma (ISOT), and the United States Eye Injury Registry (USEIR), have been formed to promote research, elaborate epidemiologic investigations, highlighting preventable sources of injury, emerging patterns of trauma, treatment outcomes and disseminate its results. The USEIR is presently working with the ISOT to establish the World Eye Injury Registry (WEIR). International registries have been established or are in start-up phase in Brazil, British Armed Forces, Bolivia, Canada, China, Colombia, Croatia, Finland, India, Italy, Germany, Greece, Hungary, Israel, Kenya, Korea, Lithuania, Mexico, New Zealand, Portugal, Romania, Saudi Arabia, Singapore, Slovakia, Slovenia, South Africa, Spain, Switzerland, Turkey, Venezuela, West Indies(Trinidad), Yugoslavia, Zimbabwe with assistance from the United States Eye Injury Registry.1
Unfortunately, the lack of an unambiguous common language remains a major limiting factor in effectively sharing eye injury information. Without a standardized terminology of eye injury types, it is impossible to design projects like the USEIR or the
WEIR; clinical trials in the field of ocular trauma cannot be planned; and the communication between ophthalmologists remains ambiguous.1,2 So, a standardized terminology for eye injury has been developed by the USEIR based on extensive experience and repeated reviews by international ophthalmic audiences. By always using the entire globe as the tissue of reference, classification is unambiguous, consistent, and simple. It provides definitions for the commonly used eye trauma terms within the framework of a comprehensive system.1
Epidemiology
Eye injuries are a major and under recognized cause of disabling ocular morbidity that especially affect the young. The public health importance of such ocular trauma is undeniable. Injuries generate a significant and often unnecessary toll in terms of medical care, human suffering, long-term disability, productivityloss, rehabilitation services, and socioeconomic cost.1-3
Globally, more than 500.000 blinding injuries occur every year. Approximately 1.6 million people are blind owing to ocular trauma, 2.3 million are bilaterally visually impaired, and 19 million have unilateral visual loss.3,4 Every year, approximately 2 million eye injuries occur in the United States, of which, more than 40 thousand results in permanent visual impairment.6,7 Prior studies in which the incidence of eye injury has been examined have produced varied results, in part because of study design differences.8- 13 When considering eye injuries requiring hospital admission, rates have ranged from 8 to 57 per 100.000.8-13 Despite the heterogeneity of results, these studies provide important information regarding the burden of eye injury. However, they have all been limited to a single year or narrow time frame making it difficult to determine trends in injury rates over time. In the United States, a population-based study reported a prevalence rate of 19.8% and an average annual incidence rate of 3.1 per 1000 population.14
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Clinical Diagnosis and Management of Ocular Trauma |
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In a more recent study from 1992 through 2002, the |
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incidence of eye injury declined overall and the |
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estimated rate of eye injury ranged from 8.2 to 13.0 |
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per 1000 population.5 |
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Worldwide, ocular trauma is a leading cause of no |
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congenital monocular blindness among children.16-20 |
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Children are disproportionately affected by ocular |
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injuries. In the United States, a population-based study |
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reported an annual incidence of ocular trauma in |
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children of 15.2 per 100.000.18 In general, males are |
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more frequently reported to have eye injuries than |
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females.17-24 Results varied across studies regardingthe |
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age-specific frequency of eye injuries17-26 with some |
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reportinga higher incidence in older children and others |
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in younger children. A study conducted among |
Fig. 1.2: Sources of eye injury1 |
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Brazilian children found that the group aged 0 to 5 |
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years was at greatest risk, regardless of sex, and that |
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among those older than 5 years, eye injuries were |
in other industrialized countries, like Italy, where clinical |
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more frequent in boys.26 |
research on ocular trauma is limited to the pediatric |
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Although the overall financial cost derived from |
population and sportsmen.22,29,30 Available information |
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ocular injuries can only be estimated,direct and indirect |
regarding the distribution and magnitude of ocular |
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costs combined run into hundreds of millionsof dollars |
trauma in developing countries is very scarce, and the |
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per year. Developing countries carry the heaviest |
existing data are difficult to interpret because reporting |
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burden, and they are the least able to afford the costs.8 |
is extremely poor and especially because of the |
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Domestic accidents (40%), industrials (13%), and |
completely differentsettings of the occurrence of ocular |
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street/highway accidents (13%) are the most common |
trauma.3 Among other factors,underreporting and lack |
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circumstances in which ocular injury occurs, (Fig. 1.1). |
of standardized forms and national integrateddatabases |
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Eye injuries incurred during athletic activity (13%) are |
make assessment of the current picture and compari- |
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becoming more common with the increasing popularity |
sonswithin and across countries practically impossible.2 |
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of indoor court games. A recent survey found |
In addition, developing countries often lack adequate |
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racquetball to exceed other sports in generating ocular |
infrastructure for persons with eye injuries to reach a |
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injuries, followed by tennis, baseball, basketball, and |
primary care center, when one exists, and the lack of |
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soccer.1 |
awareness of preventive measures and/or immediate |
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actions increases the risk for complications and |
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consequent visual disability and blindness.8 From a |
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public health and injury prevention perspective, current |
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information on eye injuries rates is needed to develop |
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effective plans for disseminating eye injury prevention |
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materials to the public and to earmark adequate |
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funding for these initiatives.1,2 |
Fig. 1.1: Places of eye injury1
The most common sources of eye injuries are blunt object (31%), sharp object (18%), and motor vehicle crash (9%), (Fig. 1.2).
While the incidence of ocular trauma has been described in the United States,6,8,12,15 United Kingdom,10 Sweden,27 and Greece,28 it has not been well studied
New Classification
The new classification of ocular trauma has been endorsed by the Board of Directors of the International Society of Ocular Trauma, the United States Eye Injury Registry, the Hungarian Eye Injury Registry, the Vitreous Society, the Retina Society, and the American Academy of Ophthalmology. This classification system categorizes ocular injuries at the time of initial examination. It is designed to promote the use of standard terminology and assessment, with applications to clinical management and research studies regarding eye injuries (Fig. 1.3).1,2,32