Current Concepts and Management of Eye Injuries

194 Pages·2016·11.287 MB·English

by  Güngör Sobacı (eds.)

Current Concepts
and Management
of Eye Injuries
Güngör Sobacı
Editor
123
Current Concepts and Management
of Eye Injuries
Güngör Sobacı
Editor
Current Concepts
and Management of Eye
Injuries
Editor
Güngör Sobacı
Department of Ophthalmology
Hacettepe University Medical School
Ankara
Turkey
ISBN 978-1-4471-7300-7 ISBN 978-1-4471-7302-1 (eBook)
DOI 10.1007/978-1-4471-7302-1
Library of Congress Control Number: 2017931399
© Springer-Verlag London 2016
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This book is dedicated to people who lost their eyes in relation
to acts of terrorism in the past when this book was written and
to our contributor, Prof Dr Cesare Forlini, who was missed in
the aforementioned period.
Güngör Sobacı, MD
Preface
Current Concepts and Management of Eye Injuries is the concise clinical
reference on the management of severe ocular injuries. Each chapter gives
you quick instructions on the management of the patients who were injured
by common causes as well as rare ones including the mass casualty inci-
dences (MCI). In addition to common thoughts related to the ocular trauma-
tology, this book covers individualized treatment strategies and up-to-date
surgical interventions to provide patients with the best anatomical and func-
tional outcomes available.
This book takes current concepts in evaluation and classification of the
injury mechanism(s) into consideration and gives you precious information
and fundamental pearls and pitfalls on the management of each injured tissue
of the globe to achieve best clinical practice. In addition, each chapter gives
special emphasis to discussion of hot topics and medicolegal issues regarding
the ophthalmologist as an expert witness.
This reader-friendly book serves as a reference guide for the clinicians
dealing with trauma and ophthalmology in practice.
Ankara, Turkey Güngör Sobacı, MD
vii
Contents
1 Severe Eye Injuries: Identification, Clinical Impact,
and Critical Issues on Emergency Management . . . . . . . . . . . . . . 1
Ali Ayata and Yakup Aksoy
2 Current Concepts and Management of Severely Traumatized
Tissues in the Outer Coatings (The Cornea, the Conjunctiva,
and the Sclera) of the Globe: Mechanical Injuries . . . . . . . . . . . 17
Hasan Basri Cakmak and Ugur Acar
3 Current Concepts and Management of Severely Traumatized
Tissues in the Outer Coatings (the Cornea, the Conjunctiva,
and the Sclera) of the Globe: Nonmechanical Injuries . . . . . . . . 31
Faruk Ozturk and Emrullah Beyazyildiz
4 Current Concepts and Management of Severely Traumatized
Tissues in the Inner Coatings (The Anterior Segment:
Anterior Chamber Structures, the Iris and the Lens)
of the Globe: Mechanical Injuries . . . . . . . . . . . . . . . . . . . . . . . . . 41
Cesare Forlini, Adriana Bratu, Matteo Forlini, and Paolo Rossini
5 Current Concepts and Management of Severely
Traumatized Tissues in the Inner Coatings (the Anterior
Segment: Anterior Chamber Structures, the Iris, and the Lens)
of the Globe: Non-mechanical Injuries . . . . . . . . . . . . . . . . . . . . . 65
Ugur Acar and Atilla Bayer
6 Current Concepts and Management of Severely Traumatized
Tissues in the Inner Coatings (The Posterior Segment:
The Ciliary Body, the Choroid, and the Retina) of the Globe:
Mechanical Injuries (Open Globe Without Intraocular
Foreign Body and Without Endophthalmitis) . . . . . . . . . . . . . . . 75
Gokhan Gurelik and Sabahattin Sul
7 Current Concept and Management of Severely
Traumatized Tissues in the Inner Coatings of the Globe:
Mechanical Injuries, Open Globe with Intraocular
Foreign Body Without Traumatic Endophthalmitis . . . . . . . . . . 93
Hua Yan and Caiyun You
ix
x Contents
8 Current Concepts and Management of Severely Traumatized
Tissues in the Inner Coatings (the Posterior Segment:
the Ciliary Body, the Choroid, and the Retina) of the Globe:
Mechanical Injuries, Perforating Injury. . . . . . . . . . . . . . . . . . . 107
Sengul Ozdek and Murat Hasanreisoglu
9 Current Concepts and Management of Severely Traumatized
Tissues in the Inner Coatings (The Posterior Segment:
The Vitreous, the Retina, the Choroid, and the Ciliary Body)
of the Globe: Mechanical Injuries (Closed-Globe Injuries) . . . 119
Yaprak Banu Ünver and Ziya Kapran
10 Current Concepts and Management of Severely Traumatized
Tissues in the Inner Coatings (The Posterior Segment:
The Ciliary Body, the Choroid and the Retina) of the Globe:
Nonmechanical Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Melih Unal and Akın Cakır
11 Current Concepts and Management of Severely
Traumatized Eye: Open-Globe Injury with
Endophthalmitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Suleyman Kaynak and Rukiye Aydın
12 Current Concepts and Management of Severely
Traumatized Ocular Adnexa and the Optic Nerve . . . . . . . . . . 167
Engin Gonul and Güngör Sobacı
13 Critical Issues in the Management of Mixed Mechanism
and Whole Globe Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Gökcen Göokce and Güngör Sobacı
Index .................................................... 189
1
Severe Eye Injuries: Identification,
Clinical Impact, and Critical Issues
on Emergency Management
Ali Ayata and Yakup Aksoy
Contents 1.1 Introduction
1.1 Introduction ................................................ 1
Severe eye injuries are defined as “trauma
1.2 Clinical Impact of Severe Eye Injuries ..... 2
resulting in permanent and significant struc-
1.2.1 Clinical Impact and Incidence
tural or functional change to the eye or adnexa”
of Severe Eye Injuries ..................................... 2
1.2.2 Risk Factors ................................................. 2 (Kuhn 2008) that also means eye injury that
1.2.3 Prevention .................................................... 4 requires surgical intervention and hospitaliza-
1.3 Current Concepts in Classification tion or that can lead to visual impairment or
and Evaluation of the Eye Trauma ........... 4 blindness which can be described as severe.
1.3.1 Terminology of the Eye Injury ..................... 4
Severe eye injury is one of the major causes of
1.3.2 Classification of the Ocular Trauma ............ 5
visual impairment and is, therefore, a public
1.3.3 Ocular Trauma Score (OTS) ........................ 7
1.3.4 Classification of Ocular Burns health problem. The severity of the trauma is
and Chemical Eye Injury ............................. 8 directly proportional to morbidity and affects
1.4 Critical Issues on Triage, Primary Care, the socioeconomic loss. The best way of pro-
Secondary Care, and Tertiary tecting the vision in severe eye injury is pre-
Care of the Patient with Severely vention of the injury by education and
Traumatized Eye ......................................... 9
legislation (Soylu et al. 2010). Beside this it’s
1.4.1 Primary Care and Triaging ........................... 9
1.4.2 Secondary Care ............................................ 9 not possible to prevent the eye traumas every
1.4.3 Tertiary Care and Rehabilitation .................. 15 time. In this situation the best method of
regaining the lost visual acuity can be possible
References ............................................................... 15
only by following the scientific way. This
means that an ophthalmologist has to know the
clinical importance of severe eye injuries and
determine and define the pathology with a
A. Ayata (*) common terminology and has a scientific treat-
Department of Ophthalmology, Gülhane Military
ment strategy to achieve maximum potential of
Medical Academy, Haydarpaşa Training Hospital,
injured eye.
Istanbul, Turkey
e-mail: [email protected]
Y. Aksoy
Department of Ophthalmology, Girne Military
Hospital, Kyrenia, Turkish Republic of Northern
Cyprus, Turkey
e-mail: [email protected]
© Springer-Verlag London 2016 1
G. Sobacı (ed.), Current Concepts and Management of Eye Injuries,
DOI 10.1007/978-1-4471-7302-1_1
2 A. Ayata and Y. Aksoy
1.2 Clinical Impact of Severe Eye lifetime prevalence in the USA of an eye injury
Injuries was estimated at over 1,400 per 100,000 popula-
tion. The initial visual acuity of patients was
1.2.1 Clinical Impact and Incidence worse than 20/200 in 50.8 % of these eyes. The
of Severe Eye Injuries final visual acuity was worse than 20/200 in
27.1 % of the followed patients. The blindness
According to World Health Organization defini- rates according to the injury type were reported
tions, visual impairment is defined as having as 23.1 % among those with contusion, 60 %
worse than 20/40 visual acuity in the better eye among those with rupture, 23 % among those
even with best correction, and blindness is with penetrating trauma, 25 % among those with
defined as having equal or worse than 20/200 intraocular foreign body (IOFB) injury, and 64 %
visual acuity in the better eye. among those with perforating trauma (Soylu
Severe eye injuries are more important since et al. 2010).
they are more prone to cause permanent visual The incidence rate for people hospitalized with
impairment or blindness. In the USA, eye injury eye injury is between 8.1 and 23.9 in different
is a primary cause of monocular blindness and is studies (Desai et al 1966; Karaman et al 2004;
the second most common cause of visual impair- Cillino et al. 2008). The introduction of pars plana
ment (Kuhn et al. 2006). vitrectomy and intravitreal antibiotics, along with
Unexpected and sudden occurrence of the many other new developments, has greatly
injury mostly permanently changes the sufferers’ increased the chance of a good outcome among
life quality, personal skills, future plans and eyes with serious injury. Over 60 % of eyes
occupational ability and qualification, etc. Also improve after the trauma, and less than 10 % expe-
recovery process may continue lifelong, and it is rience visual deterioration. Nevertheless, preven-
challenging and aching not only for the patient tion should be the ultimate goal (Kuhn et al. 2006).
but also family members, educators, and health
professionals involved in this process. Estimated
cumulative lifetime prevalence of eye injuries 1.2.2 Risk Factors
necessitating medical care is ranging from 14.4 %
to 21.1 % in an Australian study and Baltimore 1.2.2.1 Gender
eye survey, respectively (McCarty et al. 1999; Like with other forms of injury, men are more
Katz and Tielsch 1993). frequently exposed to eye injuries with male to
In recent decades, numerous reported epide- female ratio ranging from 3:1 to 7.4:1 (Cillino
miological publications have revealed enormous et al. 2008; Gordon 2012).
information about incidence and risk factors of
the eye injuries, but data is various and different 1.2.2.2 Age
according to the reporting center, country, tar- Huge majority of the injured patients are at ages
geted population, different methodology and under or around 30s (Gordon 2012; Soong et al.
inclusion criteria, and other factors. It has been 2011). Age may also influence the type of
estimated that 55 million eye injuries – restricting injury; open-globe injuries mostly caused by
personal activities more than 1 day – occur annu- sharp or flying object commonly occur in young
ally in the world; from these 750,000 cases male patients, and rupture or closed-globe inju-
require hospitalization including 200,000 open- ries more strike elders by falling. More than
globe injuries. There are approximately 1.6 mil- 40 % of all serious ocular injuries occurring
lion blind from injuries, an additional 2.3 million before 20 years of age are to those over age 15
people with bilateral low vision from this cause years. Trauma is considered the most common
(Negrel and Thylefors 1998). According to the cause of enucleation in children over 3 years of
records of the United States Eye Injury Registry age (Brophy et al. 2006). Those over 60 years of
(USEIR) database with close to 2.5 million eye age have progressively poorer prognosis; the
injuries occurring each year, the cumulative differences were statistically significant. There