Corneal Trauma

Trauma is often the main cause of unilateral loss of vision in developing countries. Although corneal trauma can range from tiny corneal abrasions to sight-threatening and penetrating ocular injuries, even minor corneal trauma that breaches the epithelium has the potential to result in microbial keratitis and its associated complications, up until complete loss of vision. Even though ocular trauma is a global problem, blindness from eye injuries occurs mostly in developing countries, especially those where wars and civil conflicts bring around eye traumas from various weapons such as land mines, chemical substances, etc. Chemical injuries from both acids and alkalies are common causes of corneal injury due to their easy availability and soft regulations regarding their use. This chapter includes photos of trauma cases of the anterior segment, corneal and conjunctival foreign bodies, sequelae of blunt and penetrating trauma, chemical injuries, as well as a case of posttraumatic iris cyst.

Individualized Corneal Patching for Treatment of Corneal Trauma Combined with Tissue Defects

Aim. To evaluate the efficacy of individualized corneal patching using a minimal graft for corneal trauma combined with tissue defects. Methods. Fifteen eyes (15 patients) were enrolled in this study, including 8 eyes with corneal perforation induced by removal of metal foreign bodies, 5 eyes with corneal laceration resulting from metal trauma, and 2 eyes with pencil injuries to the cornea. The size, shape, and depth of the tissue defects were assessed. For corneal perforation or irregular tissue defects, if the diameter or length was ≥3.0 mm, traditional penetrating keratoplasty (PK) or lamellar keratoplasty (LK) was adopted; if the diameter or length was ＜3.0 mm, a conical or irregular patch consistent with the defects was used. The visual acuity, corneal status, and postoperative complications were observed during the follow-up. Results. The diameter of corneal perforations was 1.0 mm in 2 eyes, 1.5 mm in 1 eye, 2.0 mm in 4 eyes, and 3.5 mm in 1 eye. During their PK procedures, a conical corneal graft was used in 7 eyes, while a traditional cylindrical graft was used in 1 eye. The other 7 eyes had corneal trauma combined with irregular tissue defects, which were full-thickness corneal defects in 5 eyes and lamellar defects in 2 eyes, all less than 3.0 mm in length. Thus, five eyes received PK, and 2 eyes received LK using an irregular wedge-shaped patch. The visual acuity increased greatly postoperatively, with mild corneal astigmatism. None of the patients developed immune rejection. Conclusion. Individualized corneal patching with a minimal graft can save corneal materials, relieve corneal scars, gain a good visual prognosis, and avoid immune rejection in the treatment of corneal trauma combined with tissue defects.

Ophthalmology

This chapter in the Oxford Handbook of Emergency Medicine investigates ophthalmology in the emergency department (ED). It examines a general approach to eye problems before dealing with specific issues such as corneal trauma, contact lens problems, blunt eye injury, penetrating eye injury, sudden visual loss, the red eye, and pupillary abnormality.

Management of Lagophthalmos in a Patient with Hansen Disease

Aim: To highlight the surgical management of Lagophthalmos in a patient with Hansen disease. Case Presentation: We present a case of a 58-year old man who had bilateral lagophthamos. He had pre-operative physiotherapy for two weeks, Temporalis muscle transfer for the left eye and post-operative physiotherapy for three weeks. His post-operative period was uneventful and the outcome of the surgery was satisfactory. Discussion: Lagophthalmos is a fairly common and extremely distressing condition. It is often found in association with corneal anesthesia, which is responsible for the development of the corneal trauma syndrome from keratitis and ulceration leading to blindness. Out of all the surgical methods used in treatment of Lagophthalmos, Temporalis muscle transfer according to the method of Gillies is considered the best procedure. Conclusion: Surgical correction of Lagophthalmos usually leads to restoration of voluntary blinking and closure of the eye during sleep which effectively protect the eye against further damage. Our patient was able to close his eye during sleep after the surgical correction.

Ocular trauma: prevention

Ocular trauma is an important cause of unilateral visual impairment worldwide. According to Nepal blindness survey (Brillinat et al, 1985), it accounted for 2.4% of blindness, and in another community based study (Upadhyay M et al, 2001), the prevalence of ocular trauma was observed to be 0.7%. The Bhaktapur Eye Study confirms that “corneal trauma leading to ulceration” is the second most common cause of blindness after cataract in Nepal.