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Sports-related ocular injuries.
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Eye injuries caused by bungee cords.
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Ocular injuries from paintball pellets.
OBJECTIVE: To evaluate the ocular effects of blunt trauma due to injury from a paintball pellet. DESIGN: Noncomparative case series. PARTICIPANTS: Thirteen patients who suffered ocular injury from paintballs are described. The patients presented to six different civilian and military emergency departments in tertiary care medical centers. INTERVENTION: Patients were treated for the ocular injury. MAIN OUTCOME MEASURES: Patients were evaluated for initial and final visual acuity. The reason for persistent loss of vision was delineated. RESULTS: There were 12 males and 1 female with an average age of 21 years (range, 12-33 years). Eleven of the 13 had no ocular protection at the time of the ocular injury. On initial examination, nine patients had a hyphema, nine had a vitreous hemorrhage, six had a retinal tear or detachment, three had corneal or corneal-scleral ruptures, and one had traumatic optic neuropathy. The final visual acuity was 20/40 or better in two patients, 20/50 to 20/150 in three patients, and 20/200 or worse in eight patients. CONCLUSION: Injuries due to paintball pellets can result in severe ocular damage and significant loss of vision. Eyecare professionals should be aware of the risks of this sport and must strongly advise participants to wear adequate protection when involved in this activity.
Current status of oral PUVA therapy for psoriasis. Eye protection revisions.
Recommendations for the use of oral psoralens and long-wave ultraviolet light (PUVA) were published in 1979. Since that time advances in optics technology and new knowledge on eye toxicity associated with PUVA therapy have prompted the original compilers to revise the eye protection segments of the PUVA recommendations. It is recommended that during day 1 of PUVA treatment, UVA-blocking plastic wraparound glasses be worn while outdoors from time of ingestion of the drug until bedtime. While indoors or in dim light, either the wraparound glasses or clear UVA-blocking glasses should be worn. During day 2, either the plastic wraparounds or the clear UVA-blocking glasses should be worn the entire day. Shielding of the eyes during day 2 is an absolute requirement, and on day 2 it should be encouraged but is a relative requirement. The revisions were compiled with the view of urging patient compliance.
Environmental UVA radiation and eye protection during PUVA therapy.
Experimental and clinical evidence suggests that patients receiving psoralens plus UVA radiation (PUVA) therapy for the treatment of psoriasis or other skin diseases run the risk of developing cataracts. The total exposure to UVA radiation of these patients has been difficult to quantify because they are exposed to UVA radiation in the environment as well as during PUVA therapy. In our studies, the spectral irradiances of possible environmental sources of UVA radiation (sunlight, daylight and cool white fluorescent bulbs, and incandescent bulbs) were measured and compared to the spectral irradiance of a bank of PUVA bulbs. Sunlight and PUVA bulbs were found to have similar irradiances in the UVA waveband. Window glass reduced the UVA irradiance from sunlight. Artificial sources of illumination had a very low UVA irradiance compared with PUVA bulbs and sunlight. These results indicate that patients should protect their eyes from sunlight both outdoors and indoors after ingestion of psoralens; however, protection from incandescent bulbs or cool white and daylight fluorescent bulbs is much less important, and possibly unnecessary.
Safety parameters for avoiding acute ocular damage from the reflected CO2 (10.6 microns) laser beam.
Reflections from instruments in the surgical field involving the CO2 laser beam present a serious ocular hazard. In addition to the use of plastic or glass protective eyewear, this hazard can be minimized by utilizing anodized instruments and recognizing the specific distances at which various reflections are no longer hazardous depending upon certain variables, including laser output wattage, emergent beam lengths, and surface characteristics of the reflecting instruments.
The tanning salon: an area survey of equipment, procedures, and practices.
Because so little data are available on practices and procedures used by tanning salons, we studied, as customers, salons in a major city in Arkansas, the state where the practice began. We measured both ultraviolet A (UVA) and ultraviolet B (UVB) output at multiple reference points and found UVB always to be present, but at lower-than-expected levels. The highest irradiance was always at the umbilicus and the lowest was on the face. We evaluated compliance with accepted safety principles and federal guidelines and regulations; too often we found no eye protection and sometimes we found inadequate limits of exposure time. Persons with skin types I and II were sometimes promised a safe, effective UVA tan that would protect against sunburn. From our experience we concluded that if the industry is to continue, there is need for closer supervision and regulation.
Surgical pearl: Q-switched Nd:YAG laser removal of eyeliner tattoo.
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Compliance with recommendations for universal precautions among prehospital providers.
STUDY OBJECTIVE: To evaluate the compliance of emergency medical responders with local employer and Centers for Disease Control and Prevention recommendations for disposal of sharps and use of personal protective equipment in the prehospital environment. DESIGN: Prospective, single-blinded observational study of 297 ambulance runs conducted for 3 months. SETTING: A metropolitan emergency medical service system. PARTICIPANTS: Sixty-nine emergency medical technicians and paramedics. INTERVENTIONS: None. RESULTS: Observers recorded the handling of sharps and the use of personal protective equipment in four situations: i.v. line placement, endotracheal intubation, large-wound management, and body fluid hazard. Emergency medical workers properly handled sharps in 24 of 65 situations (37%). They were usually compliant with glove use during the observed procedures. However, compliance with the use of other personal protective equipment was poor. CONCLUSION: Sharps were often improperly handled. Most workers complied with recommendations for the use of gloves but often underused goggles, masks, and gowns. Although education and restructuring of the environment and equipment may improve compliance, strong consideration should be given to developing standardized and more practical recommendations for the prehospital environment.
Partial depilation of the eyebrow from inappropriate use of a bio-occlusive dressing.
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Dosimetric evaluation of lead and tungsten eye shields in electron beam treatment.
PURPOSE: The purpose of this study is to report that commercially available eye shields (designed for orthovoltage x-rays) are inadequate to protect the ocular structures from penetrating electrons for electron beam energies equal to or greater than 6 MeV. Therefore, a prototype medium size tungsten eye shield was designed and fabricated. The advantages of the tungsten eye shield over lead are discussed. METHODS AND MATERIALS: Electron beams (6-9 MeV) are often used to irradiate eyelid tumors to curative doses. Eye shields can be placed under the eyelids to protect the globe. Film and thermoluminescent dosimeters (TLDs) were used within a specially constructed polystyrene eye phantom to determine the effectiveness of various commercially available internal eye shields (designed for orthovoltage x-rays). The same procedures were used to evaluate a prototype medium size tungsten eye shield (2.8 mm thick), which was designed and fabricated for protection of the globe from penetrating electrons for electron beam energy equal to 9 MeV. A mini-TLD was used to measure the dose enhancement due to electrons backscattered off the tungsten eye shield, both with or without a dental acrylic coating that is required to reduce discomfort, permit sterilization of the shield, and reduce the dose contribution from backscattered electrons. RESULTS: Transmission of a 6 MeV electron beam through a 1.7 mm thick lead eye shield was found to be 50% on the surface (cornea) of the phantom and 27% at a depth of 6 mm (lens). The thickness of lead required to stop 6-9 MeV electron beams is impractical. In place of lead, a prototype medium size tungsten eye shield was made. For 6 to 9 MeV electrons, the doses measured on the surface (cornea) and at 6 mm (lens) and 21 mm (retina) depths were all less than 5% of the maximum dose of the open field (4 x 4 cm). Electrons backscattered off a tungsten eye shield without acrylic coating increased the lid dose from 85 to 123% at 6 MeV and 87 to 119% at 9 MeV. For the tungsten eye shield coated with 2-3 mm of dental acrylic, the lid dose was increased from 85 to 98.5% at 6 MeV and 86 to 106% at 9 MeV. CONCLUSION: Commercially available eye shields were evaluated and found to be clearly inadequate to protect the ocular structures for electron beam energies equal to or greater than 6 MeV. A tungsten eye shield has been found to provide adequate protection for electrons up to 9 MeV. The increase in lid dose due to electrons backscattered off the tungsten eye shield should be considered in the dose prescription. A minimum thickness of 2 mm dental acrylic on the beam entrance surface of the tungsten eye shield was found to reduce the backscattered electron effect to acceptable levels.
Comments on ocular globe topography in Radiotherapy by Karlsson et al. IJROBP 33(3):705-712;1995.
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Evaluation of eye shields made of tungsten and aluminum in high-energy electron beams.
PURPOSE: To protect the lens and cornea of the eye when treating the eyelid with electrons, we designed a tungsten and aluminum eye shield that protected both the lens and cornea, and also limited the amount of backscatter to the overlying eyelid when using electron beam therapy. METHODS AND MATERIALS: Custom curved tungsten eye shields, 2 mm and 3 mm thick, were placed on Kodak XV film on 8 cm polystyrene and irradiated to evaluate the transmission through the shields. To simulate the thickness of the eyelid and to hold the micro-TLDs, an aquaplast mold was made to match the curvature of the eye shields. Backscatter was measured by placing the micro-TLDs on the beam entrance side to check the dose to the underside of the eyelid. Measurements were done with no aluminum, 0.5, and 1.0 mm of aluminum on top of the tungsten eye shields. The measurements were repeated with 2- and 3-mm flat pieces of lead to determine both the transmission and the backscatter dose for this material. RESULTS: Tungsten proved to be superior to lead for shielding the underlying structures and for reducing backscatter. At 6 MeV, a 3-mm flat slab of tungsten plus 0.5 mm of aluminum, resulted in .042 Gy under the shield when 1.00 Gy is delivered to dmax. At 6 MeV for a 3-mm lead plus 0.5-mm aluminum, .046 Gy was measured beneath the shield, a 9.5% decrease with the tungsten. Backscatter was also decreased from 1.17 to 1.13 Gy, a 4% decrease, when using tungsten plus 0.5 mm of aluminum vs. the same thickness of lead. Measurements using 9 MeV were performed in the same manner. With 3 mm tungsten and 0.5 mm of aluminum, at 3 mm depth the dose was .048 Gy compared to .079 Gy with lead and aluminum (39% decrease). Additionally, the backscatter dose was 3% less using tungsten. Simulating the lens dose 3 mm beyond the shield for the 2-mm and 3-mm custom curved tungsten eye shields plus 0.5 mm of aluminum was .030 and .024 Gy, respectively, using 6 MeV (20% decrease). Using 9-MeV electrons, the dose 3 mm beyond the shield was .048 Gy for the 2-mm shield and .029 Gy for the 3-mm shield (40% decrease). Backscatter was not further decreased using thicker tungsten. With a 6-MeV beam, using the 2-mm or 3-mm custom tungsten eye shields plus 0.5 mm of aluminum, the backscattered doses were 1.03 and 1.02 Gy, respectively. The backscatter dose with 9 MeV was 1.06 Gy using the 2-mm custom shield plus 0.5 mm aluminum and 1.05 Gy with a 3-mm custom shield plus 0.5 mm aluminum. There was very little difference in backscatter dosage under the eyelid using 0.5 vs. 1.0 mm of aluminum. Therefore, for patient comfort, we recommend using 0.5 mm of aluminum. CONCLUSIONS: Tungsten is superior to lead as a material for eye shields due to its higher density and lower atomic number (Z). Using 6- and 9-MeV electrons, tungsten provides the necessary protection for the lens and cornea of the eye and decreases the amount of backscatter to the eyelid above the shield.
MR in vivo imaging of oxygen suppression effect of soft contact lens on the human cornea.
The O(2) suppression effect of a soft contact lens on the human cornea was measured using dynamic magnetic resonance imaging (MRI) of the anterior chamber transcorneally exposed to O(2). Dynamic T(1)-weighted fast spin echo imaging of anterior chambers (TR = 2 s, TE = 15 ms, 5-mm slice) was performed both before and during oxygen supply to a full goggle placed on the face of volunteers wearing a soft contact lens on one eye and nothing on the other eye as a control. Within 15 min after O(2) administration, significantly lower intensity changes were obtained in the anterior chambers of the eyes with the contact lens than in those of the eyes without one, suggesting that dynamic MRI of the anterior chamber transcorneally exposed to O(2) can be used to evaluate the O(2) suppression effect of a soft contact lens on the cornea.
The evaluation of eye patching in the treatment of traumatic corneal epithelial defects.
The objective of this study was to compare the rates of healing for patched and non-patched traumatic corneal epithelial defects (CEDs) after 1 day of treatment. To achieve this we initiated a randomized, controlled, prospective, clinical investigation comparing patching vs. non-patching of CEDs. Patients were evaluated initially and at 24 h using slit lamp biomicroscopy, and each corneal epithelial defect was documented on standardized initial and follow-up grid sheets. Percentage of healing and healing rates were determined by comparing the grid sheets. Our results found no significant difference in abrasion size between the two groups, but there was found to be a significantly improved rate of healing at follow-up in non-patched patients. This study demonstrates a significant improvement in the healing rate of traumatic CEDs in the non-patched group as compared to the patched group; therefore, the use of eye patching is not mandatory for corneal epithelial healing to occur.
Sun and the eye: prevention and detection of light-induced disease.
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Effectiveness of interventions to prevent work-related eye injuries.
OBJECTIVE: The objective of this review was to describe the effectiveness of interventions designed to prevent work-related eye injuries in construction, manufacturing, and agricultural industries. Two types of interventions were of interest: (1) effectiveness of different types of eye protection and/or environmental controls in the workplace, and (2) evaluation of behavioral interventions focused on increasing the use of eye protection among at-risk workers. METHODS: Cochrane Collaboration search strategies were used to identify reports of the effectiveness of interventions designed to prevent eye injuries. To be included, a measurable outcome (change in eye injury rates, use of eye protection or costs for eye injury care) had to be reported. Studies that focused on exposures to lasers, radiation or microwaves were not included. RESULTS: Seven reports met inclusion criteria-all from industrial settings. None of the studies was a controlled trial and only one involved a comparison group. CONCLUSIONS: Although there is some evidence that policy changes are effective in changing behaviors and reducing eye injuries in manufacturing settings either in conjunction with a broader program focused on eye safety or by policy alone, there is limited scientific literature about the effectiveness of eye injury prevention interventions. There is a need for systematic evaluation of interventions designed to prevent eye injuries and to change the overall safety culture.