[The periphery of the fundus oculi and eye injuries].
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We performed a histologic study to support our clinical observations on the mechanisms responsible for traction retinal detachment after a penetrating injury in the rhesus monkey eye. The monkey eyes (40 eyes; 40 monkeys) were characterized by intraocular fibrosis with the formation of a cyclitic membrane and epiretinal and subretinal membranes. The progression to a fibrous ingrowth from the wound occurred only in eyes with blood in the vitreous. The intravitreal fibroblastic proliferation had its origin mainly from the stroma of the ciliary body and choroid at the wound but probably also from the nonpigmented ciliary epithelium. A fibroblastic response was present within the vitreous as early as four days after injury, and had progressed to form a cyclitic membrane by six weeks. Epiretinal membranes were identified as early as four weeks after injury. They were most prominent over the peripheral retina anterior to the equator. It is likely that they are derived from multiple cellular sources including the fibrous ingrowth from the wound but they were also connected to the surface of the retina by bridges of tissue indicating a glial origin. The subretinal membranes appeared to be derived from both retinal pigment epithelium cells and glial cells.
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Ocular injuries of sufficient severity to necessitate admission to the Eye and Ear Clinic, Royal Victoria Hospital, Belfast, were sustained by 1707 male patients and 325 female patients. Blunt injury occurred in 1063 eyes (49.2%), perforating injury in 1037 (48%), and intraocular or intraorbital foreign bodies in 181 eyes (8.4%). More than three-quarters of the patients (77.4%) were less than 36 years of age and 84% of all injuries occurred in males. Normal visual acuity (6/6 or better) was regained by 41.2% of the patients in whom the final visual outcome was known. The benefit of wearing seat belts in road vehicles and protective goggles in industry and sport should receive more publicity on radio and television and via poster campaigns. Compulsory fitting of laminated windscreens in all road vehicles is recommended. The vulnerability of children to ocular injury should be highlighted through the mass media, schools, and health centres.
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In the present study, the records of 242 children, aged 1-14 years, admitted with perforating ocular injury were reviewed retrospectively over a 5-year period. There were 175 boys and 67 girls in the study group. The patients were divided into 3 groups according to their ages. Perforating injuries occurred most frequently in the street in all groups. The second most common place of the injury was at home in the 1-9 year-olds and in the fields in the 10-14 year-olds. The cause of the perforation was a metallic substance in 32.6%, wood in 15.3%, stone in 12.0%, glass in 12.3%, pellets in 12%, and injection needles in 8.3%. Most of the perforations occurred during unsupervised play, while all perforations with glass occurred during traffic accidents. Surgery was performed in 234 patients, while 8 patients in whom spontaneous closure had already occurred during admission received only medical treatment. In 28.9% the visual acuity was undetermined, in 25.7% the visual acuity was 0.1 or more, in 22.7% the visual acuity was between 0.06 and light perception, and in 22.7% there was no light perception on final evaluation. It is emphasized that educative and legislative measures such as informing the parents, teachers and children about the causative factors and potential hazards of perforating ocular injuries and restricting the availability of dangerous items to children, should be taken into consideration in order to prevent perforating ocular injuries in children.
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Clinical findings on 219 ball injuries demonstrate that whereas air-filled balls do not produce fractures they do produce skin and eyeball lesions. In 264 cases, orbital fractures, including blow-out-fractures, were caused by inelastic objects hitting the maxillo-facial region. In this group, no trauma of an air-filled ball, especially no tennisball trauma, was seen. The pathomechanism of elastic and inelastic objects is presented with special regard to the effect of suction at the moment the air-filled ball returns from the orbital region.