Eye injuries during 'war games'.
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Little information is available on the incidence and severity of eye injuries despite the disfigurement and vision loss they cause. From a population-based study in Dane County, Wisconsin, the incidence of acute hospital-treated eye injuries was 423/100,000 residents in 1979. The most common causes of eye injuries were assaults, work-related events, sports and recreational activities, motor vehicle crashes, and falls. Consumer products were involved in almost 70% (9/13) of severe eye injuries classified as severe. Injuries from fireworks were not found at all in this population. Implementing known strategies for eye injury prevention would substantially reduce their incidence. These include requiring certified eye protectors at workplaces and in sports activities whenever possible rather than making their use voluntary. For the preponderance of eye injuries, however, modifying potentially hazardous consumer products, including the interior of passenger cars, will be necessary.
Argon endophotocoagulation may not be possible in some eyes due to the poor view afforded by the operating microscope. This limitation is avoided by viewing through argon filter goggles with the indirect ophthalmoscope while applying treatment with the endophotocoagulation argon laser probe through a pars plana entry site. This method has proved particularly helpful in the gas-filled eye, for treatment over a preexisting scleral buckle, or for a more complete peripheral panretinal photocoagulation.
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Occupational eye injuries are common and preventable. Between 1985 and 1991, there were 635 work-related penetrating eye injuries among the 2939 cases (22%) reported to the National Eye Trauma System Registry by 48 collaborating centers in 28 states and Washington, DC. The median age of the injured workers was 30 years; 75% were younger than 40 years; and 97% were male. The commonest causes of injuries were projectiles (457 cases), sharp objects (166 cases), blunt objects (60 cases), and blasts (22 cases); these terms are not mutually exclusive. Specific objects causing injuries included nails, wire, screwdrivers, and other hand tools. There was evidence of alcohol use by at least 2% of the injured workers. When they were injured, 6% of the workers were wearing safety glasses; 3% were wearing nonsafety eyewear. Posterior segment trauma, which occurred in 63% of the cases, included vitreous hemorrhage (42%), intraocular foreign bodies (35%), and retinal detachment (10%). Hyphema occurred in 35% and traumatic cataract in 32% of the cases. Initial visual acuity after injury was hand motion or worse in 43% of the cases. National Eye Trauma System Registry data are useful to identify strategies to prevent occupational eye injuries such as wider use of safety glasses and improvement in engineering controls.
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OBJECTIVE: To investigate the epidemiology of eye injuries sustained by professional basketball players in the National Basketball Association (NBA). METHODS: A prospective study involving all NBA athletes who sustained eye injuries between February 1, 1992, and June 20, 1993, was conducted. Twenty-seven NBA team athletic trainers, physicians, and ophthalmologists were provided data forms to complete for any player examined for an eye injury. Practice and game exposures during the preseason, regular season, playoffs, and championships were included. RESULTS: Of the 1092 injuries sustained by NBA players during the 17-month period, 59 (5.4%) involved the eye and adnexa. Eighteen (30.5%) of the injuries occurred while the player was in the act of rebounding, and 16 (27.1%) while the player was on offense. The most common diagnoses included 30 abrasions or lacerations to the eyelid (50.9%), 17 contusions (edema and/or ecchymosis) to the eyelid or periorbital region (28.8%), and seven corneal abrasions (11.9%). There were three orbital fractures (5.1%). Most injuries were caused by fingers (35.6%) or elbows (28.8%). Nine players (15.3%) missed subsequent games because of their injury. Fifty-seven players (96.6%) were not wearing protective eyewear at the time of injury. CONCLUSIONS: The incidence of eye injuries in NBA players during the 17-month period was 1.44 per 1000 game exposures. Frequent physical contact in professional basketball players leaves them at great risk for sustaining eye injuries. To prevent these injuries, protective eyewear is recommended.
OBJECTIVE: To determine the efficacy of various eye protection measures during carbon dioxide laser laryngoscopy. DESIGN: A standard medical mannequin was equipped with indicator paper over the eyes and subjected to multiple passes of direct carbon dioxide laser beam contact at 400-mm focal length with powers ranging from 2.5 to 4.0 W during simulated laser microlaryngoscopy. Several different eye protection materials, including silk tape, paper tape, cloth tape, occlusive dressing, and eye pads, were used to cover the eyes and tested for their degree of protection against the laser beam. Thermal injuries were quantified and compared among these protective materials. SETTING: Academic medical center. MAIN OUTCOME MEASURE: Degree of eye protection against the laser beam injury on a scale of 0 to 4. RESULTS: The carbon dioxide laser beam at both 2.5 and 4.0 W produced considerable thermal damage to the indicator paper in the absence of any protective barrier. Among the adhesive protective barriers, moistened cloth tape was the most effective adhesive material against laser beam-induced thermal damage (P<.001). Silk tape and paper tape offered poor protection. Moist eye pads, although not adhesive and therefore unable to maintain eye closure, were very effective barriers against the laser beam. Dry paper tape and dry eye pads were imminently flammable. CONCLUSION: A combination of moistened cloth tape to maintain eye closure coupled with placement of well- moistened cotton-based eye pads over the tape provides excellent eye protection during carbon dioxide laser laryngoscopy.
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Respiratory syncytial virus (RSV) infections in hospitalized children were identified by indirect fluorescent antibody technique. Patients with RSV infections were assigned to one of two isolation categories. In one category, the health care workers entering the child's room did not wear masks and goggles; in the other category, the workers did wear masks and goggles. The RSV illness rate in health care workers using masks and goggles was 5%, but the rate for those not using masks and goggles was 61%. In the no mask/goggles group, the RSV illness rates in the health care workers correlated directly with the number of exposures. In this modest study, the use of masks and goggles was associated with a significant reduction of RSV illnesses in pediatric health care workers.
Eighty-two injuries secondary to the racket sports were studied during a 15-month period. Ordinary glasses provided considerable protection in the play of tennis and badminton, but not in the play of squash and racquet ball. Plastic safety lenses (USA Standard Practice for Occupational and Educational Eye ,nd Face Protection, approved Sept 18, 1968 by the USA Standards Institute [ANSI Z87.1-1968]) mounted in a sturdy frame (industrial or athletic) or an eye protector are necessary for squash and racquet ball. Contact lenses provide no ocular protection. Males suffered more serious injuries than females, but injuries were not related to the age or experience of the players. Eye protection is recommended for the racket sports.
BACKGROUND AND OBJECTIVE: A number of lasers are available for cutaneous periorbital surgery, yet not all eye shields are appropriate for all applications. We tested a variety of commercially available eye shields to assess their safety features. STUDY DESIGN/MATERIALS AND METHODS: Six commercially available eye protectors were studied. A focused laser was incident upon the shield, and the intensity and exposure duration required for visible damage to the shield were measured. We then measured the temperature on the underside of the eye shield during exposure from the laser. Time-dependent temperature measurements were made with a type-T thermocouple fixed to the eye shield with silicon grease. RESULTS: Thermal response curves and rates of warming for each of the six eye shields were generated. Plastic shields showed significant thermal damage with most of the lasers tested. The metallic shields warmed more slowly and to a lesser degree. CONCLUSION: Overall, the metallic eye shields had the most acceptable safety profile. Many of the plastic shields exhibited significant thermal damage, and therefore we discourage their use in periorbital laser surgery.
Medical health personnel have acquired serious and rarely fatal infections in the operating room from AIDS patients. Yet, there are no officially approved AIDS safety programs designed to protect medical health care personnel in the operating room. A sequential safety program is proposed beginning with the following steps: 1) evaluation and staging of the patient and associated complications; 2) protection of the major surgical and laser instruments; 3) use of an efficient evacuator system to avoid plumes of laser fragments from polluting the operating room environment; 4) protection of the operating room staff with special eye protection including helmets and shields, fluid-soak-resistant fabrics for garments, double surgical gloves, and special orderly trays with safety holders for syringes, needles, sharp instruments, and suture holders; 5) reporting and treatment of accidents, such as needlestick puncture wounds, that require immediate attention and an infectious disease consultation; 6) postoperative care, which includes providing medical health care personnel protection from bloody bandages, needles, and the infectious patient; and 7) and finally, the washing and sterilizing of contaminated instruments by medical health care personnel using face shields and masks, gloves, and protective fabrics for garments. Continued experience with this proposed safety program will determine its future value for AIDS surgical patients and for all health care workers.
Diabetic patients routinely have their pupils dilated for fundoscopy as part of the annual review. To assess the ability of diabetic patients to drive after pupillary dilatation we studied 61 diabetic patients (18 IDDM, 43 NIDDM), mean age 54.98 years, before and 1 h after pupillary dilatation with 1% tropicamide. Binocular visual acuity (BVA) and contrast sensitivity were checked without glare, with glare, and with glare and sunglasses. Glare was introduced using a 60 W bulb in all 61 patients and with a 500 W bulb in 37 of these patients. Prior to dilatation all 61 patients had a BVA of 6/9 or better. A significant reduction in BVA was found post-dilatation (p = 0.005) and 4 out of the 61 patients (6.56%) had a post-dilatation BVA of less than 6/9. The 60 W glare source caused a significant reduction in BVA pre-dilatation (p < 0.05), but not the 500 W glare. With glare, post-dilatation BVA reduced further, resulting in 6 and 7 patients having a BVA of less than 6/9 with the 60 W and 500 W glare source, respectively. The addition of sunglasses with glare did not improve the BVA. No patient with a BVA of 6/5 pre-dilatation reduced to less than 6/9 post-dilatation. No significant change in contrast sensitivity was found in any of the test conditions. We conclude that patients who meet the visual legal requirements to drive (BVA < or = 6/9) prior to dilatation may not fulfil them post-dilatation. This has important clinical implications and the time course of the phenomenon requires exploration. Meanwhile, patients need to be warned not to drive after pupillary dilatation when they attend for annual fundoscopic examination, certainly for at least two hours.
The goal of the catheterization laboratory radiation safety program is to facilitate invasive cardiology while simultaneously reducing staff risks to an acceptable level. Achieving this goal requires a balance between the value of catheterization to the patient and the associated radiation risk to the staff. This article introduces the principles of radiation protection as applied in the catheterization laboratory. Prudent conformance to these principles will appropriately reduce radiation risk. Cathet. Cardiovasc. Intervent. 47:347-353, 1999.