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The incidence of eye injuries in New England adults.

A population-based study examined the incidence of eye injuries among New England adults and its association with demographic characteristics and risk-taking behaviors. In 3253 random digit-dialed telephone interviews, 26 adults reported 27 eye injuries during the preceding year, yielding a rate of 9.75 eye injuries per 1000 New England adults. Fifty-nine percent of eye injuries occurred at work. Men had a risk of eye injuries 5.5 times that of women and there was a steep linear decline in eye injury rates with advancing age. Individuals who had other, noneye injuries during the preceding year and individuals who had recently driven after drinking, used marijuana, received a ticket for a moving violation, or not worn seat belts had higher rates of eye injury, but these elevated rates were not statistically significant. Educational and preventive efforts to avoid eye injuries should be directed toward young males in high-risk occupations.

Adolescent↗

Eye injuries associated with anesthesia. A closed claims analysis.

Claims against anesthesiologists for eye injuries were analyzed as part of the ASA Closed Claims Project. Eye injury occurred in 3% of all claims in the database (71 of 2,046). The payment frequency for eye injury claims was higher than that for non-eye injury claims (70% vs. 56%; P less than or equal to 0.05). The median cost of eye injury claims was less than that for other claims ($24,000 vs. $95,000; P less than or equal to 0.01). Two distinct subsets were identified. The first was characterized by corneal abrasion during general anesthesia (25 of 71 claims; 35%). Claims for corneal abrasion were characterized by low incidence of permanent injury (16%) and low median payment ($3,000). Reviewers were able to identify a mechanism of injury in only 20% of claims for corneal abrasion. The second subset of eye injury was characterized by patient movement during ophthalmologic surgery (21 of 71; 30%). Blindness was the outcome in all cases. Sixteen of the claims involving movement occurred during general anesthesia, and 5 occurred during monitored anesthesia care. The median payment for claim involving movement was 10 times greater than for non-movement claims ($90,000 vs. $9,000; P less than or equal to 0.01). Anesthesiologist reviewers deemed the care rendered in the general anesthesia "movement" claims as meeting standards in only 19% of claims. From the perspective of patient safety, as well as risk management, these data suggest two specific needs: research directed at better understanding of the etiology of corneal abrasion and clinical strategies designed to assure patient immobility during ophthalmic surgery.

Adult↗

Penetrating eye injuries.

A review of all penetrating eye injuries treated at the Manchester Royal Eye Hospital over four years (1 January 1982-31 December 1985) was undertaken. A total of 202 penetrating eye injuries were seen of which 68 (34%) were in children under the age of 15 years. Airgun, dart, and knife injuries accounted for 28 (41%) of the injuries. Thirty seven patients (54%) achieved a good visual result (6/12 or better) and eight (12%) had enucleations. The period of inpatient treatment ranged from two to 18 days. From the analysis of the activities at the time of the injury, many of the injuries can be considered to be preventable.

Adolescent↗

Eye injuries in Victoria, Australia.

OBJECTIVE: To outline the spectrum of eye injuries in the Victorian population. DESIGN AND SETTING: Prospective survey of all eye injuries treated at the Royal Victorian Eye and Ear Hospital; and a review of morbidity data from all Victorian hospitals to estimate the incidence of ocular trauma across the State. RESULTS: During a 12-month period, 6308 patients were treated at the hospital. Most had superficial injuries, but 401 (6%) were admitted for severe trauma. Most were male and young; children aged under 15 years comprised 25% of hospitalisations (severe injuries). The workplace accounted for 44% of all injuries and 19% of severe trauma, including ruptured globes and internal bleeding. Sports injuries accounted for 5% of all injuries, but 19% of severe injuries. The incidence estimate for penetrating eye injuries was 3.6 per 100,000 population. The incidence of eye injuries requiring hospitalisation was 15.2 per 100,000. Annual medical costs were estimated conservatively at $15.8 million a year for this hospital alone and projected at $39 million a year for 29,000 eye injuries in Victoria and $155 million a year for 116,000 cases nationwide. CONCLUSIONS: Most ocular trauma occurs in young people and could be prevented by proper use of safety eyewear.

Adolescent↗

Gun-related eye injury in the United States, 1993-2002.

OBJECTIVE: To present the descriptive epidemiology of gun-related eye injury in the United States from 1993 through 2002. METHODS: Data from the National Electronic Injury Surveillance System was used to estimate the number of patients treated in the United States for gun-related eye injury (GEI) (air guns and firearms), air gun-related eye injury (AEI) (BB/pellet guns and rifles) and firearm-related eye injury (FEI) (all powder discharge guns) during the time period 1993 through 2002. Rates were calculated according to age, gender, race, weapon type and circumstances surrounding the injury event (e.g., locale and intent). RESULTS: The rate of gun-related eye injury in the United States declined to 7.5 per 1,000,000 in 2002 from 14.8 per 1,000,000 in 1993, representing a decline of approximately 5.4% per year (p = 0.0002), due primarily to a decline in the rate of FEI (6.7% per year, p = 0.029). The rate of AEI was relatively constant. GEI rates were highest among those aged 10-19 years, males, and Blacks. The overall rate of AEI was higher than the rate of FEI (6.0 per 1,000,000 and 5.1 per 1,000,000, respectively). According to race, the rate of FEI was higher than the rate of AEI in Blacks whereas the rate of AEI was higher than the rate of FEI in Whites and Hispanics. The majority of GEIs occurred at home and were unintentional. CONCLUSION: The rate of gun-related eye injury in the United States declined from 1993 through 2002 primarily due to a reduction in firearm-related eye injury, whereas the rate of air gun-related eye injury remained constant. Persons who were young, Black, and male were at highest risk for gun-related eye injury.

Adolescent↗

Trends in eye injury in the United States, 1992-2001.

PURPOSE: To report the trends of eye injury in the United States from 1992 through 2001. METHODS: The National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey were used to collect information on eye injuries from 1992 to 2001. Rates of eye injury per 1000 population were calculated according to age, gender, and race. RESULTS: From 1992 through 2001, the overall estimated rate of eye injury ranged from 8.2 to 13.0 per 1000 population. During this period the incidence of eye injury significantly declined overall, in persons aged 39 years and younger, in both genders, and in the black and white populations (all P <0.05). CONCLUSIONS: From 1992 through 2002, the incidence of eye injury in the United States declined overall, in persons aged 39 and younger, in both genders, and in both racial groups. Certain segments of the population, however, continued to be at high risk (i.e., males and persons aged 39 and younger) of eye injury and represent those groups toward whom prevention resources should be directed.

Adolescent↗

The nature, incidence, and impact of eye injuries among US military personnel: implications for prevention.

OBJECTIVES: To assess incidence rates of eye injuries in the US Armed Forces and to identify demographic and occupational correlates of risk. DESIGN: Retrospective population-based study. SETTING: US military medical facilities worldwide. PARTICIPANTS: All individuals in the US Armed Forces during 1998. MAIN OUTCOME MEASURES: Incidence rates of hospitalizations and ambulatory visits for eye injuries. RESULTS: The incidence rate of ambulatory visits (983 per 100 000 person-years) for eye injuries was 58 times higher than the incidence rate of hospitalizations (17 per 100 000 person-years) for eye injuries. Orbital floor fractures, contusions, and open wounds to the ocular adnexa and orbit accounted for 85% of eye injuries resulting in hospitalization, while 80% of ambulatory visits were for superficial wounds and foreign bodies. Hospitalization rates varied widely across demographic subgroups. Men had twice the incidence rate as women, and the youngest age group (17-24 years) had 6 times the incidence rate of the oldest age group (35-65 years). Together, motor vehicle crashes and fights caused nearly half of the hospitalizations. Ambulatory rates varied significantly in relation to occupation but not to demography. Tradespeople (eg, metal body machinist, welder, and metalworker) had incidence rates 3 to 4 times higher than the overall population rate. CONCLUSIONS: Hospitalization and ambulatory data provide different views of the morbidity associated with eye injuries. General safety precautions and behavior modification, rather than eye-specific interventions, are indicated to prevent the most serious eye injuries. However, the consistent use of eye protection during known hazardous occupational activities could prevent much of the morbidity associated with the less serious, yet more common, eye injuries.

Accidents, Occupational↗

[Perforating eye injuries caused by darts].

Four perforating eye injuries sustained by children playing with darts are analyzed. The injuries occurred within a period of 17 months. All the patients had minor injuries of the anterior segment and severe injuries in the posterior segment, such as vitreous hemorrhages and double perforations. Precautions should be taken to prevent such injuries: games involving darts are not suitable for children.

Adolescent↗

Predictors of blinding or serious eye injury in blunt trauma.

Multivariate analysis was used to identify factors predicting injury and visual outcome in 94 blunt trauma patients evaluated for eye injuries among 6700 admissions to a level I trauma center over a 29-month period. Patients with penetrating eye injuries were excluded from this review. Eye injury was detected in 93% or 87 of the patients evaluated. Seven percent of eye injuries resulted in blindness, 22% were serious (visual acuity between 20/40 and 20/200 or eye injury requiring surgery), and 71% were temporary (final visual acuity of 20/40 or better). The presence of an afferent pupillary defect or a nonreactive pupil was the most important factor in predicting the severity of eye injury (p = 0.0023), followed by facial fractures (p = 0.0084), and no eye opening or eye opening to pain within the Glasgow Coma Scale (p = 0.02). Eye injury is an infrequent complication of blunt trauma. Appropriate consultation for evaluation of this problem can be obtained based on findings from the initial history and screening physical examination.

Adolescent↗

[Incidence of sports-related eye injuries].

The incidence of sports-related eye injuries was analyzed retrospectively for 1991-1993. It was fairly steady at about 2% of all eye casualties annually. 21% of those with sports-related eye injuries required hospitalization. The commonest pathological findings were corneal erosion (32%), eye lid injuries (27%), hyphema (19%) and macular edema (3%). Most eyes were injured during soccer (37%) and basketball (27%) games, the most popular sports in Israel.

Athletic Injuries↗

Eye injuries after nonocular surgery. A study of 60,965 anesthetics from 1988 to 1992.

BACKGROUND: Eye injuries after anesthesia, although infrequent, may result in visual impairment. Previous studies have not defined the risk factors associated with these injuries. To study the cause of these injuries and to determine incidence data, the authors reviewed the records from a 4.5-y period of patients who sustained eye injuries after anesthesia and nonocular surgery. METHODS: The records were surveyed of 60,965 patients who underwent anesthesia for nonocular surgery at our institution from January 1988 to July 1992. Eye injuries were identified by examining several sources of information, including quality improvement data, postoperative visits or telephone calls, and examination of medical records of postoperative patients who required an ophthalmology consultation. Records were reviewed to determine the types and causes of eye injuries. Logistic regression, with univariate and multivariate analysis, was used to identify the importance of possible risk factors. RESULTS: Of 34 patients who sustained eye injuries (0.056%), the most common was corneal abrasion (n = 21). Other injuries were conjunctivitis, blurred vision, red eye, chemical injury, direct trauma, and blindness. Independent factors associated with a higher relative risk of eye injury were long surgical procedures (odds ratio, 1.16 per hour of anesthetic care; CI, 1.1 to 1.3), lateral positioning during surgery (odds ratio, 4.7; CI, 2 to 11), operation on the head or neck (odds ratio, 4.4; CI, 2.2 to 9.0), general anesthesia (odds ratio, 3.0; CI, 2.2 to 38), and surgery on a Monday (odds ratio, 2.7; CI, 1.4 to 5.3). In only 21% of cases was a specific cause of injury identified. CONCLUSIONS: For reasons not understood, eye injuries are more common in patients who are older or who undergo lengthier procedures. The cause of injury was usually not determined by the authors' methods. Until the mechanisms producing perioperative eye injuries are better understood, it is difficult to identify strategies to prevent this type of injury.

Adult↗

Serious fireworks-related eye injuries.

OBJECTIVE: To analyze and compare epidemiological and clinical information on serious fireworks-related eye injuries from two affiliates of the United States Eye Injury Registry. METHOD: Retrospective review. RESULTS: In the Eye Injury Registry of Alabama (EIRA) database, 185 of the 4150 injuries (4.4%) were caused by fireworks. In the Hungarian Eye Injury Registry database, only two of the 1245 cases (0.1%, p=0.000001) were fireworks-related. In the EIRA, 79% of patients were males and 87% were under 31 years. A bystander was injured in 67% of the cases, being an average of 23 feet away; 39% of bystanders had a final vision < or =19/200. No injured person wore eye protection. Bottle rockets caused 80% of the 185 injuries. Overall, 20% of eyes had <5/200 final visual acuity. Twenty-five percent of bottle rocket-injured eyes, compared to 64% of those injured by other devices, had > or =20/40 final vision (p=0. 000004). CONCLUSIONS. The rate of fireworks-related serious eye injuries has not decreased in Alabama in the last 16 years; most patients are young males. Since bystanders are at a measurable risk even at a distance of 100 feet, wearing eye protection is recommended to both bystanders and operators. Bottle rockets cause most of the injuries and the more severe ones, and should be the prime target for prevention. The benefit of a strict and enforced legislative ban on private fireworks displays is demonstrated by the much lower incidence figure in Hungary. Such a ban should be considered in other countries where fireworks-related eye injuries are common.

Adolescent↗

Perforating eye injuries in a western part of Sweden.

We performed a prospective study of all perforating eye injuries in a western part of Sweden during 1989-1991. We registered 140 cases (141 eyes) in a population of 1.4 million. Annual incidence was 3.3 per 100,000 inhabitants. Follow-up time was 6 months or more in 91 (64%) of the cases. Perforating eye injuries were 5.6 times more common in men than in women. Occupational injuries accounted for 37% of perforating eye injuries. Twenty-nine per cent of perforating eye injuries were injuries that occurred during domestic and leisure time. In addition to metal fragments, a whole nail was a common perforating object in these groups. Playing activity accounted for 11% of the perforating eye injuries, traffic accidents for 3% and assault for 9%. In a group of elderly patients (9%) perforating eye injuries were caused by falls. Visual acuity was 0.5 or better in 57 (63%) of the eyes with a follow-up period of at least 6 months. Only 2 of the 141 eyes were enucleated.

Adolescent↗

Baseball hardness as a risk factor for eye injuries.

BACKGROUND: Baseball is the leading cause of sports-related eye injuries in young persons. It is known that softer baseballs reduce the potential for brain and cardiac injury, but it has been speculated that softer baseballs may increase eye injuries by intruding more into the orbit. It also has been claimed that softer baseballs would change the "feel" of the game. OBJECTIVES: To determine the orbital intrusion and eye injury potential of baseballs of varying hardness, and whether a player can feel the difference between these different baseballs. MAIN OUTCOME MEASURES: Orbital force and penetration of baseballs of various hardness into an artificial orbit. Ability of subjects of varying age and baseball experience to determine the hardness of baseballs. RESULTS: The peak orbital force and force onset rate from softer baseballs, at all impact velocities, were less than the force and force onset rate from baseballs that had hardness equal to, or greater than, major league baseballs. The softest (10% of major league hardness) baseballs intruded into the orbit significantly more than balls that were 15% of major league hardness or harder. Children younger than 14 years could not differentiate balls 15% of major league hardness or harder, and adults could not differentiate 20% of major league hardness or harder from each other or from major league balls. CONCLUSION: The potential for injury to the unprotected eye from soft baseballs is significant, but not greater than that from a major league baseball. Baseballs that are 15% to 20% of major league ball hardness are recommended for youth baseball because these balls feel like major league balls, reduce the potential for brain injury and commotio cordis, cause less pain on impact, and do not increase the potential for eye injury to the unprotected player. Eye injuries in youth baseball could be minimized by the use of protective eyewear that conforms to the standard specifications of the American Society of Testing and Materials (Philadelphia, Pa), standards F910 (for batters and baserunners) and F803 (for fielders).

Adolescent↗

Eye injuries in women's lacrosse players.

OBJECTIVE: To determine the prevalence of eye injuries among intercollegiate women's lacrosse players as well as the level of play, specific play settings, and particular mechanisms associated with these injuries. DESIGN: Anonymous, retrospective, survey. SETTING: Intercollegiate lacrosse tournament. PARTICIPANTS: Collegiate and postcollegiate women's lacrosse players. MAIN OUTCOME MEASURES: Self-reports of eye injuries, injury circumstances, treatment received, playing time missed, and continuing problems were recorded. RESULTS: Surveys were collected from 667 players from 34 teams (83% of players listed on rosters). A total of 125 injuries were reported among 84 players (12.6%). Injuries occurred equally in high school and college. Athletes were injured most frequently in games (41 injuries) and practices (38 injuries), with 17 players injured during the off-season. Several mechanisms of injury were noted. Fifty-three women sustained injuries requiring medical attention. Of those athletes injured, 23 missed 1-5 days and 9 players missed more than 5 days. Four athletes (4.8%) reported residual problems from an eye injury sustained while playing lacrosse. CONCLUSIONS: Eye injuries are occurring more frequently than current surveillance data suggest. Because injuries are seen at all levels of play, in many different situations, and by multiple mechanisms, mandatory eyewear is needed to prevent serious eye injuries in women's lacrosse.

Adult↗

Eye injuries associated with 'war games'.

Eye injuries sustained by 4 patients who took part in 'war games' (in which young men shoot at each other with pistols powered by compressed carbon dioxide and firing latex rubber bullets filled with non-toxic paint) are described. In 3 cases the injuries were severe, including traumatic cataract, and 1 of these patients has a permanent macula scar with vision reduced to 6/36. Although eye protection is recommended, it was found that in the 'battle situation' combatants did not always follow regulations. Attention is drawn to the seriousness of disregarding the need for correct protective glasses.

Adolescent↗

[Prognosis of corneal transplantation after penetrating eye injury].

BACKGROUND: The success of penetrating keratoplasty (PKP) after penetrating eye injuries is often worse than in keratoplasty with Fuchs' endothelial dystrophy. However, comparable investigations are rare. Therefore, we have retrospectively analyzed the results and complication rates of PKPs in patients who experienced penetrating eye injuries. PATIENTS AND METHODS: Between 1990 and 1997 forty-four patients who received a corneal transplant at Kiel University Eye Hospital after penetrating eye injury (study group S) were analyzed. 29 patients were re-examined (visual acuity testing, slit lamp microscopy, applanation tonometry, stereo testing, corneal TMS topography, keratometry, endothelial microscopy, perimetry, indirect retinoscopy, testing of the retinal visual acuity and probatory contact lens fitting). Postoperative follow-up ranged between 1 and 6 years (median 3 years). The results were compared to a group of corneal grafts performed in patients with Fuchs' endothelial dystrophy (K, n = 18 patients, 25 eyes, median follow-up 2.8 years). RESULTS: 38males and 6 women had had a bilateral visual acuity of 0.8 or better before the accident, except for three cases. At the time of eye injury the patients' age ranged from 4 to 76 years. The eye trauma was caused by splinters of metal (45 %), glass (20 %), wood (16 %) or stone (11 %). In 73 % of the cases the injury was confined to the anterior segment of the eye (S1). The posterior part of the eye was involved in 27 % (S2). BCVA of S before keratoplasty (KP) was 1/15 on average (K 0.2), at least one year after KP 0.25 (K 0.4); post KP S1 was better than S2 (p = 0.0234), and K better than S (p = 0.0009). In group S 29 patients received a graft at random because of a central corneal scar, 14 patients received an HLA-typed graft with 2.3 mismatches on average. 93 % of the grafts (41 patients) were clear at the last examination, 8 patients showed rejection episodes, half of them were reversible. 5 patients received a second graft because of an irreversible rejection or endothelial decompensation. BCVA improved by at least one line in 84 % in S (K 92 %). BCVA was unchanged after KP in 6.8 % (K 8 %). In 9.1 % of S BCVA after KP was worse (K 0 %). 32 out of 44 patients had a BCVA of 0.1 or better after the last check-up, 13 out of 44 patients presented with a BCVA of 0.5 or better (K40 %). 15 out of 29 patients separately tested showed stereopsis compared to 8 preoperatively in S. In 48 % of the patients studied stereovision could not be restored. 82 % of the patients suffered from topographical irregular astigmatism in S, the superficial geometry of recipient's cornea seems relevant for astigmatism of the graft. Frequent postsurgical complications consisted of secondary glaucoma (S 27 %, K 4 %), immunological rejections (S 18 %, K 0 %), and amblyopia (S 14 %, K 0 %). CONCLUSION: Compared to patients with Fuchs' dystrophy the results of grafting after eye injuries are significantly worse. This relates to BCVA, astigmatism, frequency of secondary glaucoma and graft rejection.

Adolescent↗

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.

Accident Prevention↗