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Ocular Hazards of Rigid Blade Lawn Trimmers
94
AMERICAN JOURNAL OF OPHTHALMOLOGY
Ocular Hazards of Rigid Blade Lawn Trimmers Anthony J. L u b n i e w s k i , M . D . , R. Joseph Oik, M . D . , and M. Gilbert Grand, M . D . Department of Ophthalmology, Washington University School of Medicine. Inquiries to R. Joseph Oik, M.D., Suite 17413 East Pavilion, 4949 Barnes Hospital Plaza, St. Louis, MO 63110. Rigid blade lawn trimmers consist of a rigid rotating blade on the end of a long handle. The blade, made of either rigid plastic or steel, is used to cut through heavy brush. We previously described a variety of injuries associated with nylon line lawn trimmers. 1 We have encountered two cases of ocular trauma associated with rigid blade lawn trimmers, one of which occurred with the motor switched off. Casel A 60-year-old man had just finished working with his rigid blade lawn trimmer and turned the machine off. He removed the safety glasses he had been wearing. The blade, which was spinning to a stop, struck the ground and threw a piece of metal into the man's left eye. There was immediate pain and decreased vision. On initial examination, visual acuity in the left eye was reduced to counting fingers. Results of slit-lamp examination disclosed a corneal laceration with the iris incarcerated in the wound, and blood in the anterior chamber. A traumatic cataract was noted but the fundus could not be seen. Results of roentgenography studies of the orbit showed an intraocular metallic foreign body. The patient underwent repair of his corneal laceration, pars plana lensectomy, vitrectomy, and removal of the intraocular foreign body. The patient subsequently developed a dense vitreous hemorrhage and underwent repeat vitrectomy and a scierai buckling procedure. Despite surgery he developed a blind painful eye and eventually required enucleation. Case 2 A 58-year-old man was using his rigid blade lawn trimmer when he inadvertently struck a large piece of metal lying on the ground. He was wearing sunglasses, but not safety glasses, at the time of his accident. He noted irritation of his right eye along with minimal blurring of
July, 1988
vision. The next morning his symptoms had abated. Approximately one month later the patient noted blurred vision. A traumatic cataract was diagnosed. The patient underwent cataract extraction and removal of a metallic foreign body with placement of an anterior chamber intraocular lens. Visual acuity reportedly improved to 20/25. He required two sessions of laser treatment for retinal holes. Approximately one year after his original injury, the patient noted a gradual decrease in vision and was referred for retinal examination. On initial examination the patient's visual acuity was counting fingers in the right eye and 20/25 in the left eye. Results of slit-lamp examination disclosed normal eyelids, eyelashes, and conjunctiva. The cornea had a well-healed superior laceration and the anterior chamber intraocular lens was in place. Also noted in the anterior chamber were 3+ cells and flare and 2+ pigmented cells were present in the vitreous. Ophthalmoscopy showed a large inferior retinal detachment complicated by several fixed folds inferonasally and inferotemporally. There was an equatorial flap tear at the 5 o'clock meridian. He underwent a scierai buckling procedure with a lamellar dissection, pars plana vitrectomy, internal drainage of fluid, and gas-fluid exchange using 30% sulfur hexafluoride. Visual acuity improved from light perception to 20/200. The retina has remained attached and vision was stable eight months postoperatively. The hazards of a rigid blade lawn trimmer when switched on are evident. The rigid blade spins freely on the end of a long handle. Only a portion of the blade is protectively housed, allowing for the cutting of weeds and brush. Ocular and generalized trauma from projectiles, as well as severe lacerations and amputations from direct contact with the rotating blade have been documented (Brush cutters, in Seasonal Safety Alert, U.S. Consumer Products Safety Commission, 1985). The danger these machines present when switched off is not as readily apparent. The rigid blade continues to spin after the machine is turned off. The potential for injury by decelerating blades has been recognized in safety guidelines published by the government on lawn mower use (The product safety fact sheet. I. Power lawn mowers, U.S. Consumer Products Safety Commission, 1980). Because rigid blade trimmers are only partially covered in a protective housing, the decelerating blade has
Vol. 106, No. 1
Letters to the Journal
95
an even greater chance than lawn mowers of throwing a projectile or coming into contact with the user. Use of wraparound polycarbonate safety goggles is only one of the many safety measures that can help prevent the disabling ocular injuries that are possible with motorized lawn equipment.
further diagnostic evaluation. However, optic disk drusen may coexist in a patient with increased intracranial pressure. Two cases of coexistent optic disk drusen and pseudotumor cerebri have previously been described, although their concurrence was presumed to have been due to chance. 2,3 Herein we describe two additional patients with coexisting optic disk drusen and pseudotumor cerebri.
Reference
Case 1 A 34-year-old obese, black woman was referred for evaluation of headaches and frequent transient visual obscurations. The visual acuity was 20/20 in each eye and perimetry disclosed bilateral enlargement of the blind spots. Ophthalmoscopy disclosed bilateral papilledema with optic disk drusen (Figure). Fluorescein angiography showed autofluorescence of the drusen, with leakage and staining of the optic disk. A lumbar puncture showed an opening pressure of 370 mm Hg. Noncompliance with diet and intolerance to acetazolamide prompted therapy with furosemide, which was associated with a resolution of the visual obscurations and improvement of the papilledema. The optic disk drusen persisted.
1. Lubniewski, A. }., Oik, R. }., and Grand, M. G.: Ocular dangers in the garden. A new menace. Nylon line lawn trimmers. Ophthalmology 95:906, 1988.
Optic Disk Drusen and Pseudotumor Cerebri David M. Reifler, M . D . , and D a v i d I. Kaufman, D . O . Departments of Surgery (Ophthalmology) and Internal Medicine (Neuro-Ophthalmology), Michigan State University Colleges of Human and Ostéopathie Medicine. Inquiries to David M. Reifler, M.D., 1000 E. Paris Ave. S.E., Grand Rapids, Ml 49506. Optic disk drusen (hyaline bodies) are deposits of material within the substance of the nerve head that occur in anatomically susceptible disks. 1 They are a common cause of pseudopapilledema (anomalous elevation of the optic disk without increased intracranial pressure), 2 and their presence may lead to a termination of
Case 2 A 29-year-old black woman with a history of psychiatric disease and headaches had bilateral disk elevation. Perimetry disclosed enlarged blind spots bilaterally. The results of fluorescein angiography were consistent with optic disk drusen. One month later, réévaluation of worsening headaches disclosed bilateral disk edema with minimal retinal folds, venous engorgement, and loss of central cupping. Drusen were
I
Figure (Reifler and Kaufman). Case 1. Fundus photographs from a patient with bilateral papilledema and optic disk drusen.
AMERICAN JOURNAL OF OPHTHALMOLOGY
Ocular Hazards of Rigid Blade Lawn Trimmers Anthony J. L u b n i e w s k i , M . D . , R. Joseph Oik, M . D . , and M. Gilbert Grand, M . D . Department of Ophthalmology, Washington University School of Medicine. Inquiries to R. Joseph Oik, M.D., Suite 17413 East Pavilion, 4949 Barnes Hospital Plaza, St. Louis, MO 63110. Rigid blade lawn trimmers consist of a rigid rotating blade on the end of a long handle. The blade, made of either rigid plastic or steel, is used to cut through heavy brush. We previously described a variety of injuries associated with nylon line lawn trimmers. 1 We have encountered two cases of ocular trauma associated with rigid blade lawn trimmers, one of which occurred with the motor switched off. Casel A 60-year-old man had just finished working with his rigid blade lawn trimmer and turned the machine off. He removed the safety glasses he had been wearing. The blade, which was spinning to a stop, struck the ground and threw a piece of metal into the man's left eye. There was immediate pain and decreased vision. On initial examination, visual acuity in the left eye was reduced to counting fingers. Results of slit-lamp examination disclosed a corneal laceration with the iris incarcerated in the wound, and blood in the anterior chamber. A traumatic cataract was noted but the fundus could not be seen. Results of roentgenography studies of the orbit showed an intraocular metallic foreign body. The patient underwent repair of his corneal laceration, pars plana lensectomy, vitrectomy, and removal of the intraocular foreign body. The patient subsequently developed a dense vitreous hemorrhage and underwent repeat vitrectomy and a scierai buckling procedure. Despite surgery he developed a blind painful eye and eventually required enucleation. Case 2 A 58-year-old man was using his rigid blade lawn trimmer when he inadvertently struck a large piece of metal lying on the ground. He was wearing sunglasses, but not safety glasses, at the time of his accident. He noted irritation of his right eye along with minimal blurring of
July, 1988
vision. The next morning his symptoms had abated. Approximately one month later the patient noted blurred vision. A traumatic cataract was diagnosed. The patient underwent cataract extraction and removal of a metallic foreign body with placement of an anterior chamber intraocular lens. Visual acuity reportedly improved to 20/25. He required two sessions of laser treatment for retinal holes. Approximately one year after his original injury, the patient noted a gradual decrease in vision and was referred for retinal examination. On initial examination the patient's visual acuity was counting fingers in the right eye and 20/25 in the left eye. Results of slit-lamp examination disclosed normal eyelids, eyelashes, and conjunctiva. The cornea had a well-healed superior laceration and the anterior chamber intraocular lens was in place. Also noted in the anterior chamber were 3+ cells and flare and 2+ pigmented cells were present in the vitreous. Ophthalmoscopy showed a large inferior retinal detachment complicated by several fixed folds inferonasally and inferotemporally. There was an equatorial flap tear at the 5 o'clock meridian. He underwent a scierai buckling procedure with a lamellar dissection, pars plana vitrectomy, internal drainage of fluid, and gas-fluid exchange using 30% sulfur hexafluoride. Visual acuity improved from light perception to 20/200. The retina has remained attached and vision was stable eight months postoperatively. The hazards of a rigid blade lawn trimmer when switched on are evident. The rigid blade spins freely on the end of a long handle. Only a portion of the blade is protectively housed, allowing for the cutting of weeds and brush. Ocular and generalized trauma from projectiles, as well as severe lacerations and amputations from direct contact with the rotating blade have been documented (Brush cutters, in Seasonal Safety Alert, U.S. Consumer Products Safety Commission, 1985). The danger these machines present when switched off is not as readily apparent. The rigid blade continues to spin after the machine is turned off. The potential for injury by decelerating blades has been recognized in safety guidelines published by the government on lawn mower use (The product safety fact sheet. I. Power lawn mowers, U.S. Consumer Products Safety Commission, 1980). Because rigid blade trimmers are only partially covered in a protective housing, the decelerating blade has
Vol. 106, No. 1
Letters to the Journal
95
an even greater chance than lawn mowers of throwing a projectile or coming into contact with the user. Use of wraparound polycarbonate safety goggles is only one of the many safety measures that can help prevent the disabling ocular injuries that are possible with motorized lawn equipment.
further diagnostic evaluation. However, optic disk drusen may coexist in a patient with increased intracranial pressure. Two cases of coexistent optic disk drusen and pseudotumor cerebri have previously been described, although their concurrence was presumed to have been due to chance. 2,3 Herein we describe two additional patients with coexisting optic disk drusen and pseudotumor cerebri.
Reference
Case 1 A 34-year-old obese, black woman was referred for evaluation of headaches and frequent transient visual obscurations. The visual acuity was 20/20 in each eye and perimetry disclosed bilateral enlargement of the blind spots. Ophthalmoscopy disclosed bilateral papilledema with optic disk drusen (Figure). Fluorescein angiography showed autofluorescence of the drusen, with leakage and staining of the optic disk. A lumbar puncture showed an opening pressure of 370 mm Hg. Noncompliance with diet and intolerance to acetazolamide prompted therapy with furosemide, which was associated with a resolution of the visual obscurations and improvement of the papilledema. The optic disk drusen persisted.
1. Lubniewski, A. }., Oik, R. }., and Grand, M. G.: Ocular dangers in the garden. A new menace. Nylon line lawn trimmers. Ophthalmology 95:906, 1988.
Optic Disk Drusen and Pseudotumor Cerebri David M. Reifler, M . D . , and D a v i d I. Kaufman, D . O . Departments of Surgery (Ophthalmology) and Internal Medicine (Neuro-Ophthalmology), Michigan State University Colleges of Human and Ostéopathie Medicine. Inquiries to David M. Reifler, M.D., 1000 E. Paris Ave. S.E., Grand Rapids, Ml 49506. Optic disk drusen (hyaline bodies) are deposits of material within the substance of the nerve head that occur in anatomically susceptible disks. 1 They are a common cause of pseudopapilledema (anomalous elevation of the optic disk without increased intracranial pressure), 2 and their presence may lead to a termination of
Case 2 A 29-year-old black woman with a history of psychiatric disease and headaches had bilateral disk elevation. Perimetry disclosed enlarged blind spots bilaterally. The results of fluorescein angiography were consistent with optic disk drusen. One month later, réévaluation of worsening headaches disclosed bilateral disk edema with minimal retinal folds, venous engorgement, and loss of central cupping. Drusen were
I
Figure (Reifler and Kaufman). Case 1. Fundus photographs from a patient with bilateral papilledema and optic disk drusen.