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Corneal Burns from Watch Battery Explosion
798
AMERICAN JOURNAL OF OPHTHALMOLOGY
Editor: I began a series of 20 patients, taking their pressure first by applanation with out fluorescein followed by a repeat ex amination with fluorescein. There was a consistent increase of 5 mm Hg or more in the fluorescein reading. I therefore feel that performing tonometry without fluo rescein will result in an erroneously low and innacurate reading. K E N N E T H J. H O F F E R ,
Santa Monica,
M.D.
California
Reply Editor: I have found no significant difference in applanation pressures without fluores cein using a white light, or with fluores cein using a cobalt blue light, provided the mires are of almost equal thickness. Applanation pressures vary with the thickness of the mires and, therefore, with the amount of fluorescein used. The thicker the mires the higher the reading. I must assume that Dr. Hoffer is most liberal in the amount of fluorescein he uses to produce such a differential. The disadvantages of fluorescein are obvious: the cost, added time, "messiness," and the possibility of infection. Also, if too much fluorescein is used the mires may become distorted. I have performed applanation tonome try for years with white light without fluorescein and have found it extremely satisfactory. RAYMOND S M I T H ,
M.D.
Bermuda Corneal Burns From Watch Battery Explosion Editor: A number of case reports have demon strated some unexpected hazards of com mon products in widespread use, ranging
OCTOBER, 1979
from soda pop bottle to butane lighter explosions. 1 - 4 Reported here is the case of a 10-year-old girl who suffered corneal burns following the spontaneous explo sion of a silver-oxide battery in her elec tronic digital wristwatch. CASE REPORT The patient was brought to the emergency room by her mother who stated that the watch had not been struck or mishandled in any way. The explo sion was audible and sprayed a substance over the patient's face and into her eyes. Her mother immedi ately irrigated the eyes with water for five minutes. The patient subsequently complained of blurry vi sion. Physical examination disclosed visual acuity of 6/6 (20/20) in both eyes with mild conjuntival injec tion. Tear film p H was 7.2. Slit-lamp examination revealed bilateral corneal epithelial burns and clear anterior chambers. There were no signs of penetrat ing injury and results of the remainder of the oph thalmic examination were normal. On follow-up examination, the vision was still normal and the corneas were clear. The mother brought in the wristwatch, which was not damaged, the back having been apparently blown off by the force of the explosion. One piece of one of the batteries was recovered; the p H was 8.0. The other battery was intact. The batteries had been in use for approximately one year. Each battery is sold with the following warning, "Do not connect backwards, charge or dispose of in fire, it may explode or leak."
Although in this instance there was no serious injury, this may indicate an envi ronmental hazard that may be seen more frequently with the increased use of mini ature batteries. In order to determine the extent of this problem, we would appreci ate communication from physicians re garding similar cases to be sent to us at the address below: A L L E N W. Z I E K E R ,
M.D.
AND J E F F R E Y WISNICKI
Department of Ophthalmology Albany Medical Center Hospital Albany, NY 12208 REFERENCES 1. Bergeson, P., Sehring, S., and Callison, J.: Pop bottle explosions. J.A.M.A. 238:1048, 1977. 2. : Pop bottle explosions. Further infor mation. J.A.M.A. 239:2447, 1978.
VOL. 88, NO. 4
BOOK REVIEWS
3. Sousa-Lennox, I. J.: Pop bottle explosions. Further information. J.A.M.A. 239:2448, 1978. 4. Lanzara, R. G.: Severe burns from butane lighter explosions. J.A.M.A. 237:2719, 1977.
BOOK REVIEWS Perinatal Retinal Hemorrhages. By B. von Barsewisch. Berlin, SpringerVerlag, 1979. Hardcover, 184 pages, subject index, bibliography, 29 tables, 64 black and white figures. $31.90 This text developed from a monograph originally written in German as a "Habilitationsschrift" (a paper which partially fulfills the requirement for "Privatdozent" at the University of Munich). The author has based his comprehen sive evaluation on the observation of more than 400 newborn infants who were examined within the first 24 hours of life. Two hundred were delivered normally from the occipital presentation and they formed the control group to be compared with other types of delivery and to a group in which a fibrinolysis inhibitor had been applied. The number and locali zation of retinal hemorrhages were care fully noted. Extensive photographs were taken. Thirty-one children had macular hemorrhages and were reexamined at ages 6 and 7 years. The perinatal period for the newborn infant can be a particularly hazardous one. The medical care and scientific in vestigations of the infant and mother have been intensified in the past decade to the extent that "neonatal or perinatal medi cine ' is an important subspecialty. Ophthalmology can contribute to neo natal medicine in many ways but particu larly in the observation of the fundi, which may reveal a spectacular abnor mality that occurs in a high percentage of newborn infants, perinatal retinal hemor rhages. The hemorrhages can be so exten
799
sive as to cover more than half of the retina. Retinal hemorrhage in the new born was first described in 1881. Its struc ture, cause, and significance have been under discussion ever since. The pub lished material on this subject contains numerous diverse views and speculations particularly with regard to macular dam age and amblyopia. Dr. Von Barsewisch's study provides well documented material on the subject of perinatal retinal hemor rhages. The eyes of eight children who died within a few hours to three days after birth were studied histologically. It is remarkable that such a physiologic process as birth should be related to the frequent occurrence of retinal hemor rhages which are present during such a short period of postnatal life. The de tailed analysis of this phenomenon makes this a valuable monograph. The illustra tions are numerous and of high quality. Extensive references are included. R O B I N S O N D. H A R L E Y
Vitrectomy, 2nd ed. By Robert Machemer and Thomas M. Aaberg. New York, Grune and Stratton, Inc., 1979. Hardcover, 262 pages, table of contents, index, appendix, 3 tables, 139 black and white figures. $23.50 In 1975, Dr. Machemer first summa rized his concepts and experience with vitrectomy. It is a tribute to the first edition that so much of it remains rele vant today, and indeed is retained in this current edition. However, vitrectomy is a rapidly changing field and a second edi tion is appropriate, as indicated by the inclusion of Dr. Aaberg's perspective. The first edition was partly an introduc tion of the vitreous infusion suction cut ter (VISC), a full-function probe that provided cutting, suction, and infusion. One of the major developments in vit rectomy in the last five years has been the
AMERICAN JOURNAL OF OPHTHALMOLOGY
Editor: I began a series of 20 patients, taking their pressure first by applanation with out fluorescein followed by a repeat ex amination with fluorescein. There was a consistent increase of 5 mm Hg or more in the fluorescein reading. I therefore feel that performing tonometry without fluo rescein will result in an erroneously low and innacurate reading. K E N N E T H J. H O F F E R ,
Santa Monica,
M.D.
California
Reply Editor: I have found no significant difference in applanation pressures without fluores cein using a white light, or with fluores cein using a cobalt blue light, provided the mires are of almost equal thickness. Applanation pressures vary with the thickness of the mires and, therefore, with the amount of fluorescein used. The thicker the mires the higher the reading. I must assume that Dr. Hoffer is most liberal in the amount of fluorescein he uses to produce such a differential. The disadvantages of fluorescein are obvious: the cost, added time, "messiness," and the possibility of infection. Also, if too much fluorescein is used the mires may become distorted. I have performed applanation tonome try for years with white light without fluorescein and have found it extremely satisfactory. RAYMOND S M I T H ,
M.D.
Bermuda Corneal Burns From Watch Battery Explosion Editor: A number of case reports have demon strated some unexpected hazards of com mon products in widespread use, ranging
OCTOBER, 1979
from soda pop bottle to butane lighter explosions. 1 - 4 Reported here is the case of a 10-year-old girl who suffered corneal burns following the spontaneous explo sion of a silver-oxide battery in her elec tronic digital wristwatch. CASE REPORT The patient was brought to the emergency room by her mother who stated that the watch had not been struck or mishandled in any way. The explo sion was audible and sprayed a substance over the patient's face and into her eyes. Her mother immedi ately irrigated the eyes with water for five minutes. The patient subsequently complained of blurry vi sion. Physical examination disclosed visual acuity of 6/6 (20/20) in both eyes with mild conjuntival injec tion. Tear film p H was 7.2. Slit-lamp examination revealed bilateral corneal epithelial burns and clear anterior chambers. There were no signs of penetrat ing injury and results of the remainder of the oph thalmic examination were normal. On follow-up examination, the vision was still normal and the corneas were clear. The mother brought in the wristwatch, which was not damaged, the back having been apparently blown off by the force of the explosion. One piece of one of the batteries was recovered; the p H was 8.0. The other battery was intact. The batteries had been in use for approximately one year. Each battery is sold with the following warning, "Do not connect backwards, charge or dispose of in fire, it may explode or leak."
Although in this instance there was no serious injury, this may indicate an envi ronmental hazard that may be seen more frequently with the increased use of mini ature batteries. In order to determine the extent of this problem, we would appreci ate communication from physicians re garding similar cases to be sent to us at the address below: A L L E N W. Z I E K E R ,
M.D.
AND J E F F R E Y WISNICKI
Department of Ophthalmology Albany Medical Center Hospital Albany, NY 12208 REFERENCES 1. Bergeson, P., Sehring, S., and Callison, J.: Pop bottle explosions. J.A.M.A. 238:1048, 1977. 2. : Pop bottle explosions. Further infor mation. J.A.M.A. 239:2447, 1978.
VOL. 88, NO. 4
BOOK REVIEWS
3. Sousa-Lennox, I. J.: Pop bottle explosions. Further information. J.A.M.A. 239:2448, 1978. 4. Lanzara, R. G.: Severe burns from butane lighter explosions. J.A.M.A. 237:2719, 1977.
BOOK REVIEWS Perinatal Retinal Hemorrhages. By B. von Barsewisch. Berlin, SpringerVerlag, 1979. Hardcover, 184 pages, subject index, bibliography, 29 tables, 64 black and white figures. $31.90 This text developed from a monograph originally written in German as a "Habilitationsschrift" (a paper which partially fulfills the requirement for "Privatdozent" at the University of Munich). The author has based his comprehen sive evaluation on the observation of more than 400 newborn infants who were examined within the first 24 hours of life. Two hundred were delivered normally from the occipital presentation and they formed the control group to be compared with other types of delivery and to a group in which a fibrinolysis inhibitor had been applied. The number and locali zation of retinal hemorrhages were care fully noted. Extensive photographs were taken. Thirty-one children had macular hemorrhages and were reexamined at ages 6 and 7 years. The perinatal period for the newborn infant can be a particularly hazardous one. The medical care and scientific in vestigations of the infant and mother have been intensified in the past decade to the extent that "neonatal or perinatal medi cine ' is an important subspecialty. Ophthalmology can contribute to neo natal medicine in many ways but particu larly in the observation of the fundi, which may reveal a spectacular abnor mality that occurs in a high percentage of newborn infants, perinatal retinal hemor rhages. The hemorrhages can be so exten
799
sive as to cover more than half of the retina. Retinal hemorrhage in the new born was first described in 1881. Its struc ture, cause, and significance have been under discussion ever since. The pub lished material on this subject contains numerous diverse views and speculations particularly with regard to macular dam age and amblyopia. Dr. Von Barsewisch's study provides well documented material on the subject of perinatal retinal hemor rhages. The eyes of eight children who died within a few hours to three days after birth were studied histologically. It is remarkable that such a physiologic process as birth should be related to the frequent occurrence of retinal hemor rhages which are present during such a short period of postnatal life. The de tailed analysis of this phenomenon makes this a valuable monograph. The illustra tions are numerous and of high quality. Extensive references are included. R O B I N S O N D. H A R L E Y
Vitrectomy, 2nd ed. By Robert Machemer and Thomas M. Aaberg. New York, Grune and Stratton, Inc., 1979. Hardcover, 262 pages, table of contents, index, appendix, 3 tables, 139 black and white figures. $23.50 In 1975, Dr. Machemer first summa rized his concepts and experience with vitrectomy. It is a tribute to the first edition that so much of it remains rele vant today, and indeed is retained in this current edition. However, vitrectomy is a rapidly changing field and a second edi tion is appropriate, as indicated by the inclusion of Dr. Aaberg's perspective. The first edition was partly an introduc tion of the vitreous infusion suction cut ter (VISC), a full-function probe that provided cutting, suction, and infusion. One of the major developments in vit rectomy in the last five years has been the