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Missed ocular perforations after road traffic accidents
Injury, 4, 79-80
79
Missed ocular perforations after road traffic accidents K. G. Soni and P. Eustace Senior Ophthalmic Registrars, The Birmingham and Midland Eye Hospital, Church Street, Birmingham Six cases of missed ocular perforation after road traffic accidents are presented. The clinical features of ocular perforations are reviewed.
INTRODUCTION THE incidence of facial lacerations in road accidents is considerable and in a high proportion of cases the eyelids are also involved. If lid lacerations are present, ocular perforation should be suspected. In a series of 64 road traffic accidents seen at the Birmingham and Midland Eye Hospital during the period January, 1966 to April, 1971, in which eye injuries occurred, 6 cases were seen in whom, after initial treatment of their facial and other injuries, a delay had occurred in the diagnosis of an ocular perforating injury.
at the Birmingham and Midland Eye Hospital (Soni, 1971). In 6 patients who had already received treatment for their facial injuries, ocular perforating injuries were missed, the delay in diagnosis varying from 2 days to 8 months. These patients were all seen subsequently because of visual complaints and the outcome in visual terms was serious. Three eyes kept only intermediate vision, 1 could be considered as blind, and 2 eyes were enucleated. Although the prognosis in cases of ocular perforation is poor, it is worse if there is any delay in treatment (RoperHall, 1969). Thus there seems little doubt that earlier diagnosis would have helped at least some of these cases. When there are lid lacerations present, there is often considerable chemosis. If, in addition,
Table/.--Details of 6 cases of ocular perforation Age
Sex
19 20 18 32 18 24
M. M. M. M. F. F.
Date of accident
2Dec.,1966 6 Nov., 1967 25 July, 1968 26 Dec.,1969 30 Jan., 1970 27 May, 1970
Date seen at B.M.E.H.
9 14 9 11 3 6
Dec.,1966 Aug., 1968 Aug., 1968 Feb.,1970 Feb., 1970 June, 1970
Visual outcome of injured eye
6/18 Eye enucleated 6/12 1/60 Eye enucleated 6/24
METHOD These patients were seen during the course of a retrospective study of road traffic accidents seen at the Birmingham and Midland Eye Hospital between January, 1966 and April, 1971. The salient details of these patients are set out in Table L In all instances they had a corneoscleral perforation.
DISCUSSION Between January, 1966 and April, 1971, 64 road traffic accidents with eye injuries were treated
the patient is shocked or unconscious it is then even more difficult to assess the extent of any damage. Local anaesthetic drops such as benoxinate hydrochioride (Novesine) instilled into the conjunctival sac reduce blepharospasm and this will often allow the examiner a satisfactory view of the globe. If it is still difficult to see the eye the lids should be gently prised open with retractors but great care is necessary when examining the eye in this fashion to avoid further damage from pressure on a perforated eye. Very rarely a
80
satisfactory examination is only possible under a general anaesthetic. The signs and symptoms to be looked for are : - a. Lid lacerations. b. Reduction of visual acuity. c. Subconjunctival haemorrhage or hyphaema. d. Deformity of the pupil. e. Haziness of the ocular media f. Reduction of intra-ocular pressure, which can be detected by gentle digital pressure comparing the uninjured eye with the injured eye. It is advisable in the presence of any of these signs or symptoms to seek an ophthalmic opinion.
Injury: the British Journal of Accident Surgery Vol. 4/No. 1 Acknowledgements
We would like to thank the consultants of the Birmingham and Midland Eye Hospital for permission to report their cases and in particular Mr. P. Jameson Evans for his helpful criticism.
REFERENCES
ROPER-HALL,M. J. (1969), ' A retrospective study of eye injuries ', Ophthahnologica, 158, 12. SONI, K. G. (1971), 'Eye injuries in road traffic accidents ', Proc. R. Soc. Med., 64, 940.
Requests for reprints should be addressed to:--K. G. Soni,Esq., M.B., F.R.C.S.,D.O., King'sLynnGeneralHospital,King'sLynn.
79
Missed ocular perforations after road traffic accidents K. G. Soni and P. Eustace Senior Ophthalmic Registrars, The Birmingham and Midland Eye Hospital, Church Street, Birmingham Six cases of missed ocular perforation after road traffic accidents are presented. The clinical features of ocular perforations are reviewed.
INTRODUCTION THE incidence of facial lacerations in road accidents is considerable and in a high proportion of cases the eyelids are also involved. If lid lacerations are present, ocular perforation should be suspected. In a series of 64 road traffic accidents seen at the Birmingham and Midland Eye Hospital during the period January, 1966 to April, 1971, in which eye injuries occurred, 6 cases were seen in whom, after initial treatment of their facial and other injuries, a delay had occurred in the diagnosis of an ocular perforating injury.
at the Birmingham and Midland Eye Hospital (Soni, 1971). In 6 patients who had already received treatment for their facial injuries, ocular perforating injuries were missed, the delay in diagnosis varying from 2 days to 8 months. These patients were all seen subsequently because of visual complaints and the outcome in visual terms was serious. Three eyes kept only intermediate vision, 1 could be considered as blind, and 2 eyes were enucleated. Although the prognosis in cases of ocular perforation is poor, it is worse if there is any delay in treatment (RoperHall, 1969). Thus there seems little doubt that earlier diagnosis would have helped at least some of these cases. When there are lid lacerations present, there is often considerable chemosis. If, in addition,
Table/.--Details of 6 cases of ocular perforation Age
Sex
19 20 18 32 18 24
M. M. M. M. F. F.
Date of accident
2Dec.,1966 6 Nov., 1967 25 July, 1968 26 Dec.,1969 30 Jan., 1970 27 May, 1970
Date seen at B.M.E.H.
9 14 9 11 3 6
Dec.,1966 Aug., 1968 Aug., 1968 Feb.,1970 Feb., 1970 June, 1970
Visual outcome of injured eye
6/18 Eye enucleated 6/12 1/60 Eye enucleated 6/24
METHOD These patients were seen during the course of a retrospective study of road traffic accidents seen at the Birmingham and Midland Eye Hospital between January, 1966 and April, 1971. The salient details of these patients are set out in Table L In all instances they had a corneoscleral perforation.
DISCUSSION Between January, 1966 and April, 1971, 64 road traffic accidents with eye injuries were treated
the patient is shocked or unconscious it is then even more difficult to assess the extent of any damage. Local anaesthetic drops such as benoxinate hydrochioride (Novesine) instilled into the conjunctival sac reduce blepharospasm and this will often allow the examiner a satisfactory view of the globe. If it is still difficult to see the eye the lids should be gently prised open with retractors but great care is necessary when examining the eye in this fashion to avoid further damage from pressure on a perforated eye. Very rarely a
80
satisfactory examination is only possible under a general anaesthetic. The signs and symptoms to be looked for are : - a. Lid lacerations. b. Reduction of visual acuity. c. Subconjunctival haemorrhage or hyphaema. d. Deformity of the pupil. e. Haziness of the ocular media f. Reduction of intra-ocular pressure, which can be detected by gentle digital pressure comparing the uninjured eye with the injured eye. It is advisable in the presence of any of these signs or symptoms to seek an ophthalmic opinion.
Injury: the British Journal of Accident Surgery Vol. 4/No. 1 Acknowledgements
We would like to thank the consultants of the Birmingham and Midland Eye Hospital for permission to report their cases and in particular Mr. P. Jameson Evans for his helpful criticism.
REFERENCES
ROPER-HALL,M. J. (1969), ' A retrospective study of eye injuries ', Ophthahnologica, 158, 12. SONI, K. G. (1971), 'Eye injuries in road traffic accidents ', Proc. R. Soc. Med., 64, 940.
Requests for reprints should be addressed to:--K. G. Soni,Esq., M.B., F.R.C.S.,D.O., King'sLynnGeneralHospital,King'sLynn.