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Ocular Injuries Caused by Misuse of an Immersion Heater
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AMERICAN JOURNAL OF OPHTHALMOLOGY
July, 1992
treatment resulted in gradual decrease in the size of the cyst. The patient's visual acuity improved to 20/80 in the right eye. Despite warnings concerning the proper preparation of food in microwave ovens, ocular injuries unfortunately continue to occur. Such injuries usually involve foods with nonporous skin, membranes (including the yolk of an egg), or shells that expand with increased tempera ture and pressure. When the pressure is re leased suddenly, an explosion may occur. Our case is unusual in that the ocular injury was severe and resulted in a permanent loss of vision. Hence, when examining such patients physicians must carefully rule out more exten sive ocular injuries that may have occurred.
References 1. DeRespinis, P. A., and Frohman, L. P.: Micro wave popcorn may pose danger to the eyes. N. Engl. J. Med. 323:1212, 1990. 2. Routhier, P., Matlin, A. H., and Ishman, R. E.: Eye injury from microwave popcorn. N. Engl. J. Med. 315:1359, 1986. 3. Singh, J., Shah, P., and Sutton, G. A.: Exploding eggs. N. Engl. J. Med. 325:1749, 1991. Figure (Mansour and Razzuk). Impacted white fiberglass powder in the superficial surface of the cornea.
Ocular Injuries Caused by Misuse of an Immersion Heater A. M. Mansour, M.D., and A. M. Razzuk, M.S. Department of Ophthalmology, University of Texas Medical Branch. Inquiries to A. Mansour, M.D., UTMB-Ophthalmology, Galveston, TX 77550. Immersion heaters are light, inexpensive, portable electrical appliances, designed to boil water for coffee or soup. These products come with a list of instructions on the back of the package, and with a large-print, double-sided red warning label attached to the electric cord. The users are warned to unplug the heater before removing it from liquid. We treated five patients who sustained ocular injuries from misuse of the immersion heater. From January 1987 to December 1991, five young men between the ages of 18 and 35 years were treated for ocular injuries related to the
immersion heater. The incidents occurred after the lighting of cigarettes with the heater out side of liquid. In two cases the age of the heater was four days and three weeks. One patient described the heater as glowing before using it to light a cigarette. The ocular injuries were bilateral in four patients, and unilateral in one. All five patients sustained corneal abrasions involving from 30% to 80% of the corneal surface and healing within 48 hours (with anti biotic ointment and patching of the most se verely affected eye). Corneal foreign bodies were present in two patients and were removed by gentle scraping (Figure). The foreign bodies were white fiberglass granules. Other com bined ocular injuries included an eyelid lacera tion (one case), eyelid abrasions (two cases), conjunctival abrasions and foreign bodies (two cases), severe iritis (one case), and vitreous hemorrhage (one case). An immersion heater has three parts: a heat ing coil, a fiberglass insulating sleeve, and a
Vol. 114, No. 1
Letters to The Journal
chrome-plated brass cover. Keeping the immer sion heater in water prevents the external sur face of the metallic cover from heating above 100 C. We speculate that use of the device outside liquid allows the temperature of the heater to increase to a level that damages the insulation. This damaged insulation creates a connection between the heating coil and the outer metallic plate, resulting in an explosion. Explosion of the heater causes the hot fiberglass to impact the cornea, conjunctiva, and eyelids. The damage takes two forms: thermal burns and foreign bodies.
Choroidal Neovascularization Occurring Within a Demarcation Line Pedro F. Lopez, M.D., Thomas M. Aaberg, M.D., H. Michael Lambert, M.D., Paul Sternberg, Jr., M.D., and A n t o n i o Capone, Jr., M . D . Department of Ophthalmology, Emory University School of Medicine. Supported in part by Research to Prevent Blindness, Inc., New York, New York; by National Institutes of Health Departmental Core
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Grant P30 EY06360; and by a Heed/Knapp Ophthal mic Foundation Fellowship (P.F.L., A.C.). Inquiries to Pedro F. Lopez, M.D., Department of Ophthalmology, Emory University Eye Center, 1327 Clifton Rd. N.E., Atlanta, GA 30322. Choroidal neovascularization has been de scribed in a variety of degenerative, hereditary, traumatic, and inflammatory conditions gener ally characterized by breaks in Bruch's mem brane. 1 · 2 We encountered an unusual case of choroidal neovascularization occurring within the demarcation line of a chronic retinal de tachment. A 20-year-old man with severe proliferative diabetic retinopathy developed recurrent vitre ous hemorrhage and extension of a peripapillary traction retinal detachment into the macu la of his right eye. Pars plana vitrectomy with en bloc dissection 3 of the fibrovascular preretinal membranes was performed. An irregular, poorly pigmented, juxtafoveal demarcation line was identified along the temporal border of the crescentic traction retinal detachment (Figure, left). No retinal breaks were identified during the operation, and subretinal fluid was not drained. Macular photocoagulation was never performed in this eye. Three months postoperatively, the visual
Figure (Lopez and associates). Left, Three months after pars plana vitrectomy in the right eye, the early phase of the fluorescein angiogram shows the crescentic hypofluorescent demarcation of the chronic diabetic traction retinal detachment (arrowhead). Irregular hyperfluorescence (arrow) is present between the demarcation line and a geographic area of macular hypofluorescence. Right, A later phase of the fluorescein angiogram shows subretinal leakage and several foci of blocked choroidal fluorescence (arrow) adjacent to the demarcation line (arrowhead), consistent with choroidal neovascularization with overlying foci of subretinal hemorrhage.
AMERICAN JOURNAL OF OPHTHALMOLOGY
July, 1992
treatment resulted in gradual decrease in the size of the cyst. The patient's visual acuity improved to 20/80 in the right eye. Despite warnings concerning the proper preparation of food in microwave ovens, ocular injuries unfortunately continue to occur. Such injuries usually involve foods with nonporous skin, membranes (including the yolk of an egg), or shells that expand with increased tempera ture and pressure. When the pressure is re leased suddenly, an explosion may occur. Our case is unusual in that the ocular injury was severe and resulted in a permanent loss of vision. Hence, when examining such patients physicians must carefully rule out more exten sive ocular injuries that may have occurred.
References 1. DeRespinis, P. A., and Frohman, L. P.: Micro wave popcorn may pose danger to the eyes. N. Engl. J. Med. 323:1212, 1990. 2. Routhier, P., Matlin, A. H., and Ishman, R. E.: Eye injury from microwave popcorn. N. Engl. J. Med. 315:1359, 1986. 3. Singh, J., Shah, P., and Sutton, G. A.: Exploding eggs. N. Engl. J. Med. 325:1749, 1991. Figure (Mansour and Razzuk). Impacted white fiberglass powder in the superficial surface of the cornea.
Ocular Injuries Caused by Misuse of an Immersion Heater A. M. Mansour, M.D., and A. M. Razzuk, M.S. Department of Ophthalmology, University of Texas Medical Branch. Inquiries to A. Mansour, M.D., UTMB-Ophthalmology, Galveston, TX 77550. Immersion heaters are light, inexpensive, portable electrical appliances, designed to boil water for coffee or soup. These products come with a list of instructions on the back of the package, and with a large-print, double-sided red warning label attached to the electric cord. The users are warned to unplug the heater before removing it from liquid. We treated five patients who sustained ocular injuries from misuse of the immersion heater. From January 1987 to December 1991, five young men between the ages of 18 and 35 years were treated for ocular injuries related to the
immersion heater. The incidents occurred after the lighting of cigarettes with the heater out side of liquid. In two cases the age of the heater was four days and three weeks. One patient described the heater as glowing before using it to light a cigarette. The ocular injuries were bilateral in four patients, and unilateral in one. All five patients sustained corneal abrasions involving from 30% to 80% of the corneal surface and healing within 48 hours (with anti biotic ointment and patching of the most se verely affected eye). Corneal foreign bodies were present in two patients and were removed by gentle scraping (Figure). The foreign bodies were white fiberglass granules. Other com bined ocular injuries included an eyelid lacera tion (one case), eyelid abrasions (two cases), conjunctival abrasions and foreign bodies (two cases), severe iritis (one case), and vitreous hemorrhage (one case). An immersion heater has three parts: a heat ing coil, a fiberglass insulating sleeve, and a
Vol. 114, No. 1
Letters to The Journal
chrome-plated brass cover. Keeping the immer sion heater in water prevents the external sur face of the metallic cover from heating above 100 C. We speculate that use of the device outside liquid allows the temperature of the heater to increase to a level that damages the insulation. This damaged insulation creates a connection between the heating coil and the outer metallic plate, resulting in an explosion. Explosion of the heater causes the hot fiberglass to impact the cornea, conjunctiva, and eyelids. The damage takes two forms: thermal burns and foreign bodies.
Choroidal Neovascularization Occurring Within a Demarcation Line Pedro F. Lopez, M.D., Thomas M. Aaberg, M.D., H. Michael Lambert, M.D., Paul Sternberg, Jr., M.D., and A n t o n i o Capone, Jr., M . D . Department of Ophthalmology, Emory University School of Medicine. Supported in part by Research to Prevent Blindness, Inc., New York, New York; by National Institutes of Health Departmental Core
101
Grant P30 EY06360; and by a Heed/Knapp Ophthal mic Foundation Fellowship (P.F.L., A.C.). Inquiries to Pedro F. Lopez, M.D., Department of Ophthalmology, Emory University Eye Center, 1327 Clifton Rd. N.E., Atlanta, GA 30322. Choroidal neovascularization has been de scribed in a variety of degenerative, hereditary, traumatic, and inflammatory conditions gener ally characterized by breaks in Bruch's mem brane. 1 · 2 We encountered an unusual case of choroidal neovascularization occurring within the demarcation line of a chronic retinal de tachment. A 20-year-old man with severe proliferative diabetic retinopathy developed recurrent vitre ous hemorrhage and extension of a peripapillary traction retinal detachment into the macu la of his right eye. Pars plana vitrectomy with en bloc dissection 3 of the fibrovascular preretinal membranes was performed. An irregular, poorly pigmented, juxtafoveal demarcation line was identified along the temporal border of the crescentic traction retinal detachment (Figure, left). No retinal breaks were identified during the operation, and subretinal fluid was not drained. Macular photocoagulation was never performed in this eye. Three months postoperatively, the visual
Figure (Lopez and associates). Left, Three months after pars plana vitrectomy in the right eye, the early phase of the fluorescein angiogram shows the crescentic hypofluorescent demarcation of the chronic diabetic traction retinal detachment (arrowhead). Irregular hyperfluorescence (arrow) is present between the demarcation line and a geographic area of macular hypofluorescence. Right, A later phase of the fluorescein angiogram shows subretinal leakage and several foci of blocked choroidal fluorescence (arrow) adjacent to the demarcation line (arrowhead), consistent with choroidal neovascularization with overlying foci of subretinal hemorrhage.