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Retained Ocular Gunpowder
762
December, 1988
AMERICAN JOURNAL OF OPHTHALMOLOGY
References
Figure (Duerksen and associates). Left eye of patient was injured by exploding bottlecap from 2-liter soft drink bottle.
patient underwent surgical repair of the laceration and four months postoperatively had a visual acuity of 20/50, the result of irregular corneal astigmatism and scarring. Case 2 A 32-year-old woman had decreased vision and bleeding from her left eye after being struck by the bottlecap from a similar bottle. The bottle had not been opened previously and was stored at room temperature. The patient had a laceration of the left upper eyelid, increased intraocular pressure, commotio retinae, and iritis. Treatment consisted of topical cycloplegics, corticosteroids, and 0.5% timolol maleate. Two weeks later visual acuity was 20/30. Case 3 A 48-year-old man was examined after he was struck in the left eye from a bottlecap when he attempted to open a 2-liter soda bottle (Figure). The bottle was refrigerated and had been previously opened; approximately 50% of the volume remained. The patient used pliers to remove the cap. He suffered a full-thickness corneal laceration, ruptured lens capsule, and cataract formation. The laceration was repaired and subsequently an extracapsular cataract extraction was performed. The patient's best corrected visual acuity was 20/30 six months after the injury. Similar ocular injuries have been reported from 12 to 32 ounce beverage containers. 1,2 In our cases, the bottle volume was more than twice the size previously reported. Waikhom 3 postulated that a greater projectile force might be created by a larger volume bottle. This may account for the severity of the injuries in our patients.
1. Modino, B. J., Brown, S. I., and Grand, M. G.: Ocular injuries from exploding beverage bottles. Arch. Ophthalmol. 96:2040, 1978. 2. Gupta, A. K., Nadiger, M., and Moraes, O.: Ocular injury from a carbonated beverage bottle. J. Pediatr. Ophthalmol. Strabismus 17:394, 1980. 3. Waikhom, J. S.: Ocular injuries from beverage bottles. Arch. Ophthalmol. 97:975, 1979.
Retained Ocular Gunpowder W i l l i a m N . White, A . B . , Rebecca Preston, M . D . , Craig M. Morgan, M . D . , and Marilyn C. Kincaid, M . D . Department of Surgery (W.N.W. and C.M.M.), the Marshall University School of Medicine, and Department of Ophthalmology (R.P., C.M.M., and M.C.K.), W. K. Kellogg Eye Center. Inquiries to Craig M. Morgan, M.D., Huntington Eye Associates, 1151 Hal Greer Blvd., Huntington, WV 25701. Retained gunpowder particles following ocular gunpowder injuries are uncommon and have been reported to be clinically well tolerated by the eye. 1 3 We had the opportunity to examine histologically the conjunctiva of a patient with retained gunpowder particles and found that the particles had not elicited any apparent inflammatory reaction. A 16-year-old boy was making a bomb with modern smokeless gunpowder when it exploded in his face. Instantaneously he lost vision in both eyes, and his eyes were extremely painful. Examination immediately after the injury disclosed that his visual acuity was hand motions in both eyes. Numerous gunpowder particles were embedded in the eyelids and facial skin. Marked conjunctival chemosis was present, and a conjunctival laceration was present temporally in the left eye. In both eyes, there were multiple intracorneal and conjunctival gunpowder deposits. A 10% hyphema was present in the left eye. The anterior chamber was formed in both eyes, and it did not appear that any of the gunpowder particles had penetrated either eye. The pupils were of normal configuration and reactive, and the lens was clear in each eye. Initial treatment included topical antibiotics and cycloplegia, and subsequently
Vol. 106, No. 6
Letters to the Journal
763
Fig. 2 (White and associates). Higher-power view of the conjunctiva showing dense deposits of irregular jet black foreign material (arrows), which is extracellular. There is no inflammatory reaction. Conjunctival epithelium (E) with goblet cells is seen in several areas in this somewhat distorted specimen (hematoxylin and eosin, X120).
topical corticosteroids. Two weeks later, the corneal epithelium was intact in both eyes. The numerous gunpowder particles remained embedded at various levels in the conjunctiva and cornea. Three months after the injury, a cataract had developed in the left eye, and the visual acuity was R.E.: 20/50 and L.E.: counting fingers at 2 feet. The gunpowder particles in the conjunctiva and cornea were unchanged, and clinically it appeared as if they had not elicited any ocular inflammation. There was no vascularization of the cornea. An uneventful cataract extraction was performed on the left eye. At the time of surgery, a portion of the conjunctiva containing some of the gunpowder particles was excised and sent for histopathologic examination. Review of this specimen (Figs. 1 and 2) showed that the gunpowder particles had remained extracellular, and that there was no inflammatory reaction to the particles. One year after the injury, the visual acuity was R.E.: 20/30 and L.E.: 20/20. There had been no change in the embedded gunpowder particles and there was no clinically apparent inflammatory response. These histologie findings support the previously reported clinical observations that retained ocular gunpowder particles are well tolerated by the eye and do not need to be removed unless there is a specific indication for doing so.
References 1. Belkin, M., and Ivry, M.: Explosive intraocular foreign bodies. Am. J. Ophthalmol. 85:676, 1978. 2. Dreizen, N. G., and Stulting, R. D.: Ocular gunpowder injuries. Am. J. Ophthalmol. 100:852, 1985. 3. Runyan, T. E., and Ewald, R. A.: Blank cartridge injury of the cornea. Arch. Ophthalmol. 84:690, 1970.
Universal 35-mm Camera Mount for Ophthalmic Ultrasound Units Marc M. Whitacre, M . D . , S. Asher Ertel, and Joe G i l l e s p i e University of Kansas Medical Center. Inquiries to Marc M. Whitacre, M.D., Department of Ophthalmology, Sudler Hall, University of Kansas Medical Center, 39th and Rainbow Blvd., Kansas City, KS 66103. We have designed a 35-mm camera mount for ultrasound units, which is compatible with any 35-mm camera. The mount consists of a sheet of V4-inch-thick aluminum cut and bent to the configuration shown in the Figure. It is impor-
December, 1988
AMERICAN JOURNAL OF OPHTHALMOLOGY
References
Figure (Duerksen and associates). Left eye of patient was injured by exploding bottlecap from 2-liter soft drink bottle.
patient underwent surgical repair of the laceration and four months postoperatively had a visual acuity of 20/50, the result of irregular corneal astigmatism and scarring. Case 2 A 32-year-old woman had decreased vision and bleeding from her left eye after being struck by the bottlecap from a similar bottle. The bottle had not been opened previously and was stored at room temperature. The patient had a laceration of the left upper eyelid, increased intraocular pressure, commotio retinae, and iritis. Treatment consisted of topical cycloplegics, corticosteroids, and 0.5% timolol maleate. Two weeks later visual acuity was 20/30. Case 3 A 48-year-old man was examined after he was struck in the left eye from a bottlecap when he attempted to open a 2-liter soda bottle (Figure). The bottle was refrigerated and had been previously opened; approximately 50% of the volume remained. The patient used pliers to remove the cap. He suffered a full-thickness corneal laceration, ruptured lens capsule, and cataract formation. The laceration was repaired and subsequently an extracapsular cataract extraction was performed. The patient's best corrected visual acuity was 20/30 six months after the injury. Similar ocular injuries have been reported from 12 to 32 ounce beverage containers. 1,2 In our cases, the bottle volume was more than twice the size previously reported. Waikhom 3 postulated that a greater projectile force might be created by a larger volume bottle. This may account for the severity of the injuries in our patients.
1. Modino, B. J., Brown, S. I., and Grand, M. G.: Ocular injuries from exploding beverage bottles. Arch. Ophthalmol. 96:2040, 1978. 2. Gupta, A. K., Nadiger, M., and Moraes, O.: Ocular injury from a carbonated beverage bottle. J. Pediatr. Ophthalmol. Strabismus 17:394, 1980. 3. Waikhom, J. S.: Ocular injuries from beverage bottles. Arch. Ophthalmol. 97:975, 1979.
Retained Ocular Gunpowder W i l l i a m N . White, A . B . , Rebecca Preston, M . D . , Craig M. Morgan, M . D . , and Marilyn C. Kincaid, M . D . Department of Surgery (W.N.W. and C.M.M.), the Marshall University School of Medicine, and Department of Ophthalmology (R.P., C.M.M., and M.C.K.), W. K. Kellogg Eye Center. Inquiries to Craig M. Morgan, M.D., Huntington Eye Associates, 1151 Hal Greer Blvd., Huntington, WV 25701. Retained gunpowder particles following ocular gunpowder injuries are uncommon and have been reported to be clinically well tolerated by the eye. 1 3 We had the opportunity to examine histologically the conjunctiva of a patient with retained gunpowder particles and found that the particles had not elicited any apparent inflammatory reaction. A 16-year-old boy was making a bomb with modern smokeless gunpowder when it exploded in his face. Instantaneously he lost vision in both eyes, and his eyes were extremely painful. Examination immediately after the injury disclosed that his visual acuity was hand motions in both eyes. Numerous gunpowder particles were embedded in the eyelids and facial skin. Marked conjunctival chemosis was present, and a conjunctival laceration was present temporally in the left eye. In both eyes, there were multiple intracorneal and conjunctival gunpowder deposits. A 10% hyphema was present in the left eye. The anterior chamber was formed in both eyes, and it did not appear that any of the gunpowder particles had penetrated either eye. The pupils were of normal configuration and reactive, and the lens was clear in each eye. Initial treatment included topical antibiotics and cycloplegia, and subsequently
Vol. 106, No. 6
Letters to the Journal
763
Fig. 2 (White and associates). Higher-power view of the conjunctiva showing dense deposits of irregular jet black foreign material (arrows), which is extracellular. There is no inflammatory reaction. Conjunctival epithelium (E) with goblet cells is seen in several areas in this somewhat distorted specimen (hematoxylin and eosin, X120).
topical corticosteroids. Two weeks later, the corneal epithelium was intact in both eyes. The numerous gunpowder particles remained embedded at various levels in the conjunctiva and cornea. Three months after the injury, a cataract had developed in the left eye, and the visual acuity was R.E.: 20/50 and L.E.: counting fingers at 2 feet. The gunpowder particles in the conjunctiva and cornea were unchanged, and clinically it appeared as if they had not elicited any ocular inflammation. There was no vascularization of the cornea. An uneventful cataract extraction was performed on the left eye. At the time of surgery, a portion of the conjunctiva containing some of the gunpowder particles was excised and sent for histopathologic examination. Review of this specimen (Figs. 1 and 2) showed that the gunpowder particles had remained extracellular, and that there was no inflammatory reaction to the particles. One year after the injury, the visual acuity was R.E.: 20/30 and L.E.: 20/20. There had been no change in the embedded gunpowder particles and there was no clinically apparent inflammatory response. These histologie findings support the previously reported clinical observations that retained ocular gunpowder particles are well tolerated by the eye and do not need to be removed unless there is a specific indication for doing so.
References 1. Belkin, M., and Ivry, M.: Explosive intraocular foreign bodies. Am. J. Ophthalmol. 85:676, 1978. 2. Dreizen, N. G., and Stulting, R. D.: Ocular gunpowder injuries. Am. J. Ophthalmol. 100:852, 1985. 3. Runyan, T. E., and Ewald, R. A.: Blank cartridge injury of the cornea. Arch. Ophthalmol. 84:690, 1970.
Universal 35-mm Camera Mount for Ophthalmic Ultrasound Units Marc M. Whitacre, M . D . , S. Asher Ertel, and Joe G i l l e s p i e University of Kansas Medical Center. Inquiries to Marc M. Whitacre, M.D., Department of Ophthalmology, Sudler Hall, University of Kansas Medical Center, 39th and Rainbow Blvd., Kansas City, KS 66103. We have designed a 35-mm camera mount for ultrasound units, which is compatible with any 35-mm camera. The mount consists of a sheet of V4-inch-thick aluminum cut and bent to the configuration shown in the Figure. It is impor-