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Severe ocular injuries from headgear
LETTER TO THE EDITOR
Severe ocular injuries from headgear To the Editor:
For several years the American Association of Orthodontists has encouraged its members to alert their patients to the dangers of incorrect handling and disengagement of extraoral tractional devices? We would like to remind your readers of the potential risk for severe facial injuries from these appliances. We have recently seen two 13-year-old girls who sustained blinding injuries to their eyes from orthodontic headgear. In one patient both eyes were penetrated by the rigid metallic bow; in the other a unilateral ocular penetration occurred. Because the bows were contaminated with saliva, each injured eye developed an endophthalmitis caused by multiple bacteria. Due to the delicacy of intraocular structures and the difficulty with which me'cations--including antibiotics-reach intraocular tissues, bacterial endophthalmitis has a grave prognosis. Two of the involved eyes were destroyed as a result of the infections. Through early, aggressive medical and surgical therapy, one eye in the bilaterally injured patient retains useful, although significantly decreased, vision. In both cases the injuries occurred after the patients accidentiy hit the headgear devices with their hands during outdoor recreational activities. In both cases the bows were pulled from their mouths under tension and snapped back with considerable force, striking their eyes. In one patient there was little initial pain despite ocular penetration. The severity of the injury was not recognized until the following day, which significantly reduced the prognosis for successful treatment of her infection. In addition to development and use of safer appliances, the orthodontic community is encouraged to con-
tinue in their efforts to educate patients and their families in the proper use of extraoral tractional devices. Their potential for causing severe ocular and facial injuries when disengaged through carelessness or inappropriate handling should be stressed. Patients should seek immediate attention from an ophthalmologist whenever an eye is struck with such a device, even in the absence of significant symptoms. In a recent publication, we reported our experience in the management of these patients to the ophthalmic community? Fortunately such injuries are uncommon? ,4 Through the coordinated efforts of orthodontists and ophthalmologists, the incidence of such tragedies hopefully can be reduced even further. Gary N. Holland, M.D. * David A. Wallace, M.D. Bartly J. Mondino, M.D.* Stuart H. Cole, M.D.'/ Stephen J. Ryan, M.D. Departments of Ophthalmology UCLA School of Medicine* USC School of MedicineP Los Angeles, Calif. REFERENCES 1. AAO issues special bulletins on extraoral appliance care (editorial). AN J ORTHOD 68: 457, 1975. 2. Holland GN, Wallace DA, Mondino BJ, et al: Severe ocular injuries from orthodontic headgear. Arch Ophthalmol 103:649-651, 1985. 3. Seel D: Extraoral hazards of extraoral traction. Br J Orthod 7: 53, 1980. 4. Preliminary results of headgear survey. The Bulletin (American Association of Orthodontists) 1: 1, 1982.
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Severe ocular injuries from headgear To the Editor:
For several years the American Association of Orthodontists has encouraged its members to alert their patients to the dangers of incorrect handling and disengagement of extraoral tractional devices? We would like to remind your readers of the potential risk for severe facial injuries from these appliances. We have recently seen two 13-year-old girls who sustained blinding injuries to their eyes from orthodontic headgear. In one patient both eyes were penetrated by the rigid metallic bow; in the other a unilateral ocular penetration occurred. Because the bows were contaminated with saliva, each injured eye developed an endophthalmitis caused by multiple bacteria. Due to the delicacy of intraocular structures and the difficulty with which me'cations--including antibiotics-reach intraocular tissues, bacterial endophthalmitis has a grave prognosis. Two of the involved eyes were destroyed as a result of the infections. Through early, aggressive medical and surgical therapy, one eye in the bilaterally injured patient retains useful, although significantly decreased, vision. In both cases the injuries occurred after the patients accidentiy hit the headgear devices with their hands during outdoor recreational activities. In both cases the bows were pulled from their mouths under tension and snapped back with considerable force, striking their eyes. In one patient there was little initial pain despite ocular penetration. The severity of the injury was not recognized until the following day, which significantly reduced the prognosis for successful treatment of her infection. In addition to development and use of safer appliances, the orthodontic community is encouraged to con-
tinue in their efforts to educate patients and their families in the proper use of extraoral tractional devices. Their potential for causing severe ocular and facial injuries when disengaged through carelessness or inappropriate handling should be stressed. Patients should seek immediate attention from an ophthalmologist whenever an eye is struck with such a device, even in the absence of significant symptoms. In a recent publication, we reported our experience in the management of these patients to the ophthalmic community? Fortunately such injuries are uncommon? ,4 Through the coordinated efforts of orthodontists and ophthalmologists, the incidence of such tragedies hopefully can be reduced even further. Gary N. Holland, M.D. * David A. Wallace, M.D. Bartly J. Mondino, M.D.* Stuart H. Cole, M.D.'/ Stephen J. Ryan, M.D. Departments of Ophthalmology UCLA School of Medicine* USC School of MedicineP Los Angeles, Calif. REFERENCES 1. AAO issues special bulletins on extraoral appliance care (editorial). AN J ORTHOD 68: 457, 1975. 2. Holland GN, Wallace DA, Mondino BJ, et al: Severe ocular injuries from orthodontic headgear. Arch Ophthalmol 103:649-651, 1985. 3. Seel D: Extraoral hazards of extraoral traction. Br J Orthod 7: 53, 1980. 4. Preliminary results of headgear survey. The Bulletin (American Association of Orthodontists) 1: 1, 1982.
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