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Soda Pop Top Ophthalmopathy
Vol. 106, No. 6
Letters to the Journal
761
sellar-suprasellar tumor may displace the dura mater through which the third nerve passes and stretch the nerve secondarily. The fibers innervating the levator palpebrae superioris muscle would seem to be more sensitive to stretch. The recurrence of the blepharoptosis in our patient was presumably caused by either hemorrhage into the tumor or infarction of part of the tumor with associated edema.
References
Fig. 2 (Small and Buckley). Magnetic resonance image (Ti-weighted, sagittal section) showing the markedly increased signal intensity of the inferior area of the sellar-suprasellar mass consistent with blood or mucus. recurring partial third nerve injury with no radiologie evidence of third nerve impingement. Third nerve paresis occurs in 14% of pituitary tumors. 1 All of those patients had blepharoptosis. Three mechanisms of oculomotor nerve paresis have been proposed. Symonds 2 believed that slowly growing pituitary tumors send small projections which perforate the weak areas of the sella. As these projections extend laterally and backward they stretch the fibers of the third nerve at the level of the dura mater before arriving at the cavernous sinus. Walsh3 thought that simple pressure on the walls of the cavernous sinus by the tumor could indirectly cause oculomotor nerve injury and Jefferson4 suggested that the third nerve is compressed against the petrous sphenoidal ligament of Gruber. We believe our patient did not have tumor directly compressing the oculomotor nerve. There was no radiologie evidence of lateral extension of the tumor. The spontaneous regression and then subsequent recurrence of the blepharoptosis two years later would not be the expected course of an invasive tumor. The lack of pupilomotor fiber involvement, which are thought to be sensitive to compressive lesions, also supports our belief. We suggest that a
1. Robert, C. M., Jr., Feigenbaum, J. A., and Stern, W. E.: Ocular palsy occurring with pituitary tumors. J. Neurosurg. 38:17, 1973. 2. Symonds, C : Ocular palsy as the presenting symptom of pituitary adenoma. Bull. Johns Hopkins Hosp. 111:72, 1962. 3. Walsh, F. B.: Bilateral total ophthalmoplegia with adenoma of the pituitary gland. Report of two cases. An anatomic study. Arch. Ophthalmol. 42:646, 1949. 4. Jefferson, G.: The invasive adenomas of the anterior pituitary. The Sherrington Lecture III. Liverpool, University Press, 1955.
Soda Pop Top Ophthalmopathy Kathleen M. D u e r k s e n , M . D . , D e a n n a W. Albert, M . D . , Roger M. S a u l s o n , M . D . , and S t e p h e n C. Pflugfelder, M . D . Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine. Inquiries to S. C. Pflugfelder, M.D., Bascom Palmer Eye Institute, 900 N.W. 17th St., Miami, FL 33136. Potentially severe ocular injuries can result from the bottlecap of a 2-liter soft drink bottle if pressure within the bottle is increased enough to allow the bottlecap to " p o p " off. Three such cases were recently encountered at our institution, which resulted in significant ocular trauma. Casel A 43-year-old woman was examined after she was struck in the left eye with a bottlecap she had tried to remove with pliers from a sealed 2-liter bottle. The patient had a self-sealing full-thickness corneal laceration, as well as commotio retinae (traumatic retinopathy). The
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
Letters to the Journal
761
sellar-suprasellar tumor may displace the dura mater through which the third nerve passes and stretch the nerve secondarily. The fibers innervating the levator palpebrae superioris muscle would seem to be more sensitive to stretch. The recurrence of the blepharoptosis in our patient was presumably caused by either hemorrhage into the tumor or infarction of part of the tumor with associated edema.
References
Fig. 2 (Small and Buckley). Magnetic resonance image (Ti-weighted, sagittal section) showing the markedly increased signal intensity of the inferior area of the sellar-suprasellar mass consistent with blood or mucus. recurring partial third nerve injury with no radiologie evidence of third nerve impingement. Third nerve paresis occurs in 14% of pituitary tumors. 1 All of those patients had blepharoptosis. Three mechanisms of oculomotor nerve paresis have been proposed. Symonds 2 believed that slowly growing pituitary tumors send small projections which perforate the weak areas of the sella. As these projections extend laterally and backward they stretch the fibers of the third nerve at the level of the dura mater before arriving at the cavernous sinus. Walsh3 thought that simple pressure on the walls of the cavernous sinus by the tumor could indirectly cause oculomotor nerve injury and Jefferson4 suggested that the third nerve is compressed against the petrous sphenoidal ligament of Gruber. We believe our patient did not have tumor directly compressing the oculomotor nerve. There was no radiologie evidence of lateral extension of the tumor. The spontaneous regression and then subsequent recurrence of the blepharoptosis two years later would not be the expected course of an invasive tumor. The lack of pupilomotor fiber involvement, which are thought to be sensitive to compressive lesions, also supports our belief. We suggest that a
1. Robert, C. M., Jr., Feigenbaum, J. A., and Stern, W. E.: Ocular palsy occurring with pituitary tumors. J. Neurosurg. 38:17, 1973. 2. Symonds, C : Ocular palsy as the presenting symptom of pituitary adenoma. Bull. Johns Hopkins Hosp. 111:72, 1962. 3. Walsh, F. B.: Bilateral total ophthalmoplegia with adenoma of the pituitary gland. Report of two cases. An anatomic study. Arch. Ophthalmol. 42:646, 1949. 4. Jefferson, G.: The invasive adenomas of the anterior pituitary. The Sherrington Lecture III. Liverpool, University Press, 1955.
Soda Pop Top Ophthalmopathy Kathleen M. D u e r k s e n , M . D . , D e a n n a W. Albert, M . D . , Roger M. S a u l s o n , M . D . , and S t e p h e n C. Pflugfelder, M . D . Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine. Inquiries to S. C. Pflugfelder, M.D., Bascom Palmer Eye Institute, 900 N.W. 17th St., Miami, FL 33136. Potentially severe ocular injuries can result from the bottlecap of a 2-liter soft drink bottle if pressure within the bottle is increased enough to allow the bottlecap to " p o p " off. Three such cases were recently encountered at our institution, which resulted in significant ocular trauma. Casel A 43-year-old woman was examined after she was struck in the left eye with a bottlecap she had tried to remove with pliers from a sealed 2-liter bottle. The patient had a self-sealing full-thickness corneal laceration, as well as commotio retinae (traumatic retinopathy). The
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