Advertisement

European Perspective of Ocular Trauma Management: Diagnostic and Therapeutic Considerations Based on Our Experience

  • Alessandro MeduriEmail author
  • Mario Urso
  • Marco Zagari
  • Alessandro Arrigo
  • Pasquale Aragona
Chapter
  • 726 Downloads

Abstract

Ocular traumas represent a complex and heterogeneous nosological entity showing high variability both in terms of etiology and clinical expression. The most affected patient categories are children and workers; this data has important implications in terms of long-term prognosis, posttraumatic deficits as well as healthcare and economic cost. Indeed, ocular trauma may cause severe permanent alterations of ocular anatomy as well as visual loss. These patients may show the involvement of all ocular structures, thus requiring the intervention of an experienced surgeon in the pole to pole surgery. Moreover, multidisciplinary intervention may be required, e.g., in cases of the polytraumatized patient, making management and treatment of these cases complex and tricky. It is worth noting that often emergency care units are not able to deal with such events, thus making it necessary to refer the patient to specialized facilities for complex trauma management. However, posttraumatic visual deficits or blindness cannot always be prevented.

Keywords

Intraocular foreign body Ocular trauma score Optical coherence tomography Inflammation Postsurgical therapy 

Notes

Conflict of interests

Authors have no conflict of interest to declare.

References

  1. 1.
    Aylward GW. Vitreous management in penetrating trauma: primary repair and secondary intervention. Eye (Lond). 2008;22(10):1366–9. Doi: 10.1038/eye.2008.74 (Epub 2008 Apr 18).
  2. 2.
    Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am. 2002;15(2):139–43, v.Google Scholar
  3. 3.
    Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The Ocular Trauma Score (OTS). Ophthalmol Clin North Am. 2002;15(2):163–5, vi.Google Scholar
  4. 4.
    Morris SC. The team approach to management of the polytrauma patient. Virtual Mentor. 2009;11(7):516–20. Doi: 10.1001/virtualmentor.2009.11.7.cprl1-0907.
  5. 5.
    Shah MA, Shah SM, Applewar A, Patel C, Shah S, Patel U. Ocular Trauma Score: a useful predictor of visual outcome at six weeks in patients with traumatic cataract. Ophthalmology. 2012;119(7):1336–41. Doi: 10.1016/j.ophtha.2012.01.020.
  6. 6.
    Weber SL, Ribeiro LG, Ducca BL, Kasahara N. Prospective validation of the Ocular Trauma Score as a prognostic model to predict vision survival in injured adult patients from a developing country. Eur J Trauma Emerg Surg. 2012;38(6):647–50. Doi: 10.1007/s00068-012-0209-7.
  7. 7.
    Turgut B, Kobat SG, Tanyildizi R. The Usage of ocular trauma scoring in the visual prognostic evaluation of traumatic eye injury. Med-Sci. 2014;3(2):1224–33. Doi: 10.5455/medscience.2014.03.8123.
  8. 8.
    Rawat P, Rajput S, Gautam M, Tammannavar S. Grading of severity of ocular trauma by various ocular trauma scores and its effect on prognosis. International Journal of Scientific and Research Publications 4(12). 2014. ISSN 2250–3153.Google Scholar
  9. 9.
    Williams DF, Mieler WF, Williams GA. Posterior segment manifestations of ocular trauma. Retina. 1990;10(Suppl 1):S35–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Atmaca LS, Yilmaz M. Changes in the fundus caused by blunt ocular trauma. Ann Ophthalmol. 1993;25(12):447–52.PubMedGoogle Scholar
  11. 11.
    Tasman W, Jaeger EA. Traumatic cataract. Duane’s Clin Ophthalmol. 1997;1:13–4.Google Scholar
  12. 12.
    Kumar A, Kumar V, Dapling RB. Traumatic cataract and intralenticular foreign body. Clin Exp Ophthalmol. 2005;33(6):660–1.CrossRefPubMedGoogle Scholar
  13. 13.
    Witherspoon CD, Kunh F, Morris R, et al. Anterior and posterior segment trauma. In: Master Techniques in Ophthalmic Surgery. 1995. p. 538–47.Google Scholar
  14. 14.
    Viestenz A, Küchle M. Blunt ocular trauma. Part I: blunt anterior segment trauma. Ophthalmologe. 2004;101(12):1239–57 (quiz 1257–8).Google Scholar
  15. 15.
    Kashiwagi K, Tateno Y, Kashiwagi F, Tsukahara S. Changes in anterior chamber depth due to contusion. Ophthalmic Res. 2009;42(4):193–8. doi: 10.1159/000232402.CrossRefPubMedGoogle Scholar
  16. 16.
    Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, et al. Optical coherence tomography. Science. 1991;254(5035):1178–1181.Google Scholar
  17. 17.
    Al Kharousi N, Wali UK, Azeem S. Current applications of optical coherence tomography in ophthalmology. 2013. Doi:http://dx.doi.org/10.5772/53961.
  18. 18.
    Wali UK, Al Kharousi N. Clinical applications of optical coherence tomography in ophthalmology. 2012.Google Scholar
  19. 19.
    Al-Mujaini A, Wali UK, Azeem S. Optical coherence tomography: clinical applications in medical practice. Oman Med J. 2013;28(2):86–91. Doi: 10.5001/omj.2013.24.
  20. 20.
    Mumcuoglu T, Durukan HA, Erdurman C, Hurmeric V, Gundogan FC. Functional and structural analysis of partial optic nerve avulsion due to blunt trauma: case report. Indian J Ophthalmol. 2010;58(6):524–6. Doi: 10.4103/0301-4738.71705.
  21. 21.
    Madhusudhana KC, Hossain P, Thiagarajan M, Newsom RS. Use of anterior segment optical coherence tomography in a penetrating eye injury. Br J Ophthalmol. 2007;91(7):982–3.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Goel N, Pangtey BP, Raina UK, Ghosh B. Anterior segment optical coherence tomography in intracorneal foreign body. Oman J Ophthalmol. 2012;5(2):131–2.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Lim SH. Clinical applications of anterior segment optical coherence tomography. J Ophthalmol. 2015;2015:605729. Doi: 10.1155/2015/605729.
  24. 24.
    Kempster RC, Green WR, Finkelstein D. Choroidal rupture. Clinicopathologic correlation of an unusual case. Retina. 1996;16(1):57–63.CrossRefPubMedGoogle Scholar
  25. 25.
    Akman A, Kadayifçilar S, Oto S, Aydin P. Indocyanine green angiographic features of traumatic choroidal ruptures. Eye. 1998;12(Pt 4):646–50 (Lond).CrossRefPubMedGoogle Scholar
  26. 26.
    Kohno T, Miki T, Hayashi K. Choroidopathy after blunt trauma to the eye: a fluorescein and indocyanine green angiographic study. Am J Ophthalmol. 1998;126(2):248–60.CrossRefPubMedGoogle Scholar
  27. 27.
    Deramo VA, Shah GK, Baumal CR, Fineman MS, Corrêa ZM, Benson WE, Rapuano CJ, Cohen EJ, Augsburger JJ. Ultrasound biomicroscopy as a tool for detecting and localizing occult foreign bodies after ocular trauma. Ophthalmology. 1999;106(2):301–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Vodapalli H, Murthy SI, Jalali S, Ali MJ, Rani PK. Comparison of immersion ultrasonography, ultrasound biomicroscopy and anterior segment optical coherence tomography in the evaluation of traumatic phacoceles. Indian J Ophthalmol. 2012;60(1):63–5. Doi: 10.4103/0301-4738.91352.
  29. 29.
    Simsek T, Simsek E, Ilhan B, Ozalp S, Sekercioglu B, Zilelioglu O. Traumatic optic nerve avulsion. J Pediatr Ophthalmol Strabismus. 2006;43(6):367–9.Google Scholar
  30. 30.
    Novelline RA, Liebig T, Jordan J, Bilyk JR, Rubin PAD. Computed tomography of ocular trauma. 1994. Emergency Radiology Number 1 American Society of Emergency Radiology.Google Scholar
  31. 31.
    Kubal WS. Imaging of orbital trauma. Radiographics. 2008;28(6):1729–39. Doi: 10.1148/rg.286085523.
  32. 32.
    Weissman JL, Beatty RL, Hirsch WL, Curtin HD. Enlarged anterior chamber: CT finding of a ruptured globe. AJNR Am J Neuroradiol. 1995;16(4 Suppl):936–8.PubMedGoogle Scholar
  33. 33.
    Joseph DP, Pieramici DJ, Beauchamp NJ Jr. Computed tomography in the diagnosis and prognosis of open-globe injuries. Ophthalmology. 2000;107(10):1899–906.CrossRefPubMedGoogle Scholar
  34. 34.
    Lin KY, Ngai P, Echegoyen JC, Tao JP. Imaging in orbital trauma. Saudi J Ophthalmol. 2012;26(4):427–32. Doi: 10.1016/j.sjopt.2012.08.002.
  35. 35.
    Imran S, Amin S, Daula MIH. Imaging in ocular trauma optimizing the use of ultrasound and computerised tomography. Pak J Ophthalmol. 2011;27(3):146–151.Google Scholar
  36. 36.
    Mafee MF, Karimi A, Shah J, Rapoport M, Ansari SA. Anatomy and pathology of the eye: role of MR imaging and CT. Neuroimaging Clin N Am. 2005;15(1):23–47.CrossRefPubMedGoogle Scholar
  37. 37.
    Barker GJ. Diffusion-weighted imaging of the spinal cord and optic nerve. J Neurol Sci. 2001;186(Suppl 1):S45–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Mallery RM, Prasad S (2012) Neuroimaging of the afferent visual system. Semin Neurol. 32(4):273–319. Doi: 10.1055/s-0032-1331805.
  39. 39.
    Newman N, Biousse V. Diagnostic approach to vision loss. Continuum (Minneap Minn). 2014;20(4 Neuro-ophthalmology):785–815. Doi: 10.1212/01.CON.0000453317.67637.46.
  40. 40.
    Kapur R, Sepahdari AR, Mafee MF, Putterman AM, Aakalu V, et al. MR imaging of orbital inflammatory syndrome, orbital cellulitis, and orbital lymphoid lesions: the role of diffusion-weighted imaging. AJNR Am J Neuroradiol. 2009;30(1): 64–70. Doi: 10.3174/ajnr.A1315.
  41. 41.
    Al-Shafai LS, Mikulis DJ. Diffusion MR imaging in a case of acute ischemic optic neuropathy. AJNR Am J Neuroradiol. 2006;27(2):255–7.PubMedGoogle Scholar
  42. 42.
    Bender B, Heine C, Danz S, Bischof F, Reimann K, et al. (2014) Diffusion restriction of the optic nerve in patients with acute visual deficit. J Magn Reson Imaging. 40(2):334–40. Doi: 10.1002/jmri.24367.
  43. 43.
    Abu El-Asrar AM, Al-Amro SA, Al-Mosallam AA, Al-Obeidan S. Post-traumatic endophthalmitis: causative organisms and visual outcome. Eur J Ophthalmol. 1999;9(1):21–31.Google Scholar
  44. 44.
    Ding C, Zeng J. Clinical study on Hypotony following blunt ocular trauma. Int J Ophthalmol. 2012;5(6):771–3.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Dubois L, Steenen SA, Gooris PJ, Mourits MP, Becking AG. Controversies in orbital reconstruction–I. Defect-driven orbital reconstruction: a systematic review. Int J Oral Maxillofac Surg. 2015;44(3):308–15. Doi: 10.1016/j.ijom.2014.12.002 (Epub 2014 Dec 24).
  46. 46.
    Dubois L, Steenen SA, Gooris PJ, Mourits MP, Becking AG. Controversies in orbital reconstruction–II. Timing of post-traumatic orbital reconstruction: a systematic review. Int J Oral Maxillofac Surg. 2015;44(4):433–40. Doi: 10.1016/j.ijom.2014.12.003 (Epub 2014 Dec 25).
  47. 47.
    Zhang Y, Zhang MN, Jiang CH, Yao Y, Zhang K. Endophthalmitis following open globe injury. Br J Ophthalmol. 2010;94:111–114. Doi: 10.1136/bjo.2009.164913.
  48. 48.
    Keles S, Ondas O, Ekinci M, Sener MT. Paintball-related ocular trauma: paintball or painball? Med Sci Monit. 2014;20:564–8.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Dehghani AR, Rezaei L, Salam H, Mohammadi Z, Mahboubi M. Post traumatic endophthalmitis: incidence and risk factors. Glob J Health Sci. 2014;6(6):68–72. Doi: 10.5539/gjhs.v6n6p68.
  50. 50.
    Nobe JR, Gomez DS, Liggett P, Smith RE, Robin JB. Post-traumatic and postoperative endophthalmitis: a comparison of visual outcomes. Br J Ophthalmol. 1987;71(8):614–7.Google Scholar
  51. 51.
    Essex RW, Yi Q, Charles PG, Allen PJ. Post-traumatic endophthalmitis. Ophthalmology. 2004;111(11):2015–22.CrossRefPubMedGoogle Scholar
  52. 52.
    Cardillo JA, Stout JT, LaBree L, Azen SP, Omphroy L, Cui JZ, Kimura H, Hinton DR, Ryan SJ. Post-traumatic proliferative vitreoretinopathy. The epidemiologic profile, onset, risk factors, and visual outcome. Ophthalmology. 1997;104(7):1166–73.CrossRefPubMedGoogle Scholar
  53. 53.
    Atkins EJ, Newman NJ, Biousse V. Post-traumatic visual loss. Rev Neurol Dis. 2008; 5(2):73–81.Google Scholar
  54. 54.
    Scott R. The injured eye. Philos Trans R Soc Lond B Biol Sci. 2011;366(1562):251–260. Doi: 10.1098/rstb.2010.0234.

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Alessandro Meduri
    • 1
    Email author
  • Mario Urso
    • 1
  • Marco Zagari
    • 2
  • Alessandro Arrigo
    • 1
  • Pasquale Aragona
    • 1
  1. 1.Department of Biomedical, Dental Sciences and Morphofunctional ImagingUniversity of MessinaMessinaItaly
  2. 2.Clinic “Centro Europeo”AcicastelloItaly

Personalised recommendations