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[An analysis of 148 outpatient treated occupational accidents].

BACKGROUND: The most common eye injuries are non-perforating. Eye injuries in the workplace are a major cause of socioeconomical damage, morbidity and disability, despite well publicised standards for industrial eye protection. This study investigates the epidemiological and clinical aspects of 148 occupational cases. PATIENTS: At the University Eye Clinic of Tübingen, 709 non-perforating eye injuries were registered as occupational accidents between 1995 and 1996. Of these cases, 148 were analysed retrospectively per random. RESULTS: The 5 most common injuries of 148 patients (m/f = 138/10; mean age 33.4 +/- 12 years) were related to corneal foreign body injuries (35%), chemical burns (15.5%), sub-conjunctival foreign bodies (12%), thermal/ultraviolet injuries (11%) and contusions (7.4%). Of these patients, 22.3% were employed as construction workers and 16.2% as metal workers. At the time of examination the visual acuity of the traumatic eye was 0.9 +/- 0.3. The interval between the beginning of work and accident was 6.2 +/- 6.4 hours in average (0.5-13.5 h). Of all accidents, 8.5% were caused during the first hour of work; in contrast 45.5% of all accidents were caused after 6 hours of work. Another 12.4 +/- 14.5 hours (5min.-72 h; median 7 h) passed by until the patients arrived for eye examination at the Eye Clinic of Tübingen. Only 6% of all patients arrived within the first hour, and 29.7% after 12 hours. Of all cases, 30.4% received first-aid treatment in their company by the factory doctor or by the eye doctor before examination at the Eye Clinic. Only 6.8% of all patients had protective spectacles during work. Incapacity was seen in 30.4%; the average in total was 5.5 +/- 10 days. CONCLUSION: Despite the late examination at the Eye Clinic the functional loss was mostly little except after chemical burns. Nevertheless, most occupational accidents can be avoided with better protective devices in order to reduce the incidence of injuries and socioeconomical damage. Therefore an intense campaign about protective devices at the place of employment should be required. We conclude that education about safety glasses in the workplace by tradespeople and trades assistants during tasks for which goggles are recommended could considerably reduce the rate of occupational eye traumata. The data of the University Eye Clinic of Tübingen are useful to identify strategies to prevent eye injuries such as wider and better use of safety glasses and improvement in engineering controls.

Accidents, Occupational↗

An investigation into the effect of protective devices on the dose to radiosensitive organs in the head and neck.

A series of experiments were performed to determine the dose reduction afforded to radiosensitive organs in the head and neck by various protective devices. These included spectacles with plastic, standard glass, photochromic and lead-glass lenses, a thyroid collar and a lead-acrylic face mask. The measurements were performed using an anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters, in conditions realistic of clinical practice. Irradiations were performed using scattered radiation produced by a pelvic phantom, for X-ray beams generated at 80 kVp and 110 KVp. It was found that the reduction in dose to the lens of the eye ranged between 0% and 97%, whilst the dose to the thyroid and oesophagus was reduced by between 76% and 97%, and was dependent on the protective device and tube potential employed. A reduction in brain dose of up to 81% was also measured, for the lead-acrylic face mask. Also presented is the ratio of organ dose to dose to the bridge of the nose for thyroid, oesophagus, brain and sinuses, as measured for the case of no head or neck protection.

Brain↗

Eye protection in dental laboratories.

Many dental laboratory procedures increase the chances of serious eye injury. This would include traumatic injuries due to projectiles or through exposure to harsh chemicals or heat and infections from contact with patient body fluids. To help assure a safer working environment, awareness of the need for eye protection must be established and maintained by all laboratory personnel. The purpose of this article are: 1) to list the applicable federal regulations concerning eye safety in dental laboratory workplaces; 2) to describe the various types of appropriate eyewear; and 3) to identify which protective devices best prevent exposure to specific types of hazards. The goal of this article is to help dental laboratories with their employee safety programs, especially concerning the selection of protective eyewear. Such programs must include engineering controls and work practice controls plus appropriate personal protective equipment. Laboratories today must comply with safety mandates in the most effective and efficient manner.

Equipment Design↗

Ocular injuries in hockey.

Ocular injuries suffered by 38 hockey players during a three-year period were studied. The severity of the injuries required hospitalization for 16 of the patients. Twelve players require follow-up care for possible late complications from the following conditions: angle recession (seven cases), subluxated lens (three cases), traumatic cataract (three cases), detachment of the retina (two cases), and enucleation (one case). The use of a full-face protective mask affixed to an adequate helmet is recommended for all hockey players.

Adolescent↗

Effects of rectilinear acceleration, caloric and optokinetic stimulation of human subjects in the Spacelab D-1 mission.

A set of vestibular experiments was performed during the course of the German Spacelab D-1 mission from 30 October to 6 November 1985 by a consortium of experimenters from various european countries. Similar to the Spacelab SL-1 mission all of the scientific crew members were theoretically and practically trained for the experiments. Baseline measurements for all tests were collected 113, 86, 44, 30 and 18 days prior to the mission and compared with data taken inflight, on the landing day and the consecutive 7 to 14 days. The hardware comprised mainly a motordriven accelerating platform, the SPACE SLED, and the vestibular helmet, a multi-purpose instrument in support of a variety of vestibular experiments including air-calorisation of the ears, optokinetic stimulation pattern presentation and optical and nystagmographic recording of eye movements. Measurements of the threshold for the perception of detection of whole body movement did not reveal any dramatic changes in the 2 measured axes inflight when compared to preflight values. Early postflight values show a significantly elevated threshold for all axes in 3 out of 4 subjects. The caloric nystagmus, already found during the SL-1 mission, was confirmed on all three tested subjects during the D-1 mission. It's amplitude and in some instances it's direction were influenced by horizontal acceleration on the SLED. The amplitude of optokinetic nystagmus increased when subjects were allowed to free-float over that seen when subjects were fixed. Stimulation of the neck receptors by roll movements of the body against the fixated head resulted in illusory object motion to the contralateral side. Torsional movements of the eyes during such neck receptor stimulation was present inflight and postflight, while it had not been observed preflight. Most results point to a reduction of otolithic effects in favour of visual and proprioceptive influences for spatial orientation.

Acceleration↗

Use of infrared TV cameras built into head-mounted display to measure torsional eye movements.

PURPOSE: The head-mounted display (HMD) has produced conflict between visual and vestibular stimuli because the HMD image does not move with the head motion of the wearer. The HMD can show binocular parallax three-dimensional (3D) images, in which vergence and accommodation conflict. Thus, the HMD may affect the normal visual/vestibular functions. We attempted to develop a system that makes possible the measurement of torsional eye movements, vergence eye movements, and pupillary responses of the HMD wearer. METHODS: Our apparatus is composed of two infrared CCD cameras installed in the HMD. Iris images produced by these cameras are analyzed by a personal computer using free software. Further, a third camera fixed on the HMD projects an image of the view as the subject sees it, via video tape recorder or frame memory to the HMD. Images can be stored, replayed, or frozen. RESULTS: Our system can measure torsional eye movement with 0.20 degrees resolution every 1/30 (or 1/60) seconds even though the pupil size alternates during measurement. Binocular eye movement and pupillary response are also measured. CONCLUSION: A system was developed which can be used for assessment of the effect of 3D HMD on the visual system. A third camera coupled with HMD can control visual stimulus independently of head motion (vestibular stimulus).

Eye Movements↗

Eye injuries in Canadian amateur hockey.

Two studies, one retrospective (1972 to 1973) and one prospective (1974 to 1975), CONcerning eye injuries incurred by hockey players were conducted by the Canadian Ophthalmological Society with questionnaires to its members. Responses to the questionnaires were analyzed by age, type of injury, cause (i.e., hockey stick, puck, or other means), and results to visual acuity. The results were also designated by organized or unorganized participation. Almost 300 eye injuries were reported in each study. In the first study, 13.7% of the injured players became legally blind as a result of the injury; in the second study, 16% became legally blind. Organized hockey produced more injuries than unorganized hockey. The majority of the injuries were caused by the hockey stick. The injuries were both intraocular and extraocular. The group of 11- to 15-year olds received the highest number of injuries, and the older age group had the higher incidence of blindness. Studies have led to setting more rigid standards, altering rules of the game, and selecting face protectors for hockey players. Older players who care for their equipment prefer the plastic shield face protectors, and the younger players (who complain of fogging and scratching of the plastic) prefer mesh protectors through which neither the stick nor the puck can penetrate. New high sticking (above the shoulder level) rules were included in the 1976 official rule book for Canadian amateur hockey.

Adolescent↗

Oculomotor responses with aviator helmet-mounted displays and their relation to in-flight symptoms.

Previous experiments have raised the possibility that abnormal oculomotor functioning could be the substrate for visual problems among aviators who use helmet-mounted displays. However, until the present investigation, no direct evidence linked the two. In our experiments, experienced Apache helicopter pilots, using the same helmet-mounted display that they use in flight, viewed Apache symbology and sensor imagery while we measured their accommodation and vergence eye movements in the laboratory. We found three circumstances that frequently occur in flight in which aviators with visual symptoms had different oculomotor responses than did asymptomatic aviators. Further work needs to be done to determine why symptomatic aviators respond differently from asymptomatic ones.

Accommodation, Ocular↗

Gain and delay of human vestibulo-ocular reflexes to oscillation and steps of the head by a reactive torque helmet. I. Normal subjects.

Vestibulo-ocular reflexes (VOR) were evaluated with a reactive torque helmet that imposed high-frequency oscillation (2-20 Hz) or step displacements of the head in the horizontal plane. The present paper describes the experimental and analytical techniques and the results for normal subjects, which will serve as a baseline for the evaluation of vestibular pathology. For comparison, manually controlled head steps were also applied, as described in the literature. Eye and head movements were recorded with magnetic search coils. Non-vestibular effects were avoided by the use of high stimulus frequencies and the analysis of short time-windows (< 100 msec) after steps. Helmet-imposed steps caused a virtually uniform head acceleration (average magnitude 770 degrees/sec) in the first 90 msec. This resulted in a linear relation between eye and head velocities; the gain and delay of the VOR could be calculated independently from the slope and offset of this relation. Such estimates appear more reliable than those obtained with conventional techniques. Normal subjects had a VOR gain of about 0.9 and a delay of about 5 msec. The results of sinusoidal head oscillation were in agreement with the results for steps. The responses to manually generated head steps agreed in general with those to helmet-induced steps, but because of the non-uniform acceleration they allowed a less exact analysis of function.

Acceleration↗

Eye injuries in Canadian amateur hockey.

The incidence of eye injury in Canadian amateur hockey has declined sharply, from 257 cases in the 1974-75 season to 124 in the 1983-84 season, since face protectors certified by the Canadian Standards Association (CSA) and attached to CSA-certified helmets became mandatory for minor hockey players in this country. None of the reported cases in 1983-84 were in players wearing such equipment. The average age of the injured players was 14 years in 1974-75 but 24 years in 1983-84; that is, younger players are now protected, but older players are not. Hockey sticks and pucks were the top two causes of eye injury in both seasons, but hyphema became the commonest type of injury in 1983-84, surpassing soft tissue damage. The frequency of legal blindness as the visual outcome fell from 19% in 1974-75 to 11% in 1983-84. A suitable face protector must now be developed for older players.

Adolescent↗

Retinal detachment following hockey injury.

Thirty-three cases of retinal detachment following hockey injury were seen during a 15-year period at the retina clinic of Maisonneuve-Rosemont Hospital, Montreal. Most injuries occurred in adolescents, the average age being 18 years. The mean interval between injury and preoperative examination was 3 years. Almost half of these young hockey players remained legally blind in the affected eye even after a successful operation. A helmet with a protective face visor is suggested as the best prevention against severe ocular damage such as retinal detachment.

Adolescent↗