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At least 19 recordsLinked to original sources
PubMed2006

Emergency management of corneal injuries.

UNLABELLED: Corneal injuries account for a significant proportion of the ophthalmic workload of most emergency departments. Although the vast majority of cases are relatively minor, accurate diagnosis and appropriate management are vital to prevent potentially sight-threatening sequelae. We present a survey of corneal injury cases at a general emergency department. INTRODUCTION: Corneal injuries are very common in both the adult and paediatric population and account for a significant proportion of the workload of most emergency departments. This survey assesses management of corneal injury cases at a general emergency department. MATERIALS AND METHODS: A retrospective case study was performed of 100 patients consecutively diagnosed with a corneal abrasion by slit lamp examination at the emergency department of the Chelsea and Westminster Hospital, London. Each case was assessed to determine documentation of set criteria including visual acuity (VA), treatment and grade of examiner. RESULTS: The commonest cause of injury was direct minor trauma (64% of cases) with contact lens related problems accounting for 12% of presentations. VA was documented correctly in 85 adult patients (90.4% of adults), incorrectly in 2 cases, and not documented at all in 7 adults (7.4%). VA was not recorded in paediatric cases. All cases were treated with topical chloramphenicol drops although frequency of treatment ranged from 2 to 5 times daily and duration of treatment ranged between 3 and 5 days and for 7 days. 6 cases (6%) were assessed by an emergency nurse practitioner and the remaining number were seen by a casualty officer. DISCUSSION: VA must be accurately documented in all adult cases and should be documented in children of school age. A pinhole test should be performed in cases where VA is below 6/9. For analgesia, the use of topical nonsteroidal anti-inflammatory drugs, lubricants and bandage contact lens should be considered. Emergency nurse practitioners and general practitioners are ideally placed to follow-up uncomplicated cases.

Adult↗
PubMedDate not supplied

A retrospective study of the incidence and prevalence of thermal corneal injury in patients with burns.

The clinical course of thermal corneal injuries is not well described. A review of 1750 burn admissions to a regional burn center between 1979 through 1993 was done to determine the clinical course of thermal corneal injuries. Twenty-five out of 1750 burn admissions (1%) presented with a thermal corneal injury. Corneal injuries were identified with use of a fluorescein dye and a Wood's lamp. Ophthalmologic consultation was obtained for those identified. Data were analyzed with the Fisher's exact test and the unpaired two-tailed Student's t test. Patients with thermal corneal injury did not differ demographically from other patients with burn injury. Open-flame burns were the most common cause of injury. Improvement of corneal injury occurred in all survivors who had an intact globe on initial examination. Initial visual acuity was not a good predictor of outcome, and long-term complications were uncommon.

Adolescent↗
PubMed1988

Corneal injuries.

The article on corneal injuries illustrates the means by which mechanical, chemical, and radiant energies interrupt the normal anatomy and physiology of the cornea. Methods of diagnosis and management of such problems, including those caused by contact lenses, are presented.

Burns, Chemical↗
PubMed1985

Self-inflicted corneal injuries in children with congenital corneal anaesthesia.

Severe corneal ulceration related to self-inflicted injury in the presence of congenital corneal anaesthesia is described in four boys under 2 1/2 years of age. The ulcers had failed to heal until it was recognised that the children were scratching their own eyes. The application of arm splints allowed rapid healing. Although corneal ulceration is a recognised complication of congenital corneal anaesthesia, this preventable cause of the ulceration has not previously been recognised. In two cases there were isolated recurrences which healed quickly with the reapplication of splints. All four children had good vision initially, and, although there were no overt gross development abnormalities, two had neurological signs on detailed investigation suggesting cerebellar or brain stem malformation and one had unilateral anophthalmos, talipes equinovarus, and patent ductus arteriosus. All the children showed normal intellectual development. Whether the eye scratching behaviour was the primary cause of the ulceration or merely an aggravating factor, the identification of this abnormal behaviour is important in any child with idiopathic corneal ulceration, as even in the presence of congenital corneal anaesthesia the eyes heal quickly with effective splinting of the elbows. It is therefore important to test sensation of the cornea and face and to consider the possibility of self-inflicted injury in children with refractory corneal ulceration, as in our cases there were no other consistent diagnostic features.

Child, Preschool↗
PubMed2006

Extent of corneal injury as a biomarker for hazard assessment and the development of alternative models to the Draize rabbit eye test.

We have characterized 22 ocular irritants differing in type (surfactants, acid, alkali, bleaches, alcohol, aldehyde, acetone) and severity (slight to severe) by using the low-volume rabbit eye test. Ocular irritation was evaluated by 1) light microscopy to assess pathological changes, 2) in vivo confocal microscopy (CM) to quantify 4-dimensionally (x, y, z, and t) initial corneal injury and later responses in the same eye, and 3) laser scanning CM to quantify initial cell death. These studies revealed that regardless of the processes leading to injury, slight irritants injure the corneal epithelium, mild irritants injure the corneal epithelium and the superficial stroma, and moderate/severe irritants injure the epithelium, deep stroma, and at times the corneal endothelium. Furthermore, extent of initial corneal injury was shown to predict subsequent responses and final outcomes. These findings suggest that extent of corneal injury may be used as a basis for the development of alternative ocular irritation tests. To test the validity of this approach, we have used an ex vivo, rabbit cornea culture model to measure extent of corneal injury following exposure to ocular irritants. Data indicate that the extent of ex vivo corneal injury significantly correlate with the extent of initial injury measured previously in live animals. Overall, these findings indicate that extent of initial corneal injury can be used as a new "gold standard" for the continued refinement and ultimate replacement of the Draize rabbit eye Ocular Irritation Test.

Animal Testing Alternatives↗
PubMed1980

The role of arachidonic acid metabolites in the mediation of the polymorphonuclear leukocyte response following corneal injury.

The immediate polymorphonuclear leukocyte (PMN) response in the tear fluid was investigated following five different types of corneal injury. All injuries produced significant amounts of PMNs in the tear fluid within the first 6 hr of injury. Histological examination of injured corneas demonstrated that PMNs were attached to the denuded surface but were unable to attach to intact epithelium. Topical arachidonic acid, prostaglandin (PG) PGE1 and PGE2, and prostacyclin (PGI2) induced the arrival of PMNs into the tear fluid of normal rabbit eyes, but topical PGF2 alpha, PG-6-keto-PGF1 alpha, and thromboxane did not elicit a PMN response from normal conjunctiva. Tear fluid samples 2 to 4 hr following corneal epithelial denudation demonstrated PGE-type activity. Pretreatment with topical (0.05% and 0.5%) and intraperitoneal (i.p.) indomethacin (100 mg/kg) markedly inhibited the PMN response following partial corneal epithelial denudation. However, an i.p. dose of 5 mg/kg indomethacin potentiated the tear fluid PMN response following corneal injury. The inhibition of the PMN response by indomethacin suggested that arachidonic acid metabolites may be involved in the mediation of PMN chemotaxis following corneal injury.

Animals↗
PubMed1999

[Etiology of non-penetrating corneal injuries].

BACKGROUND: Non-penetrating injuries of the cornea are frequent. Complications like corneal infiltrations, or corneal ulcera, may follow. MATERIAL AND METHODS: This prospective study included 144 patients with non-penetrating corneal injuries. Records contained epidemiological data, field of activity, profession, cause of the injury, and stress during the trauma. RESULTS: 97% of the patients were men, 78% of the injuries occurred during working hours, 41% of the patients were from metal working professions, 73% of the accidents happened with grinding machines and drilling machines. Only 6.9% of patients weared adequate glasses. The cause of trauma was deflection and working without glasses. In 32% of patients stress played a role in the cause of injuries. CONCLUSIONS: Most of the corneal, non penetrating injuries happened during the working hours by deflection, and by neglecting safety glasses. With the use of safety glasses the number of corneal non-penetrating injuries could definitely be reduced.

Accidents, Occupational↗
PubMed1999

Quantitative measurement of acute corneal injury in rabbits with surfactants of different type and irritancy.

We have hypothesized that differences in ocular irritancy are related to differences in extent of initial injury and that, regardless of the processes leading to tissue damage, extent of injury is the primary factor that determines the final outcome of ocular irritation. In previous in vivo confocal microscopic (CM) studies we identified quantifiable differences in the extent of corneal injury occurring with four surfactants (three anionic, one cationic) known to cause different levels of ocular irritation and demonstrated that extent of initial corneal injury was related to the magnitude of cell death. The purpose of this study was to assess the applicability of this hypothesis to a broad sampling of surfactants. Specifically, initial corneal changes induced by seven different surfactants (one anionic, three cationic, three nonionic) were measured by in vivo CM and cell death was measured by an ex vivo live/dead assay. The right eye of each rabbit was treated by placing 10 microl of a surfactant directly on the cornea. Eyes were examined macroscopically and scored for irritation at 3 h and 1 day. At 3 h and 1 day, in vivo CM was used to examine the corneas and quantitate epithelial cell size, epithelial thickness, corneal thickness, and depth of stromal injury. At 3 h and/or at 1 day, corneas were removed and excised regions were placed in culture media containing 2 microM calcein AM and 4 microM ethidium homodimer. Using laser scanning CM, the number of dead epithelial and/or stromal cells in a 300 x 300 x 170-microm3 (xyz) volume of the cornea was determined. In vivo CM and live/dead assay findings revealed three surfactants to affect only the epithelium, three surfactants to affect the epithelium and superficial stroma, and one surfactant to affect the epithelium and deep stroma. Extent of initial corneal injury reflected level of ocular irritation, and magnitude of cell death was related to the extent of initial corneal injury. These findings are consistent with those for known slight, mild, and moderate to severe irritants, respectively. They suggest that our hypothesis is broadly applicable to surfactants. Additionally, we believe these surfactants should be included as part of a new "gold standard" for use in developing and validating in vitro tests to replace the use of animals in ocular irritancy testing.

Animals↗
PubMed1996

Topical analgesia for superficial corneal injuries.

OBJECTIVE: To assess the analgesic effects of a topical non-steroidal anti-inflammatory agent, flurbiprofen 0.03%, during healing after superficial corneal injuries. METHODS: 401 patients treated for corneal abrasion in a five month period were randomly allocated to one of four treatment groups: polyvinyl alcohol alone (control), homatropine 2%, flurbiprofen 0.03%, or homatropine 2% followed by flurbiprofen 0.03%. Treatments were given for 48 h. Ocular pain was recorded on a visual analogue scale by the patients over the first 24 h, and use of oral analgesics was also recorded. Usable responses were received from 224 patients (55.8%). RESULTS: Patients treated with flurbiprofen had significantly lower pain scores for the 24 h duration of the study than controls (P < 0.05). CONCLUSIONS: Flurbiprofen eye drops provide more effective pain relief than traditional treatments for superficial corneal injuries.

Administration, Topical↗
PubMed2006

Reverse geometry contact lens fitting in corneal scar caused by perforating corneal injuries.

PURPOSE: To describe a reverse geometry rigid gas permeable (RGP) contact lens fitting in corneal scar caused by perforating corneal injuries with intraocular strange body. METHODS: A reverse geometry RGP lens, with large diameter, was empirically fitted in a 38-year-old male patient who had previous open globe injuries due to work accident in right eye. Corneal suture, vitrectomy and lens extraction were performed. Irregular corneal surface with corneal scar in line with the visual axis were found with low uncorrected visual acuity. RESULTS: Snellen visual acuity improved from counterfinger to 0.8 with high contact lens acceptance, 6-9h per day of wear. Only three diagnostic contact lenses, in two visits, were necessary. Orbscan simulated fluorescein pattern was different to definitive fluorescein pattern. CONCLUSIONS: Reverse geometry RGP contact lens, with large diameters, could be a good alternative in irregular corneal surface with corneal scar. Fluorescein pattern analysis could be the proper fitting technique. This fitting could involve less time and fewer visits. Computer-aided fitting was of limited value in these cases.

Accidents, Occupational↗
PubMedDate not supplied

Suspended onion particles and potential corneal injury in onion harvesters.

The authors suspected that suspended onion particles contributed to corneal ulcers in onion harvesters in southern Taiwan. In the present study, the authors used manikins to study suspended onion particles in fields in an effort to simulate typical conditions experienced by onion harvesters. An animal eye-exposure simulation study was also performed by the authors, who impacted suspended soil grains or onion particles onto the corneas of guinea pigs via aerosol generated from the Palas dispersion nozzle. The average size of 25.9 pm for suspended particles collected during the digging of onions was the largest one of those for various harvesting activities. Some onion skin flakes were found in samples obtained from gathering and packing activities; the typical flake size was approximately 3.5 x 2.5 mm2. The results of the animal study indicated that the size of soil grains has a demonstrable effect on the severity of corneal injury (p = .009). With respect to onion skin flakes, wind velocity was also associated significantly with the occurrence of corneal injury (p = .0004). A wind velocity threshold of 7 m/sec is recommended for the maintenance of safety, and if the wind speed exceeds this threshold level, workers should not engage in harvesting activities. Furthermore, use of appropriately designed goggles is necessary for the protection of onion harvesters who work in high-wind conditions.

Agricultural Workers' Diseases↗
PubMedDate not supplied

[Implantation epithelial iris cyst following the perforating corneal injury].

The objective of this case report was to present the development of implantation cyst following the perforating corneal injury, the problems related to the treatment, including total surgical excision of the cyst, the secondary cataract extraction, iridoplasty and the artificial intraocular lens reposition. A patient first presented with perforating corneal injury inflicted by a piece of wood, with the iris prolapse. Primary wound management, reposition of prolapsed iris and corneal sutures were performed four days after the injury. Eight months later, the patient was rehospitalized due to an implantation iris cyst and traumatic cataract. The cyst was excised, the extracapsular cataract extraction was done and the anterior chamber lens was implanted. Postoperative visual acuity was normal. Three years later, the patient presented for a follow-up examination, with the cyst filled up again, occupying two thirds of the anterior chamber. This time, the cyst was completely excised, all fibrous remnants of the secondary cataract were removed, and the iridoplasty was necessary due to large iris coloboma. Reposition of the anterior chamber lens was carried out. Histological examination revealed an implantation iris cyst covered by multilayered squamous epithelium. Normal visual acuity was achieved. The patient has been followed-up for six months uneventfully. Management of perforating corneal wound with iris prolapse may lead to development of an implantation iris cyst. Puncture of the cyst as well as incomplete excision will not solve the problem. Complete surgical removal of the iris cyst is the treatment of choice.

Cataract↗
PubMed2006

Corneal injury by anti-misting agent in swim goggles: a case report.

PURPOSE: To report a case of corneal injury by swim goggle anti-misting agent. METHODS: Case report. RESULTS: A 47-year-old man presented with ocular injury caused by swim goggle anti-misting agent. Two weeks previously, the patient felt sudden ocular pain and grit after pool water flooded his goggles while swimming. Before the patient's swim, a copious amount of anti-misting agent was sprayed inside his goggles. On examination, severe corneal epithelial defect and stroma edema of the right eye were noted. Best-corrected visual acuity (BCVA) was 20/40. Right eye corneal thickness was 625 microm. Topical corticosteroids, antibiotic eye drops, and oral tetracycline were started. After 1 week of treatment, the epithelial defect of his right cornea improved slightly. Stromal edema decreased mildly. Epithelial defect persisted at 1 month follow-up. Right eye BCVA remained 20/40. Three months after treatment, the right eye epithelial defect healed completely. Mild diffuse superficial stromal opacity was noted. BCVA improved to 20/20. At 1-year follow-up, right eye corneal thickness was 547 microm, which was thinner than the left eye. Right eye corneal endothelial cell density measured approximately 1500 cells/mm2, which was less than the left eye at 2300 cells/mm2. The faint, diffuse stromal opacity disappeared; however, white subepithelial plaques were noted in the cornea centers. After 1 month of treatment with topical corticosteroids, the plaques subsided completely. The corneas remained clear at 2-year follow-up. CONCLUSION: Anti-misting agent can cause severe corneal injuries, including persistent epithelial defects, stromal edema and opacity, endothelial cell loss, and subepithelial plaque.

Anti-Bacterial Agents↗
PubMed1997

Combined non-steroidal therapy in experimental corneal injury.

PURPOSE: The effects of anti-inflammatory non-steroidal therapy combined with free-radical scavengers were studied and compared to corticosteroid use in the treatment of experimental corneal injury. METHOD: Eighty New Zealand albino rabbits were used in this study. A corneal alkali burn was induced by applying 1-N NaOH filter paper on the central axis of the right cornea for 30 s. Animals were distributed into five treatment groups: group 1 (control group) was only given gentamicin; group 2 was treated with 0.5% dimethylthiourea (DMU); group 3 received 1% dexamethasone; group 4 was given combined 0.5% DMU and 1% indomethacin; group 5 was treated with 0.5% DMU and 0.1% diclofenac sodium. One 50-microliter drop of gentamicin was instilled every 12 h, whereas the other drugs were instilled every 6 h (50 microliters). All groups received the same antibiotic treatment as the control group. The animals were killed on the 5th day. Inflammatory index, area and perimeter of the wounded corneal zone, and corneal transparency were evaluated. RESULTS: No significant differences in the inflammatory index were found between the treatment groups and the control group after 72 h. Significant differences (p < 0.001) were observed at 24 h in groups 3-5 when compared with the control group. Planimetry showed significant differences in group 4 when compared with the other groups (p < 0.05). Corneal transparency study showed statistically significantly better values in groups 4 and 5, when compared with the other groups, including group 3 (p < 0.05). CONCLUSIONS: The use of 0.5% DMU combined with 1% indomethacin can be considered an alternative to corticosteroid treatment in our experimental chemical corneal injury.

Administration, Topical↗
PubMed1998

Area and depth of surfactant-induced corneal injury predicts extent of subsequent ocular responses.

PURPOSE: To correlate area and depth of initial corneal injury induced by surfactants of differing type and irritant properties with corneal responses and outcome in the same animals over time by using in vivo confocal microscopy (CM). METHODS: Six groups of six adult rabbits were treated with anionic, cationic, and nonionic surfactants that caused different levels of ocular irritation. Test materials included slight irritants: 5% sodium lauryl sulfate (SLS), polyoxyethylene glycol monoalkyl ether (POE), and 5% 3-isotridecyloxypropyl-bis(polyoxyethylene) ammonium chloride (ITDOP); mild irritants: 5% 3-decyloxypropyl-bis(polyoxyethylene) amine (DOP) and sodium linear alkylbenzene sulfonate (LAS); and a moderate irritant: a proprietary detergent (DTRGT). Ten microliters surfactant were directly applied to the cornea of one eye of each rabbit. Ten untreated rabbits served as control subjects. Area and depth of initial injury was determined by using in vivo CM to measure epithelial thickness, epithelial cell size, corneal thickness, and depth of stromal injury in four corneal regions at 3 hours and at day 1. Area and depth of corneal responses to injury were evaluated at various times from days 3 through 35 by macroscopic grading and quantitative confocal microscopy through-focusing (CMTF). RESULTS: In vivo CM revealed corneal injury with slight irritants to be restricted to the epithelium, whereas the mild and moderate irritants caused complete epithelial cell loss with increasing anterior stromal damage: DOP < LAS < DTRGT. With the slight ocular irritants there was little or no change in corneal thickness or the CMTF intensity profiles. Three hours after treatment, mild and moderate ocular irritants caused a significant increase in corneal thickness, which peaked at day 1 with DOP (483.3+/-80.1 microm) and LAS (572.3+/-60.0 microm) and day 3 with DTRGT (601.4+/-68.7 microm); returning to normal (similar to control values) by day 7 with DOP and day 35 with LAS and DTRGT. The CMTF intensity profiles also showed significant elevation over that in the anterior stroma, which peaked at day 1 with DOP (14,608+/-4,306 U [U is defined as micrometers X pixel intensity]) and day 3 with LAS and DTRGT (18,471+/-6,581 U and 22,424+/-3,704 U, respectively) and returned toward normal by day 7 with DOP and day 14 with LAS and DTRGT. Elevated CMTF profiles principally reflected the presence of hyperreflective, punctate keratocytes and inflammatory cells at days 1 and 3 and the presence of activated keratocytes at day 7. There was a significant correlation between the elevated CMTF intensity profile and the corresponding macroscopic total score in each eye (r = 0.839; P < 0.001). More important, there was a significant correlation between area and depth of initial stromal injury measured at day 1, regardless of ocular irritant and the stromal response measured by the area under the CMTF intensity profile curve in each cornea (r = 0.87; P < 0.0005). A significant correlation between the area and depth of injury and the area under the corneal thickness curve was also observed in each cornea (r = 0.75; P < 0.0005). CONCLUSIONS: In individual animals, the extent of initial stromal injury correlated with the magnitude of the corneal responses, measured by the change in corneal thickness and the CMTF depth intensity profile. These findings further support the hypothesis that area and depth of injury are the principal factors determining the early responses and eventual repair processes after accidental eye irritation. They also support the proposed use of area and depth of acute injury as a mechanistic correlate to ocular irritation in the development and validation of potential in vitro ocular irritation tests.

Animals↗
PubMed1994

[Factors of graft failure after chemical corneal injury].

83 cases (97 eyes) of keratoplasty after chemical corneal injury were followed up for a mean 14 months with the results that 21 (21.6%) grafts were transparent and 76 (78.4%) opaque or semitransparent. The success rate depended on the severity of the chemical injury; it was 87.5% for type A corneal scarring and 15.7% for type B. The causes of graft failure were postoperative epithelial erosion (70.7%) and corneal rejection (28.0%). Most patients with epithelial erosion had problems of insufficient tear secretion and tear-film defects. The prevention and management of graft failure were discussed.

Adolescent↗
PubMed1996

Role of matrix metalloproteinases in failure to re-epithelialize after corneal injury.

Delayed re-epithelialization of the cornea after injury usually precedes stromal ulceration. Previous findings using a rat thermal injury model suggested that re-epithelialization is impeded by products of resident corneal cells, which destroy adhesive structures at the basement membrane zone. In this study, we provide additional evidence for this concept. Failure to re-epithelialize was found to correlate with an increase in the amounts of gelatinolytic matrix metalloproteinases present in the rat cornea. One of these gelatinases, gelatinase B, is synthesized by the resident corneal cells, and inhibitions of its synthesis correlated with inhibition of basement membrane dissolution. The matrix metalloproteinases collagenase and stromelysin are also synthesized by resident corneal cells in thermally injured corneas of rabbits, but the timing of bulk enzyme synthesis correlated more closely with deposition of repair tissue in the stroma than with failure to re-epithelialize. Nevertheless, in human corneas with repair defects, gelatinase B and collagenase are synthesized by cells in the basal layer of the epithelium directly adjacent to the basement membrane, suggesting that both could participate in dissolution of this structure. Importantly, treatment of thermally injured corneas with a synthetic inhibitor of matrix metalloproteinases significantly improved basement membrane integrity. These data support the concept that over-expression of matrix metalloproteinases by resident corneal cells impedes re-epithelialization after some types of corneal injury.

Animals↗