Different types of force can lead to blunt trauma. Representative micrographs of control (A,B) and 28 dpi (C,D) optic nerve cross-sections from Bl/6 (A,C) and D2 (B, C) mice. [85][Level 5], Scott R, The injured eye. The Bl/6 (A) and D2 (B) retinas appear normal at baseline in both the b-scan and fundus images. The olfactory epithelium was examined in 7 dpi Bl/6 mice (n = 4) for evidence of blast injury to the tissue between the eyes (S4 Fig). A subconjunctival hemorrhage happens when blood appears in the clear skin part of the eye (the conjunctiva) that covers the white part (the sclera). Eye Exam Caspase-1 immunolabeling at 28dpi is the same in both central (D) and mid-peripheral (E) retina. The scale bar in A is 50m and applies to all micrographs. [79]Visual acuity is worse after blunt ocular trauma if there is a hyphema, retinal detachment, and/or vitreous hemorrhage. Fig 10. The scale bar in (A) is 50m and applies to all micrographs. Quantitative trait loci (QTL) applications to substances of abuse: physical dependence studies with nitrous oxide and ethanol in BXD mice, Localization of genes influencing ethanol-induced conditioned place preference and locomotor activity in BXD recombinant inbred mice, Genetic control of the mouse cerebellum: identification of quantitative trait loci modulating size and architecture. . The number of pyknotic nuclei in the outer nuclear layer (ONL) or inner nuclear layer (INL) was quantified within a single section of retina through the middle of each eye. [72], In cases of doubtful visual acuity, electroretinogram (ERG), electrooculography (EOG), visual evoked potential (VEP) are helpful to assess the integrity of the optic nerve and retina. PMCID: PMC4493046 DOI: 10.1371/journal.pone.0131921 Abstract Damage to the eye from blast exposure can occur as a result of the overpressure air-wave (primary injury), flying debris (secondary injury), blunt force trauma (tertiary injury), and/or chemical/thermal burns (quaternary injury). Fig 3. Anterior globe rupture can be hidden by subconjunctival hemorrhage, and rupture at the site of the old surgical wound like cataract and keratoplasty may result from severe blunt trauma. Injuries in the pediatric population are more often with sharp objects directly penetrating the globe (e.g., writing utensils, scissors, or knives). The changes in labeling were uniform across the retina. P30 EY008126/EY/NEI NIH HHS/United States, R01 EY022349/EY/NEI NIH HHS/United States, NCI CPTC Antibody Characterization Program, Scott R. The injured eye. However, there were significant reductions in both amax and bmax in the D2 (n = 26) after blast when compared to baseline values (Fig 12B and 12D). A Mayo Clinic surgeon provides tips on this injury and the question of transfer. Outline the evaluation of patients with blunt eye trauma. Survey of ophthalmology. (C) Corneal edema and calcium deposits (arrow) at 7 dpi. At 3 dpi (n = 3), the GFAP positive processes were detected uniformly across the retina (Fig 8B). Clipboard, Search History, and several other advanced features are temporarily unavailable. The Journal of craniofacial surgery. [71], A plain X-ray of the skull and orbit is helpful to locate any intraocular foreign body. glial reactivity) in the retina [25]. 2012 Sep [PubMed PMID: 22929502], Rahman I,Maino A,Devadason D,Leatherbarrow B, Open globe injuries: factors predictive of poor outcome. BMJ case reports. Scientific reports. In the Bl/6 mouse, disruption of the outer segments (as determined by a bright area on the fundus, (Fig 2C) was observed in 25% of retinae within the mid-periphery at 7 days (n = 8) and in 8% of retinae at 14 (n = 13) and 28 dpi (n = 11). In order to determine the percentage of the retina with cell death, we measured and summed the lengths of all sections on the slide. Weichel ED, Colyer MH, Bautista C, Bower KS, French LM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Thus this may explain, in part, why greater glial reactivity and oxidative stress was seen in the D2 retina than in the Bl6 retina in the absence of eye drops and why these simple eye drops limited the area of retinal damage. Retinal detachments occur in both. 2011 Apr [PubMed PMID: 23960924], Rajsic S,Breitkopf R,Bachler M,Treml B, Diagnostic Modalities in Critical Care: Point-of-Care Approach. Spontaneous hyphema . Traumatic brain injury associated with combat ocular trauma. Eye Allergies The scale bar in A is 20m and applies to all micrographs. 2021 [PubMed PMID: 33780448], Ram J,Verma N,Gupta N,Chaudhary M, Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India. The bar graphs represent the average SEM for each time point and strain. In the D2 mice, no retinal detachments were detected at 7dpi (n = 10). Korean journal of ophthalmology : KJO. Commotio retinae is characterized by focal damage to the RPE and photoreceptors that spontaneously resolves in the majority of patients [1821]. Molecular changes and vision loss in a mouse model of closed-globe blast trauma. An occult posterior rupture can be present when the anterior chamber depth is variable. Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, United States of America. American family physician. [71], The cornea is stained with fluorescein stain under topical anesthesia, and the tear site is observed for an aqueous leak on pressure on the globe under a cobalt blue filter. it is an ideal way to assess the anterior chamber and iridocorneal angle in cases of blunt trauma to the eye. One study showed that ocular trauma, in general, resulted in monocular blindness in one-quarter of patients. Inclusion in an NLM database does not imply endorsement of, or agreement with, Traumatic hyphema: Management - UpToDate In the D2 mice (n = 9), OKN scores first declined significantly at 3 dpi (0.340.07 c/d, p<0.05) when compared to baseline values (0.600.03 c/d, Fig 11B). The consequences of ocular trauma range from complete recovery to irreversible blindness, with or without loss of the eye. A previous report showed that more than half of the cases of badminton eye trauma resulted in chronic vision loss. Pediatric emergency care. Contributed reagents/materials/analysis tools: TSR. The epidemiology of serious eye injuries from the United States Eye Injury Registry. Visual loss (variable) Photophobia Possible diplopia Signs of blunt trauma Mild cases (usually with good corrected vision) eyelid swelling (oedema), ecchymosis (bruising) conjunctival chemosis, subconjunctival haemorrhage unexplained subconjunctival haemorrhages in babies and young children may indicate non-accidental injury corneal abrasion However, there was no sign of injury to the olfactory epithelium or optic nerve in either strain. What are the appropriate investigations and management for blunt trauma to the eye? Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, United States of America, 2 Fig 7. 2020 Jan-Mar [PubMed PMID: 32395048], Scheufele TA,Blomquist PH, spectrum of ocular trauma at an urban county hospital. Epifluorescence micrographs of retinas from control (A), 3 dpi (B) and 28 dpi (C) eyes labeled with anti-caspase-1 (green) and DAPI (blue). Scleritis *p<0.05, **p<0.01. The journal of trauma and acute care surgery. [69], This investigation is essential to locate the epithelial defect, look for abrasions, erosions, and seidel's test. Visual acuity decreased over time in both strains, but was more rapid and severe in the DBA/2J. Graphs of OKN responses in Bl/6 (A) and D2 (B). The https:// ensures that you are connecting to the National Library of Medicine 2). The reasons for these differences are unclear. The green line in the fundus image denotes the location of the b-scan. According to. 2019 May [PubMed PMID: 30414237], Doshi R,Noohani T, Subconjunctival Hemorrhage 2020 Jan; [PubMed PMID: 31869130], Vaidyanathan U,Hopping GC,Liu HY,Somani AN,Ronquillo YC,Hoopes PC,Moshirfar M, Persistent Corneal Epithelial Defects: A Review Article. Vision loss after trauma is typically defined as best-corrected visual . Tuusulanjarvi (Lake Tuusula) 30. Myasthenia Gravis 2000;238: 153157. Protective eye gear essential for modern soldier. Vision prognosis is time-sensitive in this setting, with poorer outcomes seen in delays of greater than 4 hours from the time of symptoms. Cataracts were observed in 30% of D2 eyes at both 3 and 28 dpi (Fig 1B). The mice were wrapped in gauze, placed in a holding chamber, and head position was stabilized with a bite bar. Molecular changes and vision loss in a mouse model of closed-globe blast trauma. 2019 May-Aug [PubMed PMID: 31198291], Keel S,Xie J,Foreman J,Taylor HR,Dirani M, The prevalence of vision loss due to ocular trauma in the Australian National Eye Health Survey. Journal of clinical and diagnostic research : JCDR. The caspase-1 positive cells were present throughout the retina (Fig 7D and 7E). Posterior - Pars plana vitrectomy + lens removal + secondary IOL implantation, Topical preservative-free antibiotics hourly, plus systemic antibiotics. PMC Blunt Eye Trauma: Symptoms, Risk & Treatment | MyVision.org Two strains of commercially available mice, Bl/6 (n = 44) and D2 (n = 49), were used in this study (The Jackson Laboratory, Bar Harbor, ME). In the blast-exposed D2 mouse eye, cell death was first detected at 3 days post-injury and decreases in the ERG were first detected at 7 days post-blast [9]. Q1. Briefly, Bl/6 (n = 38) and D2 (n = 42) mice were anesthetized with an intraperitoneal injection of ketamine/xylazine (105/8 mg/kg on average), secured and padded within a housing chamber, and the left (ipsilateral) eye of the mouse was positioned against the hole in the pipe, which was aligned with the barrel of the paintball marker. 3. We collected 10 m-thick sections on 12 slides, with each slide containing representative sections from the entire eye. Imaging was performed in a masked fashion. (D) At 3dpi in the D2, grade 5 vacuoles are present in the RPE (arrowheads) and pyknotic nuclei are present in areas of retinal detachment (arrows). Find company research, competitor information, contact details & financial data for Chiller Oy of TUUSULA, Uusimaa. 2012 Oct:26(4):427-32. doi: 10.1016/j.sjopt.2012.08.002. 2013 Jul; [PubMed PMID: 23665525], Miller DD, Hasan SA, Simmons NL, Stewart MW. They reported a deficit in both the a 2011 Aug [PubMed PMID: 21860574], Kwok JM,Yu CW,Christakis PG, Retinal detachment. Damage to the eye from blast exposure can occur as a result of the overpressure air-wave (primary injury), flying debris (secondary injury), blunt force trauma (tertiary injury), and/or chemical/thermal burns (quaternary injury). This is exemplified in the myriad of ongoing studies using recombinant inbred mice showing wide phenotypic variability that can be mapped to specific genetic loci [1113]. Blunt Eye Trauma - Academia.edu The https:// ensures that you are connecting to the Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface. This site needs JavaScript to work properly. The most common mechanisms of eye trauma involve closed globe, open globe, and radiation injuries. Imaging was performed on a Nikon Eclipse epifluorescence microscope (Nikon, Melville, NY) or an Olympus FV-1000 confocal microscope (Olympus, Center Valley, PA). May D, Kuhn F, Morris R, Witherspoon C, Danis R, Matthews G, et al. Blunt eye trauma can be due to coup, countercoup, and anteroposterior compression or horizontal tissue expansion. The Israel Medical Association journal : IMAJ. Neither Bl/6 (A) nor D2 (B) control RPE and retina contains vacuoles or pyknotic nuclei. Always seek professional medical care after sustaining blunt trauma to the eye. A one-way ANOVA with a Bonferronis post-hoc test was performed on the visual acuity and ERG data using GraphPad Prism software (GraphPad, La Jolla, CA). Buchwald HJ, Weingrtner WE, Spraul CW, Wagner P, Lang GK. Answer and interpretation Q4. Fig 5. Vision loss after trauma is a harmful and usually overlooked consequence that may be avoided with a prompt and accurate intervention. For the first 3 days post-injury (dpi), mice were provided gel recovery food (Clear H2O, Portland, Maine, United States). In a dark room with only a dim red light source, mice were exposed to flashes of light ranging from -2 to 2.88 log cd*s/m2 with a flash frequency of 2000Hz. A blow to the eye: Ocular and orbital trauma - Mayo Clinic Ocular and orbital injuries may require only observation or surgery spanning from simple to complex. Blast was performed as previously described [7]. 3 Most ocular injuries that occur while playing badminton are caused by a direct hit by the shuttlecock. Ophthalmology. Second, the lack of damage to the contralateral optic nerve also supports this hypothesis since blast waves contain shearing forces that are particularly damaging to long structures such as axons [17]. Women's Eye Health, Blunt trauma to the eyes sounds pretty bad, and it can be. Current opinion in ophthalmology. Confocal micrographs of retinas from Bl/6 and D2 control eyes (A,B), Bl/6 and D2 3 dpi eyes (C,D) and Bl/6 and D2 28 dpi eyes (E,F). Rohowetz LJ, Mardelli ME, Duncan RS, Riordan SM, Koulen P. Front Neurosci. Thus, we treated all following mice with non-medicated eye drops to prevent corneal pathology, unless otherwise stated in order to test visual function. Transactions of the American Ophthalmological Society. 3 Closed globe injuries account for most sports related eye injuries. Bulk download StatPearls data from FTP. A retrobulbar hematoma is frequently associated with orbital trauma and associated orbital floor fractures. Clinical study on Hypotony following blunt ocular trauma. Hines-Beard J, Marchetta J, Gordon S, Chaum E, Geisert EE, Rex TS. A protective rigid eye shield should be utilized to prevent any additional injury; eye patches are contraindicated. Ophthalmologe. Decrease tripping hazards in the home, such as loose carpets or electrical wires. The injuries may be due to mechanical trauma (blunt or penetrating), chemical agents, or ultraviolet and ionizing radiation. The diagnosis is clinical, and rarely laboratory and imaging are warranted. 2021 May [PubMed PMID: 31416097], Wangsathaporn K,Tsui I, Commotio Retinae Resulting From Rubber Band Injury in Two Girls. Fig 6. 2019; [PubMed PMID: 31802841], Haavisto AK,Sahraravand A,Puska P,Leivo T, Toy gun eye injuries - eye protection needed Helsinki ocular trauma study. [6], Closed globe injuries are often seen in pediatric children while playing with friends and at home. Survey of ophthalmology. (E) A corneal scar and corneal neovascularization (arrow) at 28 dpi. [14]Open globe injuries are more common in males, usually in the age group of 30to 40 years. PloS one. Medical hypothesis, discovery & innovation ophthalmology journal. Assessments of ocular health (gross pathology, electroretinogram recordings, optokinetic tracking, optical coherence tomography and histology) were performed at 3, 7, 14 and 28 days post-trauma. Question Patient arrives to your ED following blunt force trauma to the right eye with pain and decreased vision. Blunt trauma to the eyes occurs due to sudden force placed on the eye from an impact. (E-F) Schematics illustrating the locations of retinal cross-sections containing TUNEL-positive cells, in relation to the optic nerve (ON) in the Bl/6 (E) and the D2 (F). Although our model directs an overpressure air-wave at the left eye in a restrained and otherwise protected mouse, retinal damage was detected in the contralateral eye. However, there is a strong association between this diagnosis and subsequent blindness. No retinal detachments were detected at 28 dpi (n = 8) suggesting that they resolved over time. The total length of each retinal section with TUNEL positive cells (affected section) was also measured. Analyzed the data: TSR CBA. government site. Prophylactic antibiotics can be used to prevent secondary endophthalmitis.[14]. The pattern of their ERG deficits is also incongruous with our findings. The lower spatial acuity threshold scores in the Bl/6 eyes were consistent with our previous findings in the blast-exposed eyes [8]. Sections were imaged on an Olympus Provis AX70 microscope using a 100x oil immersion objective lens. However, the caspase-1 labeling decreased after trauma such that no labeling was present at either 3 (n = 3) or 28 dpi (n = 3) (S1BS1C Fig). Bar graphs show the percentage of retina containing TUNEL-positive cells (A), the density of TUNEL-positive cells in the retina (B) and the density of TUNEL-positive cells within the affected region (C). Increased GFAP immunolabeling was not detected in any region of the retina at 28 dpi (n = 6) (Fig 8D). [76]In kids, research has shown that visual acuity is generally better in blunt ocular injury compared to penetrating ocular injury, although rates of glaucoma may be higher in blunt ocular trauma. Caspase-1 immunolabeling at 28dpi is the same in both central (D) and mid-peripheral (E) retina. Grade 3 vacuoles were observed in all eyes at 7 dpi (Fig 3C). Assessments of ocular . Injuries At 28 dpi, the amax recovered, but the bmax was significantly reduced at several light intensities. Huan Y, Wu XQ, Chen T, Dou YN, Jia B, He X, Wei DY, Fei Z, Fei F. Neural Regen Res. Changes in nitrotyrosine immunolabeling were limited to focal areas within both the mid-peripheral and central retina. Retinal detachments occur in both Bl/6 and D2 retinas. The traumatic lesions of blunt eye trauma are classified as closed globe injury, globe rupture, and extraocular lesions. Many cases of ocular trauma occur within the home, so consideration should be made to educating patients on ocular protection at all times, and not just traditional high-risk activities such as sports.[84]. [1] Each year,. By Altering Ocular Immune Privilege, Bone Marrowderived Cells Pathogenically Contribute to DBA/2J Pigmentary Glaucoma. Epifluorescence micrographs of retinal cross-sections from Bl/6 and D2 control eyes (A,B) and 7dpi Bl/6 and D2 eyes (C,D). The green line in the fundus image denotes the location of the b-scan. Open globe injuries can be laceration and globe rupture. Invest Ophthalmol Vis Sci. 2003 Jun [PubMed PMID: 12831145], Mnestam EI, Incidence of dislocation of intraocular lenses and pseudophakodonesis 10 years after cataract surgery. Bl/6 (n = 5) and D2 (n = 7) optic nerves were placed in 1% osmium tetroxide in 0.1 M cacodylate buffer, dehydrated in a graded ethanol series and embedded in Spurrs resin (Electron Microscopy Sciences, Hatfield, PA). Thus we describe a model of mild blunt eye trauma. One would expect similar timing of cell death if both eyes were injured by the same injury mechanism (i.e. The various modes of trauma were wood injury 24.9%, and metallic object 20.9% for open globe injury. 2015:28(91):46-8 [PubMed PMID: 26989310], Al-Thowaibi A,Kumar M,Al-Matani I, An overview of penetrating ocular trauma with retained intraocular foreign body. MRI is not indicated in cases of metallic foreign bodies. The sections were rinsed with PBS and incubated with a secondary antibody at a 1:200 dilution (Life Technologies, Grand Island, NY) for 2 hours at room temperature, rinsed with PBS and mounted in Vectashield Mounting medium with DAPI (Vector Laboratories, Burlingame, CA). -, Gendler S, Nadler R, Erlich T, Fogel O, Shushan G, Glassberg E. Eye injury in the Israeli Defense Force:An ounce of prevention is worth a pound of cure. Injury. Common symptoms of globe rupture include eye deformity, eye pain, and vision loss, though depending on the clinical suggestion, the deformity may not be readily apparent on the exam. Below are three types of blunt trauma to the eyes that are especially serious. [4], Imaging modalities like X-rays, CT, and MRI is usually required post-operatively. Blast causes ERG deficits in the D2, but not the Bl/6. GFAP labeling is increased in the Mller glia of D2 eyes at 3, Fig 9. Bricker-Anthony C, Hines-Beard J, Rex TS. Oman journal of ophthalmology. 2019 Jun [PubMed PMID: 30489490], Court JH,Lu LM,Wang N,McGhee CNJ, Visual and ocular morbidity in severe open-globe injuries presenting to a regional eye centre in New Zealand. . Caspase-1 immunolabeling increases at 28. The emergency department physician may treat superficial lacerations around the eye, but all patients with vision loss should be referred to the ophthalmologist. If the visual acuity at presentation is light perception, the prognosis is usually poor. Stroke Retina (Bl/6 n = 20; D2 n = 16) and olfactory epithelium (Bl/6 n = 4) sections were labeled with the TUNEL Apoptosis Detection Kit adhering to the manufacturers protocol (Merck Millipore, Darmstadt, Germany) and mounted with Vectashield Mounting Medium with DAPI. In addition to globe deformity and retrobulbar hematoma, C.T. At 14 dpi (n = 5), an average of 13 retinal detachments per eye were detected in 17% of eyes (Fig 2D). The scale bar for the low magnification micrographs is 250m. At 7 dpi (n = 3), GFAP positive processes were only detected in small patches in the mid-peripheral and central retina (Fig 8C). All mice were between 8 to 12 weeks of age. The examining ophthalmologist has to be careful not to exert excess pressure on the globe in case of open globe injuries to prevent extrusion of intraocular contents. Bricker-Anthony C, Hines-Beard J, DSurney L, Rex TS. Surprisingly, in the D2 mouse, we detected retinal detachments at 14, but not 7 days post-trauma. 2013 Oct 15 [PubMed PMID: 24364572], Zungu T,Mdala S,Manda C,Twabi HS,Kayange P, Characteristics and visual outcome of ocular trauma patients at Queen Elizabeth Central Hospital in Malawi. At 3 dpi (n = 7) in the D2 mouse, nitrotyrosine immunolabeling was greatly increased in the inner retina of all eyes with no apparent regional differences when compared to controls (n = 5) (Fig 10D). With eye drop treatment at 3 dpi, the average grade of RPE vacuoles was reduced to 20.6. Damage to the eye from blast exposure can occur as a result of the overpressure air-wave (primary injury), flying debris (secondary injury), blunt force trauma (tertiary injury), and/or chemical/thermal burns (quaternary injury). In the Bl/6 eyes post-injury, cell death was first detected at 7 dpi (n = 3) and was limited to small patches in the mid-peripheral and occasionally central retina (Fig 4C and 4E). Patients with traumatic cataract subluxated or dislocated nucleus should be managed by a cataract and IOL surgeon. Management of Various Manifestations of Blunt Eye Trauma, Vitamin C 500 mg B.D. Contact Lens Visual acuity decreased over time in both strains, but was more rapid and severe in the DBA/2J. TUNEL positive cells within the ONL, INL and GCL were counted and the lengths of the regions with TUNEL positive cells (affected regions) were measured using NIS Elements Advanced Research software (Nikon, Melville, NY). As a library, NLM provides access to scientific literature. (C) A retinal detachment (arrow) is present at 7 dpi in the Bl/6 retina and is visible on the fundus image as a small, round dark area (red box). The site is secure. [70], The cornea is stained with fluorescein under topical anesthesia, and the tear site is observed for spontaneous aqueous leak under a cobalt blue filter. [16] In the Bl/6 mouse (n = 16), OKN scores werent significantly different from baseline at any time point (Fig 11A). 2009 Dec; [PubMed PMID: 19815277], Chen X,Yao Y,Wang F,Liu T,Zhao X, A retrospective study of eyeball rupture in patients with or without orbital fracture. The scale bar is 50m in (A-C) and 250m in (D) and (E). Despite varying injury mechanisms, both blast and blunt ocular trauma patients share similar pathology, including corneal abrasions, cataracts, intraocular foreign bodies, retinal detachments, vitreous hemorrhage, retinal pigment epithelium (RPE) disruption and optic neuropathy [39]. Fig 2. Correction: Neurodegeneration and Vision Loss after Mild Blunt Trauma in the C57Bl/6 and DBA/2J Mouse. Focal retinal and RPE damage occurs in the eyes of both strains post-blast. Since the eye drops are not medicated, it suggests that prevention of corneal damage was due to protecting the cornea from exposure/abrasion, i.e. 2022 Jan [PubMed PMID: 31082063], Lin KY, Ngai P, Echegoyen JC, Tao JP. In both Bl/6 and D2 control retinas, RIP1 localized primarily to the Mller glia, the INL, and the inner plexiform layer (IPL), with some light staining in the outer plexiform layer (OPL) (Fig 6A and 6B). Females are more commonly affected in the elderly age group.