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Competing Interests: Competing interests: None declared.

We present patient characteristics and follow-up results of cases with anterior chamber dexamethasone implant migration. The common feature of all six presented cases was vitrectomized eyes. Four of the patients had sutured intraocular lens (IOL) implantation due to complicated cataract surgery, one had combined retinal detachment surgery with sutured IOL implantation, and one had vitrectomy for diabetic intravitreal hemorrhage cleaning and uncomplicated cataract surgery. Anterior chamber implant migration caused corneal edema in all cases and elevated intraocular pressure in three cases. In two cases, the dexamethasone implant was directed into the vitreous cavity after maximum pupillary dilation and corneal manipulation with cotton tip applicator with the patient in reverse Trendelenburg position. There was no other complication until dexamethasone implant degradation, with clear cornea at final examination. In two cases, the implant was removed from the anterior chamber by aspiration, but keratoplasty surgery was planned due to endothelial cell loss and persistent corneal edema during follow-up. In the last two cases, the dexamethasone implant was redirected into the vitreous chamber with a 23-gauge catheter and anterior chamber maintainer but they migrated into the anterior chamber again. In one of these patients, the implant was aspirated by catheter and corneal transplantation was performed due to corneal edema, while the other patient's implant was redirected into the vitreous chamber with no further anterior migration. The risk of dexamethasone implants migrating into the anterior chamber of vitrectomized eyes and those with sutured IOL implantation should be kept in mind and the patient should be informed and advised to see an ophthalmologist immediately before permanent corneal endothelial damage occurs.

A 36-year-old man presented with a corneal penetrating fishhook injury with the tip embedded in the inferior anterior chamber angle of the eye. Complete removal was achieved with extension of the wound at the limbus using the "cut-out" technique. Intraocular fishhook injuries are common in fishing communities and effective surgical removal may involve modified techniques previously described for skin or mucosal tissue., Competing Interests: None of the authors identify any conflict of interest.

Traumatic iris sphincter tear has been thought to occur secondary to anteroposterior compression of the globe with defined forces lead to equatorial expansion and active pull along the corneoscleral junction and sphincter tear. However, here in this report, we elaborate the additional forces involved in the traumatic rupture of the sphincter pupillae muscle. During the anteroposterior compressive forces along the globe, the corneal deformation beyond certain limits leads to the development of sudden displacement forces within the anterior chamber. Aqueous within it which is incontinuous circulation with a posterior narrow pupillary aperture as its entrance, find the path of least resistance that is along the pupillary orifices leading to anexpulsive drive to displace the fluid through this small aperture. During this process, the horizontally oriented mechanical stretching forces appear to be the main cause ofpupillary sphincter tear., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

A 30-year-old patient went to the emergency department because of a chemical burn to the left eye more than 10 days ago by toilet cleanser. Surprisingly, a small piece of glass was found in the inferior anterior chamber in the same eye. The visual acuity was counting fingers. There was conjunctival congestion, corneal oedema and Descemet's membrane striae. And there was also a corneal leukoma around 4 to 5 o'clock. Through repeated questioning he recalled that he was injured by an exploded light bulb around 21 years ago. He was asymptomatic until he saw "something moving" in front of the left eye one month ago. Computed tomography (CT) scanning, ultrasonography, ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT) verified the presence of multiple intraocular foreign bodies (IOFBs) in the anterior chamber and vitreous cavity. B-scan verified the IOFB in the vitreous cavity. Thus, he was diagnosed with corneal chemical burn, IOFBs and corneal leukoma of the left eye. The IOFB in the anterior chamber was removed through surgery. An attempt was made to remove the IOFB in the vitreous cavity with electromagnet, but it was not successful. Vitrectomy could not be performed as it was hindered by the opacity of cornea. After surgery, the visual acuity remained counting fingers and the corneal oedema still existed. This case is a reminder that a detailed history taking, a thorough physical examination and modern imaging techniques are beneficial for establishing the diagnosis and treatment of IOFBs., (Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Introduction: Eye injury is the second most common cause of visual impairment and a leading cause of monocular blindness in the United States. There are approximately 6 million ED visits related to drug use annually, including misuse or abuse of pharmaceuticals and illicit drug use. The purpose of this study was to assess the relationship between ocular trauma and substance abuse among emergency department patients and to assess that relationship with demographic factors, including age and gender., Methods: This study was a retrospective, observational study conducted at Miami Valley Hospital, an urban hospital ED, in Dayton, Ohio. Eligible participants included consecutive ocular trauma patients identified by the Trauma Registry from January 2014 through January 2016. Data were collected from the ED medical record including demographic information, mechanism of injury, visual acuity, slit lamp exam findings, ED procedures, inpatient procedures, toxicology results, ED diagnosis, ED disposition, and eye exam., Results: Among 229 patients, the mean age was 44 (range 14-93). 73% of patients were male. Most patients were White (74%), followed by African American (21%), Hispanic (2%), and other (3%). Most patients arrived by ambulance (62%), followed by helicopter (30%), and walk-ins (18%). Most patients were admitted to the hospital (79%). Mechanisms of injury included motor vehicle accidents (31%) and cases of assault (28%). Most ocular trauma involved the external eye (44%), the anterior chamber (28%), the orbit (25%) and the globe (22%). The incidence of substance abuse in this patient population was high. Of the patients tested for alcohol (N=143), 49% tested positive. Among 98 patients who received a urine toxicologic screen, 63% tested positive for at least one illicit substance, including opiates (39%), cocaine (12%), benzodiazepines (25%), and/or THC (27%). There was no significant association between substance abuse and ED disposition., Conclusion: Mechanisms of eye injury included primarily motor vehicle accidents and assault. Most ocular trauma involved the external eye, the anterior chamber, the orbit, and the globe. The incidence of alcohol and illicit substance abuse is high among ED patients with ocular trauma., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This video article shows the surgical removal of a three-pronged barbed fish hook from the cornea and anterior chamber of an 8-year-old boy. The advance-and-cut method is shown: the embedded barbed point of the fish hook was advanced through the cornea, its point was cut off, and the shank of the hook was withdrawn. This method was chosen due to the three-pronged configuration of the fish hook to minimize additional trauma to the eye. Other methods of fish hook removal are briefly reviewed., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

The corneal endothelium sustaining the transparency of the cornea is a vulnerable cell layer. Thermal exposure during phacoemulsification is considered to be a potential cause of post-operative cell loss. Knowledge of the temperature rise and particularly of its dependence on region and system settings could deliver useful information about a potential correlation with cell damage. However, there exists a lack of understanding of the process and location of heat generation. Analytical calculations and experiments enabled the quantification of different mechanisms acting as heat sources during phacoemulsification. Heat generation caused by viscous friction was estimated using both an analytical approach and a numerical simulation. In contrast to absorption of sound and self-heating of the probe, this effect was ascertained to be the main heat source. Calorimetric measurement of the power input verified this modeling. On the basis of these results, the local temperature distribution inside a porcine eye was computed time dependently using the finite-element method. Two different amplitude settings were compared with respect to the temperature increase at the corneal endothelium. Various conclusions on the mitigation of thermal exposure during treatment can be drawn from this finite-element simulation., (Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Computed tomography (CT) is widely used in the initial evaluation of patients with craniofacial trauma. Due to anatomical proximity, craniofacial trauma often involves concomitant injury to the eye and orbit. These injuries may have devastating consequences to vision, ocular motility, and cosmesis. CT imaging provides a rapid and detailed evaluation of bony structures and soft tissues of the orbit, is sensitive in detection of orbital foreign bodies, and often guides clinical and surgical management decisions in orbital trauma. For this reason, radiologists should be prepared to rapidly recognize common orbital fracture patterns, accurately describe soft tissue injuries of the orbit, detect and localize retained foreign bodies within the globe and orbit, and recognize abnormalities of the contents and integrity of the globe. In this review, we present a systematic approach to assist radiologists in the rapid evaluation of orbital trauma using the "BALPINE" mnemonic-bones, anterior chamber, lens, posterior globe structures, intraconal orbit, neurovascular structures, and extraocular muscles/extraconal orbit. Using this approach, we describe common traumatic findings within each of these spaces, and present common postsurgical appearances that can mimic findings of acute trauma.

Purpose: To determine whether there is an age-dependent susceptibility in retinal function in response to repeated anterior chamber cannulation with or without intraocular pressure (IOP) elevation., Methods: Baseline electroretinograms were measured in 3- and 18-month-old Sprague-Dawley rats (n = 16 each group). Following baseline assessment, eyes were randomly assigned to undergo a 60-min anterior chamber cannulation with IOP either left at baseline (sham, 15 mm Hg) or elevated to 60 mm Hg. This was repeated three additional times, with each episode separated by 1 week. At weeks 1 to 3, dark-adapted retinal function was assessed immediately before cannulation, with final functional assessment at week 4., Results: Both sham and IOP elevated eyes of older rats showed retinal dysfunction, which became more pronounced with the number of repeated insults. This effect was largest for responses arising from the inner retina. Repeated insult in younger eyes did not produce a change in amplitude but an increase in the sensitivity to light of photoreceptoral and bipolar cell components of the electroretinogram., Conclusions: Repeated trauma, not IOP, produces permanent retinal dysfunction in older eyes. Younger eyes appear to be able to withstand this type of injury by upregulating sensitivity of outer and middle retinal responses to maintain normal inner retinal function.

We present a case of a 40-year-old soldier who was in close proximity to the detonation of an improvised explosive device (IED). Bubbles of gas were visible within the anterior chamber of his left eye. The authors propose that intraocular gas, present acutely after trauma, is diagnostic of open globe injury and is of particular importance in remote military environments.

Penetrating eye injuries are uncommon in a civilian environment, but unfortunately, very common in a military emergency department. Ultrasound of the eye is quick, reliable, accurate, and easy to learn. This review aims to demonstrate normal anatomy and penetrating injuries of the anterior and posterior compartments of the eye., (Copyright © 2012 The Royal College of Radiologists. All rights reserved.)

Purpose: After blunt ocular trauma, many patients complain of visual disturbances at the emergency department of a hospital. The aim of this study was to investigate the clinical manifestations and related factors of refractive change after blunt ocular trauma., Methods: This prospective study included 192 patients who had a history of monocular blunt trauma without any corneal or conjunctival open wound. None of them had a history of ocular disease or surgery. The examinations covered uncorrected visual acuity, best corrected visual acuity, intraocular pressure, refractive power, gonioscopy for anterior chamber angle, and A-scan ultrasonography for the measurement of axial length, anterior chamber depth, and the lens thickness. All the examinations were performed right after the trauma and then 1 week, 1 month, and 3 months later. The corneal topography was examined using an ORB scan right after the trauma and 1 month later., Results: A myopic change of -2.01 ± 2.27 diopters (D) in the injured eyes, compared with the sound eyes, was identified in 161 patients (83.9%), which showed an aspect of recovery as time passed of -0.14 ± 0.51 D at 1 month after the trauma. The anterior chamber depth of the injured eyes, unlike that of the sound eyes, was significantly lower (P = 0.028), and the anteroposterior diameter of the lens of the injured eyes was significantly higher (P = 0.043)., Conclusions: Blunt ocular trauma induced a significant myopic refractive change due to lens thickening and anterior chamber shallowing, which recovers spontaneously as time passes. Therefore, conservative management and examination of refractive change without artificial refractory correction would be a good choice for managing eyes with blunt trauma at an emergency department.

Objective: To measure ocular effects (blood-aqueous barrier breakdown and intraocular pressure [IOP]) following aqueocentesis performed with needles of various sizes in dogs., Animals: 28 healthy adult dogs., Procedures: 24 dogs underwent unilateral aqueocentesis (24 treated eyes and 24 contra-lateral untreated eyes); 25-, 27-, or 30-gauge needles were used in 3 treatment groups (n = 8/group). Four dogs were untreated controls. Aqueocentesis was performed during sedation and topical anesthesia. Anterior chamber fluorophotometry was performed before and after aqueocentesis on day 1. On days 2 through 5, sedation and fluorophotometry were repeated. Intraocular pressure was measured with a rebound tonometer at multiple time points., Results: Aqueocentesis resulted in blood-aqueous barrier breakdown detected via fluorophotometry in all treated eyes, with barrier reestablishment by day 5. On day 2, the contralateral untreated eyes of all 3 groups also had significantly increased fluorescence. Use of a 25-gauge needle resulted in a significant increase in treated eyes' anterior chamber fluorescence on days 3 and 5 as well as a significant increase in IOP 20 minutes following aqueocentesis, compared with the other treatment groups., Conclusions and Clinical Relevance: Aqueocentesis performed with a 25-gauge needle resulted in the greatest degree of blood-aqueous barrier breakdown and a brief state of intraocular hypertension. Use of a 27- or 30-gauge needle is recommended for aqueous paracentesis. A consensual ocular reaction appeared to occur in dogs following unilateral traumatic blood-aqueous barrier breakdown and may be of clinical importance.

We report a case of a retained graphite anterior chamber foreign body that was masquerading as stromal keratitis. A 28-year-old male visited with complaints of visual disturbance and hyperemia in his right eye for four weeks. On initial examination, he presented with a stromal edema involving the inferior half of the cornea, epithelial microcysts, and moderate chamber inflammation. Suspecting herpetic stromal keratitis, he was treated with anti-viral and anti-inflammatory agents. One month after the initial visit, anterior chamber inflammation was improved and his visual acuity recovered to 20/20, but subtle corneal edema still remained. On tapering the medication, after three months, a foreign body was incidentally identified in the inferior chamber angle and was surgically removed resulting in complete resolution of corneal edema. The removed foreign body was a fragment of graphite and he subsequently disclosed a trauma with mechanical pencil 12 years earlier. This case showed that the presence of an anterior chamber foreign body should always be considered in the differential diagnosis of idiopathic localized corneal edema., (© 2011 The Korean Ophthalmological Society)

We present a case report on a young man complaining of transient myopia following a blunt trauma. Clinical and paraclinical (ultrasound) follow-up allowed us to discuss the different physiopathological mechanisms involved. We observed anterior lens displacement, increased lens thickness probably due to lens edema, choroidal detachment, and ciliary body edema. Progression was positive with full regression of the myopia. Ultrasound analysis also underlined an iridocorneal angle closure that could have led to angle-closure glaucoma (preventive peripheric iridotomy was discussed). The spontaneous progression showed spontaneous angle reopening on the main meridians., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: To characterize ocular hemorrhages from single, rapid head rotations in the neonatal pig., Methods: Three- to 5-day-old anesthetized piglets (n=51) underwent a single, rapid (117-266 rad/s) head rotation in the sagittal (n=13), coronal (n=7), or axial (n=31) planes. Six hours after injury, the animals were euthanatized and perfusion fixed, and the brain and eyes were harvested for gross and histopathologic examination by masked neuro- and ocular pathologists., Results: Ocular hemorrhage was found in 73% of animals (51% bilateral). Intraocular hemorrhage was primarily located near the vitreous base (70% of injured animals had ciliary body hemorrhage, and 11% had peripheral retinal hemorrhage). Hemorrhages were also found in the anterior chamber (11%), vitreous (5%), and optic nerve (disc, 8%; nerve sheath, 57%). Rapid axial head rotations resulted in a higher incidence of intraocular hemorrhage than coronal or sagittal head rotations, but the difference did not reach statistical significance (P=0.06). Control eyes had no injuries., Conclusions: Optic nerve sheath and ciliary body hemorrhages were common in piglets that experienced a single, rapid head rotation. Retinal hemorrhage was present in a smaller number of animals. Most intraocular hemorrhages were located in regions of strong vitreous attachment, suggesting that this animal model will be useful in investigating the effect of vitreoretinal adhesion on ocular hemorrhage caused by inertial head rotations. Extrapolation of this model to the human infant should not be made until the effect of anatomic differences between the human and pig on the occurrence and patterns of ocular injuries is further investigated.

Objectives: To determine the diagnostic value of the anterior chamber depth (ACD) of a globe as seen on CT for detecting open-globe injury., Methods: We enrolled 28 patients with unilateral open-globe injury confirmed by surgery and 28 controls with other types of orbital trauma. The diagnostic value of the difference of the ACDs between globes was evaluated by ROC analysis. The diagnostic performance of the following CT findings suggesting open-globe injury was also determined from independent analysis by two readers, i.e. change in the ACD and the globe contour, obvious volume loss of the globe, dislocated/deformed lens, intraocular foreign body/air and intraocular haemorrhage., Results: The ACD measurements were possible only in 15 patients with open-globe injuries. A difference in the ACDs > or =0.4 mm resulted in 0.85 of the area under the ROC curve with a sensitivity of 73% and specificity of 100% (p = 0.0001). The presence of one or more of the CT findings had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 89%., Conclusions: Change in the ACD is a helpful CT finding for detecting open-globe injury. A difference in the ACDs > or =0.4 mm is a helpful diagnostic criterion with excellent specificity.

After bilateral implantation of an angle-supported anterior chamber intraocular lens (AC IOL) in an allergic patient, the haptic tips were exposed through the limbus in the left eye. Endophthalmitis developed in the eye and was treated by pars plana vitrectomy, IOL extraction, and intravitreal antibiotic injection. Haptic repositioning was performed in the right eye. In this report, we assess the possibility that exposure of the angle-supported AC IOL haptics caused the endophthalmitis. We hypothesized that vigorous rubbing of the eye of the atopic patient might cause limbal erosion that could lead to exposure of the angle-supported AC IOL haptic through the limbus.

Purpose: We aimed to investigate changes in anterior chamber depth (ACD) prospectively in patients with recent unilateral contusion but no signs of angle recession, using a scanning peripheral anterior chamber depth analyzer (SPAC)., Methods: Among patients whose chief complaint was recent unilateral contusion and who showed no signs of angle recession by gonioscopy in 2006 and 2007, those who satisfied the following criteria were subjected to SPAC evaluation of ACD from the central to the peripheral region: no history of ocular diseases or ocular surgery including laser treatment, and similar refractory error in both eyes before trauma., Results: Thirty-seven patients satisfied the criteria (29 males, 8 females; age: 28.6 +/- 23.5 years). Fourteen patients presented with commotio retinae. Fifteen showed no ocular manifestations related to the contusion. The mean SPAC-determined ACD grades of contused and noncontused eyes were 10.7 +/- 1.6 and 9.8 +/- 2.1, respectively, demonstrating that the contused eyes had significantly larger ACD values than the noncontused ones (p = 0.0005). The contused eyes had larger ACD values in both the central and the peripheral regions. The difference in ACD between the contused and noncontused eyes tended to increase with greater distance from the center. The equivalent refractive errors were -2.3 +/- 2.2 and -1.7 +/- 2.1 dpt, respectively (p = 0.004). There were no significant differences in best-corrected visual acuity and intraocular pressure between the contused and the noncontused eyes., Conclusion: Contusion may increase ACD particularly in the peripheral region even in patients who have no apparent manifestations in the anterior ocular segment., (2009 S. Karger AG, Basel.)

A 10-year-old boy presented with a corneal perforation of the right eye caused by a fish hook injury while watching a friend fish. Surgical removal of the fish hook was performed. Under general anesthesia, the shank of the fish hook was cut and the hook was advanced and released. The observation of fly fishing is accompanied by risk similar to participation. Management is guided by the peculiarities of the injury.

A 39-year-old man was referred with complaints of pain, redness, and reduced vision in the left eye after projectile trauma during hammering. Two years previously, anterior chamber phakic intraocular lenses (pIOLs) had been implanted to correct the patient's high myopia. On presentation, the best corrected visual acuity was 20/30 in the right eye and 20/50 in the left eye. Slitlamp examination disclosed a central self-sealed corneal laceration in the left eye, and gonioscopy and a high-resolution computed tomography scan showed a metallic intraocular foreign body (IOFB) lodged in the anterior chamber angle. After the foreign body was removed, the patient regained his previous visual acuity. In this case, the pIOL may have prevented further penetration of the IOFB and protected the crystalline lens and posterior segment.

Background: The choice of design for intraocular lenses (IOLs) mainly depends on the selected location for the implant., History and Signs: We report the case of dislocation of a foldable open-loop posterior chamber IOL into the anterior chamber during retinal detachment surgery. After several vitreoretinal interventions visual acuity was hand movements., Therapy and Outcome: The IOL remained in the anterior chamber without complications such as IOP rise or endothelial decompensation for several years., Conclusions: Foldable open-loop posterior chamber IOLs can be left in suitable anterior chambers for years without complications such as rise of intraocular pressure or corneal endothelial damage. Repeated measurements of endothelial cell density can provide an informative basis for the operative removal of this lens.

Ocular trauma is readily investigated by ultrasound, which is of particular value when the light conducting media are opacified by haemorrhage or other injury. In this situation, direct visualization of the ocular contents by ophthalmoscopy is difficult or impossible. Severe complications are treated by microsurgical techniques, and ultrasound evaluation represents the only practicable method of examination for surgical planning. This review illustrates the grey-scale (B scan or two-dimensional) features of the traumatized eye and describes the examination technique.

Objective: To determine the safety and efficacy of topical aminocaproic acid (Caprogel) in the management of traumatic hyphema., Design: Multicenter, randomized, double-masked, placebo-controlled clinical trial., Participants: A total of 51 patients participated in this trial (power = 36%, 2-tailed test)., Intervention: Patients presenting with traumatic hyphema were randomly assigned to 5-day treatment with topical aminocaproic acid or a placebo gel. Patients were monitored daily with ocular examination and vital sign testing for the 5 days of treatment and at 24 and 48 hours after treatment. General physical examination and laboratory testing were performed at baseline and day 5., Main Outcome Measures: The main efficacy variable was the rate of rebleeding. Secondary efficacy variables included time to hyphema clearance, intraocular pressure, time to secondary hemorrhage, and visual acuity. Safety variables included adverse events, vital signs, and laboratory measurements., Results: Rebleeding occurred in 30% of the placebo group (8 of 27; 95% confidence interval [CI] = 14-50%), versus 8% of the treatment group (2 of 24; 95% CI = 1-27%), for an estimated continuity-corrected difference in percentage of patients with bleeding of 17% (95% CI = -3-38%). Secondary efficacy variables were similar in the groups, except that there was a trend towards more visual improvement in the topical aminocaproic acid group (54%) than in the placebo group (30%) at the last measurement (P = 0.08). Adverse events were similar., Conclusions: This study provides evidence that topical aminocaproic acid is safe and demonstrates trends towards reducing the rebleeding rate in the management of traumatic hyphema. However, because the study was terminated before complete enrollment, more definitive recommendations will require a larger trial.

Purpose: To analyze the anatomic and functional consequences of wine-cork injury to the eye in relation to the patient's age and the type of cork and wine., Methods: We retrospectively studied 13 patients, six women and seven men, presenting to our department with bottle-cork injury to the eye between January 1999 and June 2001., Results: All patients presented with closed-globe injury according to Kuhn et al's classification. All the cases were injured by bottle corks from sparkling wine: white in ten cases and red in three. Mean visual acuity at admission was 20/100 (range, hand motion to 20/20). The most frequent early injury was anterior chamber hyphema (84.6%), followed by corneal injury (62.2%), ocular hypertension (46.1%), lens subluxation (30.8%), traumatic cataract (23.1%), and post-traumatic retinal edema (23.1%). Mean final visual acuity was 20/25; the follow-up ranged from 3 to 29 months, averaging 16.1 months. Late complications were as follows: pupil motility anomalies (38.5%), traumatic cataract (30.8%), iridodialysis (15.4%), traumatic optic neuropathy (7.7%), post-traumatic glaucoma (7.7%), and traumatic maculopathy (15.4%). Surgical treatment was necessary in two cases (15.4%)., Conclusions: Bottle-cork eye injuries account for 10.8% of post-traumatic hospital admissions to our department. Most of them are due to sparkling white wine served at room temperature. There is no correlation between ocular injury and the eye-bottle distance or the type of cork.

Hyphema (blood in the anterior chamber) can occur after blunt or lacerating trauma, after intraocular surgery, spontaneously (e.g., in conditions such as rubeosis iridis, juvenile xanthogranuloma, iris melanoma, myotonic dystrophy, keratouveitis (e.g., herpes zoster), leukemia, hemophilia, von Willebrand disease, and in association with the use of substances that alter platelet or thrombin function (e.g., ethanol, aspirin, warfarin). The purpose of this review is to consider the management of hyphemas that occur after closed globe trauma. Complications of traumatic hyphema include increased intraocular pressure, peripheral anterior synechiae, optic atrophy, corneal bloodstaining, secondary hemorrhage, and accommodative impairment. The reported incidence of secondary anterior chamber hemorrhage, that is, rebleeding, in the setting of traumatic hyphema ranges from 0% to 38%. The risk of secondary hemorrhage may be higher in African-Americans than in whites. Secondary hemorrhage is generally thought to convey a worse visual prognosis, although the outcome may depend more directly on the size of the hyphema and the severity of associated ocular injuries. Some issues involved in managing a patient with hyphema are: use of various medications (e.g., cycloplegics, systemic or topical steroids, antifibrinolytic agents, analgesics, and antiglaucoma medications); the patient's activity level; use of a patch and shield; outpatient vs. inpatient management; and medical vs. surgical management. Special considerations obtain in managing children, patients with hemoglobin S, and patients with hemophilia. It is important to identify and treat associated ocular injuries, which often accompany traumatic hyphema. We consider each of these management issues and refer to the pertinent literature in formulating the following recommendations. We advise routine use of topical cycloplegics and corticosteroids, systemic antifibrinolytic agents or corticosteroids, and a rigid shield. We recommend activity restriction (quiet ambulation) and interdiction of non-steroidal anti-inflammatory agents. If there is no concern regarding compliance (with medication use or activity restrictions), follow-up, or increased risk for complications (e.g., history of sickle cell disease, hemophilia), outpatient management can be offered. Indications for surgical intervention include the presence of corneal blood staining or dangerously increased intraocular pressure despite maximum tolerated medical therapy, among others.

Material occurring in the anterior chamber as a result of trauma may be of little or major significance. The most common finding requiring treatment is hyphema. Close observation and (often surgical) treatment is especially important in patients at high risk: those with sickle cell disease, rebleeding, and elevated intraocular pressure. Cataract is a common complication in eyes sustaining serious trauma, although its presence may be difficult to confirm during the initial repair. The diagnosis is especially crucial because of the significantly increased risk of endophthalmitis. If the surgeon is able to determine that cataract is indeed present and hinders visualization of the posterior segment, or may lead to rapid elevation of the intraocular pressure, primary lens removal should be considered because vitreoretinal injuries are expected in approximately one-half of eyes, and an early retinal examination is mandatory in all eyes with lens trauma. Because one out of two eyes have posterior capsule injury, vitrectomy methods of lens removal are commonly required. Preservation of the posterior capsule is less important than avoiding traction on the anterior vitreous, because alternative methods of intraocular lens placement offer similar functional results.

Purpose: This article describes a case in which a patient presented with a previously undetected metallic foreign body in the anterior chamber angle., Methods and Results: A 42-year-old Hispanic man presented with a 5-day history of foreign-body sensation and redness in his left eye. He had been using a hand saw without safety glasses 2 days before the onset of his initial symptoms. Physical examination revealed a metallic foreign body embedded in the inferior angle of his left eye. Surgical removal of the foreign body was performed, and the patient remains well 1 year after surgery., Conclusions: All physicians should maintain a high degree of clinical suspicion for intraocular foreign bodies when presented with a patient who may have sustained ocular trauma. All eye-care providers need to emphasize the need for proper eye protection to patients who engage in high risk activities that may lead to penetrating ocular trauma.

A case is described in which viscoelastic material was used in the anterior chamber to minimize or prevent fluid flow through the area of the trabecular meshwork and Schlemm's canal during nonpenetrating filtering surgery. In cases with or without small perforations, the technique minimizes or decreases fluid flow so that the surgeon has a clearer view of these tissues and can perform more thorough and accurate stripping of deeper layers of tissue.

Purpose: To evaluate the efficacy of multiple combined procedure (Pentagon approach) as single-step secondary repair in cases of extensive keratolenticular trauma in paediatric age group., Methods: Retrospective evaluation of 18 patients of penetrating injuries with sclerokeratolenticular trauma, who underwent multiple procedure as single-step secondary repair by a single team of two surgeons during a 4 year period. Surgical procedure included reconstruction of anterior segment, synechiolysis, excision of membrane, lensectomy, open sky vitrectomy, PC IOL implantation over frill and penetrating keratoplasty. Meticulous antiamblyopia measures were applied in all cases., Results: Extensive vasoproliferative membrane, complicated cataract and anterior vitreous condensation were significant intra-operative hurdles. Moderate uveitis, secondary glaucoma, persistent epithelial defects were problems noted. Eleven (61.22%) patients attained good visual outcome. Regrafting was required in remaining cases due to delayed graft failure., Conclusion: Despite being a highly complex technique, Pentagon approach provides effective management profile in terms of graft success and functional outcome, especially in keratolenticular trauma, in children.

Course of acute traumatic uveitis was evaluated in 146 patients with penetrating wounds of different severity in scores starting from the first days after the injury was inflicted and after operations performed in early terms after the injury. The inflammatory process normalized by weeks 2-3 in a favorable course, while in severe injuries and early reoperations and in wounds of the fourth degree of severity posttraumatic uveitis persisted during weeks 3-4, and 35.2% patients developed chronic posttraumatic uveitis. Clinical signs of immunological insufficiency, presenting mainly as the infectious syndrome (28%), were detected in 35.6% patients with penetrating injuries on the basis of case history analysis by means of a universal diagnostic chart and clinical findings. Penetrating wounds of the third and fourth degree of severity, reoperations during early terms after primary surgical treatment, chronic inflammatory diseases (mainly of the ENT and bronchopulmonary system, indicating secondary immunodeficiency, which necessitate prescription of immunocorrectors starting from the first days after the injury) are factors of risk of protracted or chronic course of posttraumatic uveitis.

Background: Eye injuries are the leading cause of monocular blindness in children. At present, however, only limited follow-up studies exist., Methods: The files of 38 consecutive patients aged 16 years or younger who had been treated for open globe injuries were examined. The type of injury was classified and the severity of injury was categorized in four grades., Results: Our series included 5 eyes (13%) with a rupture, 30 (79%) with a penetrating and 3 (8%) with a perforating injury. Follow-up varied from 3 days to 7 years (mean 15.5 months). The macula was attached at the last follow-up in all eyes. The final visual acuity ranged between 1.0 and light projection. In 47% of cases (18 eyes), the visual acuity was > or =0.5; 74% (28 eyes) achieved at least 0. 1. Eighteen of 38 eyes (47%) had severe injury with posterior segment involvement. Visual acuity of at least 0.5 was achieved in 44% (8/18) of these. Eyes with grade 2-4 injury treated with early vitrectomy had a final visual acuity of > or =0.5 in 58% of cases (7/13). Twenty-one (55%) of 38 children were < or =8 years of age and eight of them (38%) had a final visual acuity of > or =0.5., Conclusion: Salvage of the eye with an attached macula was possible in all eyes. Even in severely injured eyes good visual acuity can be established in about 50% of cases.

Purpose: To report a 63-year-old man with a retained intraocular foreign body who developed a hyphema during magnetic resonance imaging (MRI) of the brain., Methods: Case report and review of the current literature on ocular injury caused by intraocular foreign bodies when subjected to an electromagnetic field., Results: Our patient underwent a brain MRI, and the intraocular foreign body caused a hyphema and increased intraocular pressure. The presence and location of the intraocular foreign body were determined by computed tomography (CT)., Conclusion: Magnetic resonance imaging can cause serious ocular injury in patients with ferromagnetic intraocular foreign bodies. This case demonstrates the importance of obtaining an occupational history, and, when indicated, a skull x-ray or CT to rule out intraocular foreign body before an MRI study.

Purpose: To report a case of caterpillar setae embedded in the deep cornea and anterior chamber., Methods: A 26-year-old man was struck in his right eye by a caterpillar (Dendrolimus punctatus walker). Severe conjunctival injection, chemosis, and erosion of the cornea developed immediately. Numerous setae fragments were found to be embedded into the palpebral conjunctiva and deep cornea, extending into the anterior chamber near the anterior iris surface., Results: After partial removal of the setae under a microscope, the inflammation subsided and visual acuity improved to RE: 20/20., Conclusion: Caterpillar setae are sharp enough to penetrate the cornea and extend into the anterior chamber.