Bruce M. Zagelbaum

Urban Eye Trauma: A One-year Prospective Study

PURPOSE The authors conducted a 1-year prospective study investigating the demographics, causation, and treatment of eye trauma in an urban population at one medical center. METHODS All patients sustaining eye injuries who were evaluated by the ophthalmology service over a 1-year interval were included. A formal questionnaire was completed with demographic data and details of the injury being obtained. An ophthalmologic examination was performed on each patient, and examination findings, diagnostic tests obtained, diagnosis, and treatment were recorded and analyzed. RESULTS This study included 584 eye injuries. Three hundred seventy-one injuries (70%) occurred in males and 159 (30%) in females. The average age was 30.5 years; 110 (21%) patients were pediatric. Sixty-two percent of all patients presented within 24 hours of their injury. Thirty-seven percent of all injuries occurred in the street, 31% at home, and only 13% at the workplace. For those older than 65 years of age, 48% of injuries were the result of a fall. Sixty percent of all eye injuries were caused by blunt trauma. Only 42 (8%) patients wore eye wear at the time of their injury. Diagnoses and management were recorded. CONCLUSIONS The inner city population is more likely to sustain eye trauma as the result of an assault and is less likely to be involved in a work- or sports-related injury. Given poor compliance with outpatient management and follow-up, aggressive primary management may be indicated to optimize visual outcome.

Corneal complications associated with the use of crack cocaine

BACKGROUND A case series of patients with corneal complications associated with crack cocaine use is presented. Patients had infectious keratitis or sterile epithelial defects. METHODS Entry criteria into this series included the presence of an infectious corneal ulcer or sterile epithelial defect after the patient used crack cocaine routinely. Patients were prospectively identified from July 1, 1989 to June 30, 1991. RESULTS Fourteen patients with crack-related corneal problems were identified. In 10 patients with infectious corneal ulcers, both bacterial and fungal organisms were isolated, and patients were treated with appropriate antimicrobial therapy. The group of patients with sterile corneal epithelial defects were seen after they had rubbed their eyes vigorously after crack cocaine use. The epithelial defects were treated and healed without complication. CONCLUSION Crack cocaine users appear to represent a unique subset of young patients predisposed to infectious keratitis and corneal epithelial defects. A number of hypotheses are offered to explain this effect. Both ophthalmologists and the general public should be aware of these severe corneal problems associated with the use of crack cocaine.

Clinical Features of Bleb Disorder of the Cornea

BACKGROUND Bleb disorder of the cornea is a rare corneal epithelial disorder that has previously been described in asymptomatic patients or those with recurrent nontraumatic corneal erosions. METHODS We report two cases of bleb disorder, each presenting with blurred vision from irregular astigmatism secondary to the bleb changes. We also report on the detection of bleb disorder in siblings. RESULTS Both patients underwent surgical debridement of the epithelium with resolution of symptoms on epithelial resurfacing. CONCLUSION The diagnostic clues, inheritance pattern, differential diagnosis, and treatment options of bleb disorder of the cornea are discussed.

Corneal perforation in a premature infant

BACKGROUND Few cases of corneal perforation in a premature infant have been described in the literature. METHODS Identical twins were born at 30-weeks gestation. One twin developed a corneal epithelial defect, infiltration, and perforation with extrusion of intraocular contents, requiring an emergency penetrating keratoplasty. The second twin developed a progressive corneal opacity, requiring a lamellar keratectomy. RESULTS After penetrating keratoplasty, the patient developed absolute glaucoma with buphthalmos, leading to enucleation. The twins lamellar keratectomy specimen proved to be a dermoid. CONCLUSIONS One must be aware of the danger of the development of spontaneous corneal perforation with extrusion of intraocular contents in premature infants presenting at birth with an epithelial defect.