Journal of Pediatric Ophthalmology and Strabismus

Perforating Injuries of the Eye in Childhood

J Scharf, MD; S Zonis, MD

Abstract

Perforating injuries of the eye in childhood are not rare because of great exposure of children to injury during the playing hours or in everyday life. The purpose of this study is to describe the causes, treatment and results of perforating injuries in children admitted to the Department of Ophthalmology, Rambam Government Hospital, Haifa, during the period of 1964-1973.

MATERIAL

The medical reports of 237 patients treated for perforating injuries during the years 1964-1973 were examined. Among those 237 cases, there were 64 patients (27%) up to the age of 14. There were 51 boys (80%) and 13 girls (20%). Division of cases according to age is presented in Table I. In 42 children, the right eye was injured; in 21, the left eye; and in one child, both eyes were injured. The causes of injuries are summarized in Table II. Fortyfour patients reached the hospital and were treated within 24 hours after the injury; 19 were treated more than 24 hours to a week after the injury; one patient presented for treatment more than a week after injury. Localization of the perforating wound is presented in Table III. In one out of 65 injured eyes, there was an intraocular foreign body. It was a war injury, the entrance wound was placed in the sclera, and the magnetic foreign body was removed by the posterior route. Table IV summarizes the treatment given to the patients. Visual results, in cases in which accurate assessing of their visual acuity was possible, are presented in Table V. Good vision is 6/6-6/12; fair is 6/18-6/36; and poor vision is 6/60 and less. The visual acuity was tested at least half a year after the injury. Complications of perforating injuries are summarized in Table VI.

Table

The relatively high incidence of school and domestic accidents, as well as great frequency of eye injuries during play and the severe consequences, demand better parental supervision and preventive measures.

SUMMARY

Sixty-four cases of perforating eye injuries in childhood were hospitalized during the period 1964-1973. Thirty-nine children (60%) were injured while playing. Because of great frequency of perforating injuries in children and poor final results, the need of preventive measures is indicated.

1 . J ohnston S: Perforating eye injury. A five year survey. Trans of Ophth Soc UK 91:895, 1971.

2. Stark N, Hosch W: Ocular lesions in childhood. Med Klin 68:274, 1973.

3. Offut RL, Schine I: Perforating injuries of the eye due to glass. Ann Ophth 6:357, 1974.

4. Bowen DI, Maganran MD: Ocular injuries caused by air gun pallets. Brit Med J 5849:33, 1973.

TABLE I

DIVISION OF CASES ACCORDING TO AGE

TABLE II

CAUSES OF PERFORATING INJURIES

TABLE III

SITUATION OF PERFORATING INJURY

TABLE IV

TREATMENT OF 65 EYES WITH PERFORATING INJURIES

TABLE V

VISUAL RESULTS IN 60 EYES WITH PERFORATING INJURIES

TABLE VI

COMPLICATIONS OF PERFORATING EYE INJURIES…

Perforating injuries of the eye in childhood are not rare because of great exposure of children to injury during the playing hours or in everyday life. The purpose of this study is to describe the causes, treatment and results of perforating injuries in children admitted to the Department of Ophthalmology, Rambam Government Hospital, Haifa, during the period of 1964-1973.

MATERIAL

The medical reports of 237 patients treated for perforating injuries during the years 1964-1973 were examined. Among those 237 cases, there were 64 patients (27%) up to the age of 14. There were 51 boys (80%) and 13 girls (20%). Division of cases according to age is presented in Table I. In 42 children, the right eye was injured; in 21, the left eye; and in one child, both eyes were injured. The causes of injuries are summarized in Table II. Fortyfour patients reached the hospital and were treated within 24 hours after the injury; 19 were treated more than 24 hours to a week after the injury; one patient presented for treatment more than a week after injury. Localization of the perforating wound is presented in Table III. In one out of 65 injured eyes, there was an intraocular foreign body. It was a war injury, the entrance wound was placed in the sclera, and the magnetic foreign body was removed by the posterior route. Table IV summarizes the treatment given to the patients. Visual results, in cases in which accurate assessing of their visual acuity was possible, are presented in Table V. Good vision is 6/6-6/12; fair is 6/18-6/36; and poor vision is 6/60 and less. The visual acuity was tested at least half a year after the injury. Complications of perforating injuries are summarized in Table VI.

Table

TABLE IDIVISION OF CASES ACCORDING TO AGE

TABLE I

DIVISION OF CASES ACCORDING TO AGE

Table

TABLE IICAUSES OF PERFORATING INJURIES

TABLE II

CAUSES OF PERFORATING INJURIES

DISCUSSION

In our survey covering ten years, 27 percent of the total number of perforating injuries were in children. Thirty-nine children were injured while playing, which is 19 percent of total perforating eye injuries in the ten years and 60 percent of cases of perforations in children.

Johnston1 found 38 percent of total perforating injuries at play. The usual causes were mechanical toys, knives, stones and sticks.2 In our series, all the children were injured at play by thrown objects as sticks and stones. The male:female ratio is 3.9:1. According to Offut and Schine 3 in patients under the age of 16, girls were nearly equal to boys in trauma. In some published series 12 percent of intra-ocular foreign bodies were in children and the main causes were firework 1 and air gun pallets.4

In our series only one patient had a perforating injury with an intra-ocular foreign body and it was a war injury. In 24 eyes out of 60, good visual results have been obtained. The best visual results have been noticed in small corneo-scleral wounds and small corneal wounds. In cases with traumatic cataract, the visual prognosis was relatively poor even In cases in which the surgical treatment was successful. Four out of 20 such children developed amblyopia. There were no cases of sympathetic ophthalmia and only two eyes developed endophthalmitis immediately after the injury.

Relatively good visual results and a low percentage of endophthalmitis can be explained by early treatment Sixty-eight percent of the children reached the hospital and received surgical and medical treatment including steroids within hours after injury. On the other hand, 21 eyes had poor visual acuity or became blind. Most of them had corneoscleral wounds and injury of the lens. The poor visual acuity was due to corneal scars and late development of lens opacities.

Table

TABLE IIISITUATION OF PERFORATING INJURY

TABLE III

SITUATION OF PERFORATING INJURY

Table

TABLE IVTREATMENT OF 65 EYES WITH PERFORATING INJURIES

TABLE IV

TREATMENT OF 65 EYES WITH PERFORATING INJURIES

Table

TABLE VVISUAL RESULTS IN 60 EYES WITH PERFORATING INJURIES

TABLE V

VISUAL RESULTS IN 60 EYES WITH PERFORATING INJURIES

Table

TABLE VICOMPLICATIONS OF PERFORATING EYE INJURIES

TABLE VI

COMPLICATIONS OF PERFORATING EYE INJURIES

The relatively high incidence of school and domestic accidents, as well as great frequency of eye injuries during play and the severe consequences, demand better parental supervision and preventive measures.

SUMMARY

Sixty-four cases of perforating eye injuries in childhood were hospitalized during the period 1964-1973. Thirty-nine children (60%) were injured while playing. Because of great frequency of perforating injuries in children and poor final results, the need of preventive measures is indicated.

REFERENCES

1 . J ohnston S: Perforating eye injury. A five year survey. Trans of Ophth Soc UK 91:895, 1971.

2. Stark N, Hosch W: Ocular lesions in childhood. Med Klin 68:274, 1973.

3. Offut RL, Schine I: Perforating injuries of the eye due to glass. Ann Ophth 6:357, 1974.

4. Bowen DI, Maganran MD: Ocular injuries caused by air gun pallets. Brit Med J 5849:33, 1973.

TABLE I

DIVISION OF CASES ACCORDING TO AGE

TABLE II

CAUSES OF PERFORATING INJURIES

TABLE III

SITUATION OF PERFORATING INJURY

TABLE IV

TREATMENT OF 65 EYES WITH PERFORATING INJURIES

TABLE V

VISUAL RESULTS IN 60 EYES WITH PERFORATING INJURIES

TABLE VI

COMPLICATIONS OF PERFORATING EYE INJURIES

10.3928/0191-3913-19761101-04

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