Bottle cork eye injuries are common events in specific seasons and areas

Plastic corks are the most dangerous, and the accidents usually occur in October and January.

ROME – Eye injuries from bottle corks are considered unusual and their frequency is often underestimated, but they can be the cause of disabling functional ocular sequelae, according to one surgeon.

“Plastic corks are more dangerous than traditional corks or metal caps. They accumulate more kinetic energy at the time of bottling and have consequently a more explosive discharge,” said Gian Maria Cavallini, MD, at the meeting of the International Society of Ocular Trauma.

Distinctive type of ocular injury

According to the classification system for ocular trauma described by Ferenc Kuhn, MD, and colleagues, bottle cork eye trauma is a contusive ocular closed-globe trauma. The blunt instrument can damage the ocular structures of the anterior and posterior segments both directly in the impact area and also through a process of counterblow.

“Bottle corks cause a distinctive type of ocular injury, characterized by a compression phase followed by rapid decompression with lengthening of the anteroposterior axis beyond the physiological range,” Dr. Cavallini said.

Almost every part of the eye can be affected, with a wide range of possible consequences, such as hyphema, corneal edema, hemorrhagic glaucoma, iridodialysis, cataract, lens luxation, capsule rupture, choroidal rupture, vitreous and retinal hemorrhage, orbital floor fracture and optic nerve avulsion.

In most cases, the injury is due to careless handling of sparkling wine bottles or accidental bursting of the cork at the moment the bottle is taken off the shelf or out of the refrigerator. Right eyes are more affected because bottles are often held by the right hand.

HyphemaIridodyalisis
A retrospective review of bottle-cork injuries in Dr. Cavallinis hospital in Modena, Italy, between 1999 and 2006 found hyphema (left) had occurred in 20 patients and iridodyalisis (right) had occurred in eight patients.

Traumatic cataractLens subluxation and dislocation
Traumatic cataract (left) occurred in four patients from bottle cork injuries and lens subluxation and dislocation (right) occurred in one patient each.

Images: Cavaillini GM

Data collection

Modena, Italy, where Dr. Cavallini’s hospital is located, is at the center of the production area of Lambrusco, a well-known sparkling red wine.

“Bottle cork injuries are relatively common here,” he said. “Through a retrospective review of our cases, we have been able to evaluate the incidence, the seasonal distribution, and the anatomical and functional consequences of this type of trauma.”

Between January 1999 and June 2006, 350 patients were admitted to Modena’s hospital for ocular trauma. About half of these traumas were contusive, and 28 were specifically due to bottle corks.

Of these 28 patients, 17 were men and 11 were women. Of the injured eyes, 18 were right eyes and 10 were left eyes. The average age of the patients was 48 years.

All patients were injured by the cork while opening the bottle. All bottles were of sparkling wine — nine of white wine and 19 of Lambrusco. In 12 cases the wine had been bottled by the producer, and in seven cases it had been bottled at home. Ten bottle corks were made of plastic, nine were cork, and nine were metal caps.

“The data relating to seasonal distribution showed a higher prevalence of bottle cork injuries in October, at the time of wine fermentation, and January, when more often the sparkling wine is consumed to celebrate the new year,” Dr. Cavallini said.

Details of trauma

Visual acuity at the time of admission to the hospital was classified according to a trauma grading system. Six patients were grade 1 (better than 20/40), four were grade 2 (20/50 to 20/100), eight were grade 3 (20/100 to 20/500) and 10 were grade 4 (20/1000 to light perception). IOP was lower than 20 mm Hg in 16 cases, between 20 and 28 mm Hg in 10 cases and higher than 40 mm Hg in two cases.

Clinical diagnosis found hyphema in 20 cases, corneal edema in seven cases and iridodialysis in eight cases. Traumatic cataract was found in four patients, subluxation of the lens in one patient and complete displacement of the lens in one patient. IOL dislocation with retinal detachment was found in one patient.

“Twenty-three patients were treated with local anti-hemorrhagic and anti-inflammatory and IOP-lowering medications. In seven patients it was necessary to treat the ocular hypertension with systemic carbonic anhydrase inhibitors and local beta-blockers. Surgical treatment was required in five cases. Two patients underwent combined vitrectomy and phacoemulsification via pars plana, with scleral implantation of the IOL. Two patients had phaco with IOL implantation, and one patient underwent exchange of a dislocated IOL, vitrectomy and silicone oil tamponade for retinal detachment,” Dr. Cavallini said.

In one patient, the bottle cork trauma had caused widespread zonular rupture with total luxation of the nucleus and cortex in the vitreous chamber.

“After removing the residuals of the broken capsule, I performed a central vitrectomy to be able to aspirate the nucleus and cortical fragments right down to the retina. For scleral fixation of the IOL, I adopted the Lewis technique without scleral flaps. A long, slightly curved needle with a 10-0 prolene suture was inserted across the anterior chamber and docked into the hollow of a curved insulin needle, which has been inserted from the opposite side, 180° away. The insulin needle is withdrawn with the long needle inside of it, so that the prolene suture is driven across the eye. I repeat the maneuver in the opposite direction, extract the two prolene threads with a hook, cut them and fix them to the IOL loop,” he explained.

Not a pop but merely a sigh

Dr. Cavallini noted that more information is needed on bottle cork eye injuries, particularly at certain times of the year and in specific areas of the country.

“Bottle cork injuries are not as uncommon as we may think. In just our region (Emilia Romagna), 500 cases of ocular injuries due to bottle corks have been reported by 32 ophthalmologists to the National Association of Cork-injured Friends (http://amicitappolesi.supereva.it). This association is collecting data and putting pressure on the Ministry of Industry to enforce new regulations concerning the use of a special safety device inside sparkling wine bottles. Safety devices and labels warning of the potential dangers of bottle opening would hopefully help lowering the incidence of this type of trauma,” he said.

In the meantime, the Comitè Interprofessionel du Vin de Champagne recommends that “a napkin should be held over the cork and the neck of the bottle while the wire is being undone and the cork is gently eased off with the bottle pointing away from the face. There should be no ‘pop’ but merely a sigh. White gloves may be worn but are not essential.”

Is it mere coincidence that the Benedictine monk Dom Perignon, inventor of the champagne cork, was blind? The cause of his blindness is not known.

For more information:
  • Gian Maria Cavallini, MD, can be reached at Struttura Complessa di Oftalmologia, Università di Modena e Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, via del Pozzo 71, 41100 Modena, Italy; +39-059-4222442; e-mail: cavallini.gianmaria@unimore.it.
  • Michela Cimberle is an OSN Correspondent based in Treviso, Italy, who covers all aspects of ophthalmology. She focuses geographically on Europe.

ROME – Eye injuries from bottle corks are considered unusual and their frequency is often underestimated, but they can be the cause of disabling functional ocular sequelae, according to one surgeon.

“Plastic corks are more dangerous than traditional corks or metal caps. They accumulate more kinetic energy at the time of bottling and have consequently a more explosive discharge,” said Gian Maria Cavallini, MD, at the meeting of the International Society of Ocular Trauma.

Distinctive type of ocular injury

According to the classification system for ocular trauma described by Ferenc Kuhn, MD, and colleagues, bottle cork eye trauma is a contusive ocular closed-globe trauma. The blunt instrument can damage the ocular structures of the anterior and posterior segments both directly in the impact area and also through a process of counterblow.

“Bottle corks cause a distinctive type of ocular injury, characterized by a compression phase followed by rapid decompression with lengthening of the anteroposterior axis beyond the physiological range,” Dr. Cavallini said.

Almost every part of the eye can be affected, with a wide range of possible consequences, such as hyphema, corneal edema, hemorrhagic glaucoma, iridodialysis, cataract, lens luxation, capsule rupture, choroidal rupture, vitreous and retinal hemorrhage, orbital floor fracture and optic nerve avulsion.

In most cases, the injury is due to careless handling of sparkling wine bottles or accidental bursting of the cork at the moment the bottle is taken off the shelf or out of the refrigerator. Right eyes are more affected because bottles are often held by the right hand.

HyphemaIridodyalisis
A retrospective review of bottle-cork injuries in Dr. Cavallinis hospital in Modena, Italy, between 1999 and 2006 found hyphema (left) had occurred in 20 patients and iridodyalisis (right) had occurred in eight patients.

Traumatic cataractLens subluxation and dislocation
Traumatic cataract (left) occurred in four patients from bottle cork injuries and lens subluxation and dislocation (right) occurred in one patient each.

Images: Cavaillini GM

Data collection

Modena, Italy, where Dr. Cavallini’s hospital is located, is at the center of the production area of Lambrusco, a well-known sparkling red wine.

“Bottle cork injuries are relatively common here,” he said. “Through a retrospective review of our cases, we have been able to evaluate the incidence, the seasonal distribution, and the anatomical and functional consequences of this type of trauma.”

Between January 1999 and June 2006, 350 patients were admitted to Modena’s hospital for ocular trauma. About half of these traumas were contusive, and 28 were specifically due to bottle corks.

Of these 28 patients, 17 were men and 11 were women. Of the injured eyes, 18 were right eyes and 10 were left eyes. The average age of the patients was 48 years.

All patients were injured by the cork while opening the bottle. All bottles were of sparkling wine — nine of white wine and 19 of Lambrusco. In 12 cases the wine had been bottled by the producer, and in seven cases it had been bottled at home. Ten bottle corks were made of plastic, nine were cork, and nine were metal caps.

“The data relating to seasonal distribution showed a higher prevalence of bottle cork injuries in October, at the time of wine fermentation, and January, when more often the sparkling wine is consumed to celebrate the new year,” Dr. Cavallini said.

Details of trauma

Visual acuity at the time of admission to the hospital was classified according to a trauma grading system. Six patients were grade 1 (better than 20/40), four were grade 2 (20/50 to 20/100), eight were grade 3 (20/100 to 20/500) and 10 were grade 4 (20/1000 to light perception). IOP was lower than 20 mm Hg in 16 cases, between 20 and 28 mm Hg in 10 cases and higher than 40 mm Hg in two cases.

Clinical diagnosis found hyphema in 20 cases, corneal edema in seven cases and iridodialysis in eight cases. Traumatic cataract was found in four patients, subluxation of the lens in one patient and complete displacement of the lens in one patient. IOL dislocation with retinal detachment was found in one patient.

“Twenty-three patients were treated with local anti-hemorrhagic and anti-inflammatory and IOP-lowering medications. In seven patients it was necessary to treat the ocular hypertension with systemic carbonic anhydrase inhibitors and local beta-blockers. Surgical treatment was required in five cases. Two patients underwent combined vitrectomy and phacoemulsification via pars plana, with scleral implantation of the IOL. Two patients had phaco with IOL implantation, and one patient underwent exchange of a dislocated IOL, vitrectomy and silicone oil tamponade for retinal detachment,” Dr. Cavallini said.

In one patient, the bottle cork trauma had caused widespread zonular rupture with total luxation of the nucleus and cortex in the vitreous chamber.

“After removing the residuals of the broken capsule, I performed a central vitrectomy to be able to aspirate the nucleus and cortical fragments right down to the retina. For scleral fixation of the IOL, I adopted the Lewis technique without scleral flaps. A long, slightly curved needle with a 10-0 prolene suture was inserted across the anterior chamber and docked into the hollow of a curved insulin needle, which has been inserted from the opposite side, 180° away. The insulin needle is withdrawn with the long needle inside of it, so that the prolene suture is driven across the eye. I repeat the maneuver in the opposite direction, extract the two prolene threads with a hook, cut them and fix them to the IOL loop,” he explained.

Not a pop but merely a sigh

Dr. Cavallini noted that more information is needed on bottle cork eye injuries, particularly at certain times of the year and in specific areas of the country.

“Bottle cork injuries are not as uncommon as we may think. In just our region (Emilia Romagna), 500 cases of ocular injuries due to bottle corks have been reported by 32 ophthalmologists to the National Association of Cork-injured Friends (http://amicitappolesi.supereva.it). This association is collecting data and putting pressure on the Ministry of Industry to enforce new regulations concerning the use of a special safety device inside sparkling wine bottles. Safety devices and labels warning of the potential dangers of bottle opening would hopefully help lowering the incidence of this type of trauma,” he said.

In the meantime, the Comitè Interprofessionel du Vin de Champagne recommends that “a napkin should be held over the cork and the neck of the bottle while the wire is being undone and the cork is gently eased off with the bottle pointing away from the face. There should be no ‘pop’ but merely a sigh. White gloves may be worn but are not essential.”

Is it mere coincidence that the Benedictine monk Dom Perignon, inventor of the champagne cork, was blind? The cause of his blindness is not known.

For more information:
  • Gian Maria Cavallini, MD, can be reached at Struttura Complessa di Oftalmologia, Università di Modena e Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, via del Pozzo 71, 41100 Modena, Italy; +39-059-4222442; e-mail: cavallini.gianmaria@unimore.it.
  • Michela Cimberle is an OSN Correspondent based in Treviso, Italy, who covers all aspects of ophthalmology. She focuses geographically on Europe.