RESUMEN
BACKGROUND: Injuries caused by firearms are fortunately rare in the field of ophthalmology. The treatment of an affected patient is a special challenge both ophthalmologically and emotionally. METHODS: We report on seven consecutive cases of patients with an orbital gunshot injury who presented in a university hospital over a period of 11 years. The course of events leading to the injury with the weapon involved, the type of projectile, the injury pattern, cranial imaging, treatment and course were evaluated. RESULTS: A total of seven cases of injuries caused by firearms could be documented and evaluated in the period 2007-2018. All seven patients were male. The average age was 44⯱ 27.5 years. Of the injuries five were caused by a suicide attempt and two by an accident. Firearms were used except for one injury caused by a crossbow. There was a retained projectile in four of the cases, the bullet went through the body in two cases and one of the cases presented with a ricochet shot. The final visual acuity was unilateral amaurosis in 1 case and bilateral amaurosis in another case, 1/35 (measured at 1â¯m) in 1 case, while it varied between 0.2 and 0.7 in the other 4 cases. No patient died as a direct consequence of the firearm injury. CONCLUSION: Injuries caused by firearms are relatively rare in Germany and mostly have a suicidal background. The pattern of the injury of the ocular structures is very variable. A reconstruction attempt is principally recommended. In the care of patients interdisciplinary cooperation between ophthalmologists and neurosurgeons, orofacial surgeons, ear nose and throat (ENT) surgeons and psychiatrists is necessary.
Asunto(s)
Lesiones Oculares , Armas de Fuego , Heridas por Arma de Fuego , Adolescente , Adulto , Anciano , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Intento de Suicidio , Heridas por Arma de Fuego/epidemiología , Adulto JovenRESUMEN
In contrast to developing countries, xerophthalmia is rather rare in developed countries. Malnutrition (e.g. in mentally deficient or psychiatric patients), chronic liver diseases (e.g. due to alcoholism), or bowel surgery can be reasons for vitamin A deficiency in developed countries. The prodromal stage of hypovitaminosis A is characterized by nyctalopia, which often manifests subclinically. Longer lasting and severe cases of vitamin A deficiency may be complicated by the occurrence of keratinizing metaplasia in the cornea and conjunctiva, xerosis, keratomalacia or blindness.
Asunto(s)
Trastornos Inducidos por Alcohol/diagnóstico , Trastornos Inducidos por Alcohol/tratamiento farmacológico , Trastornos de la Visión/prevención & control , Deficiencia de Vitamina A/diagnóstico , Deficiencia de Vitamina A/tratamiento farmacológico , Xeroftalmia/diagnóstico , Xeroftalmia/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Vitamina A/uso terapéutico , Xeroftalmia/etiologíaRESUMEN
Myotonic dystrophy Curschmann-Steinert is a genetic disease which is inherited in an autosomal dominant pattern. Patients usually suffer from myotonia, muscular atrophy and weakness and myopathic facies. Furthermore, patients often present with ophthalmological symptoms with subcapsular cataract and bilateral ptosis being the most frequent ones. Therefore the ophthalmologist can help to detect patients suspected of having this disease and initiate further investigations. Despite clinically distinct findings, the disease is often overlooked because of the diversity of symptoms and clinical manifestations.