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INTRODUCTION: Cancers around the eye are often treated using orthovoltage machines or by plastic surgery, neither of which are widely available in regional Australia. External beam radiation therapy (EBRT) using electrons and an internal eye shield is an alternative, relatively underreported technique which can provide similar cosmetic and functional outcomes. This report aimed to describe the process for the use of internal eye shields at GenesisCare Fraser Coast Radiation Oncology (GCFCRO) and the associated clinical outcomes and patient perceptions of the delivery and results of this procedure. METHODS: This project was conducted in two phases. Phase I was an audit of the departmental technique and short-term clinical outcomes of 17 patients who received EBRT for skin cancer near the eyes at GCFCRO in partnership with Wide Bay Hospital and Health Service (WBHHS). Phase II was a survey of nine of those patients to elicit the patient perspective of the delivery and long-term outcomes of the treatment. RESULTS: Phase I revealed the departmental procedures for simulation, planning and treatment at GCFCRO are consistent with other departments published protocols. Phase II results detailed positive patient perspectives regarding cosmetic outcomes and receipt of EBRT for skin cancer near their eyes. CONCLUSION: EBRT with an internal eye shield is an acceptable alternative modality to surgery for squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) around the eye in the definitive and adjuvant setting. This is particularly important in regional locations to facilitate patients receiving high-quality care and outcomes locally.

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BACKGROUND: Today, due to the side effects of drugs, there is a greater desire to use non-pharmacological interventions to relieve pain caused by painful procedures. Using non-pharmacological interventions in combination is more effective than using them alone in relieving the pain of infants. Reducing sensory and environmental stimuli such as visual and auditory stimuli is one of the non-pharmacological methods to relieve pain. The aim of this study was to investigate the effect of using eye shield and ear muffs on pain intensity during venous blood sampling of premature infants. METHODS: In this clinical trial study, 148 premature neonates admitted to the Neonatal Intensive Care Unit of Rouhani and Children Hospitals in Babol were randomly assigned to four groups of 37. Fifteen minutes before intravenous blood sampling until 15 min later, in the first group, eye shield; in the second group, ear muffs, and in the third group, eye shield plus ear muffs were used. In the fourth group (control), blood sampling was performed routinely. NIPS pain scale and demographic questionnaire were used to collect the data. RESULTS: The results showed that during the venous blood sampling was a significant difference between the mean pain intensity of neonatal in the eye shield plus ear muffs group (3.14 ± 0.71), the ear muffs group (4.43 ± 1.21), the eye shield group (5.41 ± 1.04).) and the control group (5.94 ± 0.84) (P = 0.001). Moreover, after the venous blood sampling, there was a significant difference between the mean neonatal pain intensity in the eye shield plus ear muffs group (1.19 ± 0.39), the ear muffs group (1.43 ± 0.50), the eye shield group (1.33 ± 0.37) and the control group (1.89 ± 0.90) (P = 0.001). CONCLUSIONS: In this study, the pain severity during and after venous blood sampling in the ear muffs plus eye shield was lower than in other groups. Therefore, a combination of ear muffs and eye shield is recommended as a better pain reliever when performing venous blood sampling in premature infants.

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We aim to demonstrate the unique use of embedded lead eye shields in an electron wax bolus when treating the nasal dorsum. A patient presented to the clinic with squamous cell carcinoma of the nasal dorsum requiring treatment with en face electrons. A 3D customized wax bolus was designed and imported into the treatment planning system (TPS) to calculate the dose distribution. Due to high lens dose, the bolus was customized further to create 2 milled open slots in the wax, over the lens of eye, to allow lead sheets totaling 4 mm to be slid into the wax. The patient was brought back to the clinic to be scanned with the wax bolus fitting snugly over the nose, eyes, and cheek regions. The 3D milled insert holes were contoured on the CT in the TPS, assigned HU of 2758, to mimic the lead insertion. The lens dose with lead inserts was compared to the plan without lead insert. To further confirm the lens dose, EBT3 films were placed on the right and left eye under the bolus, and nose dorsum on the first day of treatment. The maximum dose of right lens, as calculated in the TPS with the simulated lead shields in place, decreased from 989.5cGy to 457cGy. The maximum dose of left lens decreased from 1085.4cGy to 501cGy. The dose readings from EBT3 films were in good agreement with the TPS, with deviation of 3.32%, 0.26%, and 3.44% for right lens, left lens, and nose, respectively. Daily positioning deviations compared to the plan were 0.65 ± 0.16cm and 0.63 ± 0.29cm for right eye and left eye, respectively. This novel device demonstrated the feasibility, in terms of dose calculation accuracy in the TPS and fabrication, of using customized bolus with lead inserts to conveniently shield the lens of the eyes in an electron treatment for the nose, enabling a streamlined daily setup.

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RATIONALE AND OBJECTIVES: In this study, we assessed the radiation dose to the lens and the impacts of various eye shields using either a fixed or modulated tube current. MATERIALS AND METHODS: Patients undergoing head computed tomography (CT) examinations were recruited, and each was randomly assigned to one of five imaging groups, either without a CT eye shield or with one of two types of shielding and topogram-based tube current modulation (TCM). The radiation dose at the eye lens was estimated using Gafchromic films. All CT images were analyzed for quality in the orbit and brain areas. Two radiologists also qualitatively assessed image artifacts and their impacts on image quality using three-point Likert scales. RESULTS: Both barium sulfate and bismuth-antimony shields significantly reduced radiation dose to the lens (by 28.60%-31.92% and 43.87%-47.00%, respectively) while significantly inducing image artifacts. The image quality of the intraocular structure, but not the intracranial structure, was significantly degraded by shielding. In addition, discriminating the periocular tissues was improved using a bismuth-antimony shield and topogram-based TCM. Compared to fixed tube current, topogram-based TCM provided better signal-to-noise and contrast-to-noise ratios in the intracranial structures when the bismuth-antimony and barium sulfate shields were applied, respectively. CONCLUSION: Artifacts resulting from the application of eye shields during head CT examinations can be reduced by using topogram-based TCM instead of a fixed tube current. This could be an alternative approach for maintaining image quality in CT scans that do not encompass organ-based TCM.

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The purpose of this study was to examine the effects of protective football headgear on peripheral vision reaction time and visual target detection. Twenty-five Division I NCAA football players (age = 20.5 yrs ± 0.9, height = 185.9 cm ± 6.8, body mass = 99.2 kg ± 19.2, BMI = 29.6 ± 4.5) participated. In a crossover counterbalanced study design, subjects participated in one visit with three conditions: Baseline (BL) without headgear, helmet only (HO), helmet with an eye shield (HE). Subjects completed a 1-min peripheral vision reaction time test for each condition separated by 3-min recovery periods. Tests were administered using a 64 light Dynavision D2 Visuomotor board. Target detection (total hit score) was higher during BL than HO (p < 0.001) and HE (p < 0.001). Average (p < 0.001), peak (p < 0.001), minimum (p < 0.001), and median (p < 0.001) peripheral reaction times were faster during BL than HO and HE. No significant differences were observed for any measures between HO and HE conditions (p > 0.05). Findings indicate that protective football headgear impaired reaction time to peripheral visual stimuli. The addition of an eye shield to the helmet had a small non-significant effect on reaction time and target detection. These results may hold important implications in helmet design and player safety.

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A metallic contact eye shield has sometimes been used for eyelid treatment, but dose distribution has never been reported for a patient case. This study aimed to show the shield-incorporated CT-based dose distribution using the Pinnacle system and Monte Carlo (MC) calculation for 3 patient cases. For the artifact-free CT scan, an acrylic shield machined as the same size as that of the tungsten shield was used. For the MC calculation, BEAMnrc and DOSXYZnrc were used for the 6-MeV electron beam of the Varian 21EX, in which information for the tungsten, stainless steel, and aluminum material for the eye shield was used. The same plan was generated on the Pinnacle system and both were compared. The use of the acrylic shield produced clear CT images, enabling delineation of the regions of interest, and yielded CT-based dose calculation for the metallic shield. Both the MC and the Pinnacle systems showed a similar dose distribution downstream of the eye shield, reflecting the blocking effect of the metallic eye shield. The major difference between the MC and the Pinnacle results was the target eyelid dose upstream of the shield such that the Pinnacle system underestimated the dose by 19 to 28% and 11 to 18% for the maximum and the mean doses, respectively. The pattern of dose difference between the MC and the Pinnacle systems was similar to that in the previous phantom study. In conclusion, the metallic eye shield was successfully incorporated into the CT-based planning, and the accurate dose calculation requires MC simulation.

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Objective To explore the effect of the application of the modified eye shield in neonatal phototheraphy . Methods 120 neonates with jaundice were chosen and randomly divided into two groups (60 each).Control group was only applied to normal eye shield, while the improved group used the modified eye shield, wrapping with gauze, and then mositen the eyes with 1~2 Tobramycin eye drops on each side.Both groups were fixed with 3M tapes.After a 24 -hour photothera-py, the incidence rate of reseola, skin rash and eye secretions were compared.Results The improved group has better pro-tective effect and the difference between these two groups is of great statiscally significance(p<0.05).Conclusion The ap-plication of modified eye shield could effectively protect their eyes from neonatal roseola, skin rash and eye secretions, im-prove the feeling of comfort and promote high quality nursing service .

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PURPOSE: Periocular carbon dioxide ultrapulsed laser surgery can induce ocular damage. Herein we report a rare case of corneal burn after carbon dioxide ultrapulsed laser for nevus removal. CASE SUMMARY: A 25-year-old female patient presented with ocular pain, decreased visual acuity, and metamorphopsia in the left eye after laser surgery for nevus removal at a dermatology clinic 4 days prior. The patient's best corrected visual acuity in the left eye was 20/100. Central corneal haziness and corneal epithelial defect were observed on biomicroscopic examination. Antibiotics, steroid and artificial tear eye drops were administered for treatment. Glasses were prescribed to correct refraction errors. After 2 months of treatment, the best corrected visual acuity in the left eye recovered to 20/50, and corneal epithelial defect was mostly healed, however corneal haziness remained. CONCLUSIONS: Carbon dioxide ultrapulsed laser is commonly used in dermatological treatments. The use of an eye shield is important during this procedure, and possibility of ocular surface damage from laser treatment should be considered.

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