They say the eyes are the windows to your soul; the truth is that those windows are quite breakable. The delicate structure of the eye is easily susceptible to damage and one should always take extra measures to protect them. It is no secret that we take our eyes for granted, and far too often than not, a foolish act can get in the way of that protection.
While April Fool’s Day—a holiday for tricks and pranks—kicked off this month, accidental incidents of ocular trauma thrive year-round. From a simple poke in the eye to a more serious paintball pellet incident, ocular traumas are frequent and often sight threatening. While optometrists may be fully aware of the possible risks and injuries to the eye, it is the patients who grace their waiting rooms that may not be so informed.
In 1985, Michael Easterbook, M.D., and Thomas J. Pashby, M.D., reported the fi rst case of ocular trauma from a paintball injury.
While ball bearing (BB) pellets and paintballs can achieve similar velocities, paintballs have a mass 10 times greater than BB pellets and tend to cause a different range of eye injuries. Paintballs are covered with a latex or gelatin shell that is designed to shatter on impact, which makes blunt trauma the most common mechanism of injury.
Additionally, because paintballs are designed to rupture on impact, they may cause ocular damage through mechanical deformation of the globe, specifically anterior posterior compression and equatorial expansion.
Fireworks-related injuries are frequently seen around a variety of celebrations and festivities. Unfortunately, they are also responsible for a large number of blinding and fatal injuries worldwide. Injuries may result from direct high-velocity contact with the rocket, from parts of the rocket that break away during fl ights, or from debris propelled by the force of the rocket’s combustion.
Half of all fi reworks-related ocular injuries are caused by bottle rockets.
Another study found that bottle rockets were responsible for 38.5% of all fi reworks injuries and resulted in more frequent facial injury, intraocular foreign body, endophthalmitis and poorer fi nal visual outcomes than other fi reworks. As the old saying goes, it’s all fun and games until someone gets hurt—or, in this case, loses an eye.
An especially foolish deed is the unauthorized use of noncorrective decorative contact lenses. These soft, zero power, hydrogel lenses augment the natural eye color and alter the physiology of the ocular surface.
Though decorative contact lenses are regulated as medical devices by the FDA and sold by prescription from licensed professionals, their use is largely unregulated. These lenses are frequently obtained by unlicensed vendors and sold to an eager, typically young, consumer base without a prescription or fitting. Internet sites, gas stations,video stores and even fl ea markets sell decorative contact lenses with little thought to safety guidelines or instructions. This creates an alarming problem because as patients wearing these lenses are unaware of the necessary sanitary precautions and, consequently, do not adequately clean their lenses and often share them with friends.
Additionally, non-prescription lenses are not accurately fi tted to the eye and can be too tight, which can cause corneal ulcers, edema, scarring and reduced visual acuity.
The FDA has taken a strong stance against the unregulated use of decorative contact lenses; it issued a warning in 2002 against the use of noncorrective decorative lenses without a prescription or professional fi tting. However, there are still approximately three million people in the United States wearing cosmetic lenses, and at least 30% without vision correction.5 On a related note, there is also an alarming new fad among today’s youth concerning “circle lenses,” contacts with a tinted outer ring overlapping the white of the eye, making the iris appear much larger. While particularly popular in Asia, Americans have also recently taken hold of the dangerous trend. Because of their growing popularity and rabid unlicensed use, the American Academy of Ophthalmology released a statement in 2010 condemning the unregulated sale of the circle lenses, stating that they, “would like to alert consumers to the hazards of buying any decorative lenses, including circle lenses, without a prescription. Any type of contact lens is a medical device that requires a prescription, proper fi tting by an eye care professional and a commitment to proper care by the consumer.”
It is all too common for a misstep or a fumble to allow an ocular accident to occur, especially with various orbital foreign bodies. Accidental penetration to the eye is quite common—for example, picture a child with a pencil or a woman with a mascara wand.
One of the most common ocular penetrations involves the popular sport of fi shing with its treacherous, free-fl ying hooks. Fishingrelated ocular injuries often result in considerable visual loss. Preventive measures, such as the use of protective eyewear, should be insisted upon to prevent these foolish incidents.
Of 732 cases of sport-related ocular trauma, 19.54% occurred while fi shing.
April Fool’s Day dates back to 1582 when Charles IX of France introduced the Gregorian calendar, forever moving New Year’s Day from April 1 to January 1. It took many years for the word to spread about the change in the calendar, causing some to be deemed “April Fools” due to their unintentional ignorance. With that in mind, let us take advantage of more modern communication technologies to educate and remind our patients about the ocular risks of certain perilous situations.