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Management of infections at ocular injury often requires prolonged and high dose of antibiotic, which is associated with challenges of antibiotic resistance and bacterial biofilm formation. Tissue glues are commonly used for repairing ocular tissue defects and tissue regeneration, but they are ineffective in curing infection. There is a critical need for antibacterial ocular bio-adhesives capable of both curing infection and aiding wound closure. Herein, we present the development of an imine crosslinked N-(2-hydroxypropyl)-3-trimethylammonium chitosan chloride (HTCC)‑silver chloride nanocomposites (QAm 1 -Ag x ) and poly-dextran aldehyde (PDA) based bactericidal sealant (BacSeal). BacSeal exhibited potent bactericidal activity against a broad spectrum of bacteria including their planktonic and stationary phase within a short duration of 4 h. BacSeal effectively reduced biofilm-embedded MRSA and Pseudomonas aeruginosa by ∼99.99 %. In ex-vivo human cornea infection model, BacSeal displayed ∼99 % reduction of ocular infection. Furthermore, the hydrogel exhibited excellent sealing properties by maintaining ocular pressure up to 75 mm-Hg when applied to human corneal trauma. Cytotoxicity assessment and hydrogel-treated human cornea with a retained tissue structure, indicate its non-toxic nature. Collectively, BacSeal represents a promising candidate for the development of an ocular sealant that can effectively mitigate infections and may assist in tissue regeneration by sealing ocular wounds., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Colletotrichum is a rare fungal pathogen, which is known to cause anthracnose in plants and keratitis or subcutaneous infections in humans. Among the seven Colletotrichum species reported in eye infections, truncatum species is usually virulent with poor visual prognosis even after surgical treatment. Here we report a case of Colletotrichum truncatum keratitis in a young boy with thorn injury that completely resolved with topical natamycin and voriconazole., Competing Interests: None

With a wide range of applications, laser pointers used as toys by children has become a major public safety problem worldwide. Here we present a long term followup of a ten-year-old boy retina injured patient who suffered from green light laser pointer. Retina injured patients caused by green light laser pointer were traditionally treated by steroid. We gave Lutein treatment prescription according to the wishes of the patient's parents. Over 12 months followup, the patient's visual acuity and retinal recovery outcomes were similar as in cases with steroid treatment. Primary school teacher and parents should pay more attention to children playing with laser pointer to prevent laser injury accident through school and family education., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To report a case of macular injury caused by prolonged exposure to a flash from the plasma formed at the focus of a femtosecond laser., Design: Interventional case report., Participant: A patient with macular injury caused by sustained observation of the plasma flash produced by a femtosecond laser., Intervention: The patient was examined with complete ophthalmologic evaluation (including Amsler grid test, funduscopy, fluorescein angiography, and optical coherence tomography [OCT]) at 3 hours, 1 month, and 6 months after injury. The injured right eye received a retrobulbar injection of 40 mg triamcinolone acetonide (TransTon), at 4 hours and at 10 days after injury, respectively., Main Outcome Measures: Visual acuity, ophthalmoscopic, and OCT findings., Results: Three hours after injury, the best-corrected visual acuity of the right eye was 20/30 with a very small relative scotoma nasal to fixation. Funduscopy disclosed a well-circumscribed, yellow-white spot lesion located immediately temporal to the foveal center. As time passed, the patient's vision returned to 20/20 and the scotoma and retinal abnormalities had become less prominent, but were still present. In the acute stage, OCT showed a hyperreflective lesion involved all foveal retinal layers. At 1 and 6 months of follow-up, OCT revealed abnormal reflectivity located within the outer foveal retina., Conclusions: Prolonged viewing of a plasma flash induced by a focused femtosecond laser in the air without eye protection may produce persistent damage to the retina. The observed macular injury was probably the result of a combination of thermal and photochemical damage., (Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: This study was undertaken to determine whether a difference exists in treatment outcome between patients treated with tranexamic acid (TEA) plus topical steroids and those treated with topical steroids alone., Methods: A retrospective cohort study was conducted to compare treatment results for children with traumatic hyphema treated with TEA and topical steroids versus topical steroids alone. Patients were identified from a chart review of the Children's Hospital of Eastern Ontario eye clinic and the Queen's Department of Ophthalmology emergency eye clinic for charts coded "traumatic hyphema." The primary outcomes measured included visual acuity, rebleed rate, intraocular pressure, and time to hyphema resolution. Covariates were hyphema grade, the need for medications to lower intraocular pressure, and the presence of associated ocular traumatic complications. Analysis was performed with both bivariate analysis and multivariate models., Results: Two hundred and fifteen patients with traumatic hyphema were included in our study. One hundred and thirty-seven patients (63.1%) received TEA plus topical steroids, and the remaining 78 patients received topical steroids alone. There was no significant difference in rebleed rate between the TEA plus topical steroid group (1.6%) and the steroid-alone group (2.6%, p = 0.60)., Interpretation: Patients with traumatic hyphema treated with TEA plus topical steroids did not have a significantly lower incidence of rebleed than those treated with topical steroids alone.

Objective: To determine the safety and efficacy of topical aminocaproic acid (Caprogel) in the management of traumatic hyphema., Design: Multicenter, randomized, double-masked, placebo-controlled clinical trial., Participants: A total of 51 patients participated in this trial (power = 36%, 2-tailed test)., Intervention: Patients presenting with traumatic hyphema were randomly assigned to 5-day treatment with topical aminocaproic acid or a placebo gel. Patients were monitored daily with ocular examination and vital sign testing for the 5 days of treatment and at 24 and 48 hours after treatment. General physical examination and laboratory testing were performed at baseline and day 5., Main Outcome Measures: The main efficacy variable was the rate of rebleeding. Secondary efficacy variables included time to hyphema clearance, intraocular pressure, time to secondary hemorrhage, and visual acuity. Safety variables included adverse events, vital signs, and laboratory measurements., Results: Rebleeding occurred in 30% of the placebo group (8 of 27; 95% confidence interval [CI] = 14-50%), versus 8% of the treatment group (2 of 24; 95% CI = 1-27%), for an estimated continuity-corrected difference in percentage of patients with bleeding of 17% (95% CI = -3-38%). Secondary efficacy variables were similar in the groups, except that there was a trend towards more visual improvement in the topical aminocaproic acid group (54%) than in the placebo group (30%) at the last measurement (P = 0.08). Adverse events were similar., Conclusions: This study provides evidence that topical aminocaproic acid is safe and demonstrates trends towards reducing the rebleeding rate in the management of traumatic hyphema. However, because the study was terminated before complete enrollment, more definitive recommendations will require a larger trial.

Objective: Factors such as size of hyphema, intraocular pressure, initial visual acuity, and use of steroids or antifibrinolytic drugs may be associated with the likelihood of rebleeding in traumatic hyphema. The association of the visual outcome with secondary hemorrhage has been questioned., Design: Randomized, placebo-controlled, clinical trial., Participants: Two hundred and thirty-eight patients who had hyphema develop after blunt trauma., Intervention: Eighty patients received oral tranexamic acid, 80 patients received placebo, and 78 patients received oral prednisolone., Main Outcome Measures: Secondary hemorrhage and vision at the time of discharge from the hospital were measured., Results: Rebleeding occurred in 43 (18%) of the patients and was prevented significantly by oral tranexamic acid compared with the placebo (odds ratios [OR] = 0.39; 95% confidence interval [CI], 0.17, 0.89). Occurrence of secondary hemorrhage had weak associations with initial high intraocular pressure (OR = 2.7; 95% CI, 0.99, 7.3) and initial visual acuity of 6/60 or less (OR = 1.8; 95% CI, 0.9, 3.7). Secondary hemorrhage had no statistical association with age, gender, oral prednisolone, size of hyphema, and retinal damage. Visual acuity of 6/60 or less at the time of discharge was significantly associated with rebleeding (OR = 10.5; 95% CI, 3.7, 29.2), initial visual acuity of 6/60 or less (OR = 9.9; 95% CI, 2.8, 38.0), retinal damage (OR = 14.6; 95% CI, 3.8, 55.8), and male gender (OR = 6.5; 95% CI, 1.4, 31.9). Final visual acuity had no significant statistical association with age, use of oral prednisolone or tranexamic acid, and size of hyphema., Conclusions: High intraocular pressure and low vision at the time of first examination may be associated with increased chance of rebleeding. Retinal damage, secondary hemorrhage, male gender, and initial poor vision are associated with a worse visual outcome in patients with traumatic hyphema.

Objective: Oral antifibrinolytics, oral steroids, and no oral treatment are the preferred medical treatments for traumatic hyphema. Antifibrinolytics and steroids have decreased the chance of rebleeding in some studies but failed to alter the clinical course in others. Rate of secondary hemorrhage seems variable among different geographic and ethnic groups of patients. Comparison of the treatments in each population is necessary to document the most effective method of preventing recurrent hemorrhage., Design: Randomized, placebo-controlled, clinical trial., Participants: Two hundred thirty-eight patients in whom hyphema developed after a blunt trauma entered the study., Intervention: Eighty patients received 75 mg/kg per day oral tranexamic acid (TA) divided into 3 doses, 80 patients received a placebo with the same number of tablets and frequency as those of the TA group, and 78 patients received 0.75 mg/kg per day oral prednisolone divided into 2 doses., Main Outcome Measure: Secondary hemorrhage during the hospital course was measured., Results: Secondary hemorrhage occurred in 8 patients (10%) of the TA group, 14 patients (18%) of the prednisolone group, and 21 patients (26%) of the placebo group. The difference between the incidence of rebleeding between TA and placebo groups was statistically significant (P = 0.008). Patients receiving a placebo had a greater chance of secondary bleeding than did patients receiving TA (odds ratios = 3.2; 95% confidence interval = 1.3, 7.5). The incidences of rebleeding were not significantly different in placebo versus prednisolone groups (P = 0.21) and TA versus prednisolone groups (P = 0.15)., Conclusion: In a population with a high rate of secondary bleeding, TA is more effective than oral prednisolone or no oral treatment in preventing rebleeding among patients with traumatic hyphema.

Objective: This study aimed to compare the outcomes of outpatient and inpatient management of layered hyphema., Design: The charts of all patients with traumatic layered hyphema treated in the Massachusetts Eye and Ear Infirmary Emergency Ward between January 1991 and November 1995 were analyzed retrospectively. Patients with a diagnosis of microscopic hyphema, ruptured globe, or posterior segment injury other than commotio retinae on their initial emergency department visit were excluded. The study patients were compared with an historic control group of patients with hyphema who had been treated at the same institution from July 1986 to February 1989., Participants: A total of 154 patients met the study criteria. These were compared with 119 patients in the historic control group., Intervention: Of the study patients, 5% were admitted on the day of presentation, 95% were treated initially as outpatients, and 4% subsequently were admitted. All of the patients in the historic control group were treated with initial hospital admission., Main Outcome Measures: The rebleed rates of the study and control groups were compared. The final recorded visual acuity and causes of best-corrected visual acuity worse than 20/30 were analyzed for the study group., Results: The rebleed rates of the study group and the historic control group were 4.5% and 5.0%, respectively (P > 0.05). The rebleed rates of the study patients initially treated as outpatients and the historic control group were 3.4% and 5%, respectively (P > 0.05). The rebleed rates of study patients who did not receive aminocaproic acid and the subset of historic control patients who received aminocaproic acid were 3.3% and 4.8%, respectively (P > 0.05). Ninety-six percent of study patients achieved a final best-corrected visual acuity of 20/30 or better. Causes of a final documented visual acuity worse than 20/30 included loss of patient follow-up before resolution of the hyphema, traumatic cataract, macular hole, and macular degeneration., Conclusions: In the authors' predominantly white patient population, close outpatient follow-up of traumatic hyphemas appears to be safe and effective. Hospitalization for hyphema does not appear to decrease the rate of rebleeding. Decreased vision in the setting of traumatic hyphema generally results from comorbidities not affected by inpatient management.

Purpose: Topical corneal anesthetic abuse is a self-inflicted injury, causing profound corneal morbidity. Superimposed infection is an important complicating factor. The authors report four patients with confirmed topical anesthetic abuse of the cornea, in whom Candida keratitis developed., Methods: A retrospective review of the medical records of four patients with confirmed topical corneal anesthetic abuse and fungal keratitis., Results: A 21-year-old woman, two 28-year-old women, and a 35-year-old man were included in the study. All these patients sustained a corneal injury, prompting the chronic use of topical anesthetics (0.5% proparacaine hydrochloride in 3 patients, and 0.5% tetracaine hydrochloride and 0.4% benoxinate hydrochloride in the other). Corneal findings included epithelial defects in all patients, focal infiltrate in one patient, and ring-shaped stromal infiltrate in three patients. Topical anesthetic was discontinued, all patients initially were treated empirically with antibacterial agents, and three patients received topical corticosteroids. Subsequent corneal cultures grew Candida spp, Candida albicans specifically in three patients, and local and systemic antifungal therapy was started. Corneas in two patients re-epithelialized; a conjunctival flap was performed on another patient with a descemetocele; and the remaining patient was lost to follow-up, although repeat fungal cultures yielded no growth., Conclusions: Corneal superinfection with Candida may occur during topical anesthetic abuse. Therapy includes discontinuation of the anesthetic and institution of antifungal therapy.

Purpose: The purpose of this study is to determine the incidence of secondary hemorrhage after traumatic hyphema in children and to evaluate the efficacy of epsilon aminocaproic acid in reducing this incidence., Methods: In a prospective, randomized, double-blind study performed between November 1987 and February 1994, 94 children admitted for traumatic hyphema were assigned to receive either aminocaproic acid (n = 48) (100 mg/kg every 4 hours; maximum, 30 g daily) or placebo (n = 46) for 5 days. Patients who had ingested aspirin in the week preceding admission were excluded from the study., Results: Mean age of the patients was 9.4 years. Black patients comprised 4% of the study population. Secondary hemorrhage occurred in only three patients (3.2%), two from the placebo group and one from the aminocaproic acid group, none of whom had any complications. The duration of hospital stay and the clot resorption times were increased significantly in the aminocaproic acid group (P < 0.001)., Conclusions: The authors report a very low incidence of secondary hemorrhage compared with most previous studies. This difference is likely related to the small proportion of black patients in our study and to the exclusion of patients having ingested aspirin, two factors that seem to be associated with higher rates of rebleeding. The efficacy of aminocaproic acid could not be determined due to the low incidence of hemorrhage. The results of this study, however, suggest that the incidence of secondary hemorrhage in white patients without prior ingestion of aspirin is insufficient to justify routine use of aminocaproic acid in managing traumatic hyphema. Rather, an individualized decision based on the risk factors of each patient would seem more appropriate to avoid a slower clot resorption time and possible side effects of this medication.

Background: Treating traumatic corneal abrasions is a common problem for the ophthalmologist. Traditional management has been the use of a pressure patch. Three different therapeutic modalities were evaluated for their efficacy in treating traumatic corneal abrasions., Methods: Forty-seven consecutive patients with traumatic corneal abrasions were randomized prospectively in a single-masked, controlled clinical trial which compared the efficacy of (1) pressure patching, (2) a bandage contact lens, and (3) a bandage contact lens with a topical nonsteroidal anti-inflammatory drug (0.5% ketorolac tromethamine)., Results: There was no significant difference in the healing time of the three groups. However, psychometric analysis showed a significant decrease in pain in the group that received a bandage contact lens with a topical nonsteroidal anti-inflammatory drug. There was a significant difference in the ability to return to normal activities in both contact lens groups compared with the pressure-patch group. There was no significant difference among the three groups with respect to photophobia, redness, ocular irritation, headache, or tearing., Conclusion: Use of a bandage contact lens significantly shortens the time required for a patient to return to normal activities. Moreover, addition of a nonsteroidal anti-inflammatory drug to a treatment regimen significantly decreases the pain associated with traumatic corneal abrasions. Use of a bandage contact lens with a topical nonsteroidal anti-inflammatory may prove to be an effective adjunct in treating traumatic corneal abrasions.

To examine the effect of traumatic hyphema on accommodation, we reviewed the records of 158 patients (159 eyes) admitted to hospital between Jan. 1, 1988, and Dec. 31, 1989, for treatment of traumatic hyphema. A sample of 30 patients were examined an average of 29.6 months after injury, and 2 (7%) were found to have accommodative impairment of greater than 2.5 dioptres. Post-traumatic accommodative impairment may cause prolonged reading disability requiring asymmetric spectacle correction.

Background: Corneal stings from the sea nettle (Chrysaora quinquecirrha) indigenous to the Chesapeake Bay are usually painful but self-limited injuries, with resolution in 24 to 48 hours., Methods: Five patients who developed unusually severe and prolonged iritis and intraocular pressure elevation after receiving corneal sea nettle stings were followed for 2 to 4 years., Results: Decreased visual acuity, iritis, and increased intraocular pressure (32 to 48 mmHg) were noted in all cases. Iritis responded to topical corticosteroids and resolved within 8 weeks. Elevated intraocular pressure responded to topical beta blockers and oral carbonic anhydrase inhibitors. Mydriasis (4 of 5 cases), decreased accommodation (2 of 5 cases), peripheral anterior synechiae (2 of 5 cases), and iris transillumination defects (3 of 5 cases) also were noted. Mydriasis and decreased accommodation persisted for 5 months in 1 case and for more than 2 years in another. One patient has chronic unilateral glaucoma. Visual acuity returned to normal in all cases., Conclusions: The precise relationship between sea nettle venom and the observed clinical responses is not known. Corneal jellyfish stings usually produce a brief and self-limited reaction, but they do have the potential for long-term sequelae.

The use of succinylcholine in patients with suspected or proven open globes is considered dangerous by some for fear of extruding the intra-ocular contents as a consequence of the co-contraction of the extraocular muscles it produces. To test this hypothesis, the authors devised an anterior and a posterior trauma model in the cat eye. Thirty events were studied using the anterior trauma model and eight with the posterior model. The only observable effect of succinylcholine administration was forward displacement of the lens and iris. No intraocular content was lost in any event. The authors believe this study supports the argument that, when indicated, succinylcholine may be considered in open globes.

We describe two young men in whom severe anterior uveitis developed following relatively minor corneal trauma. Investigation revealed ankylosing spondylitis in both cases; neither had previously experienced uveitis. We are unaware of any previous reports implicating minor ocular trauma in precipitating a first episode of uveitis associated with ankylosing spondylitis. The possibility of occult ankylosing spondylitis should be considered in cases of disproportionately large anterior chamber reactions to minor ocular trauma.

One hundred twelve patients who sustained hyphema after blunt trauma were enrolled in a double-blind randomized clinical trial to determine the relative efficacies of aminocaproic acid (Amicar) and systemic prednisone for reducing the rate of secondary hemorrhage. Fifty-six patients received an oral dosage of 50 mg/kg of aminocaproic acid every 4 hours for 5 days, up to a maximum of 30 g daily, and 56 patients received an oral dosage of 40 mg of prednisone daily (adjusted for weight) in two divided doses. Placebo pills and liquids were given to each patient to mask the treatment schedules. There were no statistically significant differences between the patient populations for any demographic or clinical characteristic (e.g., visual acuity, intraocular pressure [IOP], initial hyphema size) measured in the study. Blacks comprised 53% of the study population, and the mean age of the patients was 23.5 years. Four patients in each of the treatment groups experienced a secondary hemorrhage; the rebleed rate was 7.1% in each group.

We studied the effect of urokinase on the natural course of posterior penetrating eye injury in an animal model that consistently results in late tractional retinal detachment. A standard penetrating injury was performed on both eyes of 20 rabbits. Each eye received 0.4 mL of heterologous rabbit plasma. Then 10 000 U of urokinase was injected in one randomly chosen eye of each animal; an equal volume of balanced salt solution (BSS) was injected in the other. By 5 to 6 weeks after the surgery 13 (65%) of the 20 urokinase-injected eyes and 15 (75%) of the 20 BSS-injected eyes showed retinal detachment; the proportions are not significantly different. Gross and microscopic study of the enucleated, sectioned eyes failed to reveal any features distinguishing the control and urokinase-treated eyes. Thus, urokinase did not appreciably alter the natural course of development of late tractional retinal detachment after posterior penetrating eye injury.