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Background: To examine the epidemiology, visual outcomes, surgical interventions, and socioeconomic costs of closed globe (CGI) and adnexal injuries. Methods: A retrospective 11‐year tertiary‐trauma centre study of 529 consecutive CGI was conducted using the Revised Globe and Adnexal Trauma Terminology classification in individuals aged ≥16 years. Outcome measures included best‐corrected visual acuity (BCVA), operating theatre visits, and socioeconomic costs. Results: CGI disproportionately impacted young males during work (89.1%) and sports (92.2%), with eye protection only worn in 11.9% and 2.0%, respectively. Home was the most prevalent location (32.5%) due to falls (52.3%) in older females (57.9%). Concomitant adnexal injuries occurred frequently (71.5%), particularly in assaults (88.1%), and included eyelid lacerations (20.8%), orbital injuries (12.5%), and facial fractures (10.2%). Final median BCVA improved to 0.2 logMAR [6/9] (IQR 0–0.2) from 0.5 logMAR [6/18] (IQR 0–0.5) (p < 0.001). Surgery was required in 89 CGI (16.8%) in 123 theatre visits. In multivariable logistical regression modelling, presenting BCVA was predictive of final BCVA (odds ratio [OR] 8.4, 95% confidence interval [95%CI] 2.6–27.8, p < 0.001), while involvement of the lids (OR 2.6, 95%CI 1.3–5.3, p = 0.006), nasolacrimal apparatus (OR 74.9, 95%CI 7.9–707.4, p < 0.001), orbit (OR 5.0, 95%CI 2.2–11.2, p < 0.001), and lens (OR 8.4, 95%CI 2.4–29.7, p < 0.001) predicted for operating theatre visits. Economic costs totalled AUD20.8–32.1 million (USD16.2–25.0 million) and were estimated at AUD44.5–77.0 million (USD34.7–60.1 million) annually for Australia. Conclusions: CGI is a prevalent and preventable burden on patients and the economy. To mitigate this burden, cost‐effective public health strategies should target at‐risk populations. [ABSTRACT FROM AUTHOR]

Background: Open globe injuries (OGI) represent a visually and economically devastating cause of vision loss. We examined the epidemiology, predictive variables, prognostic models, and economic cost of surgically managed OGI. Methods: A retrospective tertiary centre study from 2008 to 2018 of 155 consecutive OGI in individuals aged 16 and older was performed. Medical records review, application of Ocular Trauma Score (OTS) and Classification and Regression Tree Analysis (CART) and cost analysis were undertaken. Key outcomes measured were visual acuity, number of operating theatre visits, prognostication using OTS and CART and estimated costs. Results: Younger males at work with inadequate protective eyewear (89.1%) and falls in the elderly were overrepresented. Inferior visual outcomes were associated with a more severe OTS score, a larger injury zone, increasing age, the presence of retinal detachment, extraocular muscle involvement, intraocular foreign body, and globe rupture (R2 = 0.723, p < 0.001). Multiple operating theatre visits were required in the presence of retinal detachment, lens or orbit involvement, work‐related injury, globe rupture, and a history of previous intraocular surgery (R2 = 0.0423, p < 0.001). Both OTS and CART prognosticated outcomes (p < 0.001). The OTS predicted for no vision (no light perception/enucleation/evisceration) and profound visual loss (worse than 6/120; specificity: both 100%, sensitivity: 88.2% and 88%) whereas the CART predicted for visual survival (light perception or better) and minimal‐to‐severe visual loss (6/120 or better; specificity: 88.5% and 81.7% , sensitivity: 97.7% and 100%). Estimated annual OGI cost for Australia was AUD48.1–60.5 million (USD37.3–47.0 million). Conclusions: The total cost of OGI is immense with young males and the elderly being disproportionately affected. Implementation of targeted government legislation and public health preventative measures may be cost‐effective in ameliorating the significant burden. [ABSTRACT FROM AUTHOR]

Schizophrenia, a neurodevelopmental mental disorder with heterogeneous features, poses major social and health-care challenges in Australia and worldwide. Ophthalmic findings in patients with schizophrenia are varied and include conditions that result from psychotropic complications such as sun gazing, heritable genetic endophenotypes such as oculomotor abnormalities and strabismus, treatment-related complications such as chlorpromazine lenticular and corneal deposits, and co-morbid health problems such as poor compliance. This report reviews special considerations for eye care in schizophrenia and provides case examples to illustrate the complexity of problems that optometrists may encounter with this population. [ABSTRACT FROM AUTHOR]

Background: Open globe injuries (OGIs) account for 44% of the cost of ocular trauma within Australia. It is estimated that 90% of ocular trauma is preventable. However, there have been few epidemiological studies within Australia that have identified groups at risk of OGIs specifically. The aim of our study was to review the epidemiology of OGIs presenting to a tertiary referral eye hospital in Australia.Methods: The Birmingham Eye Trauma Terminology (BETT) system was used to classify injuries as globe ruptures, penetrating eye injuries (PEIs), intraocular foreign bodies (IOFBs) or perforating injuries. Demographic data, past ocular history, mechanism of trauma, ocular injuries, and best-corrected visual acuity (BCVA) before and after treatment were recorded.Results: The 205 OGIs included 80 globe ruptures, 71 PEIs, 48 IOFBs and six perforating injuries. Falls predominated in older age groups compared to the other mechanisms of injury (p<0.0001). A fall was responsible for 33 globe ruptures and 82% of these had a history of previous intraocular surgery. Globe rupture and perforating injuries had poorer visual outcomes (p<0.05), consistent with previous studies. Alcohol was implicated in 20 cases of OGI, with 11 of these due to assault. PEIs and IOFBs commonly occurred while working with metal. BCVA was significantly worse following removal of an intraocular foreign body. We found presenting BCVA to be a good predictor of BCVA at the time of discharge.Conclusions: The causes of OGI varied in association with age, with older people mostly incurring their OGI through falls and younger adults through assault and working with metal. Globe ruptures occurring after a fall often had a history of intraocular surgery. The initial BCVA is useful for non-ophthalmologists who are unfamiliar with the ocular trauma score to help predict the BCVA following treatment. [ABSTRACT FROM AUTHOR]

CASE HISTORY Thirteen cats developed ophthalmic complications following dental procedures in Australia and New Zealand between December 2014 and February 2018. All cats had at least one maxillary tooth extracted and some received a transoral maxillary nerve block. CLINICAL FINDINGS Ocular signs were identified at a median of 1.5 (min 0, max 14) days following elective dental procedures and included fibrin in the anterior chamber, aqueous flare, vision loss and miosis. Response to medical management was poor overall, with 7/13 (54%) cats undergoing subsequent enucleation and one cat was subjected to euthanasia shortly after the dental procedure due to ocular disease. The remaining five cats were managed medically. Of these, four exhibited signs of persistent inflammation at the last ophthalmic assessment, and one was subsequently subjected to euthanasia due to reasons unrelated to ocular health. Active inflammation resolved in one cat, however the lesions caused by previous inflammation persisted. PATHOLOGICAL FINDINGS Assessment of six enucleated globes showed a variety of pathological changes, with marked fibrinous exudation and suppurative inflammation as predominant features. A scleral penetration site was identified in three globes. Four globes had lens capsule rupture and phacoclastic uveitis. DIAGNOSIS Endophthalmitis following iatrogenic globe penetration during routine dental procedures. CLINICAL RELEVANCE This case series demonstrates that globe penetration during dental procedures carries a poor prognosis for the eye. Clinicians should be aware of the risks of ocular trauma during dental procedures in cats and great care should be taken to avoid ocular penetration, particularly during tooth extractions. Transoral maxillary nerve blocks should be avoided or used with extreme caution in cats.