CASE REPORT

In October 1994, a 10-year-old Asian girl wearing a three point lap shoulder belt was a front seat passenger in a 1994 Nissan Altima, which was travelling at 30–40 miles (48–64 km) per hour when it hit another car. Both front seat airbags inflated. Car damage was limited to the right front bumper and right front end. The windows and windshield were not damaged. There were no sharp objects inside the car, and the patient was not wearing eyeglasses. She sustained abrasions to her face, lacerations to her right eyelid and eye, and a bruise to her left chest. The restrained driver was uninjured.

External examination revealed moderate right periorbital and eyelid ecchymosis with two linear partial thickness lacerations of the right upper lid. There was mild ecchymosis of the left upper lid. Extraocular movements were restricted in all gazes in the right and normal in the left eye. Uncorrected Snellen visual acuity was right eye no light perception and left eye 20/40. Slit-lamp examination showed a distorted right globe with diffuse conjunctival chemosis and injection and a large linear corneoscleral laceration which extended from the superior 10 o’clock limbus, transecting the cornea, to 10 mm beyond the inferior 5 o’clock limbus (Fig 1). There was prolapsed uvea at the inferior limbus. The cornea was diffusely oedematous and hazy. The anterior chamber was collapsed. There was no view of the lens or posterior pole. The left eye had trace diffuse conjunctival injection and was otherwise normal. Computed tomography (CT) scan revealed a right orbital floor fracture with blood in the right maxillary sinus (Fig 2). There was no evidence of intraocular foreign body on CT scan.

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Figure 1

External photograph of the right eye showing large corneoscleral laceration with prolapsed uvea and collapsed globe.

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Figure 2

Computed tomography (axial view) demonstrates right inferior orbital wall fracture with haemorrhage in the right maxillary sinus.

The corneoscleral and eyelid lacerations were repaired. Visual acuity in the right eye remained no light perception and the left eye improved to 20/20. The patient’s family was reluctant to consent to enucleation until 2 weeks later, at which time enucleation of the right eye and placement of a Medpor implant was performed.

COMMENT

This is the first report of a corneoscleral laceration due to passenger-side airbag inflation and the second report of a corneoscleral laceration due to airbag inflation, without associated eyeglass wear or external objects. Since the patient was not wearing eyeglasses and her arms and hands were uninjured, it is likely that the corneoscleral laceration and orbital fractures were directly related to inflation of the airbag. This patient may have been more susceptible to this type of injury, because as an Asian individual, she lacked a prominent inferior orbital ridge and maxillary prominence. Of note, the first reported case of corneoscleral laceration due to airbag inflation also involved a young Asian woman.6

Ophthalmologists should be aware of the potential for airbag associated ocular injuries. In addition, Asian individuals may be more prone to severe ocular injury as a result of airbag inflation. As others have suggested, reports of ocular injuries related to airbags may indicate the need to refine airbag deployment systems to prevent airbag associated morbidity.1 3 4 In order to facilitate recording of airbag related injuries, all new incidents should be reported to the appropriate authorities. In the USA, incidents should be reported to the National Traffic Highway Safety Administration via the Auto Safety Hotline at 800-424-9393.