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Ocular trauma with small framed spectacles
  1. J Clarke,
  2. R Newsom,
  3. C Canning
  1. Southampton Eye Unit, Southampton, UK
  1. Correspondence to: Mr J C K Clarke, Southampton Eye Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK

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Penetrating injuries are widely reported with spectacle related eye trauma, particularly in car accidents.1–4 The use of high grade plastics and secure frames have been shown to reduce the incidence of spectacle related eye trauma.5 Spectacle safety may be compromised in the trend for small frames and frameless spectacles and may place patients at risk of serious ocular injury.3

We present the case of an aphakic patient who sustained a blunt injury following ocular compression by her spectacles. Her injuries could have been avoided if larger framed spectacles had been worn.

Case report

A 79 year old aphakic woman sustained a non-penetrating injury to her left globe by walking into a door. She noted a sharp pain and sudden loss of vision. The globe was compressed by her spectacles, which were smaller than her orbital rim. Her glasses were not damaged and there was minimal periocular soft tissue injury.

She was aphakic, following bilateral cataract extraction for congenital cataracts. The spectacle refraction was +9.00 with a short back vertex distance of 5 mm (Fig 1).

Figure 1

Note the short back vertex distance in this aphakic correction.

The pinhole acuity was 6/36, a quiet, deep anterior chamber was noted with no aqueous leak, the intraocular pressure was 0 mm Hg. Funduscopy revealed a light vitreous haemorrhage, peripapillary choroidal ruptures, and a 360 degree suprachoroidal haemorrhage (Fig 2).

Figure 2

The choroidal rupture following blunt injury to the globe.

Hypotony following traumatic ciliary artery spasm was diagnosed and the patient was treated conservatively, with topical atropine twice daily and dexamethasone four times daily. After 4 days the hypotony resolved and the intraocular pressure returned to 14 mm Hg. The suprachoroidal haemorrhages resolved over 2 weeks and the visual acuity improved to 6/24.

Comment

The potential ocular damage from framed and frameless spectacles has been highlighted in a number of reports.1–4 These often result from minor road traffic accidents or inflation of air bags that damage the spectacles. The trauma is usually sufficient to break the lenses in the spectacles and the resultant globe laceration is the main cause of morbidity.

The recent trends towards smaller framed spectacles has not been reported as a potential risk to the patient; however, in this case, with small framed spectacles (with a short back vertex distance), minor trauma was sufficient to cause serious eye injury. The patient's previous larger framed spectacles would have prevented such an injury as the lenses would have been supported by the orbital margin and not the globe.

This case demonstrates the previously unconsidered risk of small framed spectacles in aphakic patients. The back vertex distance may be short, increasing the risk of blunt injury.

References

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