Air Bag-related Corneal Rupture After Radial Keratotomy

doi:10.1016/S0002-9394(14)72737-0

American Journal of Ophthalmology

Volume 120, Issue 6, December 1995, Pages 800-802

https://doi.org/10.1016/S0002-9394(14)72737-0 Get rights and content

Purpose

We studied a case of air bag-associated corneal rupture in a patient who had previously undergone radial keratotomy surgery.

Methods

The patient was struck in the right eye when his driver's side air bag inflated during a low-speed collision.

Results

Inflation of the air bag resulted in rupture of the patient's right cornea. The rupture involved all but one of his old radial keratotomy wounds.

Conclusions

Patients who have undergone radial keratotomy may be at increased risk for corneal rupture caused by air bag trauma. These patients may benefit by wearing protective eyewear while driving cars equipped with air bags.

References (5)

AJ Smally et al.
Alkaline chemical keratitis: eye injury from airbags
Ann Emerg Med
(1992)
PS Binder et al.
An ultrastructural and histochemical study of long-term wound healing after radial keratotomy
Am J Ophthalmol
(1987)

There are more references available in the full text version of this article.

Cited by (27)

Optical Correction with Refractive Surgeries and Prosthetic Devices
2006, Borish's Clinical Refraction
The effects of depowered airbags on eye injuries in frontal automobile crashes
2005, American Journal of Emergency Medicine
The purpose of this study was to investigate eye injuries resulting from frontal automobile crashes and to determine the effects of depowered airbags. The National Automotive Sampling System database files from 1993 to 2000 were examined in a 3-part investigation of 22 236 individual crashes. Of the 2 103 308 occupants exposed to a full powered deployment, 3.7% sustained an eye injury compared to 1.7% of the 310 039 occupants exposed to a depowered airbag deployment. Occupants were at a significantly higher risk to sustain an airbag-induced eye injury when exposed to a full powered airbag compared with occupants exposed to a depowered airbag deployment (P = .04). Approximately, 90% of the eye injuries in full powered airbag deployments were caused by the airbag, compared to only 35% of the depowered airbag eye injuries.
Do motor vehicle airbags increase risk of ocular injuries in adults?
2003, Ophthalmology
This study was undertaken to evaluate the risk of eye injury in motor vehicle accidents in which airbags deploy. An attempt was made to assess the possible associations between eye injuries and eyewear in these accidents.
Retrospective observational case series and literature review with analysis.
We conducted a literature review of 62 case reports and articles describing 110 adult cases of eye injury after deployment of an airbag and examined two Finnish accident cohorts. The fatal accident series (FAS; fatal injuries with one or more cars involved) included 121 individuals sitting behind an airbag that deployed (65 survivors), and the Airbag study (AB; nonfatal, relatively serious accidents) included 210 individuals (survivors).
The type of eye injury, eyewear, and crash dynamics were studied in each of the reviewed case reports. The fatal accident series and AB studies were analyzed to disclose the eye injuries and use of eyewear and to estimate their possible relation to deployment of airbags.
Analysis of the published reports revealed that airbag-induced eye injuries were not more frequently reported among wearers of eyeglasses than among nonwearers. However, open-eye injuries were reported three times more often among eyeglass wearers (P = 0.04), whereas all injuries from airbag chemicals occurred among nonwearers. With the exception of one orbital fracture with hyphema, all eye traumas (n = 7) in the FAS and AB cohorts were mild (eyebrow laceration, lid contusion, bruising). The risk of airbag-related eye injury was 2.5% for any eye injury and 0.4% for severe eye injury. In single accidents when seat belts were used, the risks were 2.0% and 0.5%, respectively. In the accidents from the FAS data no difference was observed in the risk for eye injury between survivors in incidents involving airbag deployment and incidents not involving airbags. This risk was not found to be greater among eyeglass wearers.
Despite reported cases in the literature, we found that the risk of severe eye injury from airbags was very low (0.4%) in fatal or relatively serious accidents. Eyewear did not seem to increase this risk but might interfere with the injury pattern.
Airbags and eye injuries: Epidemiology, spectrum of injury, and analysis of risk factors
2001, Survey of Ophthalmology
Although airbags measurably reduce the overall risk of injury to adults (including eye injury), and death from motor vehicle accidents, injuries attributed to airbag deployment have been reported. To identify reported cases of ocular trauma related to airbag deployment, a MEDLINE search from 1991 to 2000 was performed. A total of 263 injuries in 101 patients were identified. Patient demographics, details of the accident, specific ocular structures injured, and visual outcomes when available where tabulated and analyzed. The most common of these affect the eyes. Damage to the orbit and virtually every ocular and adnexal structure has been seen. Although most injuries are self-limited and do not significantly compromise vision, some result in severe, permanent visual loss. Most common is damage to anterior structures due to either blunt, contusive forces and/or chemical injury. Posterior segment trauma is less common but generally more visually devastating because of the involvement of the retina or optic nerve. Data are not available to determine whether the wearing of eyeglasses or previous intraocular surgery affects the nature, severity, or outcome of these injuries. Awareness of the spectrum of airbag-associated ocular trauma will help physicians recognize these problems early and optimize their management. Data derived from analyses of these injuries will be critical to the development of safer, more effective devices.
Simulation of air-bag impact on post-radial keratotomy eye using finite element analysis
2001, Journal of Cataract and Refractive Surgery
Purpose: To determine the physical and mechanical conditions of an impacting air bag that causes corneal rupture in a post-radial keratotomy (RK) eye using a simulation model of the human eye.
Setting: Numerical simulation study on a computer.
Methods: The simulations were performed by a computer using the finite element analysis program PAM-CRASH (Nihon ESI). The air bag was set to impact the surface of a post-RK eye with 4, 6, or 8 corneal incisions at various velocities. Strain on the corneal tissue including scarred incisions exceeding 9.0% was assumed to indicate the possibility of corneal rupture.
Results: At a medium velocity of 30 m/s, corneal rupture was likely to occur. At an air-bag impact velocity of 40 m/s, 3 of 4, 5 of 6, and 8 of 8 incisions were likely to rupture in the case of 4-, 6-, and 8-incision procedures, respectively, leading to likely globe rupture in all situations. Lacerations extended beyond the incisions and involved the intact cornea at a velocity of 40 m/s. If the corneal tissue strength reduction was increased to 90%, most incisions were likely to rupture at impact velocities greater than 35 m/s in all incision procedures.
Conclusions: The results could partly reflect a reported case of globe rupture after RK and suggest that severe ocular trauma can be caused in the post-RK eye by air bags at ordinary impact velocities.
Airbags and bilateral eye injury: Five case reports and a review of the literature
2001, Journal of Emergency Medicine
We report five cases of bilateral eye injuries from airbag deployment in motor vehicle crashes and review the world’s literature on ocular injuries associated with airbags. The cases in the literature were identified by cross-referencing Medline searches from airbags and ocular injuries. Additional cases were identified after review of references from each article in the search. An additional 89 cases from the literature were identified and are included for discussion. Patients were treated individually in a noncontrolled, nonrandomized fashion according to the nature of each injury with regular follow-up examinations in clinic. Of the 94 cases studied, 24 (27%) were bilateral eye injuries, and 15 (16%) patients were wearing spectacles at the time of the accident. The most common injuries included corneal abrasions, eyelid trauma, and hyphemas. Outcomes ranged from complete resolution of symptoms and return of normal visual acuity to primary enucleation. This report describes the wide spectrum of eye injuries that may occur after airbag deployment. We suggest a management plan for the evaluation and treatment of the ocular complications of airbag-related trauma.

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¹: Inquiries to Jay S. Pepose, M.D., Department of Ophthalmology and Visual Sciences, .Washington University School of Medicine, Box 8096, 660 S. Euclid Ave., St. Louis, MO 63110-1093; fax: (314) 362-3725.

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Brief ReportsAir Bag-related Corneal Rupture After Radial Keratotomy

Purpose

Methods

Results

Conclusions

Ann Emerg Med

Am J Ophthalmol

Brief Reports
Air Bag-related Corneal Rupture After Radial Keratotomy