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Diagnostik und Akuttherapie von Augenverletzungen durch Feuerwerkskörper

Fireworks injuries of the eye: an overview of current diagnostic and treatment options

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Zusammenfassung

Feuerwerkskörper können am Auge unterschiedlichste Verletzungen hervorrufen. Die Verletzungsmuster reichen von der spontan abheilenden Binde- und Hornhauterosio bis hin zur Bulbusberstung mit schwersten Verletzungen im hinteren Augenabschnitt oder traumatischen Enukleationen. Die exakte Erstdiagnose kann in der Notfallsituation eine Herausforderung für den Augenarzt sein. Häufig sind Kinder und Jugendlichen betroffen. Der Anamnese bezüglich des Unfallhergangs kommt eine besondere Bedeutung zu, um das Ausmaß der Verletzung abschätzen zu können und eine konservative oder ggf. notfallmäßige operative Versorgung einzuleiten. Der Beitrag gibt einen Überblick über typische Verletzungsmuster und Hinweise für Diagnostik, Therapie und Komplikationsmanagement.

Abstract

Fireworks can cause very different eye injuries. The injury patterns range from spontaneously healing conjunctival and corneal lesions up to a burst eyeball with very severe injuries in the posterior ocular section and traumatic enucleation. The precise initial diagnosis in an emergency situation can be a challenge for the ophthalmologist. Children and adolescents are often affected. The patient history with respect to the circumstances of the accident is particularly important to be able to estimate the extent of the injury and to initiate a conservative or, if necessary, emergency operative treatment. This article provides an overview of typical injury patterns and advice for the diagnostics, treatment and complication management.

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Literatur

  1. Agapitos PJ, Noel LP, Clarke WN (1987) Traumatic hyphema in children. Ophthalmology 94:1238–1241

    CAS  PubMed  Google Scholar 

  2. Ahmed Y, Schimel AM, Pathengay A et al (2012) Endophthalmitis following open-globe injuries. Eye 26:212–217

    CAS  PubMed  Google Scholar 

  3. Banerjee PJ, Cornelius VR, Phillips R et al (2016) Adjunctive intraocular and peri-ocular steroid (triamcinolone acetonide) versus standard treatment in eyes undergoing vitreoretinal surgery for open globe trauma (ASCOT): study protocol for a phase III, multi-centre, double-masked randomised controlled trial. Trials 17:339

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Banerjee PJ, Xing W, Bunce C et al (2016) Triamcinolone during pars plana vitrectomy for open globe trauma: a pilot randomised controlled clinical trial. Br J Ophthalmol 100:949–955

    PubMed  Google Scholar 

  5. Bazzaz SKJ, Myers JS (2006) Post-traumatic glaucoma. In: Shaarawy TM, Sherwood MB, Hitchings RA, Crowston JFJ (Hrsg) Glaucoma: medical diagnosis & therapy, Edition 2, pp 431–444. Elsevier, Maryland Heights, MO

    Google Scholar 

  6. Billock RM, Chounthirath T, Smith GA (2017) Pediatric firework-related injuries presenting to United States emergency departments, 1990–2014. Clin Pediatr (Phila) 56:535–544

    Google Scholar 

  7. Brockhaus L, Goldblum D, Eggenschwiler L et al (2019) Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics. Clin Microbiol Infect 25(11):1364–1369

    CAS  PubMed  Google Scholar 

  8. Canner JK, Haider AH, Selvarajah S et al (2014) US emergency department visits for fireworks injuries, 2006–2010. J Surg Res 190:305–311

    PubMed  Google Scholar 

  9. Chan WC, Knox FA, Mcginnity FG et al (2004) Serious eye and adnexal injuries from fireworks in Northern Ireland before and after lifting of the firework ban—an ophthalmology unit’s experience. Int Ophthalmol 25:167–169

    Article  CAS  PubMed  Google Scholar 

  10. Chang IT, Prendes MA, Tarbet KJ et al (2016) Ocular injuries from fireworks: the 11-year experience of a US level I trauma center. Eye 30:1324–1330

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Cherry PM (1979) Factors influencing prognosis in indirect traumatic rupture of the globe. Ann Ophthalmol 11:275–279

    CAS  PubMed  Google Scholar 

  12. Cherry PM (1978) Indirect traumatic rupture of the globe. Arch Ophthalmol 96:252–256

    CAS  PubMed  Google Scholar 

  13. Chronopoulos A, Ong JM, Thumann G et al (2018) Occult globe rupture: diagnostic and treatment challenge. Surv Ophthalmol 63:694–699

    PubMed  Google Scholar 

  14. Clare G, Suleman H, Bunce C et al (2012) Amniotic membrane transplantation for acute ocular burns. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009379.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  15. Colyer MH, Weber ED, Weichel ED et al (2007) Delayed intraocular foreign body removal without endophthalmitis during operations Iraqi Freedom and Enduring Freedom. Ophthalmology 114:1439–1447

    PubMed  Google Scholar 

  16. Engelbert M, Mino De Kaspar H, Thiel M et al (2004) Intravitreal vancomycin and amikacin versus intravenous imipenem in the treatment of experimental Staphylococcus aureus endophthalmitis. Graefes Arch Clin Exp Ophthalmol 242:313–320

    CAS  PubMed  Google Scholar 

  17. Frimmel S, De Faber JT, Wubbels RJ et al (2018) Type, severity, management and outcome of ocular and adnexal firework-related injuries: the Rotterdam experience. Acta Ophthalmol 96:607–615

    PubMed  Google Scholar 

  18. Frimmel S, Theusinger OM, Kniestedt C (2017) Analysis of ocular firework-related injuries and common eye traumata: a 5-year clinical study. Klin Monbl Augenheilkd 234:611–616

    CAS  PubMed  Google Scholar 

  19. Grehn F (1987) Primary glaucoma caused by ciliolenticular block. A distinct form of glaucoma. Fortschr Ophthalmol 84:577–582

    CAS  PubMed  Google Scholar 

  20. Harlan JB Jr., Pieramici DJ (2002) Evaluation of patients with ocular trauma. Ophthalmol Clin North Am 15:153–161

    PubMed  Google Scholar 

  21. Jing Y, Yi-Qiao X, Yan-Ning Y et al (2010) Clinical analysis of firework-related ocular injuries during Spring Festival 2009. Graefes Arch Clin Exp Ophthalmol 248:333–338

    PubMed  Google Scholar 

  22. Kaufman JH, Tolpin DW (1974) Glaucoma after traumatic angle recession. A ten-year prospective study. Am J Ophthalmol 78:648–654

    CAS  PubMed  Google Scholar 

  23. Kong Y, Tang X, Kong B et al (2015) Six-year clinical study of firework-related eye injuries in North China. Postgrad Med J 91:26–29

    PubMed  Google Scholar 

  24. Kuchle M, Naumann GO (1995) Direct cyclopexy for traumatic cyclodialysis with persisting hypotony. Report in 29 consecutive patients. Ophthalmology 102:322–333

    CAS  PubMed  Google Scholar 

  25. Kuchle M, Naumann GO (1990) Direct cyclopexy in cyclodialysis with persistent hypotony syndrome. Fortschr Ophthalmol 87:247–251

    CAS  PubMed  Google Scholar 

  26. Kuhn F (2014) The timing of reconstruction in severe mechanical trauma. Ophthalmic Res 51:67–72

    PubMed  Google Scholar 

  27. Kuhn F, Morris R, Witherspoon CD (2002) Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am 15:139–143

    PubMed  Google Scholar 

  28. Kuhn F, Morris R, Witherspoon CD et al (1996) A standardized classification of ocular trauma. Ophthalmology 103:240–243

    CAS  PubMed  Google Scholar 

  29. Kuhn F, Schrader W (2018) Prophylactic chorioretinectomy for eye injuries with high proliferative-vitreoretinopathy risk. Clin Anat 31:28–38

    PubMed  Google Scholar 

  30. Kuhn FC, Morris RC, Witherspoon DC et al (2000) Serious fireworks-related eye injuries. Ophthalmic Epidemiol 7:139–148

    CAS  PubMed  Google Scholar 

  31. Kylstra JA, Lamkin JC, Runyan DK (1993) Clinical predictors of scleral rupture after blunt ocular trauma. Am J Ophthalmol 115:530–535

    CAS  PubMed  Google Scholar 

  32. Meller D, Pires RT, Mack RJ et al (2000) Amniotic membrane transplantation for acute chemical or thermal burns. Ophthalmology 107:980–989

    CAS  PubMed  Google Scholar 

  33. Merle H, Gerard M, Schrage N (2008) Ocular burns. J Fr Ophtalmol 31:723–734

    CAS  PubMed  Google Scholar 

  34. Mino De Kaspar H, Engelbert M, Thiel M et al (2002) Intravenous imipenem prophylaxis in experimental endophthalmitis. Graefes Arch Clin Exp Ophthalmol 240:557–564

    CAS  PubMed  Google Scholar 

  35. Monteiro S, Meireles A (2018) Prophylactic chorioretinectomy in open ocular trauma: a series of 36 eyes. Ophthalmologica 240:55–60

    PubMed  Google Scholar 

  36. Moore JX, Mcgwin G Jr., Griffin RL (2014) The epidemiology of firework-related injuries in the United States: 2000–2010. Injury 45:1704–1709

    PubMed  Google Scholar 

  37. Ng EW, D’amico DT (1997) Therapeutic efficacy of intravitreal ceftazidime, imipenem, and amikacin in a swine model of posttraumatic pseudomonas aeruginosa endophthalmitis. Retina 17:464–465

    CAS  PubMed  Google Scholar 

  38. Nizamoglu M, Frew Q, Tan A et al (2018) The ten-year experience of firework injuries treated at a uk regional burns & plastic surgery unit. Ann Burns Fire Disasters 31:13–16

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Oksala A (1967) Treatment of traumatic hyphaema. Br J Ophthalmol 51:315–320

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Peragine C, Walker SAN, Walker S et al (2019) Fluoroquinolone antibiotic prophylaxis to prevent post-traumatic bacterial infectious endophthalmitis: using Monte Carlo simulation to evaluate the probability of success. J Ocul Pharmacol Ther35(6):366–371

    CAS  Google Scholar 

  41. Read DJ, Bradbury R, Yeboah E (2017) Firework-related injury in the Top End: a 16-year review. ANZ J Surg 87:1030–1034

    PubMed  Google Scholar 

  42. Reim M (1990) A new treatment concept for severe caustic and thermal burns of the eyes. Klin Monbl Augenheilkd 196:1–5

    CAS  PubMed  Google Scholar 

  43. Rodman HI (1963) Chronic oper-angle glaucoma associated with traumatic dislocation of the lens. A new pathogenetic concept. Arch Ophthalmol 69:445–454

    CAS  PubMed  Google Scholar 

  44. Romano PE (2000) Systemic prednisolone prevents rebleeding in traumatic hyphema. Ophthalmology 107:812–814

    CAS  PubMed  Google Scholar 

  45. Russell SR, Olsen KR, Folk JC (1988) Predictors of scleral rupture and the role of vitrectomy in severe blunt ocular trauma. Am J Ophthalmol 105:253–257

    CAS  PubMed  Google Scholar 

  46. Sacu S, Segur-Eltz N, Stenng K et al (2002) Ocular firework injuries at New Year’s eve. Ophthalmologica 216:55–59

    PubMed  Google Scholar 

  47. Schrage NF, Struck HG, Gerard M (2011) Recommendations for acute treatment for chemical and thermal burns of eyes and lids. Ophthalmologe 108:916–920

    CAS  PubMed  Google Scholar 

  48. Serdarevic R (2015) The ocular trauma score as a method for the prognostic assessment of visual acuity in patients with close eye injuries. Acta Inform Med 23:81–85

    PubMed  PubMed Central  Google Scholar 

  49. Sharma N, Lathi SS, Sehra SV et al (2015) Comparison of umbilical cord serum and amniotic membrane transplantation in acute ocular chemical burns. Br J Ophthalmol 99:669–673

    PubMed  Google Scholar 

  50. Smith GA, Knapp JF, Barnett TM et al (1996) The rockets’ red glare, the bombs bursting in air: fireworks-related injuries to children. Pediatr Electron Pages 98:1–9

    CAS  Google Scholar 

  51. Soohoo JR, Davies BW, Braverman RS et al (2013) Pediatric traumatic hyphema: a review of 138 consecutive cases. J AAPOS 17:565–567

    PubMed  Google Scholar 

  52. Statista GmbH (2019) Statista.De. https://de.statista.com/statistik/daten/studie/284913/umfrage/umsatz-der-deutschen-pyrotechnischen-industrie/. Last access: February 2019

  53. Struck HG, Schrage NF (2011) Chemical and thermal eye burns. Conservative and surgical options of a stage-dependent therapy. Ophthalmologe 108:921–928

    CAS  PubMed  Google Scholar 

  54. Struck HG, Schrage NF (2011) Conservative and surgical therapy for chemical and thermal eye burns. Ophthalmologe 108:909

    CAS  PubMed  Google Scholar 

  55. Tamhane A, Vajpayee RB, Biswas NR et al (2005) Evaluation of amniotic membrane transplantation as an adjunct to medical therapy as compared with medical therapy alone in acute ocular burns. Ophthalmology 112:1963–1969

    PubMed  Google Scholar 

  56. Tetz M, Blum M, Greiner C et al (1993) Traumatic cataracts. Surgical methods and results in 106 patients. Ophthalmologe 90:360–363

    CAS  PubMed  Google Scholar 

  57. Turalba AV, Shah AS, Andreoli MT et al (2014) Predictors and outcomes of ocular hypertension after open-globe injury. J Glaucoma 23:5–10

    PubMed  Google Scholar 

  58. Unterlauft JD, Rehak M, Wiedemann P et al (2018) Firework-related eye trauma in Germany. Curr Eye Res 43:1522–1528

    PubMed  Google Scholar 

  59. Unterlauft JD, Wiedemann P, Meier P (2014) Firework-related eye trauma from 2005 to 2013. Klin Monbl Augenheilkd 231:915–920

    CAS  PubMed  Google Scholar 

  60. Venkatesh R, Gurav P, Tibrewal S et al (2017) Appraising the spectrum of firework trauma and the related laws during Diwali in North India. Indian J Ophthalmol 65:140–143

    PubMed  PubMed Central  Google Scholar 

  61. Viestenz A, Kuchle M (2004) Blunt ocular trauma. Part I: blunt anterior segment trauma. Ophthalmologe 101:1239–1257

    CAS  PubMed  Google Scholar 

  62. Viestenz A, Kuchle M (2003) Globe rupture after blunt ocular trauma—editorial to: Wenzel M, Aral H. Indirect traumatic rupture of the globe without conjunctival injury. Klin Monbl Augenheilkd 220:13–14

    PubMed  Google Scholar 

  63. Viestenz A, Kuchle M (2001) Retrospective analysis of 417 cases of contusion and rupture of the globe with frequent avoidable causes of trauma: the Erlangen Ocular Contusion-Registry (EOCR) 1985–1995. Klin Monbl Augenheilkd 218:662–669

    CAS  PubMed  Google Scholar 

  64. Volpe NJ, Larrison WI, Hersh PS et al (1991) Secondary hemorrhage in traumatic hyphema. Am J Ophthalmol 112:507–513

    CAS  PubMed  Google Scholar 

  65. Vounotrypidis E, Schuster I, Mackert MJ et al (2019) Secondary intraocular lens implantation: a large retrospective analysis. Graefes Arch Clin Exp Ophthalmol 257:125–134

    CAS  PubMed  Google Scholar 

  66. Walton W, Von Hagen S, Grigorian R et al (2002) Management of traumatic hyphema. Surv Ophthalmol 47:297–334

    PubMed  Google Scholar 

  67. Weissman JL, Beatty RL, Hirsch WL et al (1995) Enlarged anterior chamber: CT finding of a ruptured globe. AJNR Am J Neuroradiol 16:936–938

    CAS  PubMed  PubMed Central  Google Scholar 

  68. Wenzel M, Aral H (2003) Indirect traumatic rupture of the globe without conjunctival injury. Klin Monbl Augenheilkd 220:35–38

    PubMed  Google Scholar 

  69. Werner MS, Dana MR, Viana MA et al (1994) Predictors of occult scleral rupture. Ophthalmology 101:1941–1944

    CAS  PubMed  Google Scholar 

  70. Westekemper H, Figueiredo FC, Siah WF et al (2017) Clinical outcomes of amniotic membrane transplantation in the management of acute ocular chemical injury. Br J Ophthalmol 101:103–107

    PubMed  Google Scholar 

  71. White MH, Lambert HM, Kincaid MC et al (1989) The ora serrata and the spiral of Tillaux. Anatomic relationship and clinical correlation. Ophthalmology 96:508–511

    CAS  PubMed  Google Scholar 

  72. Wipperman JL, Dorsch JN (2013) Evaluation and management of corneal abrasions. Am Fam Physician 87:114–120

    PubMed  Google Scholar 

  73. Wisse RP, Bijlsma WR, Stilma JS (2010) Ocular firework trauma: a systematic review on incidence, severity, outcome and prevention. Br J Ophthalmol 94:1586–1591

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Augenklinik, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland

    A. Wolf

  2. Augenzentrum Würzburg, Würzburg, Deutschland

    W. Schrader

  3. Universitätsaugenklinik Freiburg, Freiburg, Deutschland

    H. Agostini

  4. Augenklinik, Klinikum Ernst-von-Bergmann Potsdam, Potsdam, Deutschland

    A. Gabel-Pfisterer

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  1. A. Wolf
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  2. W. Schrader
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  3. H. Agostini
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  4. A. Gabel-Pfisterer
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Correspondence to A. Wolf.

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A. Wolf, W. Schrader, H. Agostini und A. Gabel-Pfisterer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Wolf, A., Schrader, W., Agostini, H. et al. Diagnostik und Akuttherapie von Augenverletzungen durch Feuerwerkskörper. Ophthalmologe 116, 1152–1161 (2019). https://doi.org/10.1007/s00347-019-01000-9

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