Zhou Dan-Dan, Niu Kai, Lu Cheng-Wei, Hao Ji-Long, Zhang Bing-Jie, Hui Peng
Departments of Radiology, the First Hospital of Jilin University, Changchun, China.
Departments of Otorhinolaryngology, the First Hospital of Jilin University, Changchun, China.
Case Rep Ophthalmol. 2015 Dec 12;6(3):448-52. doi: 10.1159/000442584. eCollection 2015 Sep-Dec.
We report a rare case of traumatic injury to the eye caused by homemade fireworks in a Chinese juvenile patient with a metal ring left in the orbit after having been sutured at the Emergency Department.
An 11-year-old boy presented with a traumatic injury to the right eye from homemade fireworks. Following initial assessment involving maxillofacial computed tomography (CT) and suturing at the Emergency Department, he was transferred to our department for further evaluation because of his poor sight 1 day later. On examination, a skin laceration beneath the right eyebrow was noted, but the superior orbit was not fully visible on the maxillofacial CT performed 1 day previously. Therefore, an orbital CT scan was carried out on the second day, which showed a hyperdense ring embedded in the superior border of the orbital wall; the ring was surgically removed. On postoperative day 7, a fundus examination revealed resolving vitreous hemorrhage, blunt traumatic retinal detachment, and a large retinal tear superior to the macula. The patient refused to take surgery for retinal detachment into consideration. Therefore, we opted for oral steroids and careful observation.
After 2 months' observation, the large retinal tear had healed and white fibrous scar tissue had developed, and the retinal detachment superior to the macula had reattached itself spontaneously. The patient's vision had further improved to 20/200. During 1 year of follow-up, he remained clinically stable.
To avoid missing the diagnosis, a complete history of the mechanism of injury and accurate imaging still prove most useful. Complete removal of the foreign body by the emergency physician is necessary because of the ocular toxicity of an iron-containing foreign body. As evidenced by the current case, oral steroids and observation for a period of several months is a management of choice for traumatic retinal detachment and retinal tear superior to the macula associated with homemade fireworks in children.
我们报告一例罕见的中国青少年因自制烟花导致眼部创伤的病例，该患者在急诊科缝合后眼眶内遗留金属环。
一名11岁男孩因自制烟花导致右眼创伤。经过包括颌面计算机断层扫描（CT）的初步评估并在急诊科缝合后，由于1天后视力不佳，他被转至我们科室进行进一步评估。检查发现右眉下方有皮肤裂伤，但前一天进行的颌面CT未完全显示眶上缘。因此，第二天进行了眼眶CT扫描，显示眶壁上缘嵌入一个高密度环；该环通过手术取出。术后第7天，眼底检查显示玻璃体积血吸收、钝挫伤性视网膜脱离以及黄斑上方有一个大的视网膜裂孔。患者拒绝考虑视网膜脱离手术。因此，我们选择口服类固醇并密切观察。
经过2个月的观察，大的视网膜裂孔愈合，形成白色纤维瘢痕组织，黄斑上方的视网膜脱离自行复位。患者视力进一步提高到20/200。在1年的随访期间，他临床情况稳定。
为避免漏诊，详细的受伤机制病史和准确的影像学检查仍然非常有用。由于含铁异物的眼毒性，急诊科医生必须彻底清除异物。如本病例所示，口服类固醇并观察数月是儿童因自制烟花导致的创伤性视网膜脱离和黄斑上方视网膜裂孔的首选治疗方法。
