Caudill Gregory Brandon, Wolin Mitchell Jay, Siddens John Delmar
University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA.
Prisma Health System, Department of Surgery, Division of Ophthalmology and Oculoplastic and Reconstructive Surgery, 104 Simpson St, Greenville, SC, 29605, USA.
Am J Ophthalmol Case Rep. 2022 Mar 9;26:101476. doi: 10.1016/j.ajoc.2022.101476. eCollection 2022 Jun.
Open globe injury is an emergent, vision threatening condition. To ensure the best possible visual outcome after an open globe, it is essential to protect the eye from further trauma during the critical period of healing. In cases where the open globe is caused by repeated self-mutilation, long term prevention of re-injury must also be considered and can pose a significant challenge.
Here we describe a 68-year-old male with a history of severe intellectual disability. The patient presented after an episode of eye self-mutilation, resulting in an open globe injury. After being taken to the operating room for emergent repair of the eye, the primary concern was how to prevent re-injury. Ultimately, as an alternative to the long-term use of restraints, the decision was made to fixate a plastic eye shield over the affected eye using sutures. The eye shield prevented any unwanted manipulation of the eye while implanted, despite several attempts. After 18 days, the eye shield was forcibly removed by the patient. However, this allowed adequate healing time, and there has not been any repeated damage to the eye since.
Our proposal to suture a plastic eye shield to the orbital rims of a patient is an attempt to allow the eye to heal while avoiding prolonged use of restraints and minimizing long-term hospital stays. This intervention may prove to be beneficial for the population of psychologically or cognitively impaired individuals, as they are often implicated in cases of self-inflicted ocular trauma. To our knowledge, this is the first description of the use of this method.
开放性眼球损伤是一种紧急的、威胁视力的情况。为确保开放性眼球损伤后获得尽可能好的视觉结果，在关键的愈合期保护眼睛免受进一步创伤至关重要。在开放性眼球损伤由反复自残引起的情况下，还必须考虑长期预防再次受伤，这可能构成重大挑战。
在此，我们描述一名68岁男性，有严重智力残疾病史。该患者在一次眼部自残事件后出现开放性眼球损伤。在被送往手术室进行眼部紧急修复后，主要关注点是如何预防再次受伤。最终，作为长期使用约束措施的替代方法，决定使用缝线将塑料眼罩固定在患眼上。尽管多次尝试，但眼罩在植入期间防止了对眼睛的任何意外操作。18天后，患者强行摘除了眼罩。然而，这给予了足够的愈合时间，此后眼睛未再受到任何反复损伤。
我们将塑料眼罩缝合到患者眼眶边缘的提议，是为了让眼睛在愈合的同时避免长期使用约束措施并尽量减少长期住院时间。这种干预措施可能对心理或认知受损人群有益，因为他们常涉及自我造成的眼部创伤病例。据我们所知，这是对该方法使用的首次描述。
