SAEM Clinical Image Series: Eye Injury

Nov 02, 20

eye

An 11-year-old male presented to a pediatric trauma center following a motor vehicle collision (MVC). He was the restrained front-seat passenger when his vehicle was struck head-on, causing frontal airbag deployment. His primary complaint was pain around his right eye with associated blurry vision. He denied diplopia, pain with extraocular movements, flashers, floaters, or curtains in his vision.

Physical Exam

HEENT:

Superficial abrasions to the right periorbital area with mild upper-eyelid edema
Textured honeycomb pattern overlying 80 percent of the right cornea visible on direct visualization and more prominent with fluorescein staining under ultraviolet light
Pupils equal, round, and reactive to light, 3 mm in size
Bilateral visual fields intact to confrontation

Visual Acuity: Right eye 20/100, left eye 20/20

Intraocular Pressure: Right eye 12 mm Hg, left eye 18 mm Hg

Labs

Corneal pH: Right eye 7, Left eye 7

Case Question: What is the likely mechanism for the honeycombed appearance visible on this patient’s ocular exam?

Airbag trauma

While the use of airbags has long been associated with a reduction in MVC mortality, the incidence of ocular-related airbag trauma has been well described in ophthalmologic literature [1-6]. Airbag-related injuries include alkali burns, lens dislocation, corneal abrasions, traumatic cataracts, globe rupture, and others.

Most modern airbags are equipped with a nylon bag that deploys upon vehicle impact and can cause significant facial injury. This is the likely cause of the textured honeycombed corneal abrasion in our patient described above. Airbag-related eye injuries have been found to be exceedingly rare when the vehicle occupant survives the incident and a restraint system was used appropriately [7].

Case Discussion

The patient was treated with erythromycin ointment and moxifloxacin eye drops and discharged home with directions for a prompt outpatient ophthalmology follow-up.

Take-Home Points

In trauma patients with eye complaints following an MVC with airbag deployment, a high index of suspicion should be maintained, and a thorough ocular examination conducted.
Remember to check the corneal pH as alkali-related ocular injuries are potentially blinding and represent a true ophthalmologic emergency.

References

Anderson, S. K., U. R. Desai, and S. V. Raman. “Incidence of ocular injuries in motor vehicle crash victims with concomitant air bag deployment.” Ophthalmology. 2002;109(12): 2,356–58. DOI
Bendeddouche K, Assaf E, Emadisson H, Forestier F, Salvanet-Bouccara A. Air bags–sécurité vitale et risques oculaires: brûlures alcalines et lésions traumatiques profondes. A propos d’un cas [Air bags and eye injuries: chemical burns and major traumatic ocular lesions–a case study]. J Fr Ophtalmol. 2003;26(8):819-823. PMID: 14686223
Goldblum D, Fleischhauer J, Bachmann HU, Koerner F. Augenverletzungen durch Airbag [Eye injuries caused by air bags]. Klin Monbl Augenheilkd. 1998;212(5):376-378. doi:10.1055/s-2008-1034910. PMID: 9677583
Kenney KS, Fanciullo LM. Automobile air bags: friend or foe? A case of air bag-associated ocular trauma and a related literature review. Optometry. 2005;76(7):382-386. doi:10.1016/j.optm.2005.06.001. PMID: 16038865
Kuhn F, Morris R, Witherspoon CD. Eye injury and the air bag. Curr Opin Ophthalmol. 1995;6(3):38-44. doi:10.1097/00055735-199506000-00007. PMID: 10150868
Schmitt-Bernard CF, Arnaud B. Traumatisme oculaire et brûlure caustique par airbag [Ocular trauma and caustic burns by air bags]. J Fr Ophtalmol. 1998;21(3):220-222. PMID: 9759408
Koisaari T, Leivo T, Sahraravand A, Haavisto AK, Sulander P, Tervo TMT. Airbag deployment-related eye injuries. Traffic Inj Prev. 2017;18(5):493-499. doi:10.1080/15389588.2016.1271945. PMID: 28055229

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2020 SAEM Annual Meeting | Copyrighted by SAEM 2020 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.