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S. D. Bhaleeya, M. Pham, D. Xing, M. Zarbin, N. Bhagat; Nail Gun Induced Open Globe Injuries at New Jersey Medical School: A Nine Year Review. Invest. Ophthalmol. Vis. Sci. 2008;49(13):624.
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To describe the characteristics, demographics, and outcomes of nail gun-induced open globe injuries that presented to the University Hospital in Newark between January 1998 through October 2007.
A retrospective chart review was performed of all patients who presented with open globe injuries to the University Hospital in Newark. The following data was collected: age, gender, race, mechanism and location of injury, clinical findings on presentation, surgical procedures, initial and final post-operative visual acuity on follow up.
Of the 377 patients presenting with ruptured globes in this time period 51 patients were identified to have nail related injuries, 23 of which were found to be associated with nail gun use at the time of injury. All 23 patients were male and their ages ranged from 19 years to 50 years with a mean age of 31. Of the 23 patients, majority was Hispanic (18 cases), 4 were Caucasian, and one was African American. Use of safety goggles was documented only in 1 out of 8 patients. For cases where location of the trauma was documented, 14 out of 16 incidences occurred at work while 2 were at home. Thirteen (57%) patients had improved final visual acuity, 5 (22%) had no improvement, and 5 (22%) patients had decreased visual outcome. The average follow-up period was 8 months. Site of injury was as follows: 12 had corneal lacerations, 7 had corneoscleral lacerations, and 4 had scleral lacerations. Seven patients had traumatic cataract at initial presentation and 3 patients developed cataract on follow-up. Eleven patients had intraocular foreign body (IOFB) on presentation; all were removed during primary surgical repair. Only 45% of patients with IOFB had improved final visual acuity compared to 67% in patients without an IOFB. Seven patients had retinal tears and or retinal detachments (RD) on presentation. Three patients developed RD and proliferative vitreoretinopathy on follow up. One patient developed endophthalmitis but none required enucleation during the follow-up period.
Nail gun-induced open globe injuries appear to be more common among male Hispanics. Many of these injuries are work-related where patients were not using eye protection. Educating this population regarding use of safety goggles is important to prevent such injuries. Traumatic cataract and RD are common clinical findings in these patients. More than half of the patients had improved visual outcome. Almost 50% of nail gun injuries may lead to IOFB, hence a poorer functional and anatomic prognosis.
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