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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 12  |  Issue : 4  |  Page : 292-293

Helmet-induced ocular trauma: A rare mechanism


1 Department of Ophthalmology, NKPSIMS and Lata Mangeshkar Hospital, Nagpur, India
2 Department of Ophthalmology, JNMC, Wardha, Maharashtra, India

Date of Web Publication17-May-2018

Correspondence Address:
Dr. Mohana R Majumdar
Prasunaj, Tanga Stand Road, Dharampeth, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_33_17

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  Abstract 


A 32-year-old male presented with chief complaint of ocular injury in the left eye, in spite of wearing a helmet, in a road traffic accident. His uncorrected visual acuity in the injured eye was 6/9, and he had a full thickness lid laceration. There was a 25 mm upper eyelid laceration at the level of the eyebrow, splitting it horizontally. Early repair resulted in less tissue edema and better wound decontamination. We report this case to highlight an unusual mechanism of injury by the pro shield of a helmet and to show the need for eye protection in spite of wearing a helmet.

Keywords: Lid laceration, ocular protection, ocular trauma


How to cite this article:
Majumdar MR, Sune MP, Mohod P. Helmet-induced ocular trauma: A rare mechanism. J Datta Meghe Inst Med Sci Univ 2017;12:292-3

How to cite this URL:
Majumdar MR, Sune MP, Mohod P. Helmet-induced ocular trauma: A rare mechanism. J Datta Meghe Inst Med Sci Univ [serial online] 2017 [cited 2019 Aug 17];12:292-3. Available from: http://www.journaldmims.com/text.asp?2017/12/4/292/232581




  Introduction Top


Helmets are undoubtedly important safety equipment for any motorcyclist and have thus been made compulsory by the government. During a fall or crash, a helmet absorbs much of the force of impact that would otherwise be directed to the head. Thick plastic foam (firm polystyrene) inside the hard outer shell of a helmet provides safety by serving as a cushion to the blow. A 2008 systematic review [1] examined studies on motorcycle riders who had crashed and looked at helmet use as an intermediation. The review concluded that helmets reduce the risk of head injury by around 69% and death by around 42%. Fiberglass or fiber shells crush on impact offering better protection to the head, but some part of it may injure the eye as did in this case.


  Case Report Top


A 32-year-old healthy male presented to NKPSIMS and Lata Mangeshkar Hospital, Nagpur with a complaint of ocular injury in the left eye. His uncorrected visual acuity was 6/6 in the right eye and 6/9 in the left eye. After documenting the patient's age, occupation, and use of ocular protection, the mechanism of injury was noted. The Proshield of the helmet broke and got impacted into the upper eyelid of the left eye with resultant laceration of the eyelid at the level of eyebrow. On examination, there was a 25 mm lid laceration. The superior orbital rim was exposed, and the eyebrow was split horizontally [Figure 1] and [Figure 2]. Slit lamp biomicroscopy and fundus examination did not reveal any globe rupture, foreign body, or any other abnormality. Radiological investigation did not reveal any fracture or foreign body. Systemic antibiotics were started. The patient was taken for lid repair immediately to minimize lid edema and wound contamination. The level of laceration was above the orbital septum; hence, only the orbicularis muscle and the skin were sutured in layers. Postoperatively, there was minimal ptosis due to upper eyelid edema with good wound closure [Figure 3] and [Figure 4].
Figure 1: Anterior segment photography

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Figure 2: Anterior segment photography

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Figure 3: Postoperative photography

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Figure 4: Post-operative photography; minimal ptosis due to lid edema

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  Discussion Top


Nearly 1.3 million people die every year on the world's roads and 20–50 million people suffer non-fatal injuries, with many sustaining a disability as a result of their injury.[2] In India, the motor vehicle population is growing at a faster rate than the economic and population growth.[3] Several factors such as previous history of ophthalmic complaints, incidence of motorcycle-related ocular trauma according to season, time of injury, alcohol consumption, helmet use that could be associated with the occurrence and severity of the injury have been studied.

Failure to wear protective head gears or helmet was highly associated with the incidence of motorcycle-related ophthalmic injuries.[4] Wearing a helmet reduced the chance of having debilitating eye injuries during a motorcycle accident. However, in our case, a part of the helmet was the cause of lid laceration. Jain et al. have reported another unusual mechanism of ocular trauma where impact with a ball during a ball sport (cricket) led to extreme torsion of the frame with resultant direct blunt trauma to the right eye by the spectacle arm.[5]

Besides globe rupture, a high index of suspicion for any accompanying infections in patients with eyelid trauma must also be kept in mind.[6] Infections, including periorbital necrotizing fasciitis [7] (streptococcal gangrene), occurring after upper eyelid lacerations have been described.

Extramarginal lid lacerations usually follow relaxed skin tension lines; they heal well if tissues are properly approximated. As with all lid repairs vertical tension should be avoided. In large upper lid extramarginal lacerations, using the eyebrow hairs as a landmark may allow better anatomical tissue repositioning. If suturing dark eyebrow hairs, using a stitch that is not black aids in visualization.[6] In patients with marked lid edema, the severity of posttraumatic ptosis after the edema has resolved must be judged.

Although the use of helmet is indispensable for motorcyclists, such unusual mechanism of ocular injury suggests the need for ocular protection along with the helmet.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Liu BC, Ivers R, Norton R, Boufous S, Blows S, Lo SK, et al. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev 2008;(1):CD004333.  Back to cited text no. 1
    
2.
United Nations Decade of Action for Road Safety 2011-2020. Available from: http://www.decadeofaction.org. [Last accessed on 2013 Jul 15].  Back to cited text no. 2
    
3.
Ruikar M. National statistics of road traffic accidents in India. J Orthop Traumatol Rehabil 2013;6:1-6.  Back to cited text no. 3
  [Full text]  
4.
Larona AJ, Pe-Yan MR. Visual profile of motorcycle-related Ocular trauma in a tertiary hospital. Philipp J Ophthalmol 2012;37:111-6.  Back to cited text no. 4
    
5.
Jain V, Natarajan S, Shome D, Gadgil D. Spectacle-induced ocular trauma: An unusual mechanism. Cornea 2007;26:109-10.  Back to cited text no. 5
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6.
Ing E, Roy H, editors. Eyelid Laceration Treatment & Management Emedicine. Available from: http://www.medscape.com/article/1212531.  Back to cited text no. 6
    
7.
Balaggan KS, Goolamali SI. Periorbital necrotising fasciitis after minor trauma. Graefes Arch Clin Exp Ophthalmol 2006;244:268-70.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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