Nail Related Open Globe Injuries

1
Nail Related Open Globe Injuries Michelle E.
Andreoli M.D., Corey Westerfeld M.D., Michael T.
Andreoli, Carolyn Kloek M.D., and Christopher M.
Andreoli M.D.
RESULTS
PURPOSE There is a paucity of literature
regarding the epidemiology and outcomes of nail
related open globe injuries, despite their
relative frequency. Here we review a large series
of nail related open globe injuries in order to
identify prognostic factors that will help manage
these patients.
DISCUSSION Of the 648 consecutive open globe
patients reviewed, 80 patients were found to have
nail induced open globe injuries (12.3). This
was the fourth most common mechanism recorded.
The population was typically young men who were
injured at work. The patients generally had a
good outcomes with over 70 recovering greater
than 20/40 vision. No patient with nail related
injury developed phthisis or required enucleation
during the study period. These results were
significantly better when compared to overall
population of open globe injuries. The nail
was present as an IOFB in only 11 out of 80 cases
(13.8). The presence of IOFB at presentation did
not have a significant impact on outcome.
The laceration was most often a zone I
injury (cornea). Post-injury complications
included 15 of patients who developed an
intraocular pressure of greater than 25 during
at least one postoperative visit and 8 (10)
patients with retinal detachments. Over half
of the patients developed cataract with 23 of
patients requiring primary lensectomy during
initial repair.
35-year-old male with a nail IOFB OD. Three
months after surgical repair including
lensectomy, the BCVA was 20/40.
METHODS The charts of 648 consecutive patients
with open globe injuries presenting to a major
eye trauma center were reviewed with attention
to the age of the patient, gender, mechanism,
location of trauma event, presence of an
intraocular foreign body (IOFB), and presenting
and post-operative visual acuity.
An estimated 2.4 million eye injuries occur
annually in the U.S. Most could be prevented
through the use of protective eyewear. Safety
goggles should meet the High Impact requirements
of the American National Standards Institute's
ANSI Z87.1-2003 standard.

• CONCLUSIONS
• Nail injuries are a common etiology of open globe
  injuries
• The typical patients are young men injured while
  at work
• There is a high rate of lens damage
• Visual outcomes are relatively good

25-year-old male with nail IOFB OS. 4 months
later after open globe repair and subsequent PPV,
the vision BCVA was 20/200.