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Pediatric eye injury due to Avena fatua (wild oats)
1Department of Pediatrics and University of British Columbia, Vancouver, BC.
Insights
Ophthalmic trauma from Avena fatua seeds caused unusual symptoms in three children. Prompt diagnosis and treatment, including foreign body removal and steroid-antibiotic therapy, are crucial for managing these specific eye injuries.
Area of Science:
- Ophthalmology
- Trauma Care
- Botany
Background:
- Ophthalmic injuries can present with varied symptoms.
- Identifying the causative agent is critical for effective treatment.
Observation:
- Three children presented with severe eye pain, conjunctival edema, and inflammation after suspected trauma.
- Initial examination suggested eyelash foreign bodies, but removal was difficult.
- Botanical identification revealed Avena fatua seeds lodged in the subconjunctival space.
Findings:
- Avena fatua seeds caused florid ophthalmic signs mimicking chemical burns or allergic reactions.
- Subconjunctival seedpods required significant force for removal.
- Pain resolved with analgesia, but inflammation required steroid-antibiotic treatment in one case.
Implications:
- Ophthalmic practitioners should consider Avena fatua seed foreign bodies in cases of severe eye pain and inflammation, especially after wild grass exposure.
- Misdiagnosis as chemical injury or allergic chemosis is possible.
- Timely diagnosis, foreign body removal, and appropriate medical management are essential for optimal outcomes.
Objective:
We report on florid and unusual ophthalmic physical signs in three children where the trauma was caused by seeds from Avena fatua, a grass common in western North America.
Design:
Case series and literature review.
Setting:
Three local emergency departments (ED) during the fall of 1998.
Patients Or Participants:
Three children reporting to an ED with an acutely painful eye from which the foreign body was identified botanically as Avena fatua.
Interventions:
None.
Main Outcome Measures:
Symptoms, interventions, duration of problem.
Results:
Three male children (6, 10, 14 years) presented separately following incidents in which they had sustained direct eye injury. Each child immediately experienced severe pain and profuse watering of the eye. Severe localized edema of the conjunctiva and inflammation was evident with conjunctival vessel injection leading to bleeding, reminiscent of a chemical "burn." Initially, two children appeared to have an eyelash caught behind the lower lid. In both instances, the emergency physicians initially dismissed the possibility of there being a significant foreign body, but because of the severity of the pain, conjunctival vessel injection, and edema, they attempted to remove the "lash." Removal of the foreign body proved difficult in all three cases, requiring far greater traction than anticipated. Intact seedpods had become embedded in the subconjunctival space. Ophthalmic analgesia relieved the pain immediately, but in one child who was treated with topical antibiotic alone, significant pain was experienced for 18 hours, until steroid-antibiotic therapy was instituted. All injuries occurred in late summer when the grass propagates.
Conclusions:
The physical signs of scleral vasculitis and conjunctival edema can be mistaken for chemical injury or allergic chemosis, but where a foreign body resembling a hair or eyelash is visible, the presence of a seed-pod retained in the subconjunctival space must be considered, particularly if the patient reports exposure to wild grass. Application of local analgesia, foreign body removal, and steroid-antibiotic treatment is recommended.
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