Severe ocular injuries from orthodontic headgear

Dislocation of extraoral orthodontic tractional devices (headgear) resulted in penetrating ocular injuries in three eyes of two patients. An endophthalmitis caused by mixed flora developed in each injured eye. Despite medical and surgical therapy, only one eye retained useful vision two years following injury. All wearers of headgear and their families should be educated in the proper use of these devices and about the potential for severe facial injuries. Penetrating ocular injuries initially may be relatively asymptomatic. Thus, even persons with seemingly minor injuries from such devices should seek immediate and thorough ophthalmic evaluation. In eyes with penetrating injuries, culture of intraocular fluids should be performed at the time of initial repair. Because the penetrating device is heavily contaminated with oral flora, broad-spectrum antibiotics should be administered by intravenous, subconjunctival, and intravitreal injection. Such injuries, although rare, may have a grave prognosis.