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Severe ocular injuries from orthodontic headgear.
Archives of Ophthalmology (Chicago, Ill. : 1960)
|May 1, 1985
Summary
Headgear (orthodontic tractional devices) dislocation can cause severe eye injuries, leading to endophthalmitis. Prompt ophthalmic evaluation and aggressive antibiotic treatment are crucial for managing these rare but serious ocular injuries.
Area of Science:
- Ophthalmology
- Orthodontics
Background:
- Extraoral orthodontic tractional devices, commonly known as headgear, are used to correct malocclusions.
- Improper use or accidental dislocation of headgear can pose significant risks.
Observation:
- A case series involving two patients reported three instances of penetrating ocular injuries resulting from headgear dislocation.
- These injuries led to the development of endophthalmitis, an infection within the eye, caused by mixed bacterial flora.
Findings:
- Despite comprehensive medical and surgical interventions, only one of the three affected eyes retained useful vision two years post-injury.
- Penetrating ocular injuries from headgear may initially present with minimal symptoms, delaying diagnosis and treatment.
Implications:
- Educating patients and families on the safe and correct use of headgear is essential to prevent severe facial and ocular trauma.
- Immediate and thorough ophthalmic examination is critical for all suspected headgear-related eye injuries, regardless of initial symptom severity.
- Prophylactic broad-spectrum antibiotics, administered via multiple routes (intravenous, subconjunctival, intravitreal), are recommended due to heavy oral contamination of the penetrating device.
- Early intraocular fluid cultures during surgical repair are vital for targeted antimicrobial therapy.
- These rare injuries carry a grave prognosis, emphasizing the need for stringent safety measures and prompt medical attention.