Pediatric eye injury due toAvena fatua(wild oats)

摘要

ObjectiveWe report on florid and unusual ophthalmic physical signs in three children where the trauma was caused by seeds fromAvena fatua,a grass common in western North America.DesignCase series and literature review.SettingThree local emergency departments (ED) during the fall of 1998.Patients or ParticipantsThree children reporting to an ED with an acutely painful eye from which the foreign body was identified botanically asAvena fatua.InterventionsNone.Main Outcome MeasuresSymptoms, interventions, duration of problem.ResultsThree 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 ldquo;burn.rdquo; 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 ldquo;lash.rdquo; 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.ConclusionsThe 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.