During the study period there were 18
651 admissions to our primary care department, and of these 13 were due to ocular injuries attributed to assault with a raw egg (0.07%; table 1). All 13 eye injuries were due to eggs thrown by strangers.
Table 1Classification of ocular injuries in 13 patients
Twelve patients were men and the average age of the victims was 27.9 years. Nine patients were injured in the left eye and there were no bilateral injuries. On presentation only one patient had a visual acuity of 6/6, seven presented at 6/9 with the remainder having 6/18 or worse (one had a visual acuity of 6/60 but was densely amblyopic).
All patients had closed globe injuries; however, only three injuries were classed as minor with corneal abrasions, subconjunctival haemorrhage or, as in one patient, a simple lid haematoma. As would be expected with such injuries, all were given antibiotic treatment and discharged from care.
Two injuries were classed as intermediate injuries. One patient presented with an amblyopic eye with a corneal abrasion and traumatic uveitis—this had settled at the 1‐week review after treatment with steroid and antibiotic. On presentation, the vision was 6/60 due to amblyopia and on discharge this remained unchanged. The second case was a subconjunctival haemorrhage with traumatic uveitis that again settled after appropriate treatment.
Most of the injuries (n
8) were classified as major ocular injuries. Five of these had various combinations of commotio retinae, IOP rise and hyphaema, all of which settled after appropriate treatment. We will discuss the remaining three cases in detail.
Case 1 was a 27‐year‐old man who presented with markedly reduced visual acuity (2/60) after being hit with an egg while he was a passenger in a moving car. Examination showed subconjunctival haemorrhage and corneal abrasions; however, there was marked commotio of the macula region (Berlin's disease; fig 1). On review, although the anterior segment injuries and, clinically, the commotio settled, the patient's vision did not improve. Electrodiagnostic testing 2 months after the incident showed permanent damage to the middle and outer retinal layers of the macula corresponding to the photoreceptor layer. Testing showed the ganglion cell layer to be functioning. Clinically, he developed mottling of the macula region, signifying retinal pigment epithelium damage. In addition, there was angle recession of the anterior segment, giving the patient a lifelong risk of developing glaucoma. On discharge, his vision remained poor at 3/60.
Figure 1Marked commotio of the macula (Berlin's disease).
Case 4 presented, immediately after an assault with an egg thrown from a passing car, with pain and mildly reduced vision. Examination showed a subconjunctival haemorrhage, hyphaema, mild vitreous haemorrhage and extensive commotio retinae involving the macula; no retinal breaks were identified. Over the next few visits he gradually improved. However, 35 days after the injury he sneezed and noticed an immediate drop in visual acuity (6/18). Examination showed a marked vitreous haemorrhage, and due to the mechanism of injury he underwent vitrectomy and cryotherapy to a large inferior retinal tear and gas endotamponnade. Follow‐up in our vitreoretinal service showed satisfactory progress, but 3 months after the initial injury he developed a macula on retinal detachment that necessitated further vitrectomy with gas tamponnade. This treatment was successful and the patient was discharged from care with no retinal detachment and vision of 6/6, six months after the incident.
Case 8 was a 22‐year‐old man who presented immediately after the alleged assault with a visual acuity of 6/18. On examination, there was a large corneal abrasion, small hyphaema with secondary rise in IOP (31 mm Hg), and extensive inferior commotio retinae with some peripheral retinal haemorrhages. As the hyphaema settled, inferior angle recession was also noted. On day 34 after the injury, his vision had improved to 6/9 and IOP was normal, with no drugs being taken. A thorough examination showed no retinal breaks. As with case 1, this patient now has a higher probability of developing glaucoma throughout his life and must undergo yearly checks with his ophthalmologist.