title: Orbital trauma caused by bicycle hand brakes.
abstract: OBJECTIVE
  This report aims to increase awareness of an unusual mechanism of orbital injury sustained by bicycle riders.
  
  
  METHODS
  In this retrospective small case series, we describe two cases of orbital injury caused by upper eyelid penetration. A 5-year-old boy (patient 1) and a 6-year-old boy (patient 2) presented to our service within a 2-week period. Both had been injured by similarly styled, handlebar-mounted bicycle hand brake levers. Patient 1 had an orbital roof fracture and penetrating brain injury and underwent repair of a left upper eyelid laceration, craniotomy for pseudoencephalocele, and ptosis repair. Patient 2 had orbital hemorrhage and underwent repair of left upper eyelid laceration.
  
  
  RESULTS
  In both cases, a handlebar-mounted bicycle hand brake lever perforated the left eyelid when the rider fell onto it. Neither patient was wearing protective headwear or eyewear. Two months after surgery, patient 1 had 20/25 visual acuity OU and excellent cosmetic appearance. Patient 2 had baseline amblyopic vision 2 days after surgery but moved from town and was lost to follow-up.
  
  
  CONCLUSIONS
  Orbit injuries from bicycle brake levers are rare, and helmets or protective eyewear probably would not have prevented these injuries. However, a change in the design and/or mounting location of handlebar-mounted brake levers might help prevent further injuries of this type.
authors.affiliation: Casey Eye Institute, Portland, Oregon, U.S.A. ngj@ohsu.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Ng
authors.forename: Troy D
authors.initials: TD
authors.lastname: Payner
authors.forename: David E E
authors.initials: DE
authors.lastname: Holck
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Martin
authors.forename: William T
authors.initials: WT
authors.lastname: Nunery
mesh_terms: D001642:Bicycling / Q000293:injuries*; D001763:Blepharoptosis; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D004677:Encephalocele / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005130:Eye Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D015807:Eye Injuries, Penetrating / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005143:Eyelids / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed