Devastating endophthalmitis following penetrating ocular injury during night sleep from orthodontic headgear: case report and literature review.
BACKGROUND
Complications associated with the use of extra-oral traction devices (orthodontic headgear or facebow) including facial and ocular injuries, are considered infrequent.


METHODS
We describe the case of a 12-year-old boy who was inadvertently injured by the metallic bow of orthodontic headgear during sleep and developed blinding intra-ocular infection (endophthalmitis).


RESULTS
The injury resulted in corneal perforation. Visual acuity at presentation was 20/60 but deteriorated rapidly to light perception despite prompt medical and surgical treatment for endophathalmitis. Sympathetic ophthalmia developed and was controlled with systemic corticosteroids and imuran. Bacterial cultures showed mixed infection by gram-negative bacilli and Streptococcus viridans. In 10 (91%) out of the 11 eyes that were reported including our case, the visual acuity was hand movement perception or less.


CONCLUSIONS
The increase in case reports of such injuries should prompt the establishment of a standard policy regarding the use of orthodontic headgear and increase awareness of orthodontists and ophthalmologists to the blinding potential of even trivial and minor ocular injuries by orthodontic headgear. Intervention should be one step ahead compared with ocular injuries from other foreign bodies.
Department of Ophthalmology, Western Galilee-Nahariya Medical Center, P.O. Box 21, 22100, Nahariya, Israel.
Tami
T
Blum-Hareuveni
Uri
U
Rehany
Shimon
S
Rumelt
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D065306:Corneal Injuries; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005115:Extraoral Traction Appliances / Q000009:adverse effects*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015807:Eye Injuries, Penetrating / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D012890:Sleep; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D014792:Visual Acuity
D000900:Anti-Bacterial Agents