Victims of serious eye accidents find treatment at trauma center

November 01, 1996|By Jonathan Bor | Jonathan Bor,Sun Staff

It's easy to imagine the damage that a bullet or a switchblade can do to the eye.

But anyone who has worked at the Wilmer Eye Institute's regional trauma center knows that it doesn't take an act of violence to inflict serious abuse on an organ that is a fragile sac of fluid and gel.

The trauma center, which will occupy a major part of the new Wilmer Eye Care Pavilion, has for years functioned out of a few unassuming rooms in the world-renowned institute. Ten to 35 patients are treated there each week.

Freak accidents are often to blame.

Brian Johnson, who was training his dogs Sunday on a field near Winchester, Va., shook debris from his sweat shirt and a sleeve flew back and implanted a splinter in his eye.

"It hurt bad, but then it eventually toned itself down to the point where I could get my composure," said Johnson, a machinist with the U.S. Bureau of Printing and Engraving.

Nonetheless, the eye turned a worrisome red, so he drove himself to a Virginia emergency room where doctors "lined up" to see the unlikely culprit. Realizing that the splinter had pierced his lens, they sent him by ambulance to Wilmer.

Wilmer surgeons spent four hours opening, cleaning and sewing shut his eye. The splinter was only three-sixteenths of an inch long, but it delivered enough bacteria to threaten his sight.

Johnson emerged with his eye and his sight intact.

Wilmer's trauma center occupies a key part of Maryland's emergency medical system -- receiving the worst eye injuries from all sections of Maryland except the Washington suburbs.

Dr. Dante J. Pieramici, who runs Wilmer's trauma service, carries with him a mental catalog of eye injuries that illustrate the eye's vulnerability.

A man from the Eastern Shore reached into a pot of crabs, then yanked his hand out when one snapped a finger. To his horror, the crab flew through the air -- jabbing the eye of a nearby child.

The crab not only damaged her lens, but produced enough concussive force to dislodge the retina. Surgeons were forced to remove the lens but successfully refastened the retina. A contact lens gives her nearly 20-20 vision.

A 12-year-old boy made a bomb by placing gunpowder beneath a covering of tar and gravel. The explosion showered his eye with debris. At Wilmer, surgeons removed the lens, stopped some hemorrhaging and fixed a detached retina. He, too, is seeing 20-20.

It doesn't always work out that way.

Some injuries spill the eye's contents out of the sac that houses them. "If it all comes out, it's not salvageable," Pieramici said. In such cases, the eye must be removed.

Sometimes, surgeons are able to reassemble a damaged eye but for a variety of reasons cannot restore sight. If a patient does not perceive light in a week or so, doctors usually sacrifice the eye.

This is because the immune system tends to recognize a disabled eye as foreign and, in a quirk, attacks the good eye along with the bad.

Pieramici said blunt instruments are often more injurious than sharp ones because they cause ruptures rather than clean cuts. Beebees, pellets and paint balls are chief culprits.

Pub Date: 11/01/96

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