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Work-Related Eye Injury

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141. Evaluation of the Injured Worker (Treatment)

supervisor, should the injuries sustained be considered work related? What if the employee had taken a small detour to pick up personal dry cleaning on the way back from the office supply store? What if an employee comes in on his/her day off to catch up on paperwork at the office and trips and falls? What if, while on the clock, a mechanic at work decides to change the oil in his own car and has chemicals splash into his eyes? Because the physician will be asked to comment on causation, the medical (...) . [ ] Treatment considerations When treating an injured worker, the clinician must be aware of factors that can affect the duration and outcome of an injury. Addressing these factors results in more effective treatment and a more favorable outcome. Work-related musculoskeletal disorders occur when there is a mismatch between the physical requirements of the job and the physical capacity of the human body. More than 100 different injuries can result from repetitive motions that produce wear and tear

2014 eMedicine.com

142. Burns, Chemical (Treatment)

. . Pfister DA, Pfister RR. Acid injuries of the eye. Fundamentals of Cornea and External Disease. Cornea . 2005. Vol 2.: 1277-84. Pfister RR, Pfister DA. Alkali injuries of the eye. Fundamentals of Cornea and External Disease. Cornea . 2005. Vol 2: 1285-93. Xiang H, Stallones L, Chen G, Smith GA. Work-related eye injuries treated in hospital emergency departments in the US. Am J Ind Med . 2005 Jul. 48(1):57-62. . Morgan SJ. Chemical burns of the eye: causes and management. Br J Ophthalmol . 1987 Nov. 71 (...) of management include the following: (1) removing the offending agent, (2) promoting ocular surface healing, (3) eliminating inflammation, (4) preventing infection, and (5) controlling IOP. Remove inciting chemical (irrigation) Immediate copious irrigation remains the single most important therapy for treating chemical injuries. If available, the eye should be anesthetized prior to irrigation. Ideally, the eye should be irrigated with a sterile balanced buffered solution, such as normal saline solution

2014 eMedicine.com

143. Allergic and Environmental Asthma (Treatment)

should clean and dust their home regularly. If a patient cannot avoid vacuuming, he or she should use a face mask or a double-bagged vacuum with a high-efficiency particulate air filter. Active smoking and exposure to passive smoke must be avoided. Room air ionizers have not been proven to be effective for people with chronic asthma, and the generation of ozone by these machines may be harmful to some. Specific factors related to the home are described below. Guidelines on work-related asthma from (...) or business associates with similar problems Symptoms after eating (dried, canned, or processed food) Medications, such as beta blockers (including eye drops), aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) Physical Examination Physical examination findings are often normal. Head and neck Nasal mucosal swelling, discharge, polyps, or sinus percussion tenderness may suggest associated allergic rhinitis or sinusitis. Wheezing heard only or mostly over the neck may suggest ( ) or other

2014 eMedicine.com

144. Facial Trauma, Mandibular Fractures

accidents, 34% were caused by assaults, 7% were work-related, 7% occurred as the result of a fall, 4% occurred in sporting accidents, and the remainder had miscellaneous causes. [ ] A retrospective cohort study by Afrooz et al using hospitalized patients enrolled in the National Trauma Data Bank between 2001 and 2005 found that males made up 80% of mandibular fracture patients, with the most frequent mechanisms of injury in males being assault (49.1%), motor vehicle accidents (25.4%), and falls (12.8 (...) fractures, 43% of the patients had an associated injury. Of these patients, head injuries occurred in 39% of patients, head and neck lacerations in 30%, midface fractures in 28%, ocular injuries in 16%, nasal fractures in 12%, and cervical spine fractures in 11%. Other injuries present in this group were extremity trauma in 51%, thoracic trauma in 29%, and abdominal trauma in 14%. Of the 1067 patients studied, 12 (2.6%) died of their associated injuries before the mandible fracture could be treated

2014 eMedicine Surgery

145. Hyperbaric Oxygen Therapy

are wide surgical debridement and aggressive antibiotic therapy. Hyperbaric oxygen therapy (HBOT) is used adjunctively with these measures, as it offers several mechanisms of action to control the infection and reduce tissue loss. First, HBOT is toxic to anaerobic bacteria. [ ] Next, HBOT improves polymorphonuclear function and bacterial clearance. [ , ] Based on results of work related to CO poisoning, HBOT may decrease neutrophil adherence based on inhibition of beta-2 integrin function (...) to lower intraocular pressure and movement of a potential embolus downstream, ocular massage, anterior chamber paracentesis, and medications (both eye drops and oral). Most modalities have proven inefficacious. [ ] A small study by Hertzog et al evaluated HBOT with CRAO. Patients were divided into groups based on time of onset of CRAO to HBOT. The study noted that HBOT was most useful in preserving vision if instituted within eight hours. [ ] Another retrospective study published by Beiran compared

2014 eMedicine Surgery

146. Hyperbaric Oxygen

are wide surgical debridement and aggressive antibiotic therapy. Hyperbaric oxygen therapy (HBOT) is used adjunctively with these measures, as it offers several mechanisms of action to control the infection and reduce tissue loss. First, HBOT is toxic to anaerobic bacteria. [ ] Next, HBOT improves polymorphonuclear function and bacterial clearance. [ , ] Based on results of work related to CO poisoning, HBOT may decrease neutrophil adherence based on inhibition of beta-2 integrin function (...) to lower intraocular pressure and movement of a potential embolus downstream, ocular massage, anterior chamber paracentesis, and medications (both eye drops and oral). Most modalities have proven inefficacious. [ ] A small study by Hertzog et al evaluated HBOT with CRAO. Patients were divided into groups based on time of onset of CRAO to HBOT. The study noted that HBOT was most useful in preserving vision if instituted within eight hours. [ ] Another retrospective study published by Beiran compared

2014 eMedicine Surgery

147. Burns, Thermal

) in the United States in 2014, while in 2016, [ ] there were approximately 40,000 burn-related hospitalizations in the United States, 30,000 of which were at specialized burn centers. [ ] Work-related burns account for 20-25% of all serious burns. [ ] See the image below. Invasive burn wound infection implies that bacteria or fungi are proliferating in eschar and invading underlying viable tissues. These wounds display a change in color, new drainage, and often a foul odor. These infections are life (...) categories of burn injury (major, moderate, minor) and defines the optimal setting for the management of each. Major burn injury Major burn injury is defined as partial-thickness burns involving more than 25% of TBSA in adults or 20% of TBSA in children younger than 10 years or adults older than 50 years; full-thickness burns involving more than 10% of TBSA; burns involving the face, eyes, ears, hands, feet, or perineum that may result in functional or cosmetic impairment; burns caused by caustic

2014 eMedicine Surgery

148. Corneal Foreign Body (Diagnosis)

L. The role of in vivo confocal microscopy in the diagnosis of hidden corneal foreign bodies. J Int Med Res . 2014 Feb. 42(1):145-52. . Peate WF. Work-related eye injuries and illnesses. Am Fam Physician . 2007 Apr 1. 75(7):1017-22. . Carley F, Carley S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Mydriatics in corneal abrasion. Emerg Med J . 2001 Jul. 18(4):273. . Arbour JD, Brunette I, Boisjoly HM, Shi ZH, Dumas J, Guertin MC. Should we patch (...) for ophthalmic emergencies. Sometimes, the foreign body may not be present at the time of examination, having left the residual corneal abrasion with resultant pain. Superficial corneal foreign bodies are much more common than deeply embedded corneal foreign bodies. The possibility of an intraocular foreign body must always be considered when a patient presents with a history of trauma. In major league baseball, 33% of all eye injuries are corneal abrasions; in the National Basketball Association, corneal

2014 eMedicine.com

149. Corneal Abrasion (Diagnosis)

States, 65,000 work-related eye injuries and illnesses that cause missed time from work occur each year. [ ] A study of eye injuries in a major US automotive corporation found an annual incidence of 15 eye injuries per 1000 employees. Between July 1989 and June 1992, a total of 1983 work-related eye injuries occurred at 33 plants, with 86.7% of cases being superficial foreign bodies and corneal abrasions. [ ] The eye injuries comprised 6% of total injuries. One third of eye injuries resulted (...) . [ ] In a retrospective review from Torino, Italy, ocular injuries, including corneal abrasions, were associated with significant morbidity. [ ] Previous References Mann I. Study of epithelial regeneration in living eye. Br J Ophthalmol . 1944. 28:26. Chen JJ, Tseng SC. Abnormal corneal epithelial wound healing in partial-thickness removal of limbal epithelium. Invest Ophthalmol Vis Sci . 1991 Jul. 32(8):2219-33. . Dua HS, Gomes JA, Singh A. Corneal epithelial wound healing. Br J Ophthalmol . 1994 May. 78(5):401-8

2014 eMedicine.com

150. Allergic and Environmental Asthma (Diagnosis)

should clean and dust their home regularly. If a patient cannot avoid vacuuming, he or she should use a face mask or a double-bagged vacuum with a high-efficiency particulate air filter. Active smoking and exposure to passive smoke must be avoided. Room air ionizers have not been proven to be effective for people with chronic asthma, and the generation of ozone by these machines may be harmful to some. Specific factors related to the home are described below. Guidelines on work-related asthma from (...) or business associates with similar problems Symptoms after eating (dried, canned, or processed food) Medications, such as beta blockers (including eye drops), aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) Physical Examination Physical examination findings are often normal. Head and neck Nasal mucosal swelling, discharge, polyps, or sinus percussion tenderness may suggest associated allergic rhinitis or sinusitis. Wheezing heard only or mostly over the neck may suggest ( ) or other

2014 eMedicine.com

151. Burns, Chemical (Diagnosis)

, Pfister DA. Alkali injuries of the eye. Fundamentals of Cornea and External Disease. Cornea . 2005. Vol 2: 1285-93. Xiang H, Stallones L, Chen G, Smith GA. Work-related eye injuries treated in hospital emergency departments in the US. Am J Ind Med . 2005 Jul. 48(1):57-62. . Morgan SJ. Chemical burns of the eye: causes and management. Br J Ophthalmol . 1987 Nov. 71(11):854-7. . Klein R, Lobes LA Jr. Ocular alkali burns in a large urban area. Ann Ophthalmol . 1976 Oct. 8(10):1185-9. . Wagoner MD, Kenyon (...) Approach to Chemical Burns Updated: Sep 18, 2018 Author: Mark Ventocilla, OD, FAAO; Chief Editor: Andrew A Dahl, MD, FACS Share Email Print Feedback Close Sections Sections Ophthalmologic Approach to Chemical Burns Overview Background Chemical injuries to the eye represent one of the true ophthalmic emergencies, wherein time is truly critical. While almost any chemical can cause ocular irritation, serious damage generally results from either strongly basic (alkaline) compounds or strongly acidic

2014 eMedicine.com

152. Hyperbaric Oxygen Therapy

are wide surgical debridement and aggressive antibiotic therapy. Hyperbaric oxygen therapy (HBOT) is used adjunctively with these measures, as it offers several mechanisms of action to control the infection and reduce tissue loss. First, HBOT is toxic to anaerobic bacteria. [ ] Next, HBOT improves polymorphonuclear function and bacterial clearance. [ , ] Based on results of work related to CO poisoning, HBOT may decrease neutrophil adherence based on inhibition of beta-2 integrin function (...) to lower intraocular pressure and movement of a potential embolus downstream, ocular massage, anterior chamber paracentesis, and medications (both eye drops and oral). Most modalities have proven inefficacious. [ ] A small study by Hertzog et al evaluated HBOT with CRAO. Patients were divided into groups based on time of onset of CRAO to HBOT. The study noted that HBOT was most useful in preserving vision if instituted within eight hours. [ ] Another retrospective study published by Beiran compared

2014 eMedicine.com

153. Foreign Body Removal, Cornea

. Corneal injury from a metallic foreign body: an occupational hazard. Eye Contact Lens . 2007 Sep. 33(5):259-60. . Peate WF. Work-related eye injuries and illnesses. Am Fam Physician . 2007 Apr 1. 75(7):1017-22. . Macedo Filho ET, Lago A, Duarte K, Liang SJ, Lima AL, Freitas D. Superficial corneal foreign body: laboratory and epidemiologic aspects. Arq Bras Oftalmol . 2005 Nov-Dec. 68(6):821-3. . Roberts JR, Hedges RJ. Ophthalmologic procedures. Clinical Procedures in Emergency Medicine . 4th ed (...) in a timely manner, they can cause prolonged pain and lead to complications such as infection and ocular necrosis. An embedded foreign body. See , a Critical Images slideshow, to help identify various foreign objects and determine appropriate interventions and treatment options. An intraocular foreign body penetrates into the anterior chamber of the eye or into the globe itself. It is likely to cause significant morbidity and, thus, necessitates a through workup, including, in many instances, a detailed

2014 eMedicine.com

154. Hemorrhagic Cystitis (Overview)

, 3.35) with the bladder. In the acute setting, the bladder can be copiously irrigated with alkalinized normal saline to minimize bladder irritation. [ , ] Chemically induced hemorrhagic cystitis Cases of with no infectious etiology have been reported in patients who have been in contact with certain urotoxic chemicals, such as derivatives of aniline (found in dyes, marking pens, and shoe polish) and toluidine (found in pesticides and shoe polish). Exposure to these chemicals is usually work-related (...) in immunocompromised patients are often complicated by hemorrhage. Reported causative infectious agents for hemorrhagic cystitis include the following: Escherichia coli Adenoviruses 7, 11, 21, and 35 Papovavirus Influenza A Radiation-induced hemorrhagic cystitis Nearly 25% of patients who undergo pelvic radiation develop bladder-related complications. Mucosal ischemia secondary to radiation injury results from endarteritis inducing hypoxic surface damage, ulceration, and bleeding. The incidence in the pediatric

2014 eMedicine Pediatrics

155. Corneal Foreign Body (Overview)

L. The role of in vivo confocal microscopy in the diagnosis of hidden corneal foreign bodies. J Int Med Res . 2014 Feb. 42(1):145-52. . Peate WF. Work-related eye injuries and illnesses. Am Fam Physician . 2007 Apr 1. 75(7):1017-22. . Carley F, Carley S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Mydriatics in corneal abrasion. Emerg Med J . 2001 Jul. 18(4):273. . Arbour JD, Brunette I, Boisjoly HM, Shi ZH, Dumas J, Guertin MC. Should we patch (...) for ophthalmic emergencies. Sometimes, the foreign body may not be present at the time of examination, having left the residual corneal abrasion with resultant pain. Superficial corneal foreign bodies are much more common than deeply embedded corneal foreign bodies. The possibility of an intraocular foreign body must always be considered when a patient presents with a history of trauma. In major league baseball, 33% of all eye injuries are corneal abrasions; in the National Basketball Association, corneal

2014 eMedicine.com

156. Corneal Abrasion (Overview)

States, 65,000 work-related eye injuries and illnesses that cause missed time from work occur each year. [ ] A study of eye injuries in a major US automotive corporation found an annual incidence of 15 eye injuries per 1000 employees. Between July 1989 and June 1992, a total of 1983 work-related eye injuries occurred at 33 plants, with 86.7% of cases being superficial foreign bodies and corneal abrasions. [ ] The eye injuries comprised 6% of total injuries. One third of eye injuries resulted (...) . [ ] In a retrospective review from Torino, Italy, ocular injuries, including corneal abrasions, were associated with significant morbidity. [ ] Previous References Mann I. Study of epithelial regeneration in living eye. Br J Ophthalmol . 1944. 28:26. Chen JJ, Tseng SC. Abnormal corneal epithelial wound healing in partial-thickness removal of limbal epithelium. Invest Ophthalmol Vis Sci . 1991 Jul. 32(8):2219-33. . Dua HS, Gomes JA, Singh A. Corneal epithelial wound healing. Br J Ophthalmol . 1994 May. 78(5):401-8

2014 eMedicine.com

157. Allergic and Environmental Asthma (Overview)

should clean and dust their home regularly. If a patient cannot avoid vacuuming, he or she should use a face mask or a double-bagged vacuum with a high-efficiency particulate air filter. Active smoking and exposure to passive smoke must be avoided. Room air ionizers have not been proven to be effective for people with chronic asthma, and the generation of ozone by these machines may be harmful to some. Specific factors related to the home are described below. Guidelines on work-related asthma from (...) or business associates with similar problems Symptoms after eating (dried, canned, or processed food) Medications, such as beta blockers (including eye drops), aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) Physical Examination Physical examination findings are often normal. Head and neck Nasal mucosal swelling, discharge, polyps, or sinus percussion tenderness may suggest associated allergic rhinitis or sinusitis. Wheezing heard only or mostly over the neck may suggest ( ) or other

2014 eMedicine.com

158. Burns, Chemical (Overview)

, Pfister DA. Alkali injuries of the eye. Fundamentals of Cornea and External Disease. Cornea . 2005. Vol 2: 1285-93. Xiang H, Stallones L, Chen G, Smith GA. Work-related eye injuries treated in hospital emergency departments in the US. Am J Ind Med . 2005 Jul. 48(1):57-62. . Morgan SJ. Chemical burns of the eye: causes and management. Br J Ophthalmol . 1987 Nov. 71(11):854-7. . Klein R, Lobes LA Jr. Ocular alkali burns in a large urban area. Ann Ophthalmol . 1976 Oct. 8(10):1185-9. . Wagoner MD, Kenyon (...) Approach to Chemical Burns Updated: Sep 18, 2018 Author: Mark Ventocilla, OD, FAAO; Chief Editor: Andrew A Dahl, MD, FACS Share Email Print Feedback Close Sections Sections Ophthalmologic Approach to Chemical Burns Overview Background Chemical injuries to the eye represent one of the true ophthalmic emergencies, wherein time is truly critical. While almost any chemical can cause ocular irritation, serious damage generally results from either strongly basic (alkaline) compounds or strongly acidic

2014 eMedicine.com

159. Nonarticular Rheumatism/Regional Pain Syndrome (Follow-up)

by Neuro-Vascular Entrapment: Anatomical Findings in a Series of 97 Consecutive Patients Treated by Laparoscopic Nerve Decompression. Pain Physician . 2015 Nov. 18 (6):E1139-43. . Chammas M. Carpal tunnel syndrome. Chir Main . 2014 Apr. 33 (2):75-94. . Breslin FC, Ibrahim S, Smith P, Mustard C, Amick B, Shankardass K. The demographic and contextual correlates of work-related repetitive strain injuries among canadian men and women. Am J Ind Med . 2013 Oct. 56(10):1180-9. . Abeles AM, Pillinger MH (...) improved after a 4-year follow-up. [ ] Stress reduction combined with cognitive-behavioral therapy may be helpful. [ ] Eye movement desensitization and reprocessing (EMDR) has been found to be useful in patients with posttraumatic stress disorder (PTSD). [ ] Because the pathophysiology of fibromyalgia is similar to that of PTSD [ ] , some practitioners have been using EMDR with anecdotal success. Meditation has been shown to be helpful. [ ] Recommended is a mindfulness meditation program developed

2014 eMedicine.com

160. Burns, Chemical (Follow-up)

. . Pfister DA, Pfister RR. Acid injuries of the eye. Fundamentals of Cornea and External Disease. Cornea . 2005. Vol 2.: 1277-84. Pfister RR, Pfister DA. Alkali injuries of the eye. Fundamentals of Cornea and External Disease. Cornea . 2005. Vol 2: 1285-93. Xiang H, Stallones L, Chen G, Smith GA. Work-related eye injuries treated in hospital emergency departments in the US. Am J Ind Med . 2005 Jul. 48(1):57-62. . Morgan SJ. Chemical burns of the eye: causes and management. Br J Ophthalmol . 1987 Nov. 71 (...) of management include the following: (1) removing the offending agent, (2) promoting ocular surface healing, (3) eliminating inflammation, (4) preventing infection, and (5) controlling IOP. Remove inciting chemical (irrigation) Immediate copious irrigation remains the single most important therapy for treating chemical injuries. If available, the eye should be anesthetized prior to irrigation. Ideally, the eye should be irrigated with a sterile balanced buffered solution, such as normal saline solution

2014 eMedicine.com

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