Severe ocular injuries from orthodontic headgear
G. N. Holland, D. A. Wallace, B. J. Mondino, S. H. Cole and S. J. Ryan
Dislocation of extraoral orthodontic tractional devices (headgear) resulted
in penetrating ocular injuries in three eyes of two patients. An
endophthalmitis caused by mixed flora developed in each injured eye.
Despite medical and surgical therapy, only one eye retained useful vision
two years following injury. All wearers of headgear and their families
should be educated in the proper use of these devices and about the
potential for severe facial injuries. Penetrating ocular injuries initially
may be relatively asymptomatic. Thus, even persons with seemingly minor
injuries from such devices should seek immediate and thorough ophthalmic
evaluation. In eyes with penetrating injuries, culture of intraocular
fluids should be performed at the time of initial repair. Because the
penetrating device is heavily contaminated with oral flora, broad-spectrum
antibiotics should be administered by intravenous, subconjunctival, and
intravitreal injection. Such injuries, although rare, may have a grave
prognosis.
