Wednesday, May 20, 2009

STI: The shiner that won't go away

May 21, 2009


The shiner that won't go away

A black eye can result in permanent loss of vision if not treated properly. POON CHIAN HUI finds out more


Cartoons like Popeye often depict characters emerging from a violent tussle with a black eye but otherwise none the worse.


We may laugh at such comical scenes but for Mr Robya Alexey, 44, the black eye he got put him at risk of losing his vision.


The Russian pharmacist was unexpectedly punched in the eye by a drunk stranger in 2007. It was the same eye that had been bruised in a fight when he was a boy.


'I was walking along a street when a drunk man came up to me and, without warning, punched me in the left eye,' he recalled.


He was then living in the Russian town of Blagoveschensk with his wife Natalia, 33, and seven-year-old son. He has two daughters, aged 21 and 16, from a previous marriage.


It was not the first time that Mr Alexey got a black eye. As a child, he was a tough kid who got into the occasional schoolboy fight. At the age of nine, he came home with a bruised left eye.


The injury was treated without much fuss at a local clinic. But the damage was already done.


Over the next decade, the vision in his left eye gradually deteriorated.


When he visited an eye specialist in Moscow, he was told that he had a cataract. He was 22 years old then.


A cataract is a condition where the clear lens of the eye becomes cloudy. While commonly associated with the ageing process, cataracts can result for various other reasons, including a trauma injury.


In 1987, he had an artificial lens implanted in his left eye to replace the clouded one.


Then the second whammy came in 2007. The implanted lens crumbled. The stitched-up wound from his cataract surgery also ripped open as a result of the impact.


He underwent emergency surgery to stop the bleeding, but his vision was not repaired. In fact, several local doctors felt that his injury had become too complicated to fix - there were ruptures in the cornea and iris, bleeding in the eyeball and retinal detachment.


'The local ophthalmologists did not want to operate because of the severe condition of my left eye,' he said. Instead, he was told not to take the risk, as an inflammation might result and spread to his healthy eye.


If that happened, they said, he would lose his eyesight completely in both his eyes.


His wife, however, refused to let him be resigned to his fate.


'She was unhappy with the doctors' assessment, so she suggested that we find treatment overseas,' he said.


Earlier this February, the couple flew to Singapore to seek treatment at Raffles Hospital, which they came to know of through Mr Alexey's father, who had a heart problem treated at the hospital last year.


Ophthalmologist Lee Jong Jian, who specialises in eye trauma surgery, examined Mr Alexey's eye and found it to be badly damaged.


'It was red and soft,' he said. 'The whole eye had collapsed - its contents, including the eye jelly (a vitreous substance which fills the centre) and artificial implant, had spilled out of the eye.'


In addition, the retina was slightly detached. The cornea was also scarred and stuck to the iris, he said.


All was not lost, however. The injured eye could still perceive light. Hence, there was a chance that some vision could be regained, said Dr Lee.


'Had he delayed another six months or so, the eyeball would have shrunk and the ability to see would be completely gone,' he said.


The reconstruction surgery, which took less than three hours, involved reorganising the dislodged parts of the eye, using laser to repair the retina and the pupil, and replacing the eye jelly with a permanent oil substitute.


The results were almost immediate. MrAlexey could distinguish different colours two days after the operation and count fingers two weeks later.


He has since returned to Russia. In a recent e-mail, he said his vision is still improving.


'I can see outlines of objects that are several metres away,' he wrote.


On his left eye being able to see again, he said: 'Words cannot describe my feelings - I think that only those who almost lost their eyesight can realise how I feel.'


Dr Lee said that Mr Alexey can expect to regain at least 40 per cent of vision in his left eye.




Time is of the essence when it comes to seeking medical attention for eye trauma, even if the injury does not appear to be serious. Injuries to the eye may be, ironically, hard to see.


'Eye trauma must be attended to immediately in order to determine the extent of injury, which may not be visible,' said Dr Lee Jong Jian, an ophthalmologist at Raffles Eye Centre, Raffles Hospital with a special interest in retina and eye trauma.


Examples of such hidden damage include internal bleeding, retinal scarring and detachment. The retina is a membrane in the back of the eyeball that captures images.


Dr Lee added: 'If one waits too long, the eye may deteriorate to the point where it can't be restored to its original condition.'


He recalled a case where a nine-year-old girl fell and hit her eye, but did not seek medical help. While she did not seem to sustain any visible damage, her vision became increasingly blurred over the next six months. Upon examination, Dr Lee found that her retina was detached and heavily scarred. She underwent surgery which improved her vision significantly.


Typically, eye injuries occur as a result of blunt force trauma, foreign bodies and exposure to chemicals.


In general, an injury is considered serious if there is an open wound, internal bleeding, retinal tears or detachment or damage to the lens, which is the transparent part of the eye that focuses images onto the retina.


Minor injuries would include mild chemical burns (caused by contact with relatively caustic chemicals like acids and alkalis), bacterial infections such as conjunctivitis, and corneal abrasions.


Corneal abrasions, which are scratches to the transparent outer layer of the eye, often result from being 'poked' in the eye by objects like pencils or fingers. Thus, contact lens wearing and removal could cause such minor scratches.


Although they can heal within a day or two, corneal abrasions can be very painful, said


Dr Lee, adding that those with dry eyes should use lubricating drops before removing their contact lenses in order to prevent possible injury.


Otherwise, the nature of eye injuries tend to be unpredictable. Dr Lee commonly sees work-related injuries, such as construction workers having debris embedded in their eyes.


But he has also seen what he called 'one-in-a-million' cases. For instance, he had a patient, a golfer, whose eye was sliced by a golf tee that had rebounded from a tree trunk and then hit his eye. He had two operations to restore the eye structure and vision.


Dr Lee also said there are freak home accidents involving children.


He described treating a young boy whose eye was cut open after he jumped from the sofa and hit the edge of the coffee table.


Hence, it may be wise to protect your child by taking measures like padding sharp corners and keeping sharp objects like scissors and strong chemicals like bleach out of their reach.

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