Authors: Evan Lagouros MD, Lawrence Lohman MD FACS Department of Ophthalmology SUMMA Health Systems Northeast Ohio Universities College of Medicine Financial Disclosures: The authors have no financial interest in the subject matter of this –e-poster

 88 year-old female presented after automobile accident at unknown speed, in which airbag deployment occurred.  Her previous ocular history is significant for pseudophakia with PCIOL OU with both implants well positioned  Immediately after the accident, she complained of decreased vision OU and sensitivity to light. Her pre-accident BCVA was 20/40 OD, 20/30 OS.  Post accident she was count fingers in both eyes with a potential acuity meter of 20/70, 20/60 OD and OS respectively.

 Initial imaging revealed a small, non-displaced nasal bone fracture without any other signs of ocular trauma.  Initial exam revealed bilateral traumatic iritis, irregular pupils OU, and bilateral lens dislocation. Intraocular pressure was 24 (mmhg) OU.

 With treatment her iritis resolved, however she developed ocular hypertension, which was treated medically. Planned for surgical repair of bilateral dislocation

 The left eye was operated on first, due to the contraction and instability of the bag. Lens removal with ciliary sulcus sutured lens placement and anterior vitrectomy was performed.  Shortly after, the same procedure was performed OD  Post operative BCVA was 20/40+ OU. At last visit, the patient was still continuing IOP lower agents OU, and had been weaned off all other post-op drops.

 Air bags have become a standard feature on automobiles over the last 10 to 15 years.  Despite the countless severe injuries prevented by their use, air bag deployment is the most common cause of ocular injury in motor vehicle accidents(MVAs) 1.  Air bags have been associated with a two fold increase in eye injuries 1  Lens dislocation following air bag deployment is rarely reported 1,3,6,7. Only 1 report of bilateral dislocation was discovered by the author 7. It is unclear if this case was an artificial lens or a crystalline lens.

 Surgical management: the authors would recommend an individualized approach on a case by case basis.  However, as with other causes of traumatic dislocation, bag integrity is often compromised; somewhat limiting surgical options.  Most importantly, the patient should be educated regarding, the possible need for multiple surgeries, and possible limits of best corrected visual acuity despite surgical correction.  Wearing a safety belt resulted in a two-fold decrease in risk of ocular trauma during MVAs 1.

References 1. McGwin G Jr, Owsley C. “Risk factors for motor vehicle collision-related eye injuries”. Arch Ophthalmol Jan;123(1): Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, USA.McGwin G JrOwsley C 2. Duma SM, Rath AL, Jernigan MV, Stitzel JD, Herring IP. “The effects of depowered airbags on eye injuries in frontal automobile crashes”. Am J Emerg Med Jan;23(1):13-9. Virginia Tech-Wake Forest, Mechanical Engineering, Center for Injury Biomechanics, Blacksburg, VA 24061, USA. SMRath ALJernigan MVStitzel JDHerring IP 3. Ball DC, Bouchard CS. “Ocular Morbidity Associated with Airbag Deployment”. Cornea 20(2): , Uchio E, Kadonosono K, Matsuoka Y, Goto S. “Simulation of air-bag impact on an eye with transsclerally fixated posterior chamber intraocular lens using finite element analysis”. J Cataract Refract Surg Feb;30(2): Simulation of air-bag impact on an eye with transsclerally fixated posterior chamber intraocular lens using finite element analysis”. 5. Stitzel JD, Hansen GA, Herring IP, Duma SM. “Blunt trauma of the aging eye: injury mechanisms and increasing lens stiffness”. Arch Ophthalmol Jun;123(6): Virginia Tech--Wake Forest Center for Injury Biomechanics, Winston-Salem, NC, USA.Stitzel JDHansen GAHerring IPDuma SM 6. Blackmon SM, Fekrat S, Setlik DE, Afshari NA. “Posterior dislocation of a crystalline lens associated with airbag deployment.” J Cataract Refract Surg Dec;31(12): Blackmon SMFekrat SSetlik DEAfshari NA 7. Onwuzuruigbo CJ, Fulda GJ, Larned D, Hailstone D. “Traumatic blindness after airbag deployment: bilateral lenticular dislocation”. J Trauma Feb;40(2): Department of Surgery, Medical Center of Delaware, Wilmington, USA.Onwuzuruigbo CJFulda GJLarned DHailstone D