Ocular Injuries by Elastic Cords in Children

Background. Elastic cords hitting the eyeball as high-speed projectiles can severely damage ocular structures and can produce permanent visual function impairment. Objectives. To evaluate the frequency, mechanics, and severity of eye injuries caused by elastic cords in children to adopt the most appropriate preventive measures. Methods. A retrospective medical records review of hospital admissions secondary to ocular trauma between 1991 and 1997 in a pediatric ophthalmology unit at an urban tertiary care pediatric hospital was performed to select all children admitted for ocular injury caused by an elastic cord. Results. Eight children fulfilled the inclusion criteria; the prevalence ratio was 2% of all pediatric trauma admissions. In all cases the mechanics of trauma was a combination of blunt and high-speed projectile injury. The mechanism of trauma in younger patients was typically a cord that was misused during unsupervised playtime, whereas cord slipping from car roof racks was noted in older patients. One patient suffered a severe permanent visual impairment caused by retinal detachment. All other children regained full visual acuity at the time of discharge and maintained it through a mean follow-up of 22 months (range: 18–29). Conclusion. Circumstances of injury in younger children are different from those found in older children, the latter being similar to those reported for adults. Prevention is the primary measure to be taken to reduce the prevalence of this injury and to lower the risk for ocular severe anatomic damage as much as possible. This can be achieved primarily by modifying the design of the hooks, intensifying educational campaigns, and keeping elastic cords out of children’s reach. Pediatrics 2000;106(5). URL: http://www.pediatrics.org/cgi/content/ full/106/5/e65; ocular traumatology, pediatric age, elastic cord, prevention. Ocular trauma is a leading cause of severe anatomic and functional impairment of the visual system1,2; various reports emphasized the high occurrence and frequent severity of eye injuries in children.3–8 The greatest number of eye injuries occur during playtime or sports activities, primarily attributable to falls and to free projectiles hitting the globe at high velocity.9 Among potentially dangerous ocular injuries, those caused by elastic cords with attached metal or plastic hooks deserve special attention (Fig 1). Adults commonly use these devices for securing luggage on car roof racks. Ophthalmic literature previously described epidemiologic and clinical characteristics of this injury among adults, but in these reports children are very rarely encountered.10–14 Unfortunately, elastic cords represent an intriguing attraction for younger children, who misuse them during playtime, with a lack of proper adult supervision. Even if injuries causing severe anatomic and functional impairment are not frequent, the ability to prevent them by modifying the design of the elastic cord and by educating children and their supervisors represents a realistic goal. This article reports a summary of circumstances, clinical course, and visual outcome in pediatric patients who came to our observation after suffering eye trauma caused by elastic cords.