UNCONTROLLABLE ENDOPHTHALMITIS AFTER GLOB E PERFORATION DUE TO UNDUE HANDLING OF A DENTAL BRACE

History Dental regulation with the Headgear System is a method applied worldwide, and only few cases of device induced injuries have been do cumented. However, such injuries can be very severe, as can be seen fr om our case. Therefore, the risk/benefit relation should be considered . Patient In Dezember 1995, a 10 year-old female patient with a sclera l perforation near the limbus was sent to Zurich university eye clinic as emergency case. The evening before, the patient had tried to remov e her dental brace (Headgear) by pulling it over her head without dise ngaging the ruber bands serving for fixation before. During this attem pt, the brace escaped at eye level, shot into her face and caused a sk leral perforation in her left eye as well a contusio bulbi in her righ t eye. In the further course, a fulminant endophthalmitis (streptococc us spp and anaerobic mixed oral nora) developed in the patient's left eye, which could not be controlled inspite of two interventions with v itrectomy and finally made an enucleation necessary. Conclusion Disreg arding the worldwide application of this device in the treatment of de fective positions of teeth, the present case demonstrates that it is n ecessary to thoroughly instruct the patients regarding the handling df the Headgear and to inform them of possible dangers.