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 functio n impairment. Objectives. To evaluate the frequency, mechanics, and severity of eye injur ies caused by elastic cords in children to adopt the most appropriate preve ntive measures. Methods. A retrospective medical records review of hospital admissions seco ndary to ocular trauma between 1991 and 1997 in a pediatric ophthalmology u nit at an urban tertiary care pediatric hospital was performed to select al l children admitted for ocular injury caused by an elastic cord. Results. Eight children fulfilled the inclusion criteria; the prevalence ra tio was 2% of all pediatric trauma admissions. In all cases the mechanics o f trauma was a combination of blunt and high-speed projectile injury. The m echanism of trauma in younger patients was typically a cord that was misuse d during unsupervised play-time, 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 fol low-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 f or adults. Prevention is the primary measure to be taken to reduce the prev alence of this injury and to lower the risk for ocular severe anatomic dama ge as much as possible. This can be achieved primarily by modifying the des ign of the hooks, intensifying educational campaigns, and keeping elastic c ords out of children's reach.