Pediatric eye injury due to Avena fatua (wild oats)

Objective: We report on florid and unusual ophthalmic physical signs in thr ee children where the trauma was caused by seeds from Avena fatua, a grass common in western North America. Design: Case series and literature review. Setting: Three local emergency departments (ED) during the fall of 1998. Patients or Participants: Three children reporting to an ED with an acutely painful eye from which the foreign body was identified botanically as Aven a fatua. Interventions: None. Main Outcome Measures: Symptoms, interventions, duration of problem. Results: Three male children (6, 10, 14 years) presented separately followi ng incidents in which they had sustained direct eye injury. Each child imme diately experienced severe pain and profuse watering of the eye. Severe loc alized edema of the conjunctiva and inflammation was evident with conjuncti val vessel injection leading to bleeding, reminiscent of a chemical "burn." Initially, two children appeared to have an eyelash caught behind the lowe r lid. In both instances, the emergency physicians initially dismissed the possibility of there being a significant foreign body, but because of the s everity of the pain, conjunctival vessel injection, and edema, they attempt ed to remove the "lash." Removal of the foreign body proved difficult in al l three cases, requiring far greater traction than anticipated. Intact seed pods had become embedded in the subconjunctival space. Ophthalmic analgesia relieved the pain immediately, but in one child who was treated with topic al antibiotic alone, significant pain was experienced for 18 hours, until s teroid-antibiotic therapy was instituted. All injuries occurred in late sum mer when the grass propagates. Conclusions: The physical signs of scleral vasculitis and conjunctival edem a can be mistaken for chemical injury or allergic chemosis, but where a for eign body resembling a hair or eyelash is visible, the presence of a seed-p od retained in the subconjunctival space must be considered, particularly i f the patient reports exposure to wild grass. Application of local analgesi a, foreign body removal, and steroid-antibiotic treatment is recommended.