Ahmad, Khabir

Channa, Roomasa

Chaudhry, Tanveer Anjum

Memon, Sana Shoukat

English

eCommons@AKU

eCommons@AKUDepartment of Surgery Department of SurgeryApril 2009Cases of subconjunctival hemorrhage After a joyrideRoomasa ChannaAga Khan UniversitySana Shoukat MemonAga Khan UniversityTanveer Anjum ChaudhryAga Khan University, tanveer.chaudhry@aku.eduKhabir AhmadAga Khan University, khabir.ahmad@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surgPart of the Ophthalmology Commons, and the Surgery CommonsRecommended CitationChanna, R., Memon, S., Chaudhry, T., Ahmad, K. (2009). Cases of subconjunctival hemorrhage After a joy ride. Pak J Ophthalmol,25(4), 1-3.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surg/366See	discussions,	stats,	and	author	profiles	for	this	publication	at:	https://www.researchgate.net/publication/265079567Cases	of	Subconjunctival	Hemorrhage	after	a	JoyRideArticleCITATIONS0READS184	authors,	including:Some	of	the	authors	of	this	publication	are	also	working	on	these	related	projects:The	Karachi	Marine	Fishing	Communities	Eye	and	General	Health	Survey	View	projectRoomasa	ChannaJohns	Hopkins	Medicine54	PUBLICATIONS			912	CITATIONS			SEE	PROFILETanveer	ChaudhryAga	Khan	University,	Pakistan19	PUBLICATIONS			47	CITATIONS			SEE	PROFILEKhabir	AhmadAga	Khan	University,	Pakistan329	PUBLICATIONS			1,109	CITATIONS			SEE	PROFILEAll	content	following	this	page	was	uploaded	by	Roomasa	Channa	on	03	October	2015.The	user	has	requested	enhancement	of	the	downloaded	file.	All	in-text	references	underlined	in	blue	are	added	to	the	original	documentand	are	linked	to	publications	on	ResearchGate,	letting	you	access	and	read	them	immediately. Case Report  Cases of Subconjunctival Hemorrhage after a Joy Ride  Roomasa Channa, Sana Shoukat Memon, Tanveer A. Chaudhry*, Khabir Ahmad  Pak J Ophthalmol 2009, Vol. 25 No. 4  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . .  See end of article for authors affiliations  …  ………………………    Correspondence to: Tanveer A Chaudhry  Section of Ophthalmology, Department of Surgery,  Aga Khan University, Karachi  Received for publication February’ 2009 …  ………………………                ubconjunctival hemorrhage is a benign condition that mostly resolves spontaneously on its own, even though it may be very alarming for the patients. Multiple causes of subconjunctival hemorrhage-including local trauma, acute conjunctivitis and systemic hypertension have been reported in literature1,2.  CASES We report here a series of four cases of subconjunctival hemorrhage that occurred following a gyroscopic ride. During Easter break, a group of 4 college students, two boys and two girls, between the ages of 17-19 years, presented to the outpatient department of Barnsley District General Hospital with red eyes. Couple of hours before presenting at the eye clinic, they reported going on a gyroscopic ride outside a local pub. After the ride, they noticed red patches in white of their eyes (Table 1 and Fig. 1). They did not have any history of co-morbids, such as hypertension, diabetes, blood dyscrasias or clotting abnormalities. They were also not using any blood thinning medications, like Aspirin or Warfarin. General examination showed that vitals including blood pressures were within normal ranges. Their visual acuity was normal. All four, but one patient had bilateral sub-conjunctival hemorrhages on the lateral or medial or both sides of the limbus (Fig. 1). IOP was normal and there was no reaction in the AC.  Their pupils were reacting normally and detailed retinal examination did not reveal any pathology of the posterior chamber such as retinal edema, hemorr-hage or tear. Laboratory investigations revealed normal bleeding and clotting profiles. Patients were not given any medication, reassured and sent home. Three of them returned for examination two weeks later. All hemorrhages had completely resolved. Eye hemorrhages and retinal tears caused by amusement rides and high intensity sports such as bungee jumping and roller coaster rides have been reported previously. During 1987-2000 one person in the United States had retinal tear and a possible cerebral edema and five others had eye hemorrhage after they rode a hand-powered ride called the “Spaceball” which spins its occupants at a high speed. In addition, a boy aged 17 had vitreous hemorrhage after a gyroscopic ride3, 4. Our case series is unique in that all four members of the group developed subcon-junctival hemorrhage following a gyroscopic ride. To the best of our knowledge this is the first reported case S  series of subconjunctival hemorrhages associated with this type of ride. There is a possibility that many such cases of subconjunctival hemorrhage are not reported because they are not sight threatening.  Table 1. Characteristics of the four cases with   subconjunctival hemorrhage Patient identification Age Sex Location of the subconjunctival hemorrhage 1 17 M Bilateral; medial and lateral aspects of sclera 2 17 M Bilateral; lateral aspects of sclera 3 18 F Unilateral; medial aspect of sclera 4 19 F Bilateral    Fig. 1: Location of subconjunctival hemorrhages in three of four cases  A gyroscope is a device consisting of a rotating heavy metal wheel pivoted inside a circular frame (Fig 2). The wheel’s rotation enables it to retain its original orientation in space when the frame turns. The ride works on exactly the same principle and the high speed rotation of the passenger in multiple directions can cause rupture of the thin conjunctival vessels.    Fig. 2: A gyroscope: its structure and function   CONCLUSION Although extreme sports are very attractive, mostly for the younger generation, they can result in eye trauma ranging from benign hemorrhage to a sight-threatening retinal damage. One should observe caution while thinking of indulging in such sports and seek medical advice immediately if there is any associated eye trauma.  Author’s affiliation Roomasa Channa Section of Ophthalmology Department of Surgery Aga Khan University P O BOX 3500, Stadium Road Karachi Sana Shoukat Memon Section of Ophthalmology Department of Surgery P O BOX 3500, Stadium Road Karachi Tanveer A. Chaudhry Section of Ophthalmology Department of Surgery P O BOX 3500, Stadium Road Karachi Khabir Ahmad Section of Ophthalmology Department of Surgery P O BOX 3500, Stadium Road Karachi  REFERENCE 1. Leibowitz HM. The red eye. N Engl J Med. 2000; 343: 345-51. 2. Fukuyama J, Hayasaka S, Yamada K, et al. Causes of subconjunctival hemorrhage. Ophthalmologica 1990; 200: 63-7. 3. Jain BK, Talbot EM. Bungee jumping and intraocular haemorrhage. Br J Ophthalmol. 1994; 78: 236-7. 4. Morris CC. Amusement Ride-Related Injuries and Deaths in the United States: 1987-2000. In: Bethesda, MD: US Consumer Product Safety Commission; 2001.    ===================================================================================    Continue Guess Who? Answer  mandatory for him to write his publications in Danish. An antipathy against German, in those days the language of science, may have been gained in a childhood so filled with tension regarding nationalism. The scientific achievement that made the name Bjerrum universally known was conceived during his work on the relationship between visual acuity and the perception of the bright stimuli in various retinal zones. In accordance with his own modest attitude, this discovery was published in 1889 in a small paper which in translation was called 'An addendum to the usual examination of the visual field of glaucoma'. At that time Bjerrum was studying the visual field by means of small white objects. The idea of this investigation was to record the performance of every single functional unit of the retina. As a minimum such units in Bjerrum's opinion would subtend a visual angle of one minute of arc (in the macular region). However, even a small test object would subtend a visual angle exceeding two degrees and accordingly cover a multitude of functional units. In order to obtain a better functional portrayal of the retina, Bjerrum conceived the idea of enlarging the observation distance. Initially, a standard preemptory was carried out by the aid of a perimeter arc with a radius of 30 cm and a 10 mm test object. A screen was placed next to the perimeter arc. The subsequent step was to move the chinrest table backwards to an observation distance of two meters and plot the visual field on the screen without the use of the perimeter arc. In this case an objection of 2 mm was employed. This last procedure was the first introduction of campimetry, which eventually gained worldwide use. By campimetry Bjerrum demonstrated the very small glaucomatous scotomas later called the scotoma of Bjerrum in recognition of its discovered. During his tenure as professor beginning in 1896 Bjerrum directed the still private clinic on Harbour Street. Although he possessed limited ability as a teacher, he impressed his students with his clinical honesty and the integrity of his scientific work. In his personal dealings and in his clinical and scientific work he displayed an impressive logic and intelligence, but never lost his modesty. His never failing responsibility formed a fashion for the coming generation of Danish ophthalmologists. In 1910 when aged 59 years Bjerrum retired but continued to reside in Copenhagen. As previously mentioned, his origin from Scheleswig remained important to him all of his life and resulted in a substantial national feeling that made him feel it a duty and honour to publish his scientific works in Danish to avoid confusion with alien research. The scientific community fully realized that this was a Danish paper. His national attitude also led to one of his final decisions. The termination of the first World War and the collapse of the German Empire brought to the fore the matter of the occupied southern border districts in the post-war peace conference. In 1920, referendum was initiated to give the inhabitants of Schleswig the opportunity to choose their future homeland. The electorate was those born in the district. Already a sick and old man, Bjerrum went from Copenhagen to his native village to give his vote, and in this way he contributed to the homecoming of Schleswig to the Danish kingdom. Jannik Petersen Bjerrum died the same year. Bjerrum scotoma = a visual field defect characteristic of glaucoma. It is a nerve fiber bundle defect extending from the blind spot, sweeping around the macular region and ending in a straight line on the nasal side corresponding to the temporal raphe in the retina. Reference: History of Ophthalmology by Kluwer Academic Publishers.  View publication stats

Cases of subconjunctival hemorrhage After a joy ride

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Cases of subconjunctival hemorrhage After a joy ride

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