Hrev_master Abstract A Motor Vehicle Accident (MVA) can result in death or serious injury to the driver and passengers in case the airbags are not deployed. However, airbags can themselves cause ocular injuries of a varying degree of severity. We report the case of a 41-year-old female patient who reported facial bone fractures and a retinal detachment after her air bag deflated during a car accident. On admission to the Emergency Department (ED) the patient com- plained of facial pain, swelling and redness in the eye. Orbital CT imaging documented a fragmented fracture line displaced into the maxillary sinus at the floor of right orbit, post-traumatic changes in preorbital skin and in the right globe vitreous, an appearance thought to belong to hyperdense hemorrhage. The patient was taken to emergency operation due to retinal detachment in her right eye. Case Report Due to an eye injury brought on by the airbag’s deployment during a MVA, a 41-year-old female patient was transported by ambulance to the Antalya Training and Research Hospital Emergency Department (ED). The hospital has a 3rd level Trauma Center, where trauma physicians from all branches are present and injured patients are evaluated quickly, resuscitation, surgery, inten- sive care and emergency operations are performed. According to the story she was driving and wearing a seatbelt, and the car was traveling 55 km/h at the time of the accident. The patient did not wear glasses at the time of the accident. On admission she com- plained of facial pain, swelling, redness and blurred vision in the right eye. On physical examination, the patient was in good gener- al condition, conscious, cooperative, and oriented, with a Glasgow Coma Score (GCS) of 15. Vital signs showed a body temperature of 36.7 °C, a respiratory rate of 22/min, a heart rate of 92/min, a blood pressure of 112/76 mmHg, and an SPO2 of 98%. On exami- nation of the head and neck, the patient had a 1 cm laceration of the right upper eyelid, the conjunctiva was edematous and hemor- rhagic (Figure 1), and she also had decreased vision in her right eye. Orbital CT images was immediately performed showing a fragmented fracture displaced into the maxillary sinus at the right orbital floor (Figure 2). In the right frontal bone, a non-displaced fracture line is observed in the outer tabula anterior to the right frontal sinus. In the right globe vitreous, an appearance thought to belong to hyperdense hemorrhage is observed (Figure 3). The patient was examined by an ophthalmologist, document- ing a full-thickness incision approximately 7–8 mm long from the middle cornea to the upper part including the limbus, with a lamel- lar incision 1 mm lateral to this incision. The iris tissue protruded from the incision site, and the lens could not be selected. The patient was taken to emergency operation due to retinal detach- ment in the right eye. In the follow-up, the patient was re-operated one month later due to traumatic cataract, retinal detachment and intravitreous hemorrhage, and the treatment is still ongoing. Discussion In many countries, MVA are one of the leading causes of human injuries and deaths.1 Car accident-related mortality and morbidity are significantly diminished by seat belts and airbags Emergency Care Journal 2023; volume 19:11039 Correspondence: Fevzi Yılmaz, University of Health Sciences, Antalya Training and Research Hospital, Emergency Department, Varlık Mh. Kazım Karabekir Cd. 07100 Antalya, Turkey. Tel.: +905055907307; Fax: +902422494400 E-mail: fevzi_yilmaz2002@yahoo.com Key words: motor vehicle accident; airbag-mediated injury; eye injury; head injury; retinal detachment. Conflict of interest: the authors declare no conflict of interest. Availability of data and materials: all data underlying the findings are fully available. Ethics approval and consent to participate: no ethical committee approval was required for this case report by the Department, because this article does not contain any studies with human participants or ani- mals. Informed consent was obtained from the patient included in this study. Consent for publication: the patient gave her written consent to use her personal data for the publication of this case report and any accompany- ing images. Contribution: all authors participated in the conception and design of the work, drafted the work, or critically reviewed it. All authors approved the final version for publication. Received for publication: 28 November 2022. Revision received: 16 February 2023. Accepted for publication: 20 February 2023. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Emergency Care Journal 2023; 19:11039 doi:10.4081/ecj.2023.11039 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organiza- tions, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its man- ufacturer is not guaranteed or endorsed by the publisher. [Emergency Care Journal 2023; 19:11039] [page 17] A case of retinal detachment resulting from air bag deployment Fevzi Yılmaz, Bora Baltacıoğlu, Erdi Akça, Yavuz Fatih Yavuz Department of Emergency Medicine, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey Non -co mmerc ial us e o nly Case Report Figure 1. 1 cm long tear on the right upper eyelid, and the conjunctiva was edematous and hemorrhagic. Figure 2. A) Orbital CT images showed hyperdense bleeding in the maxillary sinus; B) Orbital CT images showed a fragmented fracture displaced into the maxillary sinus Figure 3. A) Non-displaced fracture line is observed in the outer tabula anterior to the right frontal sinus; B) In the right globe vitreous, hyperdense hemorrhage is observed. [page 18] [Emergency Care Journal 2023; 19:11039] Non -co mmerc ial us e o nly used to protect both passengers and drivers.2 In the 1960s, airbags were introduced as safety systems that significantly reduced traffic accident fatalities.3 Airbags are inflatable devices designed to act as a cushion between vehicle occupants and the steering wheel and car dashboard.4 The widespread use of airbags has significantly reduced the incidence of serious morbidity from MVA by up to 45% and has also reduced the number of serious ocular injuries.5 Although airbags have been shown to reduce the incidence of serious injury and death from motor vehicle accidents, current lit- erature indicates that airbags can cause serious eye injuries, chem- ical skin burns, bone fractures and visceral injuries.3,6,7 Reported ocular injuries include eyelid lacerations, periorbital fractures, corneal abrasions, hyphemas, lens dislocations, angle recessions, corneoscleral lacerations, alkaline corneal burns, cyclodialysis, retinal and vitreous hemorrhages, and traumatic macular holes.2,7-9 Chemical injuries to the eye can cause severe and irreversible eye damage as well as skin burns.2,9 Alkaline burns in the eye caused by the influence of hazardous gases such as carbon monoxide, nitric oxide, ammonia, benzene, toluene, ethylbenzene, xylene, etc. present in the airbag can cause serious injuries, including life- long blindness.2 However, there have been few research on retinal detachment caused by deployed airbags.5,10-16 To the best of our knowledge, this is the first case of retinal detachment after a MVA reported in Turkey. Retinal detachment is an emergency where the retina is detached from its normal position.17 Symptoms of retinal detach- ment include flashes of light in the eyes, blurred vision, the appear- ance of floaters, small spots that seem to pass through the field of view, gradual decrease in peripheral vision, and a curtain-like shadow in the field of view. Patients with suspected retinal detach- ment immediately should be consulted to the ophthalmologist. Retinal detachment should be diagnosed with an enlarged eye examination to determine whether the detachment includes the central retina (macula) and in absence of involvement, the patient should undergo emergency surgery to prevent further progression that could affect central vision.18 Our patient also had redness of the eye and blurred vision in the right eye upon admission to the ED and we decided to refer immediately the patient to the ophthal- mologist. A review of the literature finds many studies investigating the risk vs benefit of air bag impact on ocular structures.4 Duma et al.19 studied 11 million front-seat occupants from over 22,000 cases between the years 1993 and 1999. In the study, only 3% of all patients exposed to a deployed airbag suffered ocular injury. The authors concluded that, although vehicle occupants exposed to a deployed air bag had a higher risk of sustaining minor eye injuries, serious injuries such as retinal detachment, corneal laceration, and hyphema have been reported. Interestingly 29% of patients who sustained an air bag induced injury were wearing eyeglasses, but also 25% of those who did not sustain an ocular injury were also wearing glasses. In our case, the patient had redness of the eye and the conjunctiva was edematous and hemorrhagic. However, the patient was diagnosed with retinal detachment as a result of further examinations and tests. In our case, the patient did not wear glasses at the time of the accident. In determining whether the injuries to the person are caused by the explosion of the airbag, an in-depth physical examination, a crime scene investigation, accident detection reports, and all state- ments should be assessed together.20 A person in the vehicle in the accident had an injury that was easily fixed by medical interven- tion, the accident happened at a low speed, and when the patient examination findings are combined, it is clear that there wasn’t a crucial traffic accident, and the injury caused facial bone fractures and retinal detachment in the patient. The mechanical effect of the airbag was found to have caused this injury, and in general, the use of airbags in conjunction with seat belts is associated with a signif- icant reduction in facial fractures and lacerations.21 Based on the findings of some authors, seat belts are the best way to reduce the risk of eye injuries associated with motor vehicle accidents.22 Numerous U.S. studies failed to differentiate the data regarding seat belt use. These studies showed a connection between eye trau- ma and airbag deployment, but did not account for seat belt use, suggesting a more pessimistic assessment of the airbag’s ability to prevent such injuries.19-22 Ocular trauma as a consequence of air bag inflation can occur with high or low impact injuries.23 In our case, the patient developed a retinal detachment despite wearing a seat belt and being hit by a car at low speed. Conclusions This case shows that airbag deployment may sometimes cause severe ocular injury with retinal detachment leading to severe visu- al impairment. Emergency physician, regardless of vehicle speed, should be aware that serious eye injuries, including retinal detach- ment, can occur to patients who report injury from airbag deploy- ment. References 1. Ashabyamın M, Hamdamjo F. Severe facial fractures due to airbag deployment without utilization of a seat belt: A case report. Marmara Med J 2021;34:79-81. 2. Koisaari T, Leivo T, Sahraravand A, et al. Airbag deployment- related eye injuries. Traffic Inj Prev 2017;18:493-9 3. Yaremchuk K, Dobie RA. Otologic injuries from airbag deployment. Otolaryngol Head Neck Surg 2001;125:130-4. 4. Kenney KS, Fanciullo LM. Automobile air bags: friend or foe? A case of air bag-associated ocular trauma and a related litera- ture review. Optometry 2005;76:382-6. 5. Salam T, Stavrakas P, Wickham L, Bainbridge J. 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