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Doing fireworks with my kids last night, reminded me that the forth of July is one of the most common holidays for eye injuries.
Patients can frequently receive burns to the cornea from sparklers. These burns, sometimes also called abrasions, are very painful. The cornea is one of the most highly innervated tissues in the body, and very sensitive to any injury. If the abrasion is small, simple lubrication may be all that is necessary. If larger, then sometimes the cornea may need to be patched.
Not infrequently, a piece of rust or debris may also get embedded in the cornea. In most cases, these pieces lie deeper than they appear, and need to be removed in the doctor’s office.
I’ve operated on several patients who have received an explosive blast injury to the eye, from a bottle rocket, or a fire cracker. In these cases, the eye (also called the globe) is torn open, and the injury is referred to as a ruptured globe; you can read more about ruptured globes under the trauma section of this web site. These injuries tend to be relatively complicated, because the eye becomes very disorganized, and it can be difficult to suture all the pieces back together. Not infrequently, such a patient will need the care of a retina specialist to fix associated problems, like a hemorrhage in the eye, retinal detachment, or foreign body.
Fortunately, most firework-related injuries are preventable. Keeping young children a safe distance from the excitement, and handlers wearing protective eye wear, can help everyone enjoy the festivities with peace of mind.

As you have probably noticed from the videos on NaderMoinfarMD.com, a vitrectomy is a procedure that is used to address many different problems of the back of the eye.
With various modifications, a vitrectomy can be used to treat a retinal detachment, macular pucker/membrane, macular hole, and bleeding inside of the eye– also referred to as a vitreous hemorrhage,
A vitreous hemorrhage implies that the back portion of the eye contains free floating blood. Many conditions can cause a vitreous hemorrhage, but perhaps the most common is diabetes.
Diabetes can affect the eyes in a number of different ways, but more advanced stages, referred to as proliferative diabetic retinopathy, are more prone to cause visual problems. In this condition, abnormal blood vessels start to grow or “proliferate” on the surface of the retina; these vessels are abnormal, very fragile, and bleed easily.
If the bleeding is mild, then a trained retina specialist may elect to perform laser surgery in the office, if not already done.
Sometimes, a retina specialist may also choose to inject various medications into the eye, that can slow, or halt, the proliferation of new blood vessels.
If the blood doesn’t clear, then the option of removing it with vitrectomy surgery can be entertained.
As you can see from the videos on NadrMoinfarMD.com, the set up for this procedure is very familiar. The goals are to safely remove the blood, treat and remove any scar tissue, any apply laser treatment.
As with any other vitrectomy, the patient receives some mild sedative, and an anesthetic injection around the eye.
The area around the eye is then cleansed, and sterile drapes are placed around the eye.
The remaining steps are demonstrated for you on NaderMoinfarMD.com, under the “videos” pull-down menu: three cannulas are secured into the eye, the blood is removed, the vitreous is meticulously cleared, and laser is applied.
A patch is applied on the eye, and patients usually go home 30 minutes or so, after surgery.

The treatment of a macular hole involves several steps.
as with all vitrectomies, the first step is to set up three ports, allowing for the insertion of an infusion cannula, and various instruments. These initial steps are shown under the “videos” section of NaderMoinfarMD.com.
After the jelly portion of the eye, called the vitreous, is removed, steroids are sometimes used in the eye to help identify and remove any remaining pieces of the vitreous; this step can also be seen under the videos section of this website.
In order to maximize the success of closing the macular hole, many surgeons, including myself, will use a green dye to help stain a very fine and delicate tissue, called the internal limiting membrane; removal of this tissue is believed to improve the chances of surgical success.
As you can see from my video, once the tissue is stained, it can be very delicately lifted and peeled using forceps. Sometimes, the tissue can be rather sticky, so great care is often needed to prevent injury.
Once this is completed, the eye is then filled with gas, which is helps provide a surface along where the edges of the hole can come together. I usually ask patients to try to keep their face down whenever they can, for about five days.
In almost all cases, macular hole surgery is done with the patient only lightly sedated, and the eye is made comfortable with the use of local anesthetics. This surgery is done as an outpatient, meaning that the patient does not have to remain in the hospital. In most cases, the patient will usually be on their way back home within an hour after the surgery is completed.
You will probably see a lot of different recommendations on face down positioning after macular hole surgery, and this is a frequent source of confusion, and concern, for patients. Unfortunately, there are no clear set standard as to how long, if at all, face down positioning is necessary. Some surgeons don’t advise any at all, while some advise for up to two weeks. In my experience, this extreme is neither necessary, practical, or beneficial. All I ask is that a patient do the best that they can, for about three to five days; I ask that they try to keep their face down for as long as they can, then take a break for as long they feel is necessary to recharge themselves. In most cases, this is more than enough. Ultimately, the key is mindful surgery, by a caring and competent surgeon