|Year : 1982 | Volume
| Issue : 1 | Page : 47-50
Ocular injuries due to accidental explosion of carbonated beverage bottles
AK Gupta, Olive Moraos
Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
A K Gupta
Department of Ophthalmology, M.A M. College, New Delhi-2
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta A K, Moraos O. Ocular injuries due to accidental explosion of carbonated beverage bottles. Indian J Ophthalmol 1982;30:47-50
Exploding carbonated beverage bottles (CBB) can cause serious ocular injuries, loss of vision and even loss of eye. Cases of such injuries are not common. The earliest report in the ophthalmic literature of injury due to CBB is by Leydhecker. Subsequently other reports have appeared,,,,,. In the present communication, we are reporting six cases of ocular injuries caused by accidental explosion of CBB.
| Case reports|| |
A 13 year old male student reported to the hospital with a history of soda water bottle cap injury in the right eye which he sustained while opening the bottle. The patient was found to have oedematous lid, mild conjunctival and ciliary congestion. There was corneal wound upto midstromal in the lower quadrant. The wound had crenated outline corresponding to the edge of the cap of soda water bottle. There was hyphaema at 6 o'clock position. The lens showed rosette formation both in the anterior and the posterior cortex. The patient had normal intraocular pressure. The fundus examination showed hazy media, hyperaemic optic disc with engorgement of retinal veins. The visual acuity was reduced to finger counting from a distance of two meters. The patient was put on conservative treatment and discharged ten days later. On follow up, four weeks later, retinal oedema and rosette formation in the anterior and the posterior cortex in the lens persisted. There was no improvement in the visual acuity.
A 40 year old male labourer reported to the hospital with a history of injury in the left eye due to broken glass pieces of soda-water bottle. The conjunctiva, cornea, anterior chamber and lens were involved as a result of the injury. The patient had oedema of the lids and conjunctival congestion. There was a conjunctival tear at 7-9 o'clock position and the uveal tissue was incarcerated with small blood clots. The corneal tear was extending from the limbus at 8 o'clock position upto the pupillary area. The anterior chamber was shallow. Hyphaema was present and fundus could not be seen. The lids were retracted and the blood clots were removed. The uveal tissue, which was prolapsed, was excised. The lens matter was washed out. The corneal tear was sutured. The corneal tear was found to be extending into the sclera which was also sutured. The patient was put on systemic antibiotics and corticosteroids. However the eye had no vision post-operatively and was persistently congested and inflammed and enucleation had to be performed.
A 12 year old male student attended the hospital with a history of soda-water bottle glass pieces hitting the right eye. The cornea and anterior chamber were primarily involved. There was a corneal tear across the pupillary area from 3-9 o'clock position extending little outside the pupillary border on either side. There was marked oedema of the edges of the wound and anterior chamber was absent. The iris and pupil were normal. The lens was not clearly visible. The corneal tear was sutured. Postoperative course was uneventful. The visual acuity was 6/60 at the time of discharge.
A 32 year old male attended the hospital with a history of soda-water bottle glass pieces hitting the right eye. The lids, sclera, cornea, anterior chamber, and iris were affected due to the injury. There was oedema of the lids. Cornea showed 6 mm wound extending obliquely from within the cornea at 6 o'clock to 3 o'clock position and 2 mm in the sclera. The iris was incarcerated and prolapsed in the wound. The pupil was eccenteric. irregular and not reacting to light. There was a faint glow in the fundus. Surgical repair of the corneoscleral tear with excision of prolapsed uveal tissue was done. The postoperative course was uneventful. The visual acuity in the injured was 6/24 at the time of discharge.
A 25 year old male attended the hospital with a history of glass pieces of the soda-water bottle hitting the left eye when it exploded after slipping from the hand. The lid, sclera, conjunctiva, cornea and anterior chamber and iris were involved. There was a tear about 10 mm long in the lower lid. The conjunctiva was torn at 5 o'clock position Corneoscleral tear was about 8 mm in length and extended across the cornea 2 mm above the inferior limbus. There was mild corneal oedema and iris prolapse at 6 o'clock position. The anterior chamber was shallow and irregular. The pupil was irregular and pear shaped and non-reactive to light. The corneoscleral tear was repaired with excision of the prolapsed iris. Air was injected in the anterior chamber and three conjunctival sutures were given. Post-operative recovery was good. The visual acuity in the injured eye was 6/6 with glasses at the time of discharge.
A 19 year old male labourer, soda water bottle carrier was admitted to the hospital with a history of accidental soda-water bottle burst and glass pieces hitting the right eye. It was observed that sclera, conjunctiva, iris and the lens were involved There was oedema of the lid and congestion in the conjunctiva There was ciliary congestion and tenderness. A linear conjunctival tear was present at 9 o'clock position. Curvilinear corneal tear was extended from 9-1 o'clock position. The anterior chamber was shallow. The lens showed traumatic cataract and the pupil was irregular and sluggishly reacting to light. There was no fundus glow. Repair of the corneal tear with removal of the lens matter was done. Follow up after ten weeks revealed a quiet eye with visual acuity of finger counting from close range.
| Discussion|| |
The carbonated beverage bottle can act as a potentially dangerous weapon in warm seasons and in tropical climates as in India. The earliest report in the ophthalmic literature that is devoted to eye injuries from exploding beverage bottles is from Germany by Leydecker. He concluded that in 12 of 17 accidents were the result of defective bottles which resulted in blindness or loss of one eye in seven cases. Offutt and Shine have described a series of 330 penetrating ocular injuries, five injuries from exploding bottles filled with carbonated beverages. Bergeson et al have described three cases of ocular injuries due to pop bottle explosion. Mondino et a13 have described 3 cases of ocular injuries caused by exploding beverage bottles. Mayes and Andrews4 described seven injuries sustained as a result of explosion of bottles in a tropical climate. One of their cases involved a penetrating injury of the eye that ultimately required enucleation. Taylor7 has described a single case report. Avisar and Savir have described a larger series of 26 patients suffering from ocular injuries caused by glass bottles containing soft drinks and 20 percent of their patients subsequently became blind.
We have come across six patients of ocular injuries due to CBB explosions during a period of nearly two years. All the cases had unilateral involvement, right eye in four cases and left eye in two cases. All of these patients had severe visual loss. Initial visual acuity, after the injury ranged from loss of perception of light to finger counting at two meters distance. In one case the eye was badly mutilated and had to be enucleated. In five cases, the injury was caused by glass splinters, while in one case it was due to the cap of the bottle. The injury due to the bottle cap was interesting in that it left a clear impression of its crenated edge on the skin of the lids and the cornea which gives some indication of the force of the impact. In four cases the CBB exploded without provocation.
The true incidence of injuries associated with CBB is not known in India. These CBB can normally explode without provocation. It has been reported that glass fragments have traveled on explosion of the bottle as far as 7 6 meters and in one instance the bottle exploded in a refrigerator and the fragments penetrated the refrigerator wall. Explosion can also result from the impact of jostling or dropping of bottles. CBB have been reported to have been used as missiles during riots etc.
Various factors have been attributed to the hazards posed by beverage bottles. First of all, bottles containing carbonated drinks are more likely to explode than those containing non carbonated beverages because of the internal pressure generated by carbon-di-oxide. If any bottle is dropped, it may break, but the internal pressure generated by CBB increases the hazard of flying glass fragments. He has also noted that subjecting CBB to heat and agitation releases dissolved carbon-dioxide and increases the internal pressure within the bottle to levels that approach the danger zone. Negligent handling of bottles such as shaking, dropping or jostling may trigger explosion. Although these factors may be important in some cases, there are many accidents in which undue heat and agitation cannot be implicated, as in some of the cases reported in the present series. Explosions without these elements have occurred, which suggests defects in bottles or bottling process. It has been suggested that the glass of soft drink bottles is gradually dissolved by the containing liquid so that the bottle is weakened and may explode if it is used for too long a period9. Larger sized bottles may cause more severe injuries as there is a greater potential energy involved, causing fragments to be propelled with more force than with smaller bottles.
There is a great need for proper regulatory standards for assessing the quality and strength of CBB in India. Uniform Standards can be prescribed by Indian Standard Institute which may help to eliminate defective bottles and to ensure that the internal pressure within a bottle does not exceed its strength. Bottlers may be asked to attach instructions on proper handling and storage.
Although the true incidence of accidents related to CBB is not known, their hazard is disproportionate to the scant attention they have received in the ophthalmic literature.
Suggestive preventive measures that the consumer can take to minimize potential danger of an exploding CBB include storing the bottles in a cool place, avoidance of jostling or hitting bottles together, directing the cap away from the body or face when opening, storage of bottles on the floor or lowest shelves to reduce the hazard in the bottles fall or explode and avoidance of shaking CBB. Refrigeration also reduces the internal pressure before opening CBB.
| Summary|| |
Exploding carbonated beverage bottles (CBB) cause serious injuries that have not received adequate attention in the ophthalmic literature. Six male patients have been described in the present report. All of these patients had corneal laceration and gross diminution of vision. Traumatic cataract was seen in three cases. In five cases the injury was caused by glass splinters while in one case it occurred due to the cap of the bottle. Literature on the subject has been reviewed and the preventive measures to reduce the incidence of such injuries have been discussed.
| References|| |
Leydhecker, W., 1963, Klin. Monatsbl. Augenheilkd., 142 : 929.
B°rgeson. P.S., Sehring S.A. and Callison, J.R., 1977, J. Amer. Med. Assn., 238: 1048.
Mondino, B.J., Brown, S.,1. and Grand, G., 1978, Arch. Ophthalmol., 96: 2040.
Mayes, D.R. and Andrews. B.F., 1962, J. Amer. Med. Assn., 182: 969.
Offut, R.L. and Shine, I., 1974, Ann. Ophthalmol., 6 :357.
Avisar, R., and Savir, H., 1978, Isr. Harefuah., 95 : 69.
Taylor, I.B., 1963, J. Amer. Med. Assn., 183 158.
8, Hazard Analysis : 1975, Bottles for carbonated Soft Drinks : U.S. Consumer Product Safety Commission Bureau of Epidemiology, p.1.
Epstein, E., 1955, Arch. Dermatol. 71 : 24.