Bilateral eye injury caused by a high-pressure water jet from a fire hose.

We present a case of bilateral eye injury caused by a high-pressure water jet from a fire hose. Eye injury secondary to high-pressure water jets are relatively rare, but invariably result in severe damage to all ocular structures. A 51-year-old woman was admitted to our ophthalmologic department for treatment following a direct hit in the face by a water jet from a fire hose from a distance of about one meter. The patient had bilateral extensive eyelid edema and ecchymosis, conjunctival chemosis with hemorrhage, vitreous hemorrhages in the right eye and iridodialysis with hyphema in the left eye, a transient decrease in intraocular pressure, bilateral superior commotio retinae with macular edema, and bilateral impairment of vision. The patient was treated with topical corticosteroids. Four months later she was re-admitted to our department for surgical repair of iridodialysis in the left eye. Iridodialysis had affected the entire superior nasal portion of the iris, and the pupil was displaced downward temporally. The iris partly obscured the visual axis. After surgical repair the visual axis was free. At a follow-up examination two years later, the ocular findings were the same. The best corrected visual acuity was 0.1 in the right eye and 0.3 in the left eye. Visual impairment was a consequence of permanent posttraumatic posterior fundus changes, particularly of the macula in both eyes. Intraocular pressure was within normal limits in both eyes. Injuries caused by high-pressure water jets are usually bilateral. The injuries are mainly confined to the lower anterior portions of the eye (Bell's phenomenon). Our patient had bent forward during the accident, therefore the central and upper chorioretinal portions were also affected. Such injuries usually cause severe damage to the anterior and posterior portions of the eyes and greatly reduce visual acuity in both eyes. Because of the risk of late complications (cataract, glaucoma, retinal detachment), long-term follow-up is recommended in such patients.