Refractory endophthalmitis after bulbus perforation after careless handling of orthodontic headgear

HISTORY: Dental regulation with the Headgear System is a method applied worldwide, and only few cases of device induced injuries have been documented. However, such injuries can be very severe, as can be seen from our case. Therefore, the risk/benefit relation should be considered. PATIENT: In December 1995, a 10-year-old female patient with a scleral perforation near the limbus was sent to Zurich university eye clinic as emergency case. The evening before, the patient had tried to remove her dental brace (Headgear) by pulling it over her head without disengaging the rubber bands serving for fixation before. During this attempt, the brace escaped at eye level, shot into her face and caused a skeletal perforation in her left eye as well as contusion bulbi in her right eye. In the further course, a fulminant endophthalmitis (streptococcus spp and anaerobic mixed oral flora) developed in the patient's left eye, which could not be controlled inspite of two interventions with vitrectomy and finally made an enucleation necessary. CONCLUSION: Disregarding the worldwide application of this device in the treatment of defective positions of teeth, the present case demonstrates that it is necessary to thoroughly instruct the patients regarding the handling of the Headgear and to inform them of possible dangers.