Association of Ocular Injuries in Patients with Head Injury: A Tertiary-Level Armed Forces Experience

Abstract

ABSTRACT Introduction: The incidence of trauma is on an increasing trend worldwide. It has drastically increased due to urbanization, vehicular congestion, alcoholism, and poor infrastructure facilities, especially in developing countries. In the Armed Forces, the additional burden of trauma is also seen due to various unit activities, organized sports, and other adventure sports. Head injury cases are often associated with various ocular injuries. These ocular injuries, if subtle in nature, can be missed initially and progress into ophthalmological complications and rarely into permanent visual impairment. The aim of this study was to critically analyze the association of various ocular injuries in patients with head injury. Materials and Methods: A cross-sectional study was conducted in a tertiary-level Armed Forces Hospital from July 2016 to December 2018. A total of 40 patients were evaluated who had head injury along with ocular injuries. The Glasgow Coma Scale (GCS) was used to assess the severity of the head injury. Ocular manifestations such as subconjunctival hemorrhage, ecchymosis, soft tissue injuries such as lid tear, corneal injuries, and bony and associated nerve injuries were evaluated. Results: A total of 40 patients with head injury with ocular manifestations were studied. Road traffic accident (RTA) was the most common cause, followed by accidental fall from height and sports injuries. There was a male preponderance (n = 32 (80%)) over females (n = 8 (20%)). Unilateral ocular manifestation (n = 32 (80%)) was more common than bilateral involvement (n = 8 (20%)). The most frequent ocular manifestations were subconjunctival hemorrhage and ecchymosis (35 (87.5%)), followed by lid laceration (6 (15%)), corneal tear (04 (10%)), vitreous hemorrhage (01 (2.5%)), evisceration (2 (05%)), and cranial nerve injury (06 (12.5%)). Orbital wall fracture was seen in 15 (37.5%) patients, including lateral wall fracture (n = 08 (20%)), medial wall fracture (n = 04 (10%)), orbital floor fracture (n = 02 (05%)), and orbital roof fracture (n = 01 (2.5%)). Conclusion: Ocular injuries can occur in patients with head injury irrespective of the mode and kinematics involved (severe head injury may present with minimal ocular manifestations or vice versa). These patients require hospitalization, observation, thorough ophthalmic evaluation, and periodic assessment to minimize morbidity and complications.