Ocular manifestations of head injury: A clinical study

Abstract

Purpose: To clinically correlate the various ocular findings with the neurological status in cases of closed head injury and between ocular involvement and mortality rate. Study Design: Prospective study. Methods: In 189 patients with closed head injury, the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) were applied to grade the severity. A detailed ophthalmological examination was carried out within 12 h of sustaining injury. Ocular neurological signs, GCS and RTS were then used to prognosticate the outcome. Apart from suturing of laceration, patients were managed by a multidisciplinary approach. Conclusion: Ocular complications occurred in 129 of 189 (68.3%) head-injured individuals with 172 cases, (91%) male and 17 cases (9%) female in the age range 3-75 years with a mean of 28.68 years. Young adult males (16-30 years) were more vulnerable to head injury. Road traffic accident was the most common cause of head injury in 130 cases (68.8%) leading to soft-tissue injuries to the globe and adnexae in maximum no. of patients. The most frequently encountered neuro-ophthalmic manifestation was pupillary involvement, followed by papilloedema and optic nerve trauma. The association between ocular signs and the outcome was significant (P = 0.003). All the patients that died had ocular signs of neurological significance. There was a significant co-relation of the GCS, neurodeficit and the ocular signs with the outcome. Pupillary abnormalities, papilloedema and lateral rectus palsy pointed towards a poorer outcome. The GCS, neurodeficit and ocular signs contribute significantly to the prediction of outcome.