Penetrating and perforating eye injuries in 343 patients due to auto accidents before and after compulsory seat belt legislation resulting in fines (1966-1998)

Abstract

Constructional improvements of passengers safety in cars alone did not result in a significant decline of open globe injuries in traffic accidents. Only after compulsory seat belt legislation was introduced in Germany and Great Britain, a 60%-75% reduction in ocular injuries was observed. We examined, how the characteristics of severe eye injuries in car accidents changed during the last 28 years. The case records of 343 patients, who suffered from open globe injuries during car accidents between 1966 and 1993 and were primarily admitted in the University Eye Hospitals of Freiburg and Würzburg, have been analyzed retrospectively. Injuries were evaluated for their extent, time of injury (hour and season), age, sex and outcome of visual acuity after surgery. Between 1966 and 1984 wind-screen injuries declined slowly from 25/year to 16/year. Since the introduction of compulsory seat belt legislation in Germany in 1984 we observed a sudden reduction to 4 injuries/year, followed by an additional slow decline to 2.5 injuries/year. Male/female ratio changed from 2.1/1 before to 9/1 after 1984. Due to the seat belt legislation, injuries declined during summer season (april through september) by factor 7.6, during winter season (october through march) by factor 3.8. Injuries during daylight (6 a.m. to 6 p.m.) decreased more rapidly (by factor 14) than during nighttime (6 p.m. to 6 a.m.: factor 4). The decline of eye injuries was most pronounced among those with an age of less than 23 years (by factor 10.8) and those who were 31-50 years old (by factor 6.8), but least among those between 23 and 30 years of age (2.2). Since 1984, open globe injuries combined with mid-facial and cranial fractures increased resulting in a poorer visual outcome: 29% of eyes became blind before 1984 and 40% since then due to the higher survival probability of very severe accidents. A majority of injured persons still had not fastened their seat belt and about 50% were drunk. Compulsory seat belt legislation introduced in Germany in 1984 was most effective in preventing eye injuries among female passengers, during daytime or among persons younger than 23 years. However, 23-30 year old male drivers who had not fastened their seat belt, drove in darkness or during winter and had drunk alcohol, were still at highest risk for an open globe injury. The increase of victims with a combination of open globe injuries and midfacial injuries, polytrauma or cerebral trauma may be related to the airbag and other improved safety measures.