Closed Globe Injuries Research Articles

Eye injuries: Understanding ocular trauma.

Ocular trauma may result in pathology ofthe ocular surface and adnexa, extraocular muscles, orbital walls, eyeandoptic nerve. Detailed history followed by a complete ocular and, ifindicated, radiological examination istherefore a crucial part of any trauma assessment. Itis important to determine whether a patient with ocular trauma can be reassured or requires immediate referral for further investigation and surgical repair. This review examines chemical eye injuries, orbital fractures, superficial corneal foreign bodies, closed globe injury and suspected open globe injury with orwithout intra-ocular foreign bodies. Astructured approach to the history and examination is provided. The aim of this article is to enhance clinician confidence when encountering these patients. Ocular trauma can lead to serious sight‑ and eye-threatening consequences. Accurate history-taking and astute observation are paramount for timely treatment or referral that may prevent blindness. This review discusses the management and referral pathways for common presentations of ocular trauma.

Prognostic value of Ocular Trauma Score and pediatric Penetrating Ocular Trauma Score in predicting the visual prognosis following ocular injury.

Aim: To assess the role of Ocular Trauma Score (OTS) and Pediatric Penetrating Ocular Trauma Score (POTS) in predicting visual prognosis following ocular injury. Methods: 120 patients, aged 3 to 70 years, with ocular injury, presenting between August 2020 and 2021, who fulfilled the inclusion criteria, were classified using the Birmingham Eye Trauma Terminology System (BETTS). Data regarding age, sex, injury type, location, initial visual acuity, and treatment were recorded. Patients were evaluated using OTS and POTS, wherever applicable, to predict visual prognosis. Follow-up was done for 6 months post-treatment to compare the predicted and actual visual outcome.Results: 120 patients (96 males and 24 females) were included in the study. The mean age was 17.2 ± 14.7 years (range 3 to 70 years). 91.6% patients included were under the age of 40 years. Blunt trauma (n=62) was slightly more common. 80 patients (66.67%) reported to the hospital after 48 hours of injury. 34 patients (28.33%) had traumatic cataract alone and IOL implantation was done as a primary procedure. In 20 patients (16.67%), lens aspiration was done primarily, with secondary IOL implantation. Six months after the treatment, the BCVA in the open globe injury patients was 20/ 200 or better in 36 patients (75%) and 20/ 40 or better in 18 patients (37.5%). Amongst the closed globe injuries, 48 patients (66.67%), had a BCVA 20/ 200 or better, while 32 (44.44%) had a BCVA of 20/ 40 or better. Conclusion: OTS is a reliable predictor of final visual outcome, both in blunt and penetrating injuries. The POTS shows gross underestimation of final visual outcome.Abbreviations: BETTS = Birmingham Eye Trauma Terminology System, POTS = Pediatric Penetrating Ocular Trauma Score, OTS = Ocular Trauma Score, OGI = Open Globe Injury, HM = Hand Movement, NLP = No Light Perception, LP = Light Perception, CGI = Closed Globe Injury, VA = Visual Acuity, BCVA = Best Corrected Visual Acuity, IAP = Indian Academy of Pediatrics, IOL = Intraocular Lens, IGATES = International Globe and Adnexal Trauma Epidemiology Study, IOP = Intraocular Pressure, CART = Classification and Regression Tree, USA = United States of America

Epidemiological Study on Ocular Trauma and Associated Co-Morbidity at Tertiary Health Care Hospital

Aims: To classify and find out the incidence of ocular injury effects and extraocular associates. Methods and Materials: This eight-month observational study was conducted between 2017 and 2018 recruiting 111 eyes of 101 patients reporting to ophthalmology outpatient and emergency medicine departments. Results: The demographic profile is composed of 82 (81.18%) males and 19 (18.81%) females with a mean presenting age of 33.45 and 33.57 years in males and females respectively ranging from 3 to 82 years. Sixty four (57.65%) right and 47 (42.34%) left eyes studied. Closed globe injuries accounted for 95 (85.56%) and open globe injuries were found in 16 (14.41%) eyes. Mode of injuries classified as RTA 37 (33.33%), RTA Self fall 26 (23.42%), metal-induced trauma in 9 (8.10%) and exposure to vegetative matter in 9 (8.10%), self fall at home/work in 6 (5.40%), assault in 4 (2.6%), sports-related injuries in 3 (2.7%), bull gore injuries in 3 (2.7%) and explosion injuries in 3 (2.7%) eyes. RTA and RTA self fall showed the highest relative risk and odds ratio among males compared to females. The relative risk ratio and odds ratio for RTA in males showed 0.63 and 0.31 respectively. Anterior segment injury effects were observed in all eyes and 21 (18.91%) eyes with posterior segment involvement. The associated facio-maxillary injury was seen in 58 (52.25%) eyes, orbital wall fractures in 52 (46.85%), and head injury in 26 (23.42%) eyes. Thirty (35.14%) eyes required imaging for further evaluation, of which 32 (31.68%) underwent computed tomography and 2 (1.99%) eyes subjected to magnetic resonance imaging. Fifty-three (52.47%) eyes were managed surgically, 25 (24.75%) conservatively and 23 (22.77%) medically. Conclusion: This study analysis concludes that closed globe injury is the most common ocular trauma. In middle-aged male patients, RTA-induced injuries were commonly prevalent. The most frequently associated co-morbidities were facio-maxillary trauma, lateral orbital wall fractures, and subconjunctival hemorrhage. Maximum eyes required surgical management while computed tomography provided a conventional mode of imaging. The multi-departmental management approach is essential for achieving a good medical and surgical outcome.

Clinical spectrum and functional outcome of firearm pellet-related eye injuries: A prospective follow-up study

PurposeTo determine the prognostic significance of various clinical features and surgical techniques concerning anatomical and visual outcomes in shotgun pellet-inflicted ocular trauma. MethodsThis prospective follow-up study was done at a tertiary care institute in Kashmir, India. Six hundred sixty-four eyes of 643 patients with firearm pellet-related ocular trauma were followed up for 6 months. ResultsOcular injury involved one eye in 622 (96.7%) patients and both eyes in 21 (3.3%) patients. Open globe injury (OGI) occurred in 451 (67.9%) eyes with perforating injury being the commonest type (248 eyes, 54.9%). For perforating injuries, entry wounds in the cornea and limbus had the worst prognosis. Closed globe injury (CGI) occurred in 213 (32.1%) eyes.An anatomical success rate of 66.3% (n = 250) was achieved for 56.8% (377/664) eyes requiring an average of 2.8 (SD 0.5) surgeries per eye. OGI was associated with poor outcomes in 259 (57.4%) and CGI with good outcomes in 200 (93.9%) eyes. The visual outcome had a significant association with grade and zone of injury both in OGI and CGI, and with the type of injury in OGI (p < .0001 each). Ocular trauma score (OTS) had a significant association with the degree of vision impairment (p < .0001). WHO category 0 visual impairment was seen in 270 (40.7%) eyes, category 1 in 85 (12.8%), category 2 in 35 (5.3%), category 3 in 30 (4.5%), category 4 in 172 (25.9%), and category 5 in 72 (10.8%) eyes irrespective of type of injury at 6 months post-treatment. ConclusionsThe perforating injury was the commonest type of injury caused by shotgun pellets. The site of the entry wound in perforating injury had prognostic significance. The outcome was generally poor in OGI and good in CGI.

Sports ball projectile ocular trauma in dogs

To describe the clinical features, management, and outcome of dogs presenting with sports ball projectile ocular injuries. Eighteen dogs. A retrospective study reviewing cases of ocular injury due to a sports ball projectile that presented to the Cornell University ophthalmology service between 2004 and 2021. Dog age, type of sports ball, initial ocular lesions, eye affected, clinical management, and visual outcome were recorded. Sports ball projectile ocular injuries were identified in 18 eyes of 18 dogs. The median age of the dogs was 1.0 years old, ranging from 0.3- to 9-years- old. Nine dogs were male, and 9 were female. Ocular injuries were caused by small, dense balls (e.g., golf balls, baseballs) in 11 dogs; small, light balls (e.g., tennis balls, toy balls) in 5 dogs; and large, soft balls (e.g., soccer ball, football) in 2 dogs. Closed-globe injuries (12 of 18 eyes) presented with traumatic uveitis (91%), hyphema (45%), and subconjunctival hemorrhage (18%). All 12 closed-globe injury cases were medically managed, eight dogs remained visual. Open-globe injuries (6 of 18 dogs) presented with three corneal lacerations and three scleral ruptures. Five open-globe injuries required enucleation, and one was medically managed and maintained vision. Sports ball projectile ocular injuries in dogs can result in substantial ocular morbidity and in loss of vision. Small, dense balls were associated with injuries that carried the most guarded prognosis and required more aggressive management. Small and large lighter projectiles were associated with less serious ocular injuries and visual outcomes.

A clinical profile of raised intraocular pressure in closed globe injury and its management

We studied the clinical profile of patients with raised intraocular pressure (IOP) in closed globe injury and outcome of medical and surgical management.: A prospective, interventional study of 32 patients diagnosed with raised IOP following closed globe injury, who presented to a tertiary care centre during the period of November 2018 to May 2020. Most patients (59%) were young, age group of &amp;#60; 40 years. 71.9% were males. Left eye was involved in 53.1%. Mean duration of presentation after injury was 4.38 days. Most common mode of injury was industrial accidents (28%). Mean IOP at presentation was 29.19 ±7.342. Vision at presentation was ≤ 6/60 in 18.75%. Anterior segment injury was most common. On gonioscopy, 13 eyes (41%) had open angles, 1 eye (3.1%) had closed angle and deferred in rest. Angle recession was present in 2 eyes. 3% of eyes had increased cup-disc ration (CDR) &amp;#62; 0.7. 68.75% were managed medically and 31.2% surgically. In the medical group, mean initial IOP was 26.18±5.124 mm Hg and at 12 months was 14.83 ± 2.287 mm Hg (p &amp;#60;0.0001). A 44% reduction of IOP seen. The initial and final IOP in surgical group was 35.80±7.330 and18.60 ±3.777 respectively with a (p &amp;#60; 0.0001). A reduction of 48% IOP was seen at the end of 12 months in surgical group. There was no significant difference between medical and surgical intervention. There was no significant difference between medical and surgical intervention while treating glaucoma secondary to closed globe injury.

Clinical and ultrasound biomicroscopic (UBM) correlation in eyes with closed globe injury

To correlate UBM and clinical findings in patients with closed globe injury. Prospective observational study of 75 patients, ≥ 12 years of age presenting to ophthalmic outpatient department within one week of sustaining closed globe injury. Patients with seriously ill polytrauma and open globe injuries were excluded from the study. Comprehensive ophthalmic examination including Visual acuity assessment, slit lamp examination, fundus examination and IOP measurement. Gonioscopy and UBM examination was done in all patients on presentation except for patients with hyphema (UBM and gonioscopy done at 4 weeks to prevent rebleed).Mean age of the patients was 31.4 ±8 years, most common external findings included lid ecchymosis (47%), subconjunctival hemorrhage (93%). The common anterior segment finding included traumatic iritis (87%), traumatic hyphema (61%) and traumatic cataract in 27% of patients. Clinical evidence of zonular dialysis was seen in 13% of patients. UBM was able to detect zonular defects in 62% patients (P=0.008). Most of the patients (57%) had zonular dialysis less than 3 clock hours on UBM examination. UBM confirmed the presence of other clinical findings like iridodialysis, cyclodialysis. UBM is a safe and effective adjunctive tool for clinical assessment and management of ocular trauma. It can diagnose subtle zonular dialysis and other anterior segment changes following blunt trauma. UBM should be an integral part of ophthalmic examination especially in patients requiring surgical intervention after closed globe injury.

Correlative Factors for Traumatic Brain Injury in Combat Ocular Trauma.

Traumatic brain injury (TBI) remains a significant source of disability for active duty service members in both deployed and training settings as well as those who have left active service. Service members with ocular trauma are at risk for a TBI and should be screened appropriately. Early detection results in treatment to minimize long-term sequelae which can often be debilitating. This study is the first to evaluate different combat-related ocular injuries and their associations with TBI. A secondary analysis of existing data was conducted from a prospective study of patients who sustained combat ocular trauma (COT) during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) between 2006 and 2020. Clinical data of a total of 88 participants were gathered and each case reviewed, including patient demographics, injury-related factors, history of TBI, and treatments rendered. All cases were then categorized to compare COT (n = 13) versus COT-T (Combat Ocular Trauma associated with TBI; n = 75). The Fisher's exact test was completed for each category to assess for predictive factors of TBI within the ophthalmic trauma cohort. Odds ratios were calculated with their 95% CI. When compared to COT, COT-T was significantly associated with closed globe injuries (56%; OR 4.24, 95% CI 1.08-16.67), blast injuries (89.3%; OR 3.72, 95% CI 0.93-14.9), multiple surgeries (89%; OR 2.51, 95% CI 0.57-11.08), anterior segment injuries (69.3%; OR 1.41, 95% CI 0.42-4.79), optic nerve injuries (24%; OR 1.05, 95% CI 0.26-4.25), orbital fractures (48%; OR 2.08, 95% CI 0.59-7.34), enucleation (17.3%; OR 2.52, 95% CI 0.300-21.08), the use of eye protection (68.6%; OR 2.18, 95% CI 0.57-8.32), and the need to undergo plastic surgery (78.7%; OR 2.30, 95% CI 0.66-8.02). Significant factors associated with COT included penetrating injury (30.8%; OR 0.027, 95% CI 0.07-1.08), posterior segment injuries (92%; OR 0.264, 95% CI 0.032-2.17), bilateral injuries (76.9%; OR 0.678, 95% CI 0.17-2.69), and bilateral blindness (7.7%; OR 0.857, 95% CI 0.092-7.99). Patients who have sustained combat-related ocular injuries, specifically blast injury, anterior segment injury, or an orbital fracture, were noted to be more likely to have also sustained a TBI. However, of the evaluated variables in predicting the co-occurrence of TBI, only closed globe injury was identified as statistically significant. Service members with injuries requiring multiple surgical procedures, reconstructive plastic surgery, or enucleation of an eye were also more likely to be diagnosed with a TBI, but these variables were not found to be predictive of TBI among ocular trauma patients. The presence of eye protection was not protective against TBI. Further studies are needed to find significant predictors of TBI in combat ocular trauma patients to assist in the early and accurate detection of TBI.

Visual outcomes in pediatric traumatic cataract

To study epidemiology, biometry and visual outcomes (with or without posterior capsulorhexis) in cases of pediatric traumatic cataract. This was a prospective observational study conducted on 30 children of traumatic cataract belonging to an age group of less than 16 years. All patients were subjected to detailed history and ocular examination. Patients underwent cataract surgery with or without intraocular lens (IOL) implantation. Posterior capsulorhexis with posterior optic capture was done in all patients presenting with primary posterior capsular opacity. All patients were followed up till 6 months and surgical outcomes in terms of Best Corrected Visual Acuity (BCVA), and visual axis opacification (VAO) were observed. Firecracker injury was found to be the most common causal agent, followed by arrow and ball injuries. Males were more commonly injured than females (70%:30%). Open-globe injury was more frequent than closed globe injury (CGI) (53.3%:46.7%). Anterior capsular rupture was the most frequent preoperative complication. Mean axial length was 22.53 which was not significantly different from the fellow eye. 3 patients were left aphakic, 10 patients underwent single piece IOL implantation and 16 patients underwent multipiece IOL implantation. Anterior chamber IOL (ACIOL) was implanted in one case. Intraoperatively 6 patients were found to have posterior capsular plaque and were implanted with multipiece IOL with posterior optic capture. Visual acuity significantly improved in 21 out of 30 eyes from baseline after cataract surgery (p&amp;#60;0.001). 9 patients (30%) had posterior capsular opacification (PCO) on follow up. Posterior capsular opacity in pediatric traumatic cataracts can be effectively managed with posterior capsulorhexis and posterior optic capture.

Profile of ocular injuries amongst various trauma patients presenting to tertiary care centre of Punjab

To study the epidemiology and clinical profile of ocular trauma patients presenting to tertiary care centre. Prospective study. All patients of ocular trauma in OPD/Emergency were assessed for detail between 1/1/17 to 31/6/18 and data on demographic profile was established as per guidelines of Ocular Trauma Society of India. Patients were categorized in different segments and assessed/followed for visual impairment in particular. A total of 246 cases were examined out of which 87% were males. The most common mode of ocular injury was Road Traffic Accidents. Pediatric eye trauma constituted 16.7% of the total cases. 26.8% cases arrived to our centre between 4-24 hours and 62.6% cases presented after 24 hours. Amongst 131 cases of Road Traffic Accidents, none of them were using protective measures like helmets or goggles. Of these, 17.1% were under the influence of alcohol. 28.5% were involved in medicolegal proceedings. Majority of the cases comprised of monocular trauma (78.1%). Closed globe injuries constituted 88.94% of the total cases of which most cases presented with lid edema and ecchymosis. Chemical injuries were reported in 4.5% cases. 9 patients lost vision completely and 71 cases had vision from light perception to 6/18. Ocular trauma is one of the common causes of ocular morbidity. It has been seen predominantly in male population. Public needs to be educated about safety measurements and education about prompt need to specialised care to reduce ocular trauma related visual morbidity.

Surgical outcomes and prognostic factors in traumatic retinal detachment following closed-globe injuries.

To evaluate the anatomical and functional results of retinal detachment (RD) surgery following closed-globe injuries (CGI). Patients treated with vitreoretinal surgeries due to RD following CGI from 2014 to 2020 were retrospectively reviewed. Data included demographics, mechanism of injury, preoperative evaluation, and surgical intervention. Outcome measurements included anatomic success, best corrected visual acuity (BCVA), and possible prognostic factors. A total of 67 eyes from 64 patients (49 males; mean age 52.84years) were included. The most common causes of the CGI were work-related injury (22.4%) and traffic accidents (23.9%). The primary and final anatomic success rates were 80.6% (54/67) and 89.6% (60/67), respectively. In the multivariable analysis of the logistic regression models, the poor prognostic factor was proliferative vitreoretinopathy (PVR) (P = 0.009) for primary anatomic success. The median preoperative and final BCVA were logMAR 0.7 (IQR, 0.3-1.6) and logMAR 0.5 (IQR, 0.1-1.1), respectively (P = 0.077). Poorly presenting BCVA (counting fingers or worse) and giant tear were associated with poor visual outcomes. Work-related injuries and traffic accidents are the prevalent causes of RD following CGI. The anatomic outcomes were favorable, but visual outcomes varied. Poor prognostic factors included PVR and poorly presenting BCVA, highlighting the importance of a careful initial evaluation.

Role of Socioeconomic Status (SES) in Globe Injuries: A Review.

Globe injury is a serious worldwide public health issue frequently leading to permanent vision impairment. The plethora of different types of globe injuries is classified into categories, including open and closed globe injuries. Globe injury occurs mainly in the workplace and at home, affecting predominantly middle-aged working men. Socioeconomic status (SES) is defined by income level, educational attainment, and employment status. Low socioeconomic status has been associated with a higher incidence of globe injury and can be utilized to identify at-risk populations. For managing open and closed globe injuries, different strategies are applied and the implementation of adequate globe injury prevention measures is needed for reducing the occurrence of globe injury. The following article aims to provide an overview of globe injury characteristics and their correlation with socioeconomic status and to highlight the significance of considering SES as a variable in globe injury prevention.

To Describe Clinical Profile of Medico-Legal Cases at Tertiary Hospital in Ahmedabad

Background: Ophthalmologists play an important role in the management and fixing of legal responsibility in ocular medico legal cases (MLCs). All penetrating or non-penetrating intentional ocular trauma causing loss of an organ or part of organ and which have as consequence the facial disfigurement or post trauma complication have forensic implications.Objective: To describe the clinical profile and meticulous documentation in ocular medico-legal cases attending the ophthalmic unit at a tertiary care hospital in Ahmedabad.Methods: Medical records of ocular MLC from May 2018 to November 2020 were considered. A total of 112 cases of ocular injury constituted the sample size. The injuries were categorized as adnexal and globe injuries. The clinical profile was recorded in the clinical record forms and analyzed accordingly.Results: A total of 112 patients with ocular trauma were recruited with follow up to 6 months following recruitment. The most affected age group was 26-40 years (25.89%). The most common mode of injury was assault with fist in 22 (18.74) of cases. Most patients had open globe injury (28, 25%), while 20 (16.5%) had closed globe injury, 38 (33.93%) had the adnexal injury, 7 (6.25%) had open plus adnexal, 7 (6.25%) had closed plus adnexal and 12 (10.71%) had chemical injury. Adnexal injuries were the most common n=38 (33.93%). Lid / periorbital contusion and subconjunctival hemorrhage were the most common presentations among adnexal and globe injuries respectively. Malingering was present in 3 % (3). Furthermore, among the adult population, majority 28 (25%) had ocular injury at workplace, while most pediatrics injuries 23 (20.54) occurred at home during play. The incidence of monocular blindness 2 (9%) was at 6 months follow up after the initial presentation. Factor that was associated with monocular blindness was open globe injuries.Conclusion: Fist injury was the most common cause of trauma to the eye. A substantial number of patients who had adnexal injuries or subconjunctival hemorrhage had good vision, contrary to open globe injuries which resulted in very poor vision.

Successful management of an unusual extra-ocular foreign body.

A 25 yr old male†, industrial worker by profession, presented to the emergency setting of Government Medical College, Chandigarh, in July 2020, with a rare foreign body impaction. This was after he sustained occupational ocular trauma while cutting iron sheets with a manual work tool machine. He was not wearing any ocular protective gear. Ocular examination revealed impaction of multiple round brass foreign bodies in the right lower lid (Fig. 1A) and closed globe injury to the globe with vitreous haemorrhage and peri-papillary retinal pallor (Fig. 1B). Non-contrast computed tomography orbit showed metallic foreign bodies abutting the globe but not causing globe rupture (Fig. 2A: axial view; Fig. 2B: coronal view; Fig. 2C: sagittal view). The foreign bodies were removed (Fig. 1. inset) and the lid and canalicular repair was done. Pars plana vitrectomy was done to clear the vitreous haemorrhage. During the procedure, fibrogliotic bands with pigmentary alterations and multiple retinal breaks were noticed inferonasally due to coup injury at the site of the impact. Differential diagnoses of chorioretinitis sclopetaria, choroidal rupture and commotio retinae were kept in mind. The breaks in the region of chorioretinitis sclopetaria were lasered using a 532 nm laser. At 12 months of follow up, the visual acuity was 20/40 with attached retina (Fig. 3A and B) and no complaints of epiphora were noted. To the best of our knowledge, the impaction of multiple foreign bodies with stacking in the extra-ocular space has not been reported previously in the spectrum of work-tool related eye injuries. A team approach by oculoplastic and retina surgeons may be required for successful management of complex occupational ocular trauma.Fig. 1: (A) Photograph showing three metallic foreign bodies stacked one above the other in the lower eyelid in the medial aspect. (B) Fundus picture showing diffuse retinal opacification around optic disc and the fundus details are masked by overlying vitreous haemorrhage (inset). Photograph showing three (two are stacked together) 15 mm round smooth disc-shaped brass foreign bodies removed from the orbit.Fig. 2: Computed tomographic scan showing metallic foreign body in the inferior orbit abutting the globe with intact inferior wall of the orbit (A, axial scan, B, coronal scan, C, sagittal scan).Fig. 3: (A) Follow-up facial photograph of the patient showing repaired eyelid after removal of the foreign bodies with puncta well opposed to the globe. (B) Fundus montage of the right eye, after pars plana vitrectomy showing inferonasal chorioretinitis sclopetaria (arrow) with laser done for retinal breaks (arrowheads).Conflicts of Interest: None.

Angle Recession in Patients with Closed Globe Injury

Purpose: To determine the frequency of angle recession following closed globe injury in patients presenting to the department of ophthalmology of a tertiary care hospital of Pakistan. Study Design: Descriptive observational study. Place and Duration of Study: Study was conducted at Eye-A Unit, Hayatabad Medical Complex, Peshawar from 14th March 2017 to 14th Sept 2017. Methods: One hundred and sixty three patients were selected for this study after applying WHO sample size calculation formula. Patients with history of closed globe injury were recruited through consecutive sampling technique. A detailed history regarding trauma, causative agent, duration of injury and site of impact was taken. Ocular examination including visual acuity and detailed examination of both anterior and posterior segment was carried out using slit lamp biomicroscope. Gonioscopy was performed to check the presence and extent of angle recession. Results: Mean age was 33 ± 8.82 years. Seventy five percent patients were male and 25% female. Type of trauma included; 57 (35%) patients had road traffic accidents, 33 (20%) patients had stone injuries, 37 (23%) patients had sports injuries while 36 (22%) patients had eye trauma due to other types like fall, fight, glass injuries, chemical exposures etc. In 90 (55%) patients, right eye was affected while 73 (45%) patients had trauma in left eye. Duration of trauma was ? 2 days in 124 (76%) patients while mean duration was 1 day with SD ± 1.034. Conclusion: Frequency of angle recession was 28% following closed globe injury. Key Words: Angle recession, closed globe injury, ocular trauma.

Оpen globe injury in children: epidemiology and predictors of an adverse outcome

Here we aimed to analyse the prevalence, clinical course, and current approaches to the prevention and treatment of open globe injury in children as well as its complications: hyphema, retinal detachment, traumatic uveitis, and endophthalmitis. Currently, children are responsible for the 10-15% of open globe injuries. In developed countries, open globe injury is the leading cause of monocular blindness in children. Open globe injury mainly affects boys (60−70% cases), yet severe injuries are rare, and closed globe injury is the most common type of eye injury. Most injuries are accidental and occur at home in daily life (50−60%), outdoors (20−35%), at school (1−5%), or while playing sports (1−3%). Open globe injury most often affects cornea and is associated with a high risk of early and late complications and poor outcomes. Wearing of protective glasses during sports and active recreation is recognised as an efficient tool for primary prevention of open globe injury in children. The main problems in prevention of complications of open globe injury are the lack of specialised care in low-income countries and the limited awareness of parents.

Clinical Profile, Etiology, and Management Outcomes of Pediatric Ocular Trauma in Saudi Arabia.

To evaluate cases of pediatric ocular trauma at a tertiary eye hospital in central Saudi Arabia and determine the demographics, causes, ocular injuries, and visual status before and after management. A retrospective review was performed of health records of children younger than 16 years with ocular trauma managed from January 1998 to December 2019. Data were collected on patient demographics, eye involved, cause of trauma, the presenting and final vision, and the duration of follow-up. Best-corrected visual acuity at the last follow-up was compared between open and closed eye injury groups. The Birmingham Eye Trauma Terminology was used to classify the ocular injuries. Among 1003 patients, 728 (72.6%) had open globe and 275 (27.4%) had closed globe injuries. The main causes of trauma were unsafe playing-related activities (n = 394; 39.3%), unsafe home environment (n = 158;15.8%) and injury by metallic objects (n = 166; 16.6%). Gunshot-related ocular trauma was noted in 62 (6.2%) children. Presenting vision less than 20/400 was noted in 292 (40.1%) eyes with open globe injuries and 110 (40%) eyes with closed globe injuries (P = 0.4). After a median follow-up of 13.3 months, best-corrected visual acuity was 20/20 to 20/200 in 393 (53%) eyes with open globe injuries and 137 (49.8%) eyes with closed globe injuries (P = 0.03). Despite proper management, children in this study sustained significant permanent visual loss secondary to ocular trauma. Public health efforts in Saudi Arabia are needed to reduce preventable injury-related childhood blindness.

POSTERIOR SEGMENT INJURIES IN OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM: 2001 to 2011.

To characterize the nature of posterior segment ocular injuries in combat trauma. Eyes in the Walter Reed Ocular Trauma Database were evaluated for the presence of posterior segment injury. Final visual outcomes in open-globe versus closed-globe injuries and by zone of injury and the types of posterior segment injuries in open-globe versus closed-globe injuries were assessed. Four hundred fifty-two of 890 eyes (50.8%) had at least one posterior segment injury. The mechanism of injury was most commonly an improvised explosive device in 280 (62.0%) eyes. Sixty-one patients (13.5%) had a Zone I injury, 50 (11.1%) a Zone II injury, and 341 (75.4%) a Zone III injury. Patients with Zone I injuries were more likely to have a final visual acuity of 20/200 or better compared with patients with either a Zone II (P < 0.001) or Zone III injury (P = 0.007). Eyes with a closed-globe injury were more likely to have a final visual acuity of 20/200 or better compared with those with an open-globe injury (P < 0.001). Furthermore, closed-globe injury compared with open-globe injury had a lower risk of vitreous hemorrhage (odds ratio 0.32, P < 0.001), proliferative vitreoretinopathy (odds ratio 0.14, P < 0.001), and retinal detachment (odds ratio 0.18, P < 0.001) but a higher risk of chorioretinal rupture (odds ratio 2.82, P < 0.001) and macular hole (odds ratio 3.46, P = 0.004). Patients with combat ophthalmic trauma had similar posterior segment injury patterns to civilian trauma in open-globe versus closed-globe injuries. Zone II and III injuries were associated with a worse visual prognosis.

Current pattern of ocular trauma as seen in tertiary institutions in south-eastern Nigeria

BackgroundOcular trauma is a leading cause of monocular blindness worldwide and in developing countries, are not only more common but also more severe. Industrialization and urbanization may alter or modify prevalent aetiological factors and the presentation of ocular trauma.ObjectiveTo determine the current pattern of eye injuries in Teaching Hospitals in Enugu State.MethodsThis prospective cross-sectional descriptive study was carried out at the eye clinics and emergency units of two tertiary institutions in Enugu, Nigeria. Consecutive ocular trauma patients were enrolled over a 5-month period. On presentation, they underwent ocular examination including visual acuity (which was categorized according to the WHO classification of visual impairment and blindness}, anterior and posterior segment examinations. Injuries were grouped using the Birmingham Eye Trauma Terminology system.ResultsWithin the study period, 2545 new patients presented to the hospitals where the study was conducted. A total of 89 patients presented with ocular trauma, giving an incidence of 3.5%. The male to female ratio was 1.3:1 and patients aged 10 to 19 years formed the majority (24%). Domestic accidents (22%) were the most common cause of ocular injuries while blunt objects (57%) were the most common agents. Closed globe injuries constituted 76% of all injuries. Forty-three per cent of patients presented within 24 h of injury.ConclusionOcular trauma is still prevalent in South-eastern Nigeria and there has indeed been a change in the pattern as well as the incidence. Assault and road traffic accidents have emerged as important causes of eye injuries. In addition, there has been an improvement in the health-seeking behaviour of people living in Enugu and this may reflect positively on the uptake of recommended preventive strategies.

Value of ocular trauma score in predicting the incidence of secondary glaucoma after closed globe injury.

To analyze the visual acuity (VA) and the incidence of secondary glaucoma among patients with closed globe injury (CGI). To determine the correlations between the ocular trauma score (OTS) with surgery rate, and evaluate the applicability of OTS in secondary glaucoma prediction and treatment. We conducted a retrospective review of 265 patients (265 eyes) with CGI admitted to Xijing Hospital between January 2014 and December 2016. The clinical characteristics; VA, IOP, injury zone, surgery, and IOP-lowering medications were collected at the initial visit and at six months. The patients with secondary glaucoma were scored and assessed by the OTS system. The correlation of the anti-glaucoma surgery with the OTS was evaluated. The difference in the number of IOP-lowering medications between the initial visit and six months was analyzed. The average age of the patients was 33.5 ± 20.7 years with 80.8% being males. The final VA outcome improved in its totality after treatment. 35 patients developed glaucoma, with an incident rate of 13.2% over six months. All glaucoma patients had an injury in zone I and II, and 12 of them had an injury in zone III. The severity of the OTS category showed a strong correlation with the anti-glaucoma surgery rate. After the surgical intervention, the number of IOP-lowering medications in OTS category 2, 3, and 4 significantly reduced. The OTS has predictive value in the incidence of secondary glaucoma after CGI. A patient with a low score is more likely to develop secondary glaucoma and might require surgical intervention.