Ocular Injuries In Patients Research Articles

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

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.

Orbital Structure Involvement in Midface Fractures Impacting Ocular Injury at a Tertiary Hospital in Eastern Indonesia

ABSTRACT Introduction: The midface is a complex anatomical area consisting of several areas. Although various factors protect the eye from trauma, such as orbital rim, blink reflex, elasticity of ocular structures, and protective eye movements by hands and head, ocular injuries remain common in patients with midface fractures, with an incidence rate of up to 90.6%. This study, the first of its kind conducted in Indonesia, aims to evaluate the characteristics and incidence of ocular injuries in midface fractures and to examine the relationship between the treatment. Methods: This observational analytic study employed a retrospective cohort design, utilizing medical record data of midface fracture patients. The independent variables included age, sex, cause, incidence, segment and severity of ocular injury, number of orbital wall involvements, and treatment options. The dependent variable was midface fracture patients. The Mann–Whitney and Fisher’s exact tests were employed to analyze the multivariate data. Results: Individuals aged 32–37 were most commonly affected due to accidents, with the anterior ocular segment and maxilla bone frequently affected. There are no special factors that differentiate a person from experiencing an ocular injury in a midface fracture (P > 0.05). Ocular injuries correlated with orbital wall injury (P = 0.008) at least one discontinuity. Impaired functions included movement and visual disturbances, diplopia, and dystopia (P = 0.134). Conclusions: No significant relationship was found between age, sex, and cause of trauma with ocular injuries in patients with midface fractures. However, a significant relationship was observed between the amount of orbital rim involvement and at least one wall discontinuity occurring in midface fracture patients.

Sustained Inhibition of VEGF and TNF-α Achieves Multi-Ocular Protection and Prevents Formation of Blood Vessels after Severe Ocular Trauma.

This study aimed to develop a clinically feasible and practical therapy for multi-ocular protection following ocular injury by using a thermosensitive drug delivery system (DDS) for sustained delivery of TNF-α and VEGF inhibitors to the eye. A thermosensitive, biodegradable hydrogel DDS (PLGA-PEG-PLGA triblock polymer) loaded with 0.7 mg of adalimumab and 1.4 mg of aflibercept was injected subconjunctivally into Dutch-belted pigmented rabbits after corneal alkali injury. Control rabbits received 2 mg of IgG-loaded DDS or 1.4 mg of aflibercept-loaded DDS. Animals were followed for 3 months and assessed for tolerability and prevention of corneal neovascularization (NV), improvement of corneal re-epithelialization, inhibition of retinal ganglion cell (RGC) and optic nerve axon loss, and inhibition of immune cell infiltration into the cornea. Drug-release kinetics was assessed in vivo using an aqueous humor protein analysis. A single subconjunctival administration of dual anti-TNF-α/anti-VEGF DDS achieved a sustained 3-month delivery of antibodies to the anterior chamber, iris, ciliary body, and retina. Administration after corneal alkali burn suppressed CD45+ immune cell infiltration into the cornea, completely inhibited cornea NV for 3 months, accelerated corneal re-epithelialization and wound healing, and prevented RGC and optic nerve axon loss at 3 months. In contrast, anti-VEGF alone or IgG DDS treatment led to persistent corneal epithelial defect (combined: <1%; anti-VEGF: 15%; IgG: 10%, of cornea area), increased infiltration of CD45+ immune cells into the cornea (combined: 28 ± 20; anti-VEGF: 730 ± 178; anti-IgG: 360 ± 186, cells/section), and significant loss of RGCs (combined: 2.7%; anti-VEGF: 63%; IgG: 45%) and optic nerve axons at 3 months. The aqueous humor protein analysis showed first-order release kinetics without adverse effects at the injection site. Concomitant inhibition of TNF-α and VEGF prevents corneal neovascularization and ameliorates subsequent irreversible damage to the retina and optic nerve after severe ocular injury. A single subconjunctival administration of this therapy, using a biodegradable, slow-release thermosensitive DDS, achieved the sustained elution of therapeutic levels of antibodies to all ocular tissues for 3 months. This therapeutic approach has the potential to dramatically improve the outcomes of severe ocular injuries in patients and improve the therapeutic outcomes in patients with retinal vascular diseases.

Pattern of Ocular Involvement in Midface Injuries Seen at a Tertiary Care Hospital in Northern Nigeria.

Aim:The aim of the study was to report the etiology, pattern, and spectrum of ocular injuries in patients with maxillofacial injuries seen at a tertiary care hospital in northern Nigeria.Patients and Methods:This is a retrospective evaluation of the etiology, spectrum, and treatment of ocular injures seen in patients with midfacial fractures, who presented at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, a tertiary care hospital in northern Nigeria. Cases were seen at the oral and maxillofacial clinic for those presenting with midfacial fractures, whereas those presenting with ocular injuries due to midfacial injuries were referred from the ophthalmology department. Data were collected on their demographics, etiology of injuries, body part(s) involved, and treatment.Results:A total of 256 patients had midfacial injuries during the period, of which 219 patients had 357 associated ocular injuries. The age range was between 3 and 76 years. There were more males (83.8%) than females (16.2%), giving a male-to-female ratio of 5.2:1; the 21–30 years' age bracket was most frequently affected (38.4%). The predominant etiology of injuries was road traffic accidents (RTAs) (90.1%), followed by assault (4.9%). Zygomatic complex fractures (38.6%) and orbital wall fractures (24.7%) were the common midfacial injuries. There were 357 ocular injuries, giving a patient: injury ratio of 1:1.6, with subconjunctival hemorrhage (32.5%) and ruptured globe (20.0%) being common. Treatments performed were reduction and immobilization of midfacial fractures plus evisceration (32.0%), followed by reduction and immobilization of fractures alone (23.9%) and reduction and immobilization plus grafting of soft tissues (21.2%).Conclusion:Ocular injuries are quite common in patients with midfacial injuries, with a ratio of 1.6:1. RTA was the most common etiology, with zygomatic complex fractures as the most common midfacial injury. Subconjunctival hemorrhage was the most common ocular injury manifestation, with young adults (21–30 years of age) being most affected. Treatment often involved reduction and immobilization of midface fractures with evisceration and grafting of ocular tissues.

Incidence of Ocular injuries in patients with Maxillofacial Trauma at Government Medical College and Hospital, Nizamabad, Telangana, India: A Prospective Study

Incidence of Ocular injuries in patients with Maxillofacial Trauma at Government Medical College and Hospital, Nizamabad, Telangana, India: A Prospective Study

Epidemiology and Clinical Patterns of Ocular Trauma at a Level 1 Trauma Center in Korea.

BackgroundTo evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea.MethodsWe analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS).ResultsThe incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases. The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001).ConclusionThis is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47–1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.

Review of Ocular Injuries in Patients with Orbital Wall Fractures: A 5-Year Retrospective Analysis.

PurposeThe purpose of this study was to determine the incidence of minor and major ocular injuries in patients with orbital wall fractures at Loma Linda University Health, a level-one trauma center, to help determine the most appropriate setting for the initial dilated fundus examination by ophthalmologists.MethodsA retrospective study was performed from January 2008 to January 2013 of patients diagnosed with orbital wall fracture secondary to trauma. Exclusion criteria included unknown mechanism of injury, the absence of ophthalmology consultation, or absence of imaging. Data collected included age, gender, mechanism of injury, visual acuity, and anterior/posterior segment findings. Ocular injuries were categorized as either minor or major.ResultsOf 567 charts reviewed, 460 met criteria and were included for analysis. In the analysis, 86.5% of patients were male, and 81.3% were Caucasian. The most common mechanism of orbital fracture was blunt injury. Visual acuity was better than 20/100 in 82.4% of patients. On chart review, 81.1% of patients were found to have either a minor injury, a major injury, or both. The most common injury was subconjunctival hemorrhage (53.5%). Globe rupture (2.9%) and vision-threatening posterior segment findings such as retinal tear and choroidal rupture (1.3%) were relatively rare. Only one retinal detachment (0.2%) was found, specifically in the setting of severe injury with concomitant globe rupture.ConclusionKnowledge of the common ocular injuries associated with orbital fractures will help emergency department (ED) physicians and ophthalmologists provide the dilated fundus exam in the most appropriate setting. The most frequent injuries identified were non-vision threatening, and visually significant posterior segment findings were relatively rare (1.3%). Thus, for the majority of patients presenting to the ED with orbital fracture, a dilated fundus exam can be performed at a later date in the outpatient clinic setting, unless urgent orbital fracture surgery is planned.

Epidemiologic Study of Ocular Injuries in Patients With Maxillofacial Fracture in Hamadan

Background: Maxillofacial fractures are frequently complicated with injury to the eye and its adnexa. These injuries may result in loss of vision in one or both eyes or may compromise ocular function. This study aimed to evaluate ocular injuries in the patients with maxillofacial trauma. Methods: Two hundred patients with maxillofacial fractures were examined by maxillofacial surgeons and suspected cases of ocular injuries were referred for ophthalmologic consult. Sixty-three patients were excluded from the study due to death and low Glasgow Coma Score (GCS). Patients’ information including maxillofacial fractures and ocular injuries were recorded in check lists and analyzed with SPSS software version 16.0. Results: out of 137 patients, 106 (77.4%) were males and 31 (22.6%) were females and their mean age was 34.1 ± 17.1. The age group with the highest rate of involvement were 21-40 years (46%). The most common cause of injury was motorcycle accident (32.1%), car accident (30.7%), and in the third place was falling down (13.9%). The incidence of right eye injuries was 5/9%. Right eye was also involved more frequently than left eye (38% and 32.1%, respectively), and in 41 cases (29.9%) both eyes were involved. The prevalence of minor ocular injury was 52.6%, moderate injury was 24.8%, and major injury was 22.6%. The most common ocular injuries were periorbital ecchymosis (83.9%) and subconjunctival hemorrhage (72.2%), and unfortunately 5 cases (3.6%) lost their vision. Conclusions: The significant prevalence of ocular injuries due to maxillofacial trauma certifies the necessity of immediate ophthalmologic examination to prevent permanent vision loss. A multidisciplinary team composed of neurosurgeons, plastic, oral and maxillofacial, ENT and ophthalmic surgeons are suggested to improve management of maxillofacial trauma.

The Incidence of Ocular Injuries in Isolated Orbital Fractures.

Prompt identification of significant ocular injuries in patients who sustain an orbital fracture is important to prevent any potential long-term visual sequelae. The true incidence of these injuries has not been determined, however. As a consequence, most surgeons choose to have all patients evaluated by an ophthalmologist. The objective of this study was to conclusively identify the incidence of significant ocular injuries in patients with isolated orbital fractures and to determine their predictors to guide more efficient patient care. A prospective cohort study powered to detect a 15% incidence of ocular injuries was designed. All patients presenting to our center with computed tomography findings of an isolated orbital fracture were included and evaluated by plastic surgery and ophthalmology services. Patients were followed up for a minimum of 1 week to identify any delayed injuries. Eighty patients were enrolled from 2012 to 2014. There were 46 men and 34 women with a mean age of 42.8 years. Assault was the most common mechanism of injury. There were 8 ocular injuries (10%): ruptured globe (1), uveal prolapse (1), retrobulbar hemorrhage (2), hyphema (2), hemorrhagic glaucoma with hyphema (1), and scleral tear (1). Predictors for significant ocular injuries were grossly abnormal visual acuity and abnormal pupillary reactivity of the affected eye. The incidence of significant ocular injuries in isolated orbital fractures is lower than previously reported. Patients presenting with grossly abnormal visual acuity or abnormal pupillary reactivity are at high risk and should receive prompt ophthalmology service evaluation.

Pattern of ocular trauma in Gusau, north west Nigeria

Background: Ocular trauma is an important public health hazard especially in the developing countries. The objective of the study was to determine the pattern of ocular injuries in patients who presented at the eye clinic of Federal Medical Center, Gusau, Zamfara State, Nigeria. Materials and Methods: A prospective study was conducted between 1st January and 31st December, 2008. All consecutive, consenting patients with ocular trauma were interviewed with the aid of an interviewer-administered questionnaire and underwent a detailed eye examination. Results: There were 121 patients in the study with 101 (83.4%) males and 20 (16.6%) females. The most common location of ocular trauma was more on the road (32.2%); road traffic accident (RTA), followed by home/domestic injury (23.1%) and at work in 15.8%. The most common anatomical site of injury was the cornea (40.6%) followed by the lids (17.5%) and the iris (14%). Conclusion: In this study, RTA was the most common cause of ocular trauma followed by domestic injuries. There is need for community education on preventive measures such as use of safety seat belts while driving and importance of supervising playing children at home.

Ocular Injuries in Patients of Zygomatico-Complex (ZMC) Fractures.

Mid face injuries commonly destroy the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7 and 90.6% as reported in literature. The eye injuries range from simple subconjunctival haemorrhage to globe rupture. The paper aims to study the types of ocular injuries in patients with ZMC fractures. A study of 67 patients, who had sustained facial trauma sufficient to lead to a facial bone fracture, was undertaken in the department of Oral and Maxillofacial Surgery, Govt Dental College, Srinagar from 2008 to 2014 and the patients received a comprehensive examination by an ophthalmologist within 1week of injury. All the patients sustaining confirmed ZMC fracture were examined by an ophthalmologist for any associated ocular injury. A thorough ophthalmologic examination included assessment of visual acuity, pupillary reactivity, anterior and posterior segment examination and extraocular motility. The variables reviewed included patient's gender, mechanism of injury, visual acuity, pupillary reactivity, extra ocular motility, presence or absence of diplopia, ocular and orbital findings, and intraorbital hypoesthesia. The most common etiology of trauma was RTA (64.1%), followed by falls (14.9%) in our study. In our study 83.5% of the patients were males. Minor ocular injuries such as subconjunctival haemorrhage and corneal injury accounted for most of the cases. Subconjunctival haemorrhage was the most common injury, present in 86.5% of the cases. Hyphema was present 13.4%, vitreous haemorrhage 2.98%, retinal haemorrhage 1.49%, corneal abrasion 4.47%, mydriasis 1.49%, choroidal rupture 5.97%, retinal detachment 2.98%, decreased visual activity 13.4%, retinal tear and angle recession was present 7.46% times. ZMC fractures are associated with higher incidence of ocular injuries. The incidence of traumatic optic neuropathy and other ocular injuries warrants a prompt ophthalmologic examination of all patients with ZMC fractures as quickly as possible to prevent morbidity.

Airbag related ocular injuries: A short case series

Airbags are designed to protect occupants of motor vehicles from injuries in the event of a crash but have been implicated in some serious ocular injuries after road traffic accidents (RTAs). Diagnosis of airbag related ocular injuries requires a high index of suspicion. Using a retrospective hospital‑based, noninterventional study design, we evaluated the frequency and severity of airbag‑related ocular injuries in patients presenting with ocular trauma to the eye clinic over a 4 years period. The case notes of patients managed for varying degrees of ocular injuries over a 4 years period in an eye clinic were reviewed. Patient demographics, the cause of injury, type of vehicle, speed, specific ocular structures injured, visual morbidity, and visual outcome were assessed. An 150 cases were identified and enrolled in the study. Only 8 (5.3%) of them were victims of RTAs. Airbag deployment was the mechanism of injury in 2 (1.33%) patients. Details of these two patients are reported. There was bilateral involvement in the two patients that had airbag‑related ocular injuries. Each of the patients sustained a ruptured globe in one eye, and one of them became bilaterally blind from airbag‑related ocular injuries. Airbag‑related ocular injuries can be very severe, and this mechanism of injury should be considered during the assessment of victims of RTAs with ocular injuries. Keywords: Airbag injuries, ocular trauma, road traffic accidents

The Incidence of Ocular Injuries in Isolated Orbital Fractures

BACKGROUND: Prompt identification of significant ocular injuries in patients who sustain an orbital fracture is important to prevent any potential long-term visual sequelae. The true incidence of these injuries has not been determined, however. As a consequence, most surgeons choose to have all patients evaluated by an ophthalmologist. The objective of this study was to conclusively identify the incidence of significant ocular injuries in patients with isolated orbital fractures and to determine their predictors to guide more efficient patient care. METHODS: A prospective cohort study powered to detect a 15% incidence of ocular injuries was designed. All patients presenting to our center with computed tomography findings of an isolated orbital fracture were included and evaluated by plastic surgery and ophthalmology services. Patients were followed up for a minimum of 1 week to identify any delayed injuries. RESULTS: Eighty patients were enrolled from 2012 to 2014. There were 46 men and 34 women with a mean age of 42.8 years. Assault was the most common mechanism of injury. There were 8 ocular injuries (10%): ruptured globe (1), uveal prolapse (1), retrobulbar hemorrhage (2), hyphema (2), hemorrhagic glaucoma with hyphema (1), and scleral tear (1). Predictors for significant ocular injuries were grossly abnormal visual acuity and abnormal pupillary reactivity of the affected eye. CONCLUSIONS: The incidence of significant ocular injuries in isolated orbital fractures is lower than previously reported. Patients presenting with grossly abnormal visual acuity or abnormal pupillary reactivity are at high risk and should receive prompt ophthalmology service evaluation. Language: en

Ocular Trauma in Patients With Maxillofacial Fractures

The purpose of this study was to analyze and evaluate ocular injuries in patients with maxillofacial fractures. Correlation of the ocular injury and patients' age, sex, trauma mechanism, and type of maxillofacial fracture was also investigated. From January 2000 to December 2009, a total of 1131 patients with facial fractures were registered. The information and data collected and analyzed included the following: age, sex, mechanism of injury, type of facial fracture, type of ocular injury, and the relationship between ocular injury and facial fracture. Ocular injury (349 injuries) was sustained by 209 patients (18.5%), with a male/female ratio of 5.33:1 (176 males and 33 females). The age range of the patients associated with ocular trauma was 3 to 68 years (mean [SD], 32.40 [11.27] y). Patients aged 30 to 39 years showed the highest risk for ocular trauma (odds ratio [OR], 1.852; P < 0.001). Children showed the lowest risk for ocular injuries (OR, 0.162; P < 0.001). Motor vehicle accidents were the most common mechanism of injury (97 patients, 46.4%). Motor vehicle accidents also had a 2.243-fold risk for ocular trauma (OR, 2.243; P = 0.021). Ocular traumas were more prone to occur in patients who sustained midfacial fractures (OR, 10.232; P < 0.001), especially the patients with multiple midfacial fractures (OR, 12.389; P < 0.001). Fracture of the mandible had the lowest risk for ocular injuries (multimandibular fractures: OR, 0.035, P < 0.001; single mandibular fracture: OR, 0.151; P < 0.001). The occurrence of ocular injuries was significantly related to sex, age, etiology, as well as the pattern and position of the maxillofacial fractures.

Ocular Nail Gun Injuries: Epidemiology and Visual Outcomes

Nail-gun accidents have become a common reason for penetrating ocular injuries in patients presenting to the emergency room with globe trauma. To date, there are only five patients (one case report and one small case series) in the medical literature of penetrating ocular injury due to nail-guns. The aim of this study is to describe the epidemiology and visual outcomes of patients presenting to a tertiary medical center with ocular injuries resulting from nail-gun injuries. This is an institutional review board-approved retrospective chart review of 24 patients presenting to the Medical University of South Carolina after sustaining eye injuries secondary to the use of nail-guns. The records of 178 patients with penetrating eye injuries treated between July 1996 and June 2006 were reviewed. Twenty-four patients (14%) had open globe injuries related to nail-guns. Demographic data, ocular examination findings, and visual outcomes were recorded. Of the 24 cases identified, 17 were work-related; this represented approximately 71% of patients. All were men with an average age of 29.4 years. Fifty-eight percent of the patients were non-English speaking. There was no record of any patient wearing safety glasses at the time of injury. The visual acuity at presentation ranged from 20/20 to hand motion or worse. Half (50%) of these patients had a presenting visual acuity of hand motion or worse. At last examination, 38% (nine patients) had visual acuity of 20/40 or better, 34% (eight patients) had visual acuity of counting fingers to hand motion, 13% (three patients) 20/60, 4% (one patient) 20/200, and three were lost to follow-up. The correlation coefficient between visual acuity at presentation and most recent was significant at 0.679 (p = 0.001). The majority of nail-gun injuries presented in this series were work-related. These injuries could be prevented with adherence to established safety measures including proper training and education of nail-gun operators, the use of sequential-trip triggers, and required safety glasses. Visual acuity outcomes of these 24 patients are better than what might be expected due to the nature of the injury.

Ocular injuries in patients with major trauma

Aim: To study the epidemiology of ocular injuries in patients with major trauma in the UK, determining the incidence and causes of ocular injuries, and their association with facial fractures....

Eye injuries in patients with major trauma.

A study was performed to determine the type and frequency of ocular injuries in patients with major trauma. All patients with ocular and adnexal injuries (n = 178) among 1,119 patients admitted with major trauma (Injury Severity Score >15) to the Royal Prince Alfred Hospital from July 1990 to December 1997 were analyzed. Sixteen percent of the major trauma cohort had ocular or orbital trauma. Fifty-five percent of patients with injuries involving the face had ocular or orbital injuries. A range of ocular injuries was seen. Analysis of the major trauma cohort showed that motor vehicle drivers, orbital and base of skull fractures, eyelid lacerations, and superficial eye injuries were strongly associated with vision-threatening injury. Patients with major trauma and facial injuries have a high risk of vision-threatening injury. Patients with orbital fractures, base of skull fracture, eyelid lacerations, and superficial eye injuries should be assessed by an ophthalmologist as part of the early management of their trauma to determine whether an ocular injury is present.

Intraocular pressure as an index of ocular injury in orbital fractures.

An improved method of screening for ocular injuries in patients sustaining orbital fractures is proposed. We performed a retrospective study of 107 patients who sustained orbital fractures. Intraocular pressures were measured on presentation in 17 patients and were found to be elevated on the side of the injury in eight patients, five (63%) of whom had significant ocular injury. No patient with normal intraocular pressure was found to have an ocular injury. In a prospective study, the intraocular pressures of 30 patients sustaining orbital fractures were measured. Twelve patients (40%) had normal (less than 22 mm Hg) and bilaterally symmetric (less than 3 mm Hg difference) intraocular pressures. One (8%) of these patients sustained ocular injury. In contrast, 18 patients (60%) had either an elevated intraocular pressure (greater than 22 mm Hg) or a difference between eyes of greater than or equal to 3 mm Hg. Eleven (61%) of these patients were found to have sustained an ocular injury. We conclude that intraocular hypertension or significant interocular pressure differences should alert the physician to a potential ocular injury.

Ocular injuries associated with traumatic hyphema in a tertiary hospital

Introduction: Traumatic hyphema is one of the most challenging clinical problems frequently encountered by ophthalmologists. Aim: The aim of this study is to determine the prevalence of ocular injuries in patients being managed for traumatic hyphema in this center to have a strategic plan to reduce consequential visual sequelae from the injury. Materials and Methods: This was a cross-sectional study conducted based on the data obtained from an eye clinic from January 2010 to July 2017. Information on demographic characteristics, chief presenting complaints and duration of symptoms before presentation, laterality, presenting visual acuity, grade of hyphema, intraocular pressure, associated ocular injury, and treatment offered were obtained. Results: Traumatic hyphema constituted 4.2% of all ocular emergencies seen in this center. There were 37 (82.2%) males and 8 (17.8%) females with a male-to-female ratio of 4.6:1.0. Of the 45 cases, 32 (71.1%) patients presented with blindness in the affected eye with the worst presentation occurring in Grade 4 hyphema. Thirty-three patients (73.3%) presented more than 24 h to the eye facility, age, and eye pain significantly affected the duration of presentation. The prevalence of ocular injuries in patients that had traumatic hyphema was 34 (75.6%). Fourteen (31.1%) patients presented with corneal injury ranging from corneal abrasions to corneal laceration. Conclusion: The prevalence of associated ocular injuries in patients with traumatic hyphema was high with corneal injuries as the most ranked complications. Reduction of consequential poor visual prognosis would include counseling on early presentation, meticulous examination of the injured eye, and quick and appropriate surgical intervention as indicated to prevent corneal staining.