Ocular Manifestations of Head Injuries

Abstract

BACKGROUND This prospective study aimed to evaluate the incidence of ocular manifestations in head injury and their correlation with the intracranial lesions. MATERIALS AND METHODS A total of 108 consecutive cases of closed head injury admitted in the neurosurgical ward of a tertiary teaching hospital underwent a thorough ophthalmic assessment. Clinical examination, radiological imaging and Glasgow Coma Scale (GCS) were applied to grade the severity of injury. RESULTS Total number of 108 patients of head injury were examined of which 38 patients had ocular manifestations (35.18%). Of these, 85.18% were males, 84% of injuries were due to road traffic accidents and 16% were due to fall from a height. The ocular manifestations were as follows-Orbital complications were seen in 6 patients (15.8%). Anterior segment manifestations included black eyes seen in 10 patients (26.3%), subconjunctival haemorrhage in 10.5% of patients (4 patients), corneal involvement in 21% of patients (8 patients) and pupillary involvement in 50% of patients (19 patients). Posterior segment manifestations were seen in 26.3% of patients (10 patients) and were as follows-Purtscher's retinopathy in 2 patients and optic atrophy in 5 patients. Cranial nerve palsies were seen in 15 patients (39.47%) and supranuclear movement disorders were seen in 3 patients (8%). CONCLUSION Even though, neurosurgeons perform comprehensive clinical examination including eye examination, the main purpose is limited to aid topical diagnosis of neurological lesions. This study emphasises the importance of a detailed eye examination by an ophthalmologist to prevent irreversible visual loss in addition to aiding in the neurological diagnosis. Pupillary involvement, papilloedema and ocular motor paresis pointed to a more severe head injury. This observational prospective study helped us to correlate the severity of head injuries in association with ocular findings in patients admitted in neurosurgical ward and in patients reported to Department of Ophthalmology with a history of head injury.