Study of epidemiology, clinical profile, visual outcome and prognostic factors of blunt ocular trauma in a teaching hospital

Abstract

To describe the epidemiology, patterns of ocular trauma, clinical presentation, visual outcome and prognostic factors of blunt ocular trauma.A teaching hospital based prospective observational study was conducted over a period of 4 years from March 2012 to Feb 2016. 226 patients of all age group fulfilling the various inclusion and exclusion criteria were included in the study. All patients underwent detailed protocol based workup including a comprehensive ocular examination along with relevant radiological tests. Data regarding demographic profile, etiology, circumstances of the injury, traumatic agents, mode and mechanism of injury, extent and severity of injury, clinical features, management and visual outcome was analyzed and prognostic factors including ocular trauma score were evaluated.Out of 402 total cases of ocular trauma, 226 caused by blunt objects were included in this study. 181 (80.1%) were male rest 45(19.9%) were female. The mean age was 42.6 ± 18.8 years. Blunt trauma was more prevalent in age group 16-25yrs (24.3%) followed by 26-35 years (23.9%). Majority (68.6%) of victims belonged to rural background. Most of the patients sustained trauma at road /street (30.5%) and home (27.9%). The most common cause of blunt trauma was road traffic accident (26.5%) followed by sports related injury (22.6%) and physical assault (21.7%). The most frequent traumatic agent was wooden object (26.0%) followed by stone / brick (25.2%) and metallic object (23.1%). Only 32.3% of patients had isolated ocular injuries, rest had associated polytrauma. 93.3% victims had unilateral ocular injury. Left eye (52.3%) was predominantly involved. Majority of injured eyes had more than 3 ocular structure involvement. Out of 241 injured eye 14.0% eyes had only globe injury while 61.4% eyes had simultaneous globe and adnexal injuries. 55.6% eyes had closed globe injury while 19.9% eyes had globe rupture. 20.7% eyes had purely posterior segment injury, while 23.2% eyes had both anterior and posterior segment injury. Most common clinical finding was corneal abrasion (45.6% eyes) followed by hyphema (44.0% eyes), traumatic mydriasis (35.7%), vitreous hemorrhage (33.2%) retinal detachment (20.3%), lens dislocation (22.8%) and traumatic cataract (17.4%). At the time of initial presentation 33.2% eyes had visual impairment and 35.7% eyes had blindness. 14.5% eyes with closed globe injury and 5.0% eyes with open globe injury had zone III injury. Ocular trauma score was in Category I in 14.9% injured eyes and in category II in 7.1% eyes. After 6 months 14.5% of the right eye and 24.2% of the left eye showed blinding outcome.Blunt trauma is the commonest mode of ocular injury. Young adult males are more vulnerable. Intraocular hemorrhage, zone III injury, posterior segment involvement and low ocular trauma score are poor prognostic factors.