The epidemiology and diagnosis of penetrating eye injuries

Abstract

It is estimated that there are 3.1 penetrating eye injuries per 100,000 person-years in the United States.

Objectives: To evaluate the epidemiology of penetrating eye injuries and to identify physical examination findings that facilitate the diagnosis and ophthalmologic referral of patients with these injuries.

Methods: This was a retrospective chart review of emergency department patients with penetrating eye injuries seen for evaluation from July 1987 to January 1999. The setting was a tertiary referral, university hospital. Three hundred eighty-four patients with 390 penetrating eye injuries were enrolled; 56% were transferred from outlying hospitals.

Results: Penetrating eye injuries were seen almost three times per month. Eighty percent of the injuries occurred in males, and the mean age was 29 years. Twenty-five percent of the patients had used alcohol in the period immediately preceding the injury. Final visual outcome was 28% with enucleation, "no light perception" (NLP) in 10%, light perception to 20/200 in 24%, and light perception of 20/200 or better in 38%. Poor visual outcome was associated with poor initial visual acuity, alcohol use, and delayed presentation (p = 0.036, 0.025, 0.036, respectively). Gun-related injuries caused 33% and motor vehicle crashes (MVCs) caused 21% of the worst outcomes (enucleation or NLP). In MVCs where seat belt use was reported, 71% of injured patients were unrestrained. The most common initial physical findings were hyphema (76%), abnormality of the pupil or uvea (94%), and initial visual acuity worse than 20/200 (77%). All patients had at least one of these findings. Complications occurred in 25% of cases, most commonly traumatic cataract or infection. Complications occurred more commonly in those patients transferred than in those presenting directly (p = 0.002).

Conclusions: Penetrating eye injuries are relatively common, occur predominantly in young males, and often result in poor visual outcome in the affected eye. Motor vehicle crashes, alcohol use, and fire-arm use are associated with more severe injuries.