Outcome and prognosis of pediatric patients with delayed diagnosis of open-globe injuries

Abstract

Purpose: Open-globe injuries in children can present in a delayed fashion, potentially increasing the risk of endophthalmitis and delaying surgical intervention. This article presents the outcome of pediatric patients with delayed diagnosis of open-globe injuries for 24 hours or more.

Methods: The study was a retrospective observational case series of patients who presented with open-globe injuries diagnosed 24 hours or more after the injury between July 2002 and March 2007.

Results: Thirteen patients were included in the study. The average age at presentation was 5.8 +/- 2.8 years; average follow-up was 11.5 +/- 14.5 months. Mean time of presentation after injury was 9.2 +/- 16.0 days. The most common chief complaints were chronic red eye (7 of 13 patients), eye pain (5 of 13 patients), and decreased vision (4 of 13 patients). All patients had self-sealing corneal wounds; 8 of 13 patients had a visually significant traumatic cataract. One patient had sympathetic ophthalmia. Initial visual acuity was 20/200 or worse in 10 patients, and final visual acuity was 20/40 or better in 6 patients. No patient had endophthalmitis.

Conclusion: Open-globe injuries, especially self-sealing corneal wounds, can present in a delayed fashion in children or may be missed if obvious findings, such as subconjunctival hemorrhage or prolapsed iris tissue, are not present. Pediatricians should be educated that they should maintain a high level of suspicion in the setting of chronic unilateral red eye, decreased visual acuity, or abnormal red reflex.