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. 2021 Jan 4;36(1):e5.
doi: 10.3346/jkms.2021.36.e5.

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

Jungyul Park  1   2 , Sang Cheol Yang  1   2 , Hee Young Choi  1   2   3
Affiliations

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

Jungyul Park et al. J Korean Med Sci. .

Abstract

Background: To 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.

Methods: We 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).

Results: The 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).

Conclusion: This 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.

Keywords: Birmingham Eye Trauma Terminology System; Epidemiology; Ocular Trauma; Ocular Trauma Score; Trauma Center.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Causes of ocular trauma in patients with major trauma, stratified by age and sex. (A) Distribution of ocular trauma in male patients. More than half of the cases are related to the TAs including motorbike crashes. Especially in 10s–20s, the number of motorbike crashes were significantly higher than other age groups. (B) Distribution of ocular trauma in female patients. Falls and Ped TAs are mostly related major causes of ocular trauma.
TA = traffic accident, Ped = pedestrian.
Fig. 2
Fig. 2. Ocular trauma associated with major trauma grouped according to the BETTS. Most of the ocular trauma patients with major trauma were not categorized into closed-globe injuries or open-globe injuries but most of them were categorized into ‘others.’
BETTS = Birmingham Eye Trauma Terminology System, IOFB = intraocular foreign body.
Fig. 3
Fig. 3. Distribution by residence of ocular trauma patients with major trauma, and its association with deprivation index. Dark gray colored box indicates the upper 5% percentile deprivation index area. Despite the lack of statistical significance, it showed a tendency of increasing the number of trauma cases within area which shows the upper 5% percentile deprivation index. Black line indicates number of ocular traumas. Red line indicates exponential function of the number of ocular traumas.
Fig. 4
Fig. 4. Distribution of final visual acuities according to the initial visual acuities. In univariate analysis, better initial visual acuity was found to be an important predictive factor of favorable visual outcome.
NLP = no light perception, LP = light perception, HM = hand motion, CF = count fingers.
See this image and copyright information in PMC

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