Pattern and clinical profile of patients with ocular trauma presenting to the emergency department of a teaching hospital in India: A prospective observational study

Abstract

Objectives: One major contributor to avoidable ocular morbidity is ocular trauma (OT). The study aimed to document the epidemiological factors, pattern of injury, and outcome among patients with OT presenting to the emergency department (ED).

Methods: This was a prospective observational study conducted in the ED of a tertiary care teaching hospital in Eastern India after due approval from the institutional ethics committee. The data were collected during the period from March 2021 to February 2022. Data pertaining to age, sex, type of injury, mechanism of injury, time and place of injury, details of tissue involvement, visual acuity, any prior history of injury, initial diagnosis, and management were noted. To estimate the severity of the injury and the probable visual outcome, we calculated through OT score (OTS), including one raw score and OTS. Statistical analysis was performed using the R, version 4.6.1.

Results: A total of 180 patient's data were included for final analysis. The median (interquartile range) age of the patients was 32 (24-45) years. The majority were males (n = 147 [81.6%]) with a male-female ratio of 4.5:1. Road traffic accidents (RTA) were the common cause of injury (n = 122 [67.7%]). Unilateral eye involvement was the most common (n = 147 [81.6%]). In the pattern of injury, most of the patients sustained closed globe injuries (CGIs) (n = 158 [87.7%]). Among the CGIs, injury to the ocular adnexa and conjunctiva (n = 141 and 127, respectively) was the most common. Injury to the retina and choroids occurred in 20 (11%) patients. The vision was not affected in most of the cases (n = 125 [69.4%]) with a visual acuity of > 6/18. The majority (n = 120 [67%]) of the patients had an OTS of grade-4, followed by grade-2 (n = 22 [12%]). Most of the patients required only medical management (n = 100 [56%]), whereas 77 (43%) patients required surgical interventions.

Conclusion: OT was a common presentation in the ED. Male patients with monocular injuries involved in RTAs were mostly affected. The vision was preserved in most of the cases.

Keywords: Emergency department; ocular trauma; ocular trauma score; visual impairment.

Figure 1

The flow diagram of the study. ED: Emergency department, OTS: Ocular trauma score

Figure 2

The Clinical image showing pattern of ocular injuries. (a) Lid injury with lacerated nose injury, (b) Close globe injury with conjunctival tear, (c) multiple lid laceration with lower lid avulsion, (d) open globe injury with corneal tear and a metallic foreign body over iris, (e) open globe injury - scleral tear with choroid and vitreous prolapse, (f) open globe injury with Phacocele and Anterior Chamber Hyphema