The Comprehensive Evaluation and Management of Ocular Trauma in a Tertiary Eye Care Center of Central India

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Abstract (English)

Objectives: This study was aimed to examine the presence of visual damage due to ocular trauma and assess visual outcomes, and document the clinical spectrum and outcome following ocular injuries among patients presenting to tertiary care centre in central India. Methods and Material: This was a hospital-based prospective interventional study conducted over a period of two years from August 2019 to August 2021. Patients with ocular injuries attending the casualty and the Ophthalmology department were included in the study after applying the inclusion and exclusion criteria. A detailed and comprehensive ophthalmic examination was performed and visual acuity was noted at the presentation and follow-ups. The patients were followed up at regular intervals, initially at one week and subsequently at three and six weeks upto 6 months. Results: During this study, 182 patients and 200 eyes with ocular injuries taken into consideration, amongst them there were 141 males (77.47%) and 41 females (22.53%) patients. The male to female ratio was 3.43:1. [Table- 1] During this study, age group with more incidence of ocular trauma was 21 – 30 years (31.32%). [Table -1] In our study, according to BETTS classification close globe injuries (69.5%) were more common than open globe injuries (30.5%). [Table-2] Contusion injuries (62%) were more common in closed globe injury while penetrating globe injuries (17%) were more common in open globe injuries. [Table-2] Ocular trauma score (OTS) 5 belonged to close globe injuries whereas ocular trauma score 1 belonged to open globe injuries, remaining ocular trauma score 2, 3, 4 belonged to both open and closed globe injuries and most of ocular injuries were between ocular trauma score 3 to 5. [Table-3] Ocular adnexa (75.5%) were predominately affected in ocular injuries with periorbital edema or ecchymosis (26%) being most common followed by lid laceration (23.5%) whereas sclera (10%) was least affected. [Table-4] Conjunctiva (47%) was the second most common structure to be involved in ocular trauma with subconjunctival haemorrhage (28%) being most common clinical presentation with conjunctival injuries. [Table-5] Cornea (42.5%) and iris (43.5%) were affected in almost equal proportions, presenting commonly as corneal foreign body (12.5%) and iris prolapse (17%) respectively. [Table-5] Traumatic cataract (7.5%) was the most common finding followed by Subluxated or dislocated (4.5%) in patients with Lens related injuries (13%). [Table-5] Among anterior chamber (36.5%) involvement, traumatic hyphema (17%) was found to be most common presentation [Table-5]. Vitreous (14%) was the most common structure affected followed by retina (12%) in posterior segment injuries (35%).[Table-6] Lid repair (23.5%) was most commonly performed surgery in closed globe and corneal-scleral laceration related surgeries (28.5%) most common surgical intervention in open globe injuries. [Table-7] Corneal opacities (25.5%) most common late complication followed by cataract (7.5%) and secondary glaucoma (5%) after ocular trauma. [Table-8] In closed globe injuries, 34.54% patients had less than 6/60 vision at the time of presentation which reduced to 12.23% after 6 months. [Table-9] In open globe injuries, only 44.26% of patient had visual acuity less than 6/60 after 6 months as compared to 96.72% at the time of presentation. [Table-10]. Conclusion: Ocular trauma remains a significant cause of monocular vision loss especially in developing country like India. Rural and young population are more prone to ocular trauma, entailing increased lifetime of disability years. Though open and closed injuries both causes long term complication and vision loss, open globe has poorer prognosis and ocular trauma score (OTS) is a simple and effective way to assess the visual of outcome. Medical as well as surgical intervention forms integral part of management in ocular trauma patients.