Prevalence of Ocular Injuries in the Setting of Trauma: A 6-year Retrospective Analysis from a Level-one Trauma Center

Purpose : To characterize ocular injuries in trauma patients requiring ophthalmic consultation. Methods : The American College of Surgeons (ACS) trauma registry was utilized to identify patients presenting to a level-one trauma center in the Midwest region who received ophthalmic evaluation for associated ocular injuries from January 1, 2006 to December 31, 2012. Data recorded from the registry included patient demographics, mechanism of injury, and the specific ocular injuries encountered. Descriptive analysis of the data was utilized. Results : 212 patients were identified as having ocular injuries related to major trauma requiring an ophthalmic evaluation. 161 patients were male (75.9%, median age 37) and 51 were female (24.1%, median age 44). Mechanisms of injury included: motor vehicle/motorcycle accidents (36%), assault (33%), fall (16%), gunshot injury (3.8%), and accidental or other cause of injury (11.2%). Of the total number of females, 72.5% (n=37) suffered a motor vehicle crash or a fall as a cause of their ocular injury, whereas 70% (n=113) of men suffered a motor vehicle crash or assault. Significant injuries included: open globe injury (24%, n=51), hyphema (16%, n=34), retrobulbar hemorrhage (14%, n=30), traumatic optic neuropathy (7%, n=15), vitreous hemorrhage (7%, n=15), optic nerve transection (2.4%, n=5), and retinal detachment (1.4%, n=3). Other common injuries included: orbital fracture (49%, n=104), eyelid laceration (32%, n=68), subconjunctival hemorrhage (24%, n=51), and corneal abrasions (14%, n=30). Orbital fractures were associated with simultaneous open globe injuries in 18 of the 51 patients (35%), traumatic optic neuropathy in 9 of the 15 patients (60%), and optic nerve transection in 3 of the 5 patients (60%). Seventy (33%) of all these patients required an ophthalmic procedural intervention. Conclusions : Patients presenting to the trauma service can also have significant ocular injuries. Young men are vulnerable to ocular injuries in the setting of trauma, especially with motor vehicle accidents and assaults. Women are more likely to suffer ocular injuries through a motor vehicle crash or fall. Orbital fractures were associated with significant sight threatening ocular injuries. Early ocular evaluation is important in the setting of major trauma, as one third of the patients in this analysis required an ophthalmologic procedural intervention.