A study on blunt injury to the eye and its management

Introduction Ocular trauma is one of the major causes of visual impairment worldwide. Annually there are in excess of 2 million cases of ocular trauma with more than 40,000 cases sustaining significant visual impairment on a permanent basis. The incidence of ocular injuries are on the rise with increased industrialization and modernisation. Blunt ocular trauma is more common among mechanical injuries to the eye. Blunt injuries occur at work place, home, in sports, motor vehicle accident, assault etc. Despite the natural protection afforded to the globe by means of the position of the eye ball in a strong bony orbit composed of the skull and frontal bones, orbital soft tissues and the physiological blink reflex. Eye trauma though trivial has a great significance. Ocular trauma not only causes visual impairment but also levies a tremendous financial penalty. In the past, severe blunt trauma invariably resulted in devastating visual loss. Understanding the pathophysiologic mechanism and advent of microsurgical technique and instrumentation has greatly improved the visual prognosis. AIM OF THE STUDY: 1. To study the impact of blunt injury on various structures of the eye. 2. To study the visual outcome in different injuries. 3. To study the demographic profile of the patient's affected. 4. Early intervention of traumatic cataract. 5. To assess the involvement of posterior segment in trivial anterior segment lesions. 6. Role of the CT scan in orbital injuries. 7. Role of B scan in the initial management of trauma. MATERIALS AND METHODS: The study was conducted at Coimbatore Medical College hospital, Coimbatore. The cases were taken from the patient's attending Ophthalmology Department and Emergency Department of Coimbatore Medical College. The study period was from Jan 2006 to October 2007. 110 cases of blunt injury were taken up for the study. Cases included those with trivial external injury to gross visual loss. A detailed history was taken to know the mode of injury and the duration between injury and presentation. Examination started with visual acquity testing with Snellen's chart, anterior segment examination done with slit lamp biomicroscopy. Intraocular pressure recording done after ruling out globe rupture with the help of schiotz tonometer / applanation tonometer Gonioscopy was done in appropriate cases. Posterior segment examination was done with direct and indirect ophthalmoscope. Field charting was carried out in relevant cases. Investigation like x-ray orbit CT scan, ultrasound B scan were done in needed cases. All the cases were followed at regular intervals to assess the visual outcome and complication. CONCLUSION: In our Study, Blunt trauma was more common in males. Most common age group was 3rd decade. Road traffic accidents constituted large number of blunt injuries. Road traffic accidents had a high rate of visual loss due to optic nerve injury. Work related injuries were common among non RTA patients. Few patients developed chronic iridocyclitis due to poor compliance. Visual loss was not severe in anterior segment lesion. Trivial anterior segment injury had vision threatening lesion in the posterior segment. So it is very important to examine the posterior segment in all the patients with injury to the eye. Secondary cataract extraction had comparatively better visual outcome than primary cataract extraction. Posterior segment lesion led to total visual loss due to retinal detachment, vitreous hemorrhage, choroidal tear and optic nerve injury. Globe rupture led to severe visual loss. CT scan is important to rule out direct optic injury and timely intervention and in surgical repair in blowout fracture