A Clinical study of Ocular Manifestations in Head Injury

INTRODUCTION: Head injury is the common cause of death and major disabilities in trauma patients. The visual system is one of the system involved in Traumatic brain injury. The eye is frequently involved due to proximity of the eye to the head as well as due to neural connections between the eye and the brain. Ocular trauma is the important preventable cause of blindness and visual impairment in the world. Eyeball is anatomically well protected inside bony orbit socket and orbital margin, covered anteriorly by eye lids with lashes, embedded in cushion of retrobulbar pad of fat behind. Inspite of all these protections eye is vulnerable to injuries. AIMS AND OBJECTIVES: 1. To evaluate the pattern of ocular manifestations in head injury. 2. To study the final visual outcome. 3. To educate patients about safety measures. MATERIALS AND METHODS: This is a prospective analysis of 164 head injury patients with ocular manifestations attending casualty, neurosurgery and ophthalmology department in Thanjavur Medical College from December 2017 to May 2019 were taken up for study after obtaining informed consent. Following ocular examinations were done in all head injury patients with ocular manifestations: A thorough clinical examination using torch light. Visual acuity by Snellen chart. In few patients vision examination was done bed side considering their general condition. Color vision examination by Ishihara’s test. Pupillary assessment. Slit lamp examination, whenever it was possible. Fundus examination by direct and binocular indirect ophthalmoscopy. B scan -if there is any posterior segment pathology. X ray or CT scan/MRI scan. Gonioscopy and Intraocular pressure measurement (if required). INCLUSION CRITERIA: All head injury patients. Presenting for first time. Unilateral and bilateral. All mode of injuries. All age group. Male and female. EXCLUSION CRITERIA: Previous H/O head and ocular injury. Congenital anomalies. Unconscious patients who did not subsequently recover adequate consciousness. RESULT: Among 164 head injury patients, 144 were males and 20 were females. Maximum head and ocular injuries were in the age group 21-30 years. The leading cause of head injury was Road traffic accident (75%), followed by assault (14.6%) and accidental self fall (10.4%). Most frequent soft tissue injury was periorbital ecchymosis (76.2%). Most frequent neuro ophthalmic manifestation was Traumatic optic neuropathy (12.8%). Orbital fracture was seen in 59.8% of head injury patients. CONCLUSION: Ocular involvement in head injury patients should be carefully evaluated, which can go long way in saving the life and sight of the patient. Road traffic accident related morbidity can be drastically reduced if precautionary measures are taken such helmets and seat belts