Clinical characteristics and functional outcome of pediatric ocular trauma in a third level reference hospital in Guadalajara, Mexico

Abstract

Background: Ocular trauma is one of the leading causes of decreased visual acuity and monocular blindness in the pediatric population. Since its occurrence is potentially preventable, it is essential to understand its demographic characteristics and risk factors to alert and implement prevention and health promotion programs. Methods: We conducted a retrospective study in which we reviewed 187 clinical records of patients ≤ 15 years old with the diagnosis of severe ocular trauma admitted in 2017 to the Hospital Civil de Guadalajara. We analyzed demographic variables, circumstances of the event, type of treatment, and the evolution of visual acuity and complications. Results: In total, 187 patients and 188 eyes were included; the average age was 6.99 ± 4.1 years. Children of 2 to 5 years of age (41%) were the most affected, and a higher occurrence was observed in males (73%). Open ocular trauma was the most common type of injury (72.7%) caused by sharp objects (45.4%). Most injuries occurred at home (78.1%), without adult supervision (48.1%), and during leisure time (74.9%). Most events were accidental (80.4%), although 12.3% were direct aggression. Surgery was required in 179 patients, in whom corneal injury repair (43.2%) was the most commonly used procedure. Final visual acuity was quantified in 132 eyes, and visual acuity < 20/200 was found in 18.1%. Loss of 4.2% of the eyeballs was recorded. Conclusions: The highest proportion of cases was identified in male patients ≤5 years old, unsupervised by an adult. Many eye injuries are preventable, so it is necessary to implement socio-educational programs in alliance with pediatric organizations that alert the severity of the problem and promote safe environments.

Ocular Trauma in Children

“…Next in line of frequency were those in the closed globe trauma category, including hyphema and cataracts. In addition, when compared with similar studies, we found conflicting remarks because several studies 1,4,10,23,24,26,28,39 had open globe trauma as the most common outcome from the insult, whereas several others 7,11,19,22,27,29,34,35 reported closed globe trauma to be the case, the most common manifestation of which was hyphema, subconjunctival hemorrhage, and ocular/adnexa contusion.…”

“…[16][17][18] Moreover, although the prevalence is decreasing, many defects require immediate surgical intervention, leaving the affected individual's caretakers with heavy financial burdens. 4,19,20 Therefore, identifying the type of mechanisms of harm, their prevalence, and ways to improve the methods of surveillance and supervision to control the incidences is of extreme value.…”

“…We also found that most injuries occurred indoors, consistent with the study of Qayum et al 29 and El-Sebaity et al 30 Whether most of the incidents tended to occur under active supervision or not is a matter of conflict in different studies, with a few reporting the former to be the case, 31 whereas several have said the exact opposite. 19,25,29,32,33 However, most of these studies found the injuries to be more prevalent indoors (eg, at home or in closed-space environments), ranging from 50% to more than 78%. 4,[10][11][12]19,21,25,29,32,[34][35][36] In our view, this finding necessitates the implementation of widespread educational programs because the indoor predominance further does, in fact, reveal the existing caretakers' knowledge gaps.…”

“…19,25,29,32,33 However, most of these studies found the injuries to be more prevalent indoors (eg, at home or in closed-space environments), ranging from 50% to more than 78%. 4,[10][11][12]19,21,25,29,32,[34][35][36] In our view, this finding necessitates the implementation of widespread educational programs because the indoor predominance further does, in fact, reveal the existing caretakers' knowledge gaps. More insults in limited indoor spaces reveal more preventable injuries and the importance of careful supervision by parents and caretakers.…”

“…Pediatric ocular trauma has been one of the most clinically defining yet preventable challenges worldwide, with several complications in the long run, ranging from minor defect to complete vision loss 16–18 . Moreover, although the prevalence is decreasing, many defects require immediate surgical intervention, leaving the affected individual's caretakers with heavy financial burdens 4,19,20 . Therefore, identifying the type of mechanisms of harm, their prevalence, and ways to improve the methods of surveillance and supervision to control the incidences is of extreme value.…”