Closed globe and adnexal eye injuries: Epidemiology, clinical and surgical outcomes, and an economic cost analysis

Abstract

Background: To examine the epidemiology, visual outcomes, surgical interventions, and socioeconomic costs of closed globe (CGI) and adnexal injuries. Methods: A retrospective 11-year tertiary-trauma centre study of 529 consecutive CGI was conducted using the Revised Globe and Adnexal Trauma Terminology classification in individuals aged ≥16 years. Outcome measures included best-corrected visual acuity (BCVA), operating theatre visits, and socioeconomic costs. Results: CGI disproportionately impacted young males during work (89.1%)and sports (92.2%), with eye protection only worn in 11.9% and 2.0%, respectively. Home was the most prevalent location (32.5%) due to falls (52.3%) in older females (57.9%). Concomitant adnexal injuries occurred frequently (71.5%), particularly in assaults (88.1%), and included eyelid lacerations (20.8%), orbital injuries (12.5%), and facial fractures (10.2%). Final median BCVA improved to 0.2 logMAR [6/9] (IQR 0-0.2) from 0.5 logMAR [6/18] (IQR 0-0.5) (p < 0.001). Surgery was required in 89 CGI (16.8%) in 123 theatre visits. In multivariable logistical regression modelling, presenting BCVA was predictive of final BCVA (odds ratio [OR] 8.4, 95% confidence interval [95%CI] 2.6-27.8, p < 0.001), while involvement of the lids (OR 2.6, 95%CI 1.3-5.3, p = 0.006), nasolacrimal apparatus (OR 74.9, 95%CI 7.9-707.4, p < 0.001), orbit (OR 5.0, 95%CI 2.2-11.2, p < 0.001), and lens (OR 8.4, 95%CI 2.4-29.7, p < 0.001) predicted for operating theatre visits. Economic costs totalled AUD20.8-32.1 million (USD16.2-25.0 million) and were estimated at AUD44.5-77.0 million (USD34.7-60.1 million) annually for Australia.Conclusions: CGI is a prevalent and preventable burden on patients and the economy. To mitigate this burden, cost-effective public health strategies should target at-risk populations.

Globe trauma associated with falls at Australian tertiary centres

“…The majority of patients with fall‐related globe and/or adnexal trauma were elderly and had the fall occur in the home. This is consistent with previous literature where falls by the elderly in the home were overrepresented 26–29 . Additionally, we found that patients most often had at least three risk for falls such as age, chronic disease and polypharmacy.…”

Closed-globe injury due to metallic foreign body in an elderly worker: A case report

“…In an Australian study, the annual socioeconomic cost of closed globe and adnexal injuries is estimated to reach USD 60.1 million [ 6 ]. This is related to the fact that closed globe injury disproportionately affect workers, thus directly impacting the economy [ 10 ]. While global surgery initiatives emphasize the importance of surgical care, there is little discourse on closed globe injuries, especially within developing nations characterized by a substantial working populace [ 11 ].…”

“…Although found to be the most cost-effective ways to address ocular trauma [ 6 ], Indonesia is still struggling with disregard for essential eye protection measures among the workers and the absence of mandated, quality, eye protection policies in Indonesian companies. Furthermore, we strongly advocate for the implementation of a comprehensive global surgery package that include essential tools for ophthalmic surgery, an imperative step, especially in the context of the burgeoning workforce populations within developing nations [ 10 , 12 ]. In order to enhance post-operative care, we also recommend exploring the integration of telemedicine services, which could facilitate remote consultations, catering to patients who may be hesitant to attend in-person appointments due to their work commitments [ 14 ].…”