Ocular manifestations of head injury: a clinical study

Abstract

Aim This prospective study aimed to clinically correlate the various ocular findings with the neurological status in cases of closed head injury. Methods A total of 200 consecutive cases of closed head injury admitted to a major teaching hospital underwent a thorough ophthalmic assessment. The Glasgow coma scale (GCS) and the Revised trauma score (RTS) were applied to grade the severity of injury and assess the prognosis. Kendall's tau-b and Fisher's exact test were used in the analysis. Results The main causes of head injury were road traffic accidents 52.5% followed by assaults in 34%. Ocular involvement was found in 167(83.5%) cases. These included corneal and scleral tears in 2%, subconjunctival haemorrhage or ecchymosis in 46%, orbital fractures 12%, pupillary involvement 6.5%, papilloedema 5.5%, intraocular trauma 5.5%, proptosis 3%, lateral rectus palsy 2%, lacrimal gland prolapse 1%, and optic nerve trauma 0.5%. All 21 patients (10.5%) who died had eye involvement. In all, 150 cases (75%) with a RTS of 12 had a good prognosis. Of these 124 (82.6%) had ocular involvement of no neurological significance. Conclusions Although sophisticated imaging techniques are available to localize lesions, early ophthalmic assessment in correlation with the GCS aids in prognosticating outcomes. Pupillary involvement, papilloedema, and ocular motor paresis pointed to a more severe head injury. To our knowledge, this is the only prospective study recording ocular findings in the first few hours and attempting a correlation with the final outcome.

Computed Tomographic Evaluation of Orbito-Ocular Injuries in Patients with Acute Head Trauma in University of Abuja Teaching Hospital Gwagwalada.

“…It was therefore not surprising to see that a large proportion of patients (22.4%)with head traumaassociated with ocular manifestations, RTA were responsible. This finding was also obtained in several other studies worldwide 4,[16][17][18] . In this setting reasons for high rates of RTA are multifactorial however, bad roads, poorly maintained vehicles, lack of appropriate government policies on road safety rules,lack of adherence to traffic regulations by road users, speed limits are not strictly observed as well as unlicensed careless driving is treated with levity may all be responsible.…”

“…The prevalence of ocular findings on computed tomography in patient with acute head injury in this study was 26.6%. This was higher than value(7.1%) obtained by Salaam et al 13 in their work on Computed Tomography: Ocular manifestations in acute head injury patients in Jos University Teaching Hospital, but lower than value reported (83.5%)by Kulkarni et al 17 in their study on ocularmanifestations of head injury. HoweverKulkarniet al 17 included abnormal ocular findings noted clinically and on computed tomography in patients with head injury.…”

“…This was higher than value(7.1%) obtained by Salaam et al 13 in their work on Computed Tomography: Ocular manifestations in acute head injury patients in Jos University Teaching Hospital, but lower than value reported (83.5%)by Kulkarni et al 17 in their study on ocularmanifestations of head injury. HoweverKulkarniet al 17 included abnormal ocular findings noted clinically and on computed tomography in patients with head injury. The similarities of this present study with Salaamet al 13 is ocular features in head trauma patients were limited to findings that were picked on Computed tomographyimaging.…”

Ocular Complications among Cases of Head Injury Seen in a Neurosurgical Hospital in Southeastern Nigeria

“…This is probably due to the fact that men 5,7,8 are more likely to be involved in activities that could lead to injuries, such as assault, or a fall from a height, etc.…”

“…Head injuries with multiple facial, ocular and neuro-ophthalmic involvement are a common outcome of these accidents. They are of great significance [4][5][6][7][8] due to the visual morbidity and mortality that could result. Even though direct injury to the orbit and globe can easily result in ophthalmic disorders, it is less appreciated that distant head injury can similarly result in injury to the retrobulbar afferent visual pathways.…”