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Nathan Wayne Blessing, Benjamin Peter Erickson, Alexa Marie Franco, Audrey Cinru Ko, Sarah Read, Wendy Wong Lee; Clinicopathologic Characteristics and Outcomes of Lacerating Injuries to the Eye and Ocular Adnexa at a Tertiary Referral Center. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6049.
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Lacerating injuries to the eye and ocular adnexa are encountered both in specialty practices and general emergency departments. However, large cohorts of these patients are not typically identified and treated at a single institution. We performed a retrospective observational clinical study to characterize the demographics, mechanisms of injury, clinicopathologic features, and outcomes of such patients at a large tertiary referral center with the aim of refining current management algorithms and improving patient outcomes.
We retrospectively identified patients who presented to the Bascom Palmer Eye Institute over a 12-month period with open wounds of the eye with and without concomitant damage of the ocular adnexa. Patients repaired primarily at an outside facility or with inadequate documentation were excluded. Demographic information, initial and final visual acuity (LogMAR units), clinical examination findings, and length of follow-up were recorded.
A total of 100 patients (n=93, 7 excluded) were identified with a mean follow-up time of 325 ± 110 days. A majority of patients were male (78%), under the age of 40 (68%, range 2 - 94), and had right-sided injuries (60%). The most common mechanisms were assault (28%) and workplace injuries (25%). The presence of hyphema, uveal prolapse, vitreous hemorrhage, and Zone 2 or 3 injuries were associated with a decrease in final visual outcome (p<0.05). There was no significant difference in final visual outcome in patients with adnexal lacerations or orbital fractures (p>0.05). Presentation with a traumatic cataract or Zone 1 globe injury portended a better visual outcome (p<0.05).
This study provides insights into a population of patients with orbital trauma at a large tertiary referral center. These patients vary widely in their degree of anatomical damage but some clinical findings may be prognostic with regards to visual outcome. In particular, the degree of adnexal damage does not appear to influence the final visual outcome in these patients. In some cases, follow-up was limited due to the patient’s ability to return for local management. Consistent with prior studies, workplace related injuries represent a potential preventable cause of vision loss. No patient in this cohort reported the use of protective eyewear at the time of injury and this remains a key public health concern.
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