Abstract
Purpose :
According to the United States Eye Injury Registry, gunshot wounds (GSW) to the eye account for approximately 6.5% of ocular trauma injuries. While studies have been conducted on gun-related eye injuries, none have concentrated on gunshot-related open globes in a civilian setting. Our aim is to describe the characteristics and outcomes of open globes secondary to GSW.
Methods :
A retrospective chart review was performed on patients with open globe injuries secondary to GSW at Memorial Hermann Hospital—Texas Medical Center between January 2010 and March 2015. Patient demographics, cause of GSW, gunshot injury characteristics, ocular signs and concurrent injuries, location of injury, evisceration/enucleation performed, and final visual acuity (VA) were recorded.
Results :
Of 480 open globes, 16 were due to GSW (3.3%). The majority were sustained by males (12 [75%]) and adults (≥18 years; 12 [75%]), with mean age 28.4 years (±17.1, range 1-74). Causes of gun trauma were accidental (6 [38%]), assault (5 [31%]), self-inflicted (4 [25%]), and unknown (1 [6%]).
All except 1 were zone 3 injuries. The majority sustained other ocular injuries, including orbital wall fractures (63%), lid lacerations (50%), and hyphema (63%). Four patients (25%) sustained canalicular lacerations. Nine (56%) and 5 (31%) eyes had orbital and intraocular foreign bodies, respectively. Six of the 10 (60%) patients with GSWs who were able to participate in VA testing at initial consultation had no light perception vision. Of the rest, 2 were hand motion, 1 was light perception, and 1 was 20/200.
Ten (63%) open globes underwent surgical repair within 24 hours, 3 (19%) in 24 – 48 hours, and 3 (19%) after 48 hours. Eleven (69%) eyes required an enucleation/evisceration. After surgical repair, 12 (79%) eyes had a final VA of NLP, 1 (6%) eye was HM and 3 (19%) eyes had final VA better than counting fingers. These 3 were all shotgun injuries, of which 2 were accidental and 1 from assault.
Conclusions :
The great majority of open globe injuries secondary to GSW have a poor visual outcome with most suffering unsalvageable damage resulting in evisceration or enucleation. The poor visual prognosis may be explained by the majority sustaining zone 3 injuries, which by nature are typically irreversible. Larger studies are needed to better understand these injuries and prevent their occurrence.
This is a 2020 ARVO Annual Meeting abstract.