Year : 1988 | Volume
: 36 | Issue : 2 | Page : 86--87
Ocular injuries--in union territory of Pondicherry-Visual outcome
Mathew M Krishnan, Renuka Srinivasan
Professor of Ophthalmology, JIPMER Pondicherry, India
Mathew M Krishnan
Professor of Ophthalmology, JIPMER Pondicherry
The visual outcome in 309 cases of ocular trauma hospitalised over a 7 year period has been studied. There was total visual loss in 63 patients (20.3%) and poor vision in 108 (34.60%), moder�ate visual impairment was seen in 35 (13.92%) and good vision retained in 83 (26.89%). In a small number of patients visual assessment was not possible (3.88%).
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Krishnan MM, Srinivasan R. Ocular injuries--in union territory of Pondicherry-Visual outcome.Indian J Ophthalmol 1988;36:86-87
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Krishnan MM, Srinivasan R. Ocular injuries--in union territory of Pondicherry-Visual outcome. Indian J Ophthalmol [serial online] 1988 [cited 2023 Nov 30 ];36:86-87
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1988/36/2/86/26140
A retrospective analysis of 309 cases of ocular injuries admitted over a 7 year period from Jan. 80 to Dec. 86, is presented, with special reference to the visual outcome. We compare our statistics with other studies. The possible reasons for the visual results are discussed.
Material and Methods
309 cases of ocular trauma over a 7 year period were analysed All cases had been hospitalised for treatment The visual acuity in the four groups was noted viz blunt, penetrating, extraocular and chemical injuries.
Observation and Results
Blunt injury: Of the 77 cases, there was no light percep�tion in 21 cases (27.27%), visual acuity less than 6/60 in 27 cases (35.06%), between 6/60 and 6/18 in 16 cases (20.77%) and greater than 6/18 in 9 cases (11.68%). In 4 cases, vision could not be assessed.
Penetrating injury: Of the 173 cases with penetrating injury, there was no light perception in 42 (24.27%) eyes, a large number, 79 (45.3%) had visual acuity less than 6/60, moderate visual loss (more than 6/60 but less than 6/18) was seen in 22 (12.7%) eyes. Good vision was preserved (i.e. more than6/18) in22 (12.7%) eyes. Visual acuity could not be assessed in 8 cases.
Extraocular and chemical injuries : 52 cases out of 59 (88.13%) had good vision.
The impact of trauma on visual acuity is particularly important' because of its sudden repercussion on the socio-economic state of the individual In the U.S. 3.7% of blindness is reported to be due to traffic injuries. The kind of trauma seems to be an important parameter for the visual outcome.
Perforating trauma appears to be particularly incompa�tible with good vision in this study, the injury was severe enough to destroy all useful vision in 24.27% of cases and caused severe visual impairment in several more (45.01%).
Other authors too have reported a similar high rate of ocular morbidity. Eva (Sweden) (1) reports 50% visual disablement in perforating lesions. Oyin Olurin (Nigeria)  reports loss of light perception in 187 out of 470 cases (3 9.78%) of ocular trauma Panda et al. (Delhi)  report absent vision in 55.2%, moderate vision in 24.3%, good vision in 20.5% in ocular trauma This is obviously related to the damage to the cornea and other vital intra ocular structures. The high rate of lenticular damage (50.8%) is quite contributory, for it is often associated with persistent uveitis and intractable glaucoma. Delayed complications like panophthalmitis, persistent uveitis, secondary glaucoma occured in 27.16% of cases. It is tempting to assume that with the advent of vitrectomy techniques, and the tendency towards more energetic management of intraocular damage e.g pri�mary lens extraction, vitrectomy and anterior segment reconstruction for ocular trauma, the final visual out�come may improve. The possibility of increasing the risk of sympathetic ophthalmia with increased intraocular manipulation and aggressive surgery in an already prone eye should also be borne in mind.
Blunt injury: Although in comparison to penetrating trauma, the overall visual outcome seems better, blunt injuries also contribute heavily towards visual loss. Total visual loss (No light perception) was seen in 21 eyes (27.27%), less than6/60 in27 (35.6%),6/60 to6/18 in 16 (20.97) good vision 6/18 in 9 (11.68%). Comparative figures from other authors: Eva L (Sweden)' report only 15 cases of disablement in 223 cases of blunt trauma in a 5 year period. This is due to the fact that only 21 out of 233 cases in that series had an intraocular involve�ment In the remaining there were only trivial extra ocular trauma
Panda et al  report an even poorer visual outcome ie. absent vision in 55.2%, moderate vision in 14.1% and good vision in 20.5%.
Lenticular damage and posterior segment changes (macular oedema, retinal detachment vitreous haemo�rrhage) were chiefly responsible for poor vision in most of our cases Although as is to be expected, cases with ruptured globe often had very poor vision, two cases out of 10 had fairly useful vision This is probably an indication towards a more conservative approach to enucleation even in seemingly severely damaged eyes.
Extraocular injuries : Extraocular injuries are usually not associated with much visual loss Even in severe lid injuries the eye ball was remarkably unscathed empha�sising the protective function of the adnexa Panda et all report 40% good visual result and 50% poor vision due to optic nerve damage. But the total number of cases in that study was too small 16.
Hence, it is reasonable to conclude that any intraocular injury is incompatible with good vision The high rate of visual morbidity in intraocular injuries is probably related to several factors.
1. Delicacy of the ocular tissues- This makes the effect of trauma particularly graver in the eye than in other parts of the body. A trauma which elsewhere causes little or no concern, can, if it occurs in the eye result in permanent blindness.
2. Severity of the injury- In many cases the injury was such that there was grave damage to the eye with little chance of restoring vision, whatever the treatment.
3. Delay in consultation - The delay in seeking help is quite contributory, for such a delay increases the chances of uveitis, secondary infection and also renders treatment more difficult owing to oedema of the wound edges.
|1||Eva Lindstedt Acta Ophthal44, 590-606, 1966.|
|2||Oyin Olurin Am. J. Ophthal 72, 159-164, 1971.|
|3||Panda A. IM Bhatia, Y Dayal Afro Asian J of Ophthal III, 167-172, 1985.|