Epidemiology of ocular trauma hospital presentations in Sydney, Australia: insights for management and prevention

Abstract

Aim: To facilitate care delivery and injury prevention by investigating the nature and outcomes of ocular trauma presentations to a tertiary care center serving an estimated 1.3 million people. Patients and methods: This is an observational case series, retrospectively analyzed, of all patients that presented to the tertiary care center for management of ocular trauma between 01/01/2006-31/12/2006. Data collected included: patient’s clinical findings, major diagnoses, initial and final visual acuity, whether the injury was work related, whether protective eyewear was worn, and whether the patient required surgery or admission to hospital. A final BCVA < 6/12 was defined as significant visual deficit. Eligible patients were identified prospectively by researchers. Patients underwent standardized clinical assessment. De-identified clinical data was entered into a Microsoft Access database retrospectively and analyzed by separate, blinded researchers. Descriptive statistical analysis was then performed in Microsoft Excel. Analysis based on an ordinal regression model and risk factor analysis was performed in SAS.
Results: There were 214 cases of ocular trauma in 197 individuals (17 bilateral injuries). Patients were mostly male (83%) with average age 35. The majority of cases were closed globe injuries (92.1%) with no significant final visual deficit (88.3%). Open globe injuries (7.9%) were more likely to have visual deficit (i.e., 47% with final BCVA < 6/12) (p < 0.01). In total, 13.1% required surgery and 12.1% required admission to hospital. Eye protection was worn in 7.9% of all cases, and 19.1% of work related cases. Nearly one quarter of cases (22.4%) were work related. Open globe injuries were more likely to occur at work. Open globe injuries at work were caused by a metal projectile in 85.7% of cases. Thirty percent of workers suffered a burn, with final BCVA < 6/12 in 10% of burns.
Conclusions: While the vast majority of ocular trauma is superficial with low morbidity, trauma persists as a significant cause of visual impairment. Most vision impairing injuries occur at work, where metal projectiles and burns are common, preventable causes of significant vision loss, which could be targeted in prevention efforts.