The spectrum of iatrogenic intraocular injuries caused by inadvertent cannula release during anterior segment surgery

OBJECTIVE

To evaluate the causes of inadvertent intraocular injuries resulting from the use of cannulas during anterior segment surgery. Method Retrospective review of all cases with inadvertent release of irrigation and viscoelastic cannulas during anterior segment surgery in 15 years.

RESULTS

Inadvertent release of cannulas occurred in 9 of 10 230 cases of anterior segment surgery during a 15-year period. The incidence of cannula release was 0.88 per 1000 procedures per year. Twenty percent of the surgeons who performed anterior segment surgery in this period were involved in this unfortunate event. Six cases occurred during cataract extraction and 3 during penetrating keratoplasty or replacement of corneal graft. The latter 3 cases included posterior capsule rupture and vitreous loss. Macular scar in 2 (22%) of the 9 cases was associated with poor visual outcome of counting fingers at 2.1 to 3.0 m (P = .03). In all other surgeries, the cannula caused iris or anterior chamber angle injury without consequences.

CONCLUSIONS

Inadvertent release of cannulas during anterior segment surgery is a rare, memorable, and unfortunate event. The severity of the injury may be related to the type of the surgical wound. In most cases, visual outcome is not compromised unless the cannula causes retinal disruption.

[Ocular injuries in mild facial trauma]

Ocular contusions are common and cause significant morbidity. The mechanism of ocular contusion is a decrease in the length of the anterioposterior axis whereas the transversal axis increases. Epidemiology data shows that young men are most injured in relation with sports, aggression, work, or car or work accidents. Injury to the ocular surface (conjunctiva and cornea) is minor. The iris is very frail, usually leading to hyphema which can progress to glaucoma. A cataract can appear after a contusion but usually years after the trauma. Final visual acuity can be compromised by retinal contusion or retinal detachment (due to a retinal dehiscence or post-traumatic dialysis). The worst outcome is optic neuropathy. The most difficult task is to predict visual acuity after the initial ocular lesion.

Proposed new classification scheme for chemical injury to the human eye

PURPOSE

Various ocular alkali burn classification schemes have been published and used to grade human chemical eye injuries for the purpose of identifying treatments and forecasting outcomes. The ILSI chemical eye injury classification scheme was developed for the additional purpose of collecting detailed human eye injury data to provide information on the mechanisms associated with chemical eye injuries. This information will have clinical application, as well as use in the development and validation of new methods to assess ocular toxicity.

METHODS

A panel of ophthalmic researchers proposed the new classification scheme based upon current knowledge of the mechanisms of eye injury, and their collective clinical and research experience. Additional ophthalmologists and researchers were surveyed to critique the scheme. The draft scheme was revised, and the proposed scheme represents the best consensus from at least 23 physicians and scientists.

RESULTS

The new scheme classifies chemical eye injury into five categories based on clinical signs, symptoms, and expected outcomes. Diagnostic classification is based primarily on two clinical endpoints: (1) the extent (area) of injury at the limbus, and (2) the degree of injury (area and depth) to the cornea.

CONCLUSIONS

The new classification scheme provides a uniform system for scoring eye injury across chemical classes, and provides enough detail for the clinician to collect data that will be relevant to identifying the mechanisms of ocular injury.

Approach to ophthalmologic emergencies

This article presents evaluation and treatment approaches to ophthalmologic conditions that are likely to be encountered in a primary care office. These conditions can be organized by diagnostic category, symptoms, and location of complaint. By using one ora combination of these categories, the practitioner can provide appropriate, timely, and effective ophthalmologic evaluation and treatment. Acute conditions are categorized according to urgency of intervention.

Assessment of occupational eye injury risk and severity: an analysis of Rhode Island workers' compensation data 1998-2002

BACKGROUND

Occupational eye injuries have been recognized as a serious health risk to workers and are in need of further investigation to develop effective interventions.

METHODS

Rhode Island workers' compensation claims of ocular injury between 1998 through 2002 (n=8,877) were examined. The Current Population Survey was used to estimate occupational employment levels as a baseline for rate calculations.

RESULTS

The estimated ocular injury claim rate was 32.9 per 10,000 workers (95% CI=32.3-33.6), with the cost of claims totaling $1,514,666 and averaging $171 per claim. The highest estimated claim rate of all occupations was found for construction laborers of 373.7 per 10,000 workers (95% CI=267.1-480.3). Relative to the durable manufacturing industry, the highest risk of injury resulting in disability indemnification was the wholesale trade industry (OR=2.18, 95% CI=1.19-4.01, P<0.05).

CONCLUSIONS

Many of the eye injuries reported were likely preventable. Greater diligence, training, and safety precautions are needed to reduce the risk of eye injury to employees.

Welding related occupational eye injuries: a narrative analysis

OBJECTIVE

To determine the activities and circumstances proximal to a welding related occupational eye injury, a hybrid narrative coding approach derived from two well developed classification systems was developed to categorize and describe the activity, initiating process, mechanism of injury, object and/or substance, and the use of protective eyewear from the narrative text data reported for each injury.

METHODS

Routinely collected workers' compensation claims over a one year period (2000) were analyzed from a large US insurance provider. An index term search algorithm of occupation, incident, and injury description fields identified 2209 potential welding related eye injury claims. After detailed review of these claims, 1353 welders and 822 non-welders were analyzed.

RESULTS

During 2000, eye(s) as the primary injured body part accounted for 5% (n = 26 413) of all compensation claims. Eye injuries accounted for 25% of all claims for welders. Subjects were mainly male (97.1%) and from manufacturing (70.4%), service (11.8%), or construction (8.4%) related industries. Most injuries were foreign body (71.7%) or burn (22.2%) and 17.6% were bilateral. Common activities include welding (31.9%) and/or grinding (22.5%). Being struck by an airborne object occurred in 56.3% of cases. Non-welders showed similar patterns except that burns (43.8%) were more frequent and more often initiated by another worker (13.9%).

CONCLUSIONS

Narrative injury text provides valuable data to supplement traditional epidemiologic analyses. Workers performing welding tasks or working nearby welders should be trained to recognize potential hazards and the effective use of proper safety equipment to prevent ocular injury.

[The present situation and progress in the research of the mechanical eye injury in China]

The patients of eye injury of inpatients and outpatients in county and prefecture hospitals were reported in some proportion in the ophthalmologic literature. Eye injury was the leading cause among the blind eyes determined at the discharge from the hospitals. Therefore, the prevention and treatment of eye injury has been the priority for Chinese ophthalmologists. In recent years, the international standard classification of the type and location of eye injury has been accepted and adopted in China. The level of primary wound management for eye injury has been raised in all hospitals. The timing of continued treatment sustaining vitrectomy procedures has been emphasized widely. The indications of primary enucleation have been strictly controlled by ophthalmologists. The remarkable progress has been made in rescue of presumed enucleation candidates. It is essential to establish a nationwide registry system and to conduct the multicenter trial for the control of eye injury in the future.

[Modification of the presentation of ocular trauma by age group in an urban Mexican population]

INTRODUCTION

We identified whether ocular trauma presentation, according to the system for classifying mechanical injuries of the eye, had modifications among different age groups, which could be useful as damage predictors during the initial evaluation of these patients.

MATERIAL AND METHODS

Ocular trauma referrals between 1995 and 2003 were re-qualified according to the system for classifying mechanical injuries. Patients were divided into 5-year groups and the most frequent categories of type, grade, pupil and zone were determined by group. Mean age of each category and the rate of categories between groups were compared (ANOVA and Kruskal-Wallis, chi2 and odds ratio [OR]).

RESULTS

Five hundred sixty-six eyes of 551 patients were evaluated (age: 0.5-90 years, mean age: 27.7); mean age was lower for type B closed globe trauma and zone II (p < 0.05). There was a higher rate of grade 1 in patients > 60 years (OR 3.8), of grade 4 in patients < 54 years (OR 3.25) and of type B closed globe in patients > 20 years (OR 3.3). The remaining comparisons showed no clinical differences.

CONCLUSIONS

There were no significant modifications in the presentation of most of the categories between age groups. Age difference was not useful as a predictor for detecting traumatic ocular damage.

[Epidemiology of open globe eye injuries: analysis of 1026 cases in 18 years]

BACKGROUND

Ocular trauma has significant impact on the patient's future quality of life. Progress in the treatment of ocular trauma may ameliorate the outcome, but preventive measures are more effective. However, prevention of ocular trauma can only be effective when the current epidemiology of ocular trauma is known. Therefore, we have now collected data on ocular trauma over nearly 20 years. This paper provides an overview on the development of open globe injuries in the past 20 years.

PATIENTS

The records of 1026 patients with open globe injuries who were primarily treated at the Universities of Freiburg and Würzburg between January 1, 1981 and December 31, 1999, were sufficiently analyzed. The following parameters were evaluated: age, extent of injury, sex, cause. and activity at the time of injury.

RESULTS

After correction for demographic distribution, the risk for open globe injury was highest for young adults and lowest for seniors. In recent years, the risk for severe eye injury is more equally distributed and is increasing for old people. We noted decreasing injuries at work and during traffic accidents, especially for young female front-seat passengers. On the other hand, we observed an increasing proportion of domestic eye injuries related to hobby activities. With increasing age we noted more posterior segment injuries. 9 % of all open globe injuries occurred among seniors (> 65 years old), but 41 % of all ruptures occurred in this age group. Preceding cataract surgery was identified as a risk factor. 38 % of injured persons in this age group had already had intraocular surgery. After the introduction of small incision techniques at the beginning of the 1990 s, the frequency of globe ruptures began to decrease again. 3.6 % of the injured eyes developed an endophthalmitis, in agricultural injuries the rate of endophthalmitis was 12 %.

CONCLUSION

There is a relative constant incidence of 3.0 open globe injuries per 100,000 population. The circumstances of the injuries underwent major changes within the period of these observations.

[Functional prognosis in ocular trauma. Does visual deficiency help in localizing the injuries that cause it?]

BACKGROUND

Prevalence of reported trauma-related blindness is 0.6% with almost half of serious ocular injuries involving the retina. Causes of visual deficit (VD) in ocular trauma were identified in patients with different grades (visual capacity), in order to determine the rate of poor functional prognosis at initial evaluation caused by posterior segment involvement and to identify a grade that could predict it.

METHODS

Ocular trauma referrals were re-qualified (1995-2003) according to the standardized classification. VD (grade >1) and zone were evaluated. The rate of VD and zone III with VD were determined. Injuries causing VD were identified and grouped by zone. The rate of these injuries was compared by zone, between each grade and the remaining, with chi2.

RESULTS

Five hundred fifty-seven eyes were included (mean age 27.7 years), 165 had VD (29.6%, CI 95% 25.8-33.4); 93 had zone III involvement (16.7%), 53 of whom had VD (9.5%, CI 95% 7.1-11.9%). Among injuries that caused VD (n = 323), 102 involved zone I (31.6%), 144 zone II (44.6%), and 77 zone III (23.8%). Injuries in zone III were more frequent in grade 5 (52%) than in the remaining groups (21.5%, p = 0.0005, OR 3.9).

CONCLUSIONS

In 90.5% of the eyes (CI 95%, 88.1-92.9), injuries caused VD by means of anterior segment involvement or did not cause it at all. A high rate of ocular trauma patients, even those with grade 5 at initial evaluation, may have an opportunity for visual recovery with early referral.

[Eyebrow injuries. Classification and therapy concept]

The aim of primary treatment for eyebrow injuries should be preservation of the original eyebrow under any circumstances. Debridement should be kept to a minimum even when the wound is severe. The treatment of total or partial loss of an eyebrow concerning the exact reconstruction of details and aesthetic aspects is a challenge for the surgeon. The therapy option depends on the type of eyebrow selected for reconstruction. We present a classification for eyebrow injuries, which considers type and size of defects. Based on this, different techniques and methods of reconstruction are recommended. Advantages and disadvantages are discussed and illustrated by several examples.

Ocular trauma in a rural south Indian population: the Aravind Comprehensive Eye Survey

PURPOSE

To determine the rate of ocular trauma in a rural population of southern India and its impact on vision impairment and blindness.

METHODS

A population-based cross-sectional study of 5150 persons 40 years or older in a randomly chosen rural population of 3 districts of southern India. Prospective information on trauma, type and agent of injury, setting of injury, and details of treatment sought for the last episode was recorded with questionnaires after face-to-face interviews. All interviewed subjects underwent a comprehensive ocular examination, including vision estimations, slit-lamp biomicroscopy examinations, and dilated posterior segment examinations.

RESULTS

We elicited a history of ocular trauma in either eye from 229 (4.5%) persons, including 21 (0.4%) persons with bilateral ocular trauma. Blunt injuries (n = 124; 54.9%) were the major cause for trauma reported in this population. The most common setting where the ocular trauma occurred was during agricultural labor (n = 107; 46.9%). Nearly three quarters (n = 170; 74.2%) of those reporting ocular trauma sought treatment from an eye specialist (n = 104; 57.8%) and one fifth (n = 37; 20.6%) from a traditional healer. The age-adjusted (adjusted to the population estimates for India for the year 2000) prevalence for blindness in any eye caused by trauma was 0.8% (95% confidence interval [CI], 0.4-1.1). The odds ratios (OR) for trauma were higher for males (OR, 2.2; 95% CI, 1.6-3.0) and laborers (OR, 1.7; 95% CI, 1.2-2.4) and lower for literates (OR, 0.7; 95% CI, 0.5- 0.9). Seeking treatment from a traditional eye healer for trauma was not associated with vision impairment (OR, 1.0; 95% CI, 0.3-3.2) or with blindness (OR, 3.4; 95% CI, 0.2-56.5).

CONCLUSIONS

Eye care programs may need to consider ocular trauma as a priority in this population, because the lifetime prevalence of ocular trauma is higher than that reported for glaucoma, age-related macular degeneration, or diabetic retinopathy from this population. Simple measures such as education regarding the use of protective eyewear could possibly significantly decrease this preventable cause of visual disability.

[Traumatology of the eyelids--what is to be done for the initial care?]

We describe the injuries of the eyelids depending on the reason, type and severity of the trauma. We are giving a diagnostical guide. By references to the anatomical specialties of the eyelids we deliver therapeutical recommendations for the different types of injuries.

Augenverletzungen im Kindes- und Jugendalter

Childhood trauma of the eye and its adnexa represents approx. 4 - 20 % of all eye injuries. Due to ambiguous patient history and limited cooperation a comprehensive diagnosis of pediatric eye trauma is often difficult. The weakness of the infantile cornea, the thin and elastic anterior lens capsule, and the firm vitreous with its strong adherence to the retina bear particular intra- or postoperative problems. Moreover, the quick development of secondary cataract and the high risk of PVR may complicate the posttraumatic and postoperative course. Small infants represent a special subgroup in various regards mainly because of the risk of amblyopia which often causes functional loss in spite of a good anatomical reconstruction. The relative frequency of certain injuries differs between children and adults. The ocular manifestation of child abuse as well as bite and fireworks injuries are characteristic for childhood and will be discussed more in detail.

Outpatient management of traumatic hyphema in children: prospective evaluation

PURPOSE

To evaluate the clinical outcome of children with traumatic hyphema treated on an outpatient basis.

METHODS

A prospective cases series. Thirty-five children with traumatic hyphema were treated as outpatients for the ocular injury from February 2002 to February 2003. Data regarding initial and final visual acuity, slit-lamp biomicroscopy, hyphema size,ophthalmoscopy, intraocular pressure, rebleeding, clearance time, and medical and surgical intervention were recorded.

RESULTS

Thirty (85.7%) children were male, and the major cause of traumatic hyphema was domestic tools (14 cases, 40.0%). Twenty-four patients (68.6%) presented low grades of hyphema. Seventeen patients (48.6%) had intraocular pressures higher than 24 mm Hg. The most common lesions associated with traumatic hyphema were corneal injuries (16 cases, 45.7%). The median final visual acuity was 20/25. Unsatisfactory final visual acuity (worse than 20/30) was statistically associated with ocular posterior segment lesions (P = 0.009) and grade of hyphema (P = 0.004). The grade of hyphema was also related to intraocular hypertension (P = 0.018) and time for hemorrhage absorption (P < 0.001). Nine patients (25.7%) underwent surgical intervention. Rebleeding occurred in three patients (8.6%).

CONCLUSIONS

Outpatient management is a feasible option for children with hyphema. Associated posterior ocular segment injuries and hyphema of greater magnitude were related to the worst final visual acuities.

Prognostic factors in open eye injury managed with vitrectomy: retrospective study

AIM

To evaluate surgery results and establish prognostic factors that predicted final functional (good or poor vision) and anatomic (final retinal detachment) outcome in open eye injury involving the posterior segment managed with pars plana vitrectomy.

METHODS

Medical records of 52 consecutive patients with open eye injury involving the posterior segment were retrospectively reviewed. Specific variables of a system for classifying mechanical injuries of the eye were analyzed: the type of injury (defined by the mechanism of injury), grade of injury (defined by initial visual acuity), zone of injury (defined by the location of the wound), and relative afferent pupillary defect. Additional variables, such as wound length, retinal detachment, endophthalmitis, and timing of vitrectomy, were also included in the analysis. Final visual outcome and retinal attachment rate were recorded. Data were analyzed with chi-square test, univariate analysis for predictors, and multivariate logistic regression analysis.

RESULTS

After a mean follow up of 20.0+/-10.5 months, 50% of eyes achieved visual acuity 0.5 or better, 27% of eyes achieved visual acuity 0.1 or worse, and 10% of eyes had final retinal detachment. According to univariate analysis results, the following parameters were predictors of good vision (visual acuity > or =0.5 in comparison with visual acuity <0.5): grade of injury (p=0.008), zone of injury (p=0.01), afferent pupillary response (p<0.001), wound length (p=0.002), and initial retinal detachment (p=0.009). The predictors of poor vision (visual acuity < or =0.1 in comparison with visual acuity >0.1) were zone of injury (p<0.001), relative afferent pupillary defect (p<0.001), wound length (p=0.002), and initial retinal detachment (p<0.001). Relative afferent pupillary defect (p=0.003) and initial retinal detachment (p<0.001) were predictors of final retinal detachment with proliferative vitreoretinopathy. However, multivariate logistic regression analyses revealed that relative afferent pupillary defect was the only significant factor for poor visual acuity (odds ratio, 10.3; 95% confidence interval, 1.1-92; p=0.04). On the other hand, none of the variables was a significant independent predictor for either good visual acuity or final retinal detachment.

CONCLUSION

Half of the eyes with a good final visual outcome in our study were successfully managed with pars plana vitrectomy for open eye injury after trauma. The classification system may become useful prognostic tool for visual outcome in posterior segment ocular injuries managed with vitrectomy. Relative afferent pupillary defect as a functional test is a good predictor for visual outcome.

Epidemiology of adult eye injuries in Split-Dalmatian county

AIM

To determine the incidence of eye injuries, population groups at risk, circumstances and activities at the time of accident, causes, mechanism, type and severity of injury, therapeutic procedures, final outcome, and the incidence of blindness in patients over 18 years of age.

METHODS

We retrospectively analyzed data on 383 patients with eye injuries (397 eyes) hospitalized at Split University Hospital, Department of Ophthalmology, between January 1998 and December 2002. Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) and eye injury score were used for eye injury categorization.

RESULTS

The incidence of ocular injuries requiring hospitalization in Split-Dalmatian County was 23.9 per 100,000 population and the incidence of monocular blindness caused by injuries was 4.1 per 100,000 population. The male to female ratio was 5.4 to 1. Forty-one percent of injuries occurred at home, 27.7% at work, 13.8% in agriculture, 7.0% during assault or scuffle, 5.2% in traffic, 3.7% during sports activities, and 1.6% at school. Among 397 injuries, 86.4% were mechanical and 13.6% chemical. Out of 343 mechanical injuries, 67.3% were closed globe and 32.7% were open globe injuries. The most frequent objects causing mechanical injuries were tree branch or wood (15.9%) causing 26.3% of ruptures and 21.4% of contusions; pieces of metal or stone (13.9%) causing 80.8% of intraocular foreign body lacerations; and nails, wire, or scissors (8.8%) causing 26.7% of lamellar and 23.9% of penetrating lacerations. Closed globe injuries were less severe and had better final visual outcome than open globe injuries. Final visual acuity was 0.4 or better in 91.4% of mild vs 13.9% of severe injuries. Injuries resulted in monocular blindness (visual acuity <0.1) in 71 (17.9%) patients: 35.2% were due to penetrating lacerations, 23.9% to ruptures, 21.1% to contusions, 16.9% to intraocular foreign body lacerations, and 1.4% due to burns as well as lamellar lacerations.

CONCLUSION

There was a high incidence of ocular trauma and consequent blindness in Split-Dalmatian County. For the prevention of serious eye injuries, health education and safety strategies should be applied both at home and place of work, where blinding injuries most often occur.

Structural changes in ocular trauma and the visual outcome

This is the presentation of one year prospective study on the anatomical structural lesions in ocular traumas with their visual outcome among those cases admitted and treated at Nepal Eye Hospital, Kathmandu. The changing life style of the people and environmental changes around with the changing nature of the causative objects on eye injuries have been observed for causing more serious structural lesions or complications including loss of vision.

The prognostic significance of a system for classifying mechanical injuries of the eye (globe) in open-globe injuries

PURPOSE

The aim of this study was to determine the prognostic significance of a previously published system for classifying mechanical injuries of the eye (globe) in open-globe injuries.

METHODS

The medical records of 150 patients with open-globe injuries identified from an established institutional database were retrospectively reviewed to classify all injuries at presentation by the four specific variables of the classification system: type of injury, defined by the mechanism of injury; grade of injury, defined by visual acuity in the injured eye at initial examination; pupil, defined as the presence or absence of a relative afferent pupillary defect in the injured eye; and zone of injury, defined by the location of the eye-wall opening. Final visual outcomes for these injuries were also recorded. Logistic regression models were used to analyze the data and to determine whether relationships existed between the specific classification variables and final visual acuity in the injured eyes.

RESULTS

All four classification variables were significant predictors of visual outcome. When adjusted for the other variables, grade and pupil were the most significant predictors of final visual acuity.

CONCLUSION

This system for classifying mechanical injuries of the eye appears to be prognostic for visual outcomes in open-globe injuries. In particular, the measurement of visual acuity and testing for a relative afferent pupillary defect at the initial examination should be performed in all injured eyes because of their relative prognostic significance.

[Identification opportunity for several types of eye injuries]

OBJECTIVE

To study the stability duration of visual acuity after eye injuries in several types, in order to define the earliest and best opportunity for identification.

METHODS

160 cases were divided into five groups, in which their stable visual acuity after injuries were divided into several ranges. Then the relationship between stability duration of visual acuity and their visual acuity level, as well as eye injury types were analyzed.

RESULTS

Significant correlation existed between eye injury types, stable visual acuity level and stability duration of visual acuity after injuries.

CONCLUSION

The earliest and best opportunity for identification after eyes injuries related to injury types and visual acuity level.

Ocular and periocular injuries from orbital fractures

BACKGROUND

Orbital fractures are associated with ocular and periocular injuries. The role of the ophthalmologist in the evaluation and management of facial trauma, including orbital fractures, has not been clearly defined. The purpose of this study is to identify and characterize ocular and periocular injuries associated with orbital fractures to define the role of the ophthalmologist in the management of facial trauma.

STUDY DESIGN

Retrospective case review.

RESULTS

Three hundred sixty-five patients with orbital fractures who were evaluated by an ophthalmologist as part of their initial trauma evaluation were studied. The majority of the patients with orbital fractures (74%) did not have associated ocular or periocular injuries. Twenty-three of 104 (22%) ocular injuries in 23 of 95 (24%) patients required immediate intervention by an ophthalmologist.

CONCLUSIONS

Facial trauma and orbital fractures are associated with significant ocular and periocular injuries, the minority of which require immediate evaluation and treatment by an ophthalmologist. These results differ from those previously reported.

Open eye injuries in the pediatric population in Kuwait

OBJECTIVE

To report the epidemiological characteristics of pediatric open globe injuries and to discuss treatment, management and outcomes of such injuries.

MATERIALS AND METHOD

The hospital records and operative notes of 95 patients 16 years old and younger who were treated for open eye injury at Ibn Sina Hospital, Kuwait between September 1995 and January 1999 were reviewed. The average age of patients was 6.6 years. Patients were divided into three groups according to their final visual acuity (FVA): group 1, FVA of 20/40 or better; group 2, 20/40-20/200, and group 3, 20/400 or worse. The FVA of each group was compared to initial visual acuity (IVA), wound entry site, injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries and medical treatment.

RESULTS

Injury was most common in children 3-6 years old. Most injuries occurred during play at home (46%), between the months of July and November (58%), and evening time (42%). The most common causes were glass, pencil, stick, soft drink bottle, metal bar, and stone. The cornea was the most common entry site (59 cases). Seventy-three patients presented on the day of injury, and 38 of them had surgical repair that same day. The follow-up period ranged from 2 weeks to 58 months. Thirty-eight patients (40%) had an FVA of 20/40 or better (group 1), 23 (24%) between 20/40 and 20/200 (group 2), 12 (13%) 20/400 or worse (group 3), and 22 (23%) had no record of FVA. The difference between IVA and FVA of wound entry site was statistically significant (p < 0.005). Differences due to injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries, and the use of systemic antibiotics were found not to be statistically significant (p > 0.2).

CONCLUSION

The prevalence of open globe injury among the pediatric population in Kuwait was high. Most injuries were due to household objects and occurred at home in the evening during the summer and autumn. IVA and anatomical location of the wound impacted on final outcome.