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Predictors of traumatic eye injuries at high-risk for ophthalmic complications in children

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Abstract

Eye injuries are important cause of ocular morbidity in children. There is lack of data regarding predictors for high-risk injuries that will result in ophthalmic complications. Most cases are managed by the emergency department (ED) physicians without immediate ophthalmologist evaluation. Our aim was to identify predictors for ophthalmological complications and to imply indications for early ophthalmologic consultation in the ED. A retrospective chart review of 834 patients ages 0–18 years who presented to the emergency department at Tel Aviv Medical Center between 2015 and 2018 following traumatic eye injuries was performed. All cases which later needed ophthalmological care were considered as high-risk for ophthalmic complications. An increased rate of eye injury was revealed over the years, but high-risk injury rate was stable. High-velocity mechanism, sport injury, orbital, anterior chamber, and retinal involvement were all significantly more common in the high-risk group compared to the low risk group. Only 10 patients, which represent 1.2% of all the patients, had decreased visual acuity on the last follow up, with significantly more injuries of high-velocity mechanism and anterior chamber involvement, in comparison to patients with normal visual acuity on the last follow up.

Conclusion: High-velocity mechanism by itself, even with normal visual acuity and eye examination by the ED physician, should prompt to consider an urgent ophthalmologist consult.

What is Known:

•Traumatic eye injuries are an important cause of ocular morbidity in children.

• Most injuries can be handled by a trained ED physician, but there are indications for an urgent ophthalmologist consultation.

• It is crucial to discriminate between low and high-risk ocular injuries.

What is New:

• High-velocity mechanisms stand out as the most likely risk factor for final impaired visual acuity.

• Normal visual acuity on presentation is not reassuring.

• We recommend urgent ophthalmologist consultation in cases of high-velocity injury, even if visual acuity is preserved at presentation.

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Abbreviations

ED:

Emergency department

MVA:

Motor vehicle accident

VA:

Visual acuity injury

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Author notes

  1. Neta Cohen and Eyal Cohen contributed equally to this work.

Authors and Affiliations

  1. Pediatric Emergency Medicine Department, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Neta Cohen & Ayelet Rimon

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Neta Cohen, Eyal Cohen, Adi Anafy, Anat Margaliot, Kira Kaganov, Nir Gomel, Dana Barequet, Daphna Mezad-Koursh & Ayelet Rimon

  3. Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Eyal Cohen, Nir Gomel, Dana Barequet & Daphna Mezad-Koursh

  4. Department of Pediatrics, Dana Duek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Adi Anafy & Anat Margaliot

Authors
  1. Neta Cohen
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  2. Eyal Cohen
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Contributions

Neta Cohen and Eyal Cohen equally contributed significantly to the planning of the study, the study design, and did major manuscript preparation. Neta Cohen performed statistical analysis. Adi Anafy, Anat Margaliot, Kira Kaganov, Nir Gomel, and Dana Barequet performed the data collection. Daphna Mezad-Koursh contributed her manuscript expertise. Ayelet Rimon contributed significantly to the study design and manuscript editing and contributed her manuscript expertise.

Corresponding author

Correspondence to Neta Cohen.

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Cohen, N., Cohen, E., Anafy, A. et al. Predictors of traumatic eye injuries at high-risk for ophthalmic complications in children. Eur J Pediatr 180, 177–185 (2021). https://doi.org/10.1007/s00431-020-03734-0

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  • DOI: https://doi.org/10.1007/s00431-020-03734-0

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