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Ocular manifestations of head injury and incidence of post-traumatic ocular motor nerve involvement in cases of head injury: a clinical review

Abstract

As the eyes are in close proximity to the skull, they can get simultaneously affected in head injuries. This close association warrants careful ocular examination in all cases of head injury. This is a prospective non-randomized analytical study to evaluate various ocular manifestations in cases of head injury with special reference to ocular motor nerve involvement, correlation between pupillary changes, and survival. A total of 1,184 patients with head injury were screened for ocular manifestations. This study comprises 594 patients with ocular manifestations of head injury. All the relevant data was compiled and analyzed as per proforma. Ocular manifestations were evaluated in each patient and appropriate investigations were carried out. Patients with ocular morbidity were analyzed for age, sex, mode of injury, Glasgow Coma Score, and associated injuries in addition to ophthalmic and neurosurgical evaluations. Of the 594 patients, 81.6 % were male and 18.4 % were female, with a male-to-female ratio of 4:1. The major cause of head injury was road traffic accidents (70.37 %). The most common age group involved was, 21–40-year-olds (67.40 %). Out of 594 patients, ecchymosis was found in 51.85 %, subconjunctival hemorrhage in 44.44 %, lid edema in 41.48 %, lacerated wound in 22.59 %, pupillary involvement in 21.04 %, ptosis in 6.73 %, cranial nerve palsy in 11.62 %, orbital fractures in 10.44 %, optic nerve trauma in 4.04 %, and exposure keratitis in 4.21 %. Patients with bilaterally dilated or pinpoint fixed pupils had a 10 times higher risk of mortality than patients without pupillary involvement. Third nerve involvement was seen 2.85 times more frequently in frontal and parietal region injuries compared to other sites of injury. The involvement of the sixth nerve occurred 4.6 times more frequently in parietal region injuries compared to other sites of injury.

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References

  1. United Nations Decade of action for road safety 2011-2020. Available from: http://www.decadeofaction.org.Accessed on 6/11/13

  2. World Health Organization (2013) Road traffic injuries fact sheet no. 358, March 2013. http://www.who.int/mediacentre/factsheets/fs358/en/. Accessed on 6 Nov 2013

  3. Peden M, Sminkey L (2004) World Health Organization dedicates World Health Day to road safety. Inj Prev 10:67

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  4. Arvind Kumar, Sanjeev Lalwani, Deepak Agrawal, Ravi Rautji, Dogra TD (2008) Fatal road traffic accidents and their relationship with head injuries: an epidemiological survey of five years. Indian J Neurotrauma 5(2):63–67

    Article  Google Scholar 

  5. NCRB (2005) National crime records bureau, Ministry of Home Affairs, Govt. of India

  6. Kulkarni AR, Aggarwal SP, Kulkarni RR, Deshpande MD, Walimbe PB (2005) Ocular manifestations of head injury: a clinical study. Eye (Lond.) 19:1257–1263

    CAS  Article  Google Scholar 

  7. Annegers JF, Grabow JD, Kurland LT, Laws ER (1980) The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935–1974. Neurology 30:912–919

    CAS  PubMed  Article  Google Scholar 

  8. WHO Neurological Disorder Survey (2002) NCMH background papers burden of disease in India

  9. Van Stavern GP, Biousse V, Lynn MJ, Simon DJ, Newman NJ (2001) Neuro-ophthalmic manifestations of head trauma. J Neuroophthalmol 21(2):112–117

    PubMed  Article  Google Scholar 

  10. Raju NSD (1983) Ocular manifestations in head injuries. IJO 31(6):789–792

    CAS  Google Scholar 

  11. Sabates N, Gonce M, Farris B (1991) Neuro-ophthalmological findings in closed head trauma. J Clin Neuroophthalmol 11:273–277

    CAS  PubMed  Google Scholar 

  12. Moster ML, Volpe NJ, Kresloff MS (1999) Neuro-ophthalmic findings in head injury. Neurology 52(2):23

    Google Scholar 

  13. Keane JR (1989) Neurologic eye signs following motor vehicle accidents. Arch Neurol 46:761–762

    CAS  PubMed  Article  Google Scholar 

  14. Baker RS, Epstein AD (1991) Ocular motor abnormalities from head trauma. Surv Ophthalmol 35:245–267

    CAS  PubMed  Article  Google Scholar 

  15. Odebode TO, Ademola-Popoola DS, Ojo TA, Ayanniyi AA (2005) Ocular and visual complications of head injury. Eye (Lond.) 19:561–566

    CAS  Article  Google Scholar 

  16. Gururaaj G (2002) Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 24(1):24–28

    Article  Google Scholar 

  17. Rowbotham GF, Maciver IN, Dickson J, Bousfield ME (1954) Analysis of 1,400 cases of acute injury to the head. Br Med J 1(4864):726–730

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  18. Pathak A (2003) Assessment in neuroophthalmic trauma. Indian J Neurotrauma (IJNT) 4(1):31–33

    Article  Google Scholar 

  19. King AB, Walsh FB (1949) Trauma to head with particular reference to ocular science. Am J Ophthalmol 1949:32–191

    Google Scholar 

  20. Cross AG (1957) Neuromuscular aspects in ocular sequelae of head injury. Trans Ophthal Surg 9:265

    Google Scholar 

  21. Falbe Hansen I, Gregerson E (1959) The prognosis for disturbances in ocular motility following trauma to the head. Acta Ophthalmol (Copenh) 37:359–370

    CAS  Article  Google Scholar 

  22. Singh YP, Chawla VK (1980) Randomized controlled trial on head trauma patients. Med J Armed Forces 61:187–189

    Google Scholar 

  23. Blackeslee GA (1929) Eye manifestations in fractured skull. Arch Ophthal 2:566

    Article  Google Scholar 

  24. Malik SRK, Gupta AK, Chaudhry S (1968) 280 cases of non-occupational injuries in Delhi. Indian J Ophthalmol 16:178

    CAS  Google Scholar 

  25. Masila F (2012) Ocular findings in patients with head injury at Kenyatta National Hospital. College of Health Sciences 1523

  26. Cowan CL (1983) Associated eye signs and symptoms of head injuries. J Natl Med Assoc 31(6):789–792

    Google Scholar 

  27. Shukla B, Khanna B (1983) Trauma index-a system of evaluation of ocular damage due to trauma. Indian J Ophthalmol 31:439–441

    CAS  PubMed  Google Scholar 

  28. Herbella FA, Mudo M, Delmonti C, Braga FM, Del Grande JC (2001) Raccoon eyes’ (periorbital hematoma) as a sign of skull base fracture. Injury 32(10):745–747

    CAS  PubMed  Article  Google Scholar 

  29. Duke Elder (1957) Text book of ophthalmology vol. 4. Henry Kimton, London, p 39–54

  30. Mariak Z, Mariak Z, Stankiewicz A (1997) Cranial nerve II–VII injuries in fatal closed head trauma. Eur J Ophthalmol 7:68–72

    CAS  PubMed  Google Scholar 

  31. Kowal L (1992) Ophthalmic manifestations of head injury. Aust NZ J Ophthalmol 20:35–40

    CAS  Article  Google Scholar 

  32. Turner JWA (1943) Indirect injuries of optic nerves. Brain 51(66):140

    Article  Google Scholar 

  33. Lepore FE (1995) Disorders of ocular motility following head trauma. Arch Neurol 52:26

    Article  Google Scholar 

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Correspondence to Bhavana Sharma.

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Sharma, B., Gupta, R., Anand, R. et al. Ocular manifestations of head injury and incidence of post-traumatic ocular motor nerve involvement in cases of head injury: a clinical review. Int Ophthalmol 34, 893–900 (2014). https://doi.org/10.1007/s10792-014-9898-8

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  • DOI: https://doi.org/10.1007/s10792-014-9898-8

Keywords

  • Head Injury
  • Ocular motor nerve
  • Pupillary signs
  • Ocular manifestations