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
United Nations Decade of action for road safety 2011-2020. Available from: http://www.decadeofaction.org.Accessed on 6/11/13
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
Peden M, Sminkey L (2004) World Health Organization dedicates World Health Day to road safety. Inj Prev 10:67
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
NCRB (2005) National crime records bureau, Ministry of Home Affairs, Govt. of India
Kulkarni AR, Aggarwal SP, Kulkarni RR, Deshpande MD, Walimbe PB (2005) Ocular manifestations of head injury: a clinical study. Eye (Lond.) 19:1257–1263
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
WHO Neurological Disorder Survey (2002) NCMH background papers burden of disease in India
Van Stavern GP, Biousse V, Lynn MJ, Simon DJ, Newman NJ (2001) Neuro-ophthalmic manifestations of head trauma. J Neuroophthalmol 21(2):112–117
Raju NSD (1983) Ocular manifestations in head injuries. IJO 31(6):789–792
Sabates N, Gonce M, Farris B (1991) Neuro-ophthalmological findings in closed head trauma. J Clin Neuroophthalmol 11:273–277
Moster ML, Volpe NJ, Kresloff MS (1999) Neuro-ophthalmic findings in head injury. Neurology 52(2):23
Keane JR (1989) Neurologic eye signs following motor vehicle accidents. Arch Neurol 46:761–762
Baker RS, Epstein AD (1991) Ocular motor abnormalities from head trauma. Surv Ophthalmol 35:245–267
Odebode TO, Ademola-Popoola DS, Ojo TA, Ayanniyi AA (2005) Ocular and visual complications of head injury. Eye (Lond.) 19:561–566
Gururaaj G (2002) Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 24(1):24–28
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
Pathak A (2003) Assessment in neuroophthalmic trauma. Indian J Neurotrauma (IJNT) 4(1):31–33
King AB, Walsh FB (1949) Trauma to head with particular reference to ocular science. Am J Ophthalmol 1949:32–191
Cross AG (1957) Neuromuscular aspects in ocular sequelae of head injury. Trans Ophthal Surg 9:265
Falbe Hansen I, Gregerson E (1959) The prognosis for disturbances in ocular motility following trauma to the head. Acta Ophthalmol (Copenh) 37:359–370
Singh YP, Chawla VK (1980) Randomized controlled trial on head trauma patients. Med J Armed Forces 61:187–189
Blackeslee GA (1929) Eye manifestations in fractured skull. Arch Ophthal 2:566
Malik SRK, Gupta AK, Chaudhry S (1968) 280 cases of non-occupational injuries in Delhi. Indian J Ophthalmol 16:178
Masila F (2012) Ocular findings in patients with head injury at Kenyatta National Hospital. College of Health Sciences 1523
Cowan CL (1983) Associated eye signs and symptoms of head injuries. J Natl Med Assoc 31(6):789–792
Shukla B, Khanna B (1983) Trauma index-a system of evaluation of ocular damage due to trauma. Indian J Ophthalmol 31:439–441
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
Duke Elder (1957) Text book of ophthalmology vol. 4. Henry Kimton, London, p 39–54
Mariak Z, Mariak Z, Stankiewicz A (1997) Cranial nerve II–VII injuries in fatal closed head trauma. Eur J Ophthalmol 7:68–72
Kowal L (1992) Ophthalmic manifestations of head injury. Aust NZ J Ophthalmol 20:35–40
Turner JWA (1943) Indirect injuries of optic nerves. Brain 51(66):140
Lepore FE (1995) Disorders of ocular motility following head trauma. Arch Neurol 52:26
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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