CLOSED HEAD INJURY AND ITS OCULAR MANIFESTATIONS: A CLINICAL STUDY
Journal Title: National Journal of Medical and Dental Research - Year 2018, Vol 6, Issue 2
Abstract
Introduction: The visual system is one of the systems involved in traumatic brain injury. The eye is frequently involved in head trauma due to proximity of the eye to the head as well as due to the neural connections between the eye and the brain. Aim: To assess the simultaneous involvement of ocular structures in cases of closed head injury and describe the spectrum of ocular involvement. Meterial and Method: A hospital based cross sectional study was carried out for duration of 1 year concerning ocular trauma in closed head injury patients. Adult patients with closed head injury diagnosed by surgical team on basis of history, neurological findings, admission Glasgow Coma Scale (GCS) score and brain computerized tomography (CT) scan findings, admitted within a week of injury were included in the study. Apart from the detailed surgical evaluation ophthalmic examination was carried out. Abnormalities of the visual system were classified as soft tissue injuries to the globe and adnexa, neuro‑ophthalmic abnormalities, and injuries to the bony orbit. All the ocular injuries were managed as per standard protocol. Result: A total of 65 consecutive adult cases of closed head injury were recruited in the study. There were 54 (83%) male and the mean age of patients was 38.7 ± 8.2 years. The main cause of head injury was road traffic accidents 35 (53.8%) followed by physical assault 20 (30.7%). Ocular involvement was found in 36 (55.4%) cases.Soft tissue injuries to the globe and adnexa included ecchymosis (43%), subconjuctivalhaemorrhage (26%), corneal epithelial defects (15.4%), commotion retinae (15.4%). Neuro‑ophthalmic abnormalities recorded werepapilloedema (9.2%), traumatic optic neuropathy (15.4%). Injuries to the bony orbit were in form of orbital fractures in 23 (35.4%) patients. Floor and lateral wall were most commonly involved. There was no significant association of GCS score with the ocular involvement in this series Conclusion: In cases of head injury spectrum of ocular involvement ranges to non significant findings like edema, ecchymosis to loss of vision and motility as in traumatic optic neuropathy and extraocular muscle palsy. In all the cases of head injury ophthalmic examination is essential for early diagnosis and timely management of these cases.
Authors and Affiliations
Ramabhilash Dubey, Aditi Dubey, Yogeshwar Prasad Shukla, Salil Kumar
Keywords
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