Ocular trauma is a major cause of vision loss and long term morbidity particularly in young male population. It is the most common cause for monocular blindness. The personal impact of ocular trauma is compounded by socioeconomic costs, such as treatment, hospitalization, loss of work and rehabilitation. Patients with major facial trauma have a high risk of vision threatening injury.

Lifestyle, culture and socioeconomic condition of the people influence the nature and cause of trauma. Eye injuries constitute about 7% of all bodily injuries and 10 to 15% of all eye disorders. It is estimated that 90% of all eye injuries are preventable. Road traffic accidents remain the most common etiology of eye injuries followed by assault and accidental self falls. Trauma patients should be carefully evaluated for the presence of hidden eye injuries beyond obvious ones, since they represent a major risk factor for visual impairment.

Our study was conducted in 560 trauma patients with ocular and orbital involvement at Department of Ophthalmology associated with Department of Pathology & Microbiology, KMC Medical College & Hospital from April 2024 to April 2025. Patients of all age groups with involvement of one eye or both the eyes were included in the study. Patients with old ocular trauma and other vision threatening diseases were excluded from the study. Detailed history regarding demographic information and specific history of trauma such as nature of injury, type of injury and mode of injury and characteristics of traumatic agent were noted.

All patients underwent complete ophthalmologic evaluation as follows:

1. Visual acuity by Snellen’s chart
2. Refraction
3. Pupillary reaction for normal pupil, sluggish pupil or RAPD.
4. General ophthalmic examination with torch light and slit lamp biomicroscopy
5. Intraocular pressure measurement by non-contact and applanation tonometry
6. Fundus examination by direct ophthalmoscope and slit lamp biomicroscopy using 90 Dioptre lens and indirect ophthalmoscopy.
7. Extraocular movement examination using torch light
8. Force duction test was done in all cases with extraocular movement restriction
9. Test for infraorbital sensation
10. Examination of orbital margins for irregularity, gaps, tenderness and emphysema
11. Colour vision evaluated by Pseudo-isochromatic Ishiharas chart
12. Central fields by Bjerrums screen
13. Visual fields by Automated perimetry
14. Ultrasound B scan
15. Diplopia charting
16. CT Facial bones and orbit

TABLE 1 OCCURENCE IN DIFFERENT AGE GROUPS

TABLE 2 OCCURENCE IN DIFFERENT GENDERS

TABLE 3 MECHANISM OF INJURY IN OCULAR TRAUMA

TABLE 4 TYPE OF INJURY

TABLE 5 ORBITAL WALL FRACTURES

TABLE 6: VISUAL ACUITY AT PRESENTATION BY SNELLENS CHART

In this era of high speed vehicles and industrialization, the incidence of ocular injuries is increasing in general along with other bodily

injuries. Inspite of the fact that eyes are well protected with lids, margins of orbit, nose and fat cushion from behind, eyes are prone to all form of injuries.

In our study of 560 trauma patients with ocular involvement, most commonly males were involved. The commonest age group involved was young males between 21 to 30 years (29.2%). Males (82.1%) had higher frequency of orbital wall fractures with ocular manifestations when compared to females. Unilateral ocular involvement was more common in our study.

Road traffic accident (51.4%) was the most common etiology followed by assault, self fall, sports injuries and work place injuries. Facial involvement has been considered a risk factor for sight threatening injuries. In our study, patients who sustained facial injuries suffered sight threatening injuries. Visual acuity was normal (6/6) in most cases (58.9%). 11 cases had no perception of light due to total globe rupture and traumatic optic neuropathy.

The most commonly reported eye injury in our study was periorbital edema with ecchymosis (69.3%). Periorbital edema and ecchymosis was associated with majority of the cases along with other ocular manifestations. The second most common manifestation was orbital fractures (13.6%). Orbital fractures were associated with periorbital edema and ecchymosis in most cases. The lateral wall of the orbit (42.1%) was most commonly involved in our study patients.

Subconjunctival hemorrhage (11.3%) was seen in 63 patients. Lid lacerations were also commonly seen in our patients. 4 cases had third nerve palsy. Globe rupture was seen in 2 cases. 2 patients had corneal tear. Hyphema was seen in 2 cases. Facial nerve palsy was seen in 1 patient presenting with lagophthalmos and exposure keratitis. One patient had Subluxation of lens. Commotio retina was present in 4 cases. Posterior segment was less commonly involved than anterior segment in our study. The most common posterior segment finding was Berlins edema. Traumatic optic neuropathy was seen in 9 cases presenting with relative afferent papillary defect.

In our study, it was concluded that Road traffic accidents was the most common etiology of ocular injuries. Young males were more commonly involved. Periorbital edema with ecchymosis was the most common ocular manifestation in our study patients followed by orbital fractures and subconjunctival hemorrhage. In orbital fractures, lateral wall was most commonly fractured in our patients. Unilateral involvement was more common than bilateral. Most cases had normal vision. In our study, most ocular injuries were minor without major visual disability.

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