Ophthalmic trauma: risk and management update

Abstract

Management of ocular trauma is both challenging and controversial. Using current available evidence in literature and author experience this review aims to highlight critical issues in management of ocular and orbital trauma. This review provides a working framework from initial presentation, investigations, management principles, complications and prognosis to outcome and controversies involved in management. The review will focus on the concept of atraumatic repair of traumatized globe and will also give guidelines about strategic planning in ocular trauma management. Clinicians are occasionally faced with dilemmas and challenges in management of severely traumatized eyes with limited or no visual potential in view of life-time risk of sympathetic ophthalmia and the authors aim to address the controversy surrounding it.

Keywords::

• corneal trauma
• no light perception
• ocular trauma score
• open globe injury
• primary enucleation
• ophthalmic trauma
• traumatic cataract

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• In any patient with ophthalmic trauma, any life-threatening injury should be first ruled out.

• Assess visual acuity status in patients with ocular trauma at time of presentation and in both eyes.

• Document all the findings legibly using clinical photographs or diagrammatic representation as these cases can be potentially medicolegal.

• Use the international terminology and classification system in ocular trauma eyes to prevent any ambiguity in communication.

• There should be committed multidisciplinary team in management of the complex traumatized eyes.

• Globe injuries should be managed using the broad principles of ocular trauma management and surgical repair of these eyes should be based on ‘atraumatic repair’ approach.

• Counseling needs to be the main backbone in management of trauma patients and hence the clinicians need to empower patients with tools such as ocular trauma score and it should be used regularly with use of standardized terminology for ocular trauma.

Notes