gms | German Medical Science

Ophthalmic trauma is a leading cause of acquired unilateral blindness in childhood, being responsible for up to one third of cases of vision loss in the first decade of life. Ocular trauma has been an important cause of hospitalization in paediatric patients and corresponds to a significant amblyopic inductor factor. Preschool children (<5 years) who sustain ocular trauma fall into a special category who are prone to amblyopia if not managed well and in time. Most injured children have normal vision before the accident and many of the injuries lead to permanent visual loss. Several prognostic factors have been described which determine the ultimate visual outcome in these cases. These include reporting time, length of perforation, vitreous loss, presence or absence of lens damage, hyphema, tears of rectus insertion and retinal detachment. The pattern of ocular injures in preschool children were studied at New Delhi in India in 24 children as a retrospective analysis. There was a significant male preponderance. Mean age was 3.2 years for males and 3.4 years for females. Corneal perforation was found to be the commonest type of injury (68% cases). Other types of injuries included infected cornea (20.80%), Iris prolapse (45.17%), lens damage (49.92%), vitreous prolapse (12.48%), Retained foreign body (08.32%), mutilated eye (04.16%) and healed endophthalmitis with retinal detachment (04.16%). Surprisingly the incidence of self inflicted injuries and accidental fall was low, 16.64 % each. Commonest type of injury was by others (66.72%). This highlights the important fact that injury to preschool children is in many a case preventable since it is not commonly self inflicted.Out of the 24 cases 15 were managed by suturing, 5 required enucleation, conservative treatment was given in 3 cases and paracentesis was done in 1 case. On analysis of final visual outcome, useful vision was achieved in 29.1% of cases, 20.8% cases achieved a useful vision after a second procedure. Dense corneal opacities and aphakia precluded useful vision in 12.5% and 16.6% cases respectively. 20.8% cases either required a removal or had no vision. Factors which were responsible for a high morbidity were identified. These included delayed reporting, incomplete examination, injury with unidentified objects, poor lid reflex, other man injury (not self inflicted) and a poor follow up. It is recommended that to achieve a more satisfactory final visual outcome in ocular injuries sustained by preschool children, it is important that there should be no delay in treatment. Examination under anesthesia should be performed as soon as possible, wherever required, careful planning and safe approach should be followed and second surgery should be carried out wherever required at the most appropriate time