Improving Care in Globe and Adnexal Trauma

Abstract

The assessment of globe and adnexal trauma can be complex. Understanding the nature of globe and adnexal trauma including ophthalmology involvement will assist the development of preventative and management strategies. To understand the role of ophthalmology services in tertiary trauma centres we report on the aetiology, acute assessment and management of globe and adnexal trauma at two tertiary trauma centres in Sydney, New South Wales Australia

A retrospective case series was completed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) on patients admitted between January 2015 and December 2019. The International Classification of Disease, Tenth Revision codes, diagnostic and procedural coding data were used to identify patients. Data extracted from medical records comprised of demographics, details of the trauma mechanism of injury, examination findings and whether ophthalmology assessment occurred.

Over the 5-years, 773 patients with the average age of 53years, were admitted to RNSH and RPAH with globe and/or adnexal trauma. The most common mechanism of injury was falls (n=346, 45%), followed by burns (n=101, 13%). Four-hundred and thirty-eight (57%) patients suffered globe trauma and 228 (29%) were classified as severe. Globe trauma occurred more frequently if orbital/mid-facial trauma was present. Fifty-five-percent of patients only had a gross ocular exam or no exam documented by emergency staff, this increased to 65% in patients between 66-85years and 72% in those older than 85years.

Orbital or mid-facial trauma can indicate an increased risk of globe trauma. Thorough ocular assessment especially if mid-facial/orbital trauma is present is needed to exclude trauma. Specialist ophthalmology review has an important role in assisting medical staff in the acute assessment and management of globe and adnexal trauma. Further, research is required utilising trauma registries to follow the outcomes of patients with globe and adnexal trauma.