CLINICAL ASSESSMENT AND ASSOCIATION OF OCULAR MANIFESTATIONS WITH NEUROLOGICAL RESULTS IN CLOSED-HEAD INJURY PATIENTS

Abstract

Background: India has the very unenviable distinction that it has the highest incidence in the world of head injury. About 100,000 lives are lost every year in India, with more than 1 million suffering from severe head injuries. Men, women and children suffer head injuries each day.

Aims & objectives: To assess clinically the ocular manifestations and correlate them with neurological findings in patients with closed head injury.

Materials and Methods: The study involved 300 patients from a closed brain injury tertiary healthcare center who were subjected to comprehensive ocular assessment as early as possible after determining the seriousness of head injury with the Glasgow coma scale (GCS) and Updated Trauma Score (RTS). The results were later identified. When required, patients were monitored by a multidisciplinary approach.

Results: Out of 300 patients with head injury, 272 were male (91 percent) and 28 were female (9 percent). With an average of 30.56 years, the age varied from 7 years to 60 years. Young adults are the common age group and the common mechanism is the road traffic accident with 180 patients out of 300 (60 percent) leading to head injury and eye manifestations. Out of 300 patients, 204 patients (68 percent) had ocular manifestations. The most common ocular injury is soft tissue injury involving ocular adnexa, with abrasions and lacerations across the globe. Traumatic optic neuropathy, often affecting the pupillary reaction, was the most common form of neuro-ophthalmological manifestation noted.

Conclusion: A statistically significant correlation was observed when patient outcomes were linked to ocular manifestations (p value < 0.05). GCS and ocular symptoms were also associated with the finding. Any type of ocular involvement was present in all patients who died in the study. Together with GCS, RTS, ocular manifestations may serve as an effective predictor of the final outcome.

Keywords: Head injury, ocular manifestations, Glasgow coma scale, Revised Trauma Score.