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The Epidemiology and Incidence of Visual Deficits Following Ocular Trauma in Pediatric Patients

by Juthani, Viral Virendra

Abstract (Summary)
Ocular trauma has long been a significant disabling American health problem and a leading cause of unilateral visual loss in children. These injuries have many diverse costs including human suffering, long-term disabilities, loss of productivity, and economic hardship. Although several studies have evaluated the epidemiology of specific types or mechanisms of ocular trauma, there are few that describe the epidemiology and visual outcomes of a comprehensive set of ocular trauma diagnoses. The purpose of this thesis is to describe the incidence of significant deficits in visual acuity following pediatric ocular trauma and to describe the overall epidemiology of pediatric ocular trauma presenting to the Yale Eye Center or Yale Ophthalmology consult service between 1999 and 2006.

A retrospective analysis of 396 cases of pediatric ocular trauma that presented to the Yale Eye Center or Yale Ophthalmology Consult Service between 1999 and 2006 was performed in which the study population was defined as children between 0 and 18 years of age with the following ICD-9 codes: 802.4-802.9 (malar, maxillary, orbital floor, and facial bone fractures), 870.0-870.9 (open wounds of the ocular adnexa), 871.0-871.9 (open wounds of the eyeball), 918.0-918.9 (superficial injury of the eye and adnexa), 921.0-921.9 (contusion of the eye and adnexa), 950.0-950.9 (injury to optic nerve and pathways), and 951.0-951.4 (injury to the other ocular cranial nerves). All data were examined for any correlation between parameters studied. Statistical significance for categorical data was performed using 2x2 contingency tables, Fishers exact test, and two-tailed P values.

A total of 61 patients (15.4 %) had a final visual acuity with some degree of deficit. However, only a small proportion (7.3%) of children seen for an ocular injury was significantly visually impaired in the affected eye as a result of the injury. Males had a disproportionately large representation in the blindness category where they made up 77.3% compared to 65% of the overall patient population. . Males in the 10-14 year age group were at the highest risk for eye injury (20.9%), and females in the 5-9 year age group were at the lowest risk (8.7%). The most common injuries were superficial injuries to the eye and ocular adnexa (33%) and contusions of the eye and adnexa (27.6%). In all age groups, the most common sites of injury were in the home (30.6%) and on streets/roads (30.6%).

The data presented demonstrate a clear need for primary prevention and control of pediatric ocular trauma. Education targeting parents, school teachers, and children regarding hazardous objects, toys and the devastating consequences of seemingly innocuous actions is needed to reduce the incidence of ocular trauma and its consequences. It will also be important to continue to recognize the geographic variability, and dynamic changes throughout time in the epidemiology of ocular trauma.

Bibliographical Information:

Advisor:M. Bruce Shields

School:Yale University

School Location:USA - Connecticut

Source Type:Master's Thesis

Keywords:ophthalmology connecticut child epidemiology visual acuity eye wounds and injuries pediatric

ISBN:

Date of Publication:03/25/2008

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