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PRESENTER- DR. PIYUSH MADAN, GUIDE -DR. S. DAIGAVANE, - DR.P. SUNE

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“Ocular Manifestations In Patients With Head Injury Following Road Traffic Accidents In Central India”

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PRESENTER- DR. PIYUSH MADAN, GUIDE -DR. S. DAIGAVANE, - DR.P. SUNE

  1. 1.  “OCULAR MANIFESTATIONS IN PATIENTS WITH HEAD INJURY FOLLOWING ROAD TRAFFIC ACCIDENTS IN CENTRAL INDIA” PRESENTER- DR. PIYUSH MADAN GUIDE -DR. S. DAIGAVANE - DR.P. SUNE pmadan01@gmail.com THE AUTHOR HAS NO FINANCIAL CONFLICT OF INTEREST
  2. 2.  The role of ocular injuries secondary to head trauma in causation of blindness continues to be an immense public problem(1).  Ocular trauma is an important , preventable public health problem worldwide. As many as half a million people in the world are blind as a result of ocular injuries.(2)  WHO estimated that 55 million eye injury occur yearly, of which 750000 requires hospitalization.(2)  Over the past decade, the incidence of ocular injuries due to vehicular accidents have increased tremendously.  It is evident that a good number of patients sustaining head injury in RTA, attend the casualty of medical college(3).
  3. 3. AIMS & OBJECTIVES: To assess the ocular morbidity and severity of patients with head injury. Type of Study- Cross sectional , Non Interventional study. Sample size: 457 eyes will be included. Duration of study: 6months
  4. 4. Inclusion criteria: Patients who had sustained head injury secondary to Road Traffic Accident. Exclusion criteria Patient or relative not willing to give informed or written consent. Patients with pre existing diseases ocular pathology were excluded. Statistical Analysis: All statistical analyses will be calculated using IBM SPSS statistical software.
  5. 5. MATERIALS AND METHODS: This study will be conducted over a period of 6 months in A.V.B.R.H. hospital (Sawangi) . All patients attending the ophthalmology OPD and casualty of A.V.B.R.H. hospital (Sawangi) who met the inclusion criteria will be counseled regarding the disease and study and those willingly consenting to participate in the study will be selected. Informed and written consent will be obtained from all patients with consent form approved by the institutional ethical committee of college.
  6. 6. All subjects will undergo a thorough ophthalmic examination including- CLINICAL HISTORY VISUAL ACUITY BEST CORRECTED VISUAL ACUITY TORCH LIGHT EXAM – OF ANTERIOR SEGMENT. WHERVER POSSIBLE DETAILED  SLIT –LAMP EXAMINATION FUNDUS EXAMINATION BY DIRECT AND INDIRECT OPHTHALMOSCOPY IOP MEASUREMENT BY DIGITAL , SCHIOTZ, APPLANATION TONOMETRY
  7. 7.  OBSERVATION: TABLE 1: Age  TABLE2:Sex  Table 3: Type of vehicle Involved in Causation of Ocular injury AGE NO. OF PAT. % <15 YRS 50 10.9% 15-29 YRS 141 30.8% 30-44 YRS 169 36.9% 45-59 YRS 73 15.9% >60 YRS 24 5.2% Sex No. of patients % MALE 374 81.8 % FEMALE 83 18.2% Type of RTA Bystanders 27 5.9% Bike riders 292 63.89% Three wheeler 31 6.7% Four wheeler 13 2.8% Truck and bus 94 20.5%
  8. 8.  Table 4: Laterality  Table 5: Visual acuity at presentation  Table 6 : Mode of Presentation  Table 7 : Month of Accident Ocular involvement No of patients % U/L 178 38.94% B/L 279 61.05% Vision in better eye No of patient % Good (VA>6/18) 116 25.3% Fair (V/A 6/18-6/60) 297 64.9% Poor (<6/60) 38 8.3% PL (negative) 6 0.13% Referral centre Directly attending From PHC From CHC From DHH NO OFPATIENT 347 9 18 86 % 75.9% 1.9% 3.9% 18.8% Month June July August Sept Oct Nov Patients no 132 73 86 50 54 62 % 28.8% 15.9% 18.8% 10.9% 11.8% 13.5%
  9. 9.  Table 8 : Ocular Traumas classified in Accordance to BETT terms and definition  Table 9 : Classification of open globe injury  Table 10 : Open globe injury Type of injury No of patient % Closed globe injury 89 75.4% Open globe injury 29 24.5% Type Nos. % Rupture 19 65.5% Laceration 10 34.4% Type of injury Nos % Hyphema 2 6.8% Corneal laceration 5 17.2% Sclera laceration 7 24.1% Lens dislocation 1 3.4% Traumatic mydriasis 3 10.3% Vitreous haemorrhage 1 3.4% Pre retinal haemorrhage 2 6.8% Sub conjunctival haemorrhage 24 82.7%
  10. 10. Sub conjunctival haemorrhage 81 91.05 Corneal abrasion 15 16.8% Traumatic mydriasis 5 5.6% Berlin oedema 4 4.4% Partial thickness sclera laceration 2 2.2% Partial thickness corneal tear 1 1.1% Hyphema 7 7.8% Vitreous haemorrhage 8 8.9% Pre retinal haemorrhage 5 5.6% Sphincter tear 9 10.1% Lens subluxation 4 4.4% Table 11 : Closed globe injury ORBITAL FRACTURE (N=11)3.93% ORBITAL MARGIN 9 3.14% BLOW OUT 2 0.69% 68 PATIENTS (14.8%) HAD CONSUMED ALCOHOL DURING DRIVING 48 PATIENTS 9 (10.5%) WERE USING MOBILE DURING DRIVING 195/292 (66.7%) OF BIKE RIDERS DID NOT WEAR HELMET
  11. 11.  DISCUSSION-  Most head injury cases are mild and can be treated as out patients. Those that need neuro observation are treated in-patients for 24-48 hrs.  Majority of patients are young (<40years) and a significant portion males.  Most of the RTA occurs while driving a two-heeler without helmet.  Studies done by lagarde E.(4) suggested that most of patients of 30-44 years were commonly affected.  Closed globe injuries outnumbered the open globe patients(89:29).
  12. 12.  Injury to soft tissue of globe and adnexa were seen in 90 cases (50.8%) and was the most prominent form of ocular injury.  1.3% had no PL at reporting due to ocular nerve injury. Majority of the patients were young (<40 yrs) and a significant potions were male.  Majority of patients were driving a two-wheeler.  The eyes are often involved in head injury with a neuro-ophthalmic deficits. REFERENCES 1. Negrel A D , thylefors B . The global impact of eye injuries, Ophthalmic Epidemiology 1998. 5143-169.169 [PubMed Poon A, McCluskey PJ, Hill D A. Eye injuries in patients with major trauma. J Trauma 1999;46494-499.499[pubmed] 2. Bener A, Ahmad MD MF, EI-Tawil MS, AL-Bakr S . Visual impairment and motor vehicle accident.THE Middle East Journal of Emergency Medicine 2004;4;1 3. Owsley C, McGwin G Jr. Vision impairment and driving. Surv ophthalmol 1999;43:535-50 4. Lagarde E. Road traffic injury is an escalating burden in Africa and deserve proportionate research efforts. Plos Med 2007;4e170 5. Museru LM, Macharo CN, Leshabari MT. Road traffic accidents in Tanzania:A ten year epidemiology appraisal. East and Central African Journal of surgery 2002;7:23-6

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