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

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.  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. 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. 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. 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. 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.  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.  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.  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. 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.  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.  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.
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