Open globe injuries in children

A retrospective review of open globe injuries in children was performed to identify the common types of injury and to correlate features of the injuries and surgical management with visual prognosis.

The hospital records of 70 patients were reviewed to determine demographic data, the nature and location of the injuries, the anatomic and functional status of the injured eye before the initial repair, the details of all primary and subsequent surgical procedures, and the final visual outcome.

Fifty of the patients studied (71%) were male and 20 (29%) were female. The average age of the patients was 5 years. Sharp objects caused the majority of injuries (67%). Most of the injuries happened at home (72%). The cornea was involved in a majority of the injuries (92%). Thirty-two eyes (46%) required only primary repair; 15 eyes (21%) required primary repair with anterior vitrectomy and primary lensectomy; 17 eyes (24%) underwent secondary lensectomy or vitreoretinal surgeries, and 5 eyes (7%) were enucleated. Visual acuity of 20/40 or better was achieved by 45% of those patients who required only primary repair. Of those patients requiring a second procedure, 19% had a visual acuity of 20/40 or better. Initial clinical findings associated with an unfavorable visual outcome were retinal detachment, relative afferent pupillary defect, vitreous hemorrhage, and hyphema.

The prognosis after an open globe injury in children is strongly influenced by the nature of the injury and the extent of the initial damage. Visual outcome is better in eyes that require only primary repair.