Forceps Delivery-Related Ophthalmic Injuries: A Case Series

To report a case series of neonatal ophthalmic trauma induced by forceps-assisted vaginal delivery.

Retrospective, non-comparative case series focusing on presentation and long-term outcomes.

Eleven cases of ophthalmic injury secondary to forceps delivery (7 male, 4 female) from October 1997 to July 2014 are presented. Eight cases were born at a single center from January 2006 to July 2014, a rate of 1 case per 413 forceps-assisted deliveries. Follow-up ranged from 2 months to 17 years. Three cases had self-limiting eyelid bruising only. There was one case each of vitreous hemorrhage and hyphema, which resolved spontaneously. There were two cases of oculomotor nerve palsy associated with intracranial hemorrhage, both requiring surgical ptosis repair at 3 and 5 weeks old, respectively. There was one case of facial nerve palsy. Four cases sustained corneal trauma, manifesting as corneal edema in three cases at birth. The fourth of these cases presented at age 4.5 years with corneal scarring and amblyopia. Resulting astigmatism in these four cases ranged from 3.5 to 7.5 diopters and best-corrected visual acuity ranged from 6/12 to 6/36 Snellen at last follow-up.

Although rare, ophthalmic trauma secondary to forceps-assisted delivery can result in a wide spectrum of anatomical injuries, which may be self-limiting or cause significant long-term visual impairment. The authors recommend awareness among obstetricians and pediatricians of these injuries, and referral to the ophthalmologist of any newborn delivered by forceps with evidence of compressive trauma such as scalp or eyelid bruising to rule out the presence of more serious ophthalmic trauma.