Post-traumatic visual sequelae from a forensic medicine perspective: A retrospective analysis of 10 years of data

Vision is one of the most fundamental functions required for a quality life. In this context, eye trauma is frequently subject to medico-legal evaluation to determine both the severity of the injury and the presence of any sequelae, and, if present, the extent of visual function loss. This study examines the medico-legal assessment process following ocular trauma. The aim is to reduce potential confusion by providing explanations that offer standardization and guidance in forensic assessments.

Between January 1, 2014 and January 1, 2024, the files and reports of 210 cases (210 eyes) were retrospectively analyzed. These cases involved forensic medico-legal assessments conducted by the Department of Forensic Medicine, Dokuz Eylul University Faculty of Medicine, focusing on the severity of the injury and the presence of visual function impairment or loss following eye trauma in the context of criminal proceedings. Sociodemographic data, type and cause of trauma, initial diagnosis, classification of injury according to the Birmingham Eye Trauma Terminology System (BETTS), anatomical site of injury, injury severity, and whether visual function impairment or loss had occurred were evaluated. Statistical analysis was performed using the IBM SPSS 29.0 software package.

Of the 210 patients, 171 (81.4%) were male and 39 (18.6%) were female. Ocular trauma was most frequently observed in the 19-30 age group (n=62, 29.5%). There were 157 (74.8%) closed globe injuries and 53 (25.2%) open globe injuries. Subconjunctival hemorrhage (n=132, 62.9%) was the most common finding at the initial ophthalmological examination following trauma. An injury outside Zone 1 was identified as the strongest negative prognostic factor for visual impairment or loss.

From a forensic medicine perspective, eye trauma alone is not considered a life-threatening condition. However, a multidisciplinary approach, including forensic medicine specialists and ophthalmologists, should be adopted in the assessment of visual sequelae, that is, the impairment or loss of visual function, following eye trauma related to criminal proceedings. First, it must be determined whether the healing process is complete and whether there is a causal link between the trauma and vision loss. Once healing is complete, the visual function of each eye should be assessed individually. The assessment method should be chosen based on whether visual acuity loss, visual field defects, or any other diagnoses are present in one eye alone or in both eyes.