Assault-related penetrating ocular injury

We performed a retrospective study of 42 patients with penetrating ocular injury resulting from assault over a five-year period (1986 through 1991). Thirty-six patients were male (86%) and six were female, with a mean age of 29 years. Twenty-nine of 42 patients (70%) had consumed alcohol or used illegal drugs before their injury. Fists were the leading cause of injury (ten patients), followed by broken glass (nine patients). At least six months of follow-up was obtained on 40 patients (95%), with a mean follow-up of ten months. Ten (25%) patients had good visual outcome with final visual acuity of 20/40 or better. Twenty-five patients (63%) had final visual acuity of less than 5/200 at final follow-up. In this group with poor visual outcome, 12 patients (48%) underwent enucleation or evisceration (five primarily) because of extensive ocular damage. Five of 42 patients (12%) had visual acuity of no light perception, and eight (20%) had visual acuity ranging from light perception to counting fingers. The remaining five patients (12%) had final visual acuities between 20/100 and 5/200. Factors predictive of poor visual outcome were as follows: (1) initial visual acuity of light perception or worse; (2) injury by a blunt object; (3) posterior scleral lacerations (> 15 mm in length); and (4) presence of vitreous hemorrhage, retinal detachment, and prolapsed uvea. Penetrating ocular injury with posterior segment involvement caused by assaultive injury results in guarded visual outcome in most patients. Prevention of such injuries remains difficult.