Geriatric patients suffer more severe open globe injuries, worse visual outcomes

This study's authors retrospectively examined the pattern of ocular trauma in geriatric patients with open globe injuries and compared it with younger patients. They found that open globe injuries are a significant potential source of severe vision loss in the elderly. These older patients tend to be female and involved in falls at home resulting in globe rupture. The authors conclude that a better understanding of these potentially devastating open globe injuries in the geriatric population is necessary in order to improve prevention and treatment strategies.

The authors reviewed the charts of 846 consecutive patients with open globe injuries treated between January 2000 and April 2009 at one hospital. They found that 166 of these injuries occurred in patients aged 65 and older.

Females comprised 58 percent of the geriatric patients compared with only 14 percent of the younger patients (P < 0.0001). Falls were the most common mechanism of injury in the geriatric group (65 percent) compared with only 4 percent of injuries in the control group (P < 0.0001) The most common setting for a geriatric trauma was at home (76 percent) in contrast to the work site for younger patients (39 percent). The injuries among the geriatric patients tended to occur in the late morning or late at night.

There were no cases of endophthalmitis and fewer instances of enucleation in the older patients. The median raw Ocular Trauma Score was 47, significantly more severe than in the younger subset (P < 0.0001). The injuries more often were in zones II and III in the geriatric population, which was significantly different than in the nongeriatric population (P < 0.0001). Geriatric patients were significantly more likely to have undergone previous intraocular surgery (P < 0.0001), which primarily consisted of cataract procedures. Visual acuity at presentation (P < 0.0001) and best postoperative visual acuity (P < 0.0001) were each significantly worse in the geriatric population.

The authors conclude that the elderly represent a unique, yet neglected ocular trauma population. These patients are more likely to have a wound from previous ophthalmic surgery that can weaken the globe, likely predisposing to ruptures. The authors say that without obvious physical or radiologic clues, diagnosis of the sometimes occult zone II and III globe injuries that occur in geriatric patients may be delayed or missed. They recommend a high index of suspicion for ocular injury in geriatric patients who sustain falls, with urgent ophthalmic consultation in all cases in which ocular trauma cannot be excluded.