This review of childhood eye injuries at a single center in Australia found that although outcomes were better than in previous studies, the majority of injuries were preventable.
The authors reviewed the etiology and outcome of childhood open- and closed-globe injuries presenting to a children's hospital in Sydney, Australia, from 2000 through 2008.
There were 203 cases of childhood eye injuries during this period, comprising 81 open-globe and 122 closed-globe injuries. They found an overall improvement in final visual outcome compared with previous studies, with 68 percent of children achieving an excellent visual outcome (> 6/12) and 78 percent achieving a favorable outcome. More than one-half (54 percent) of open-globe injuries in this study had excellent visual outcomes compared with 36 percent in an earlier study of results at this hospital.
The authors write that there are various factors that could have contributed to this improved visual outcome. First, the prognosis of eye injuries is influenced by the nature and severity of the injury, and this study comprised mainly closed-globe injuries and less severe penetrating injuries. Also, advanced microsurgical techniques, improved visual rehabilitation with the use of intraocular lenses and extended-wear contact lenses, and more importantly, a dedicated team of orthoptists involved in the assessment and follow-up of all children for amblyopia had a direct influence.
Favorable visual outcomes were more common with closed-globe injuries compared with open-globe injuries (P < 0.01). Parameters associated with a poor visual outcome included globe ruptures, zone 3 injuries, poor initial visual acuity, wound length >10 mm and lens trauma.
The most common cause of injury (26 percent) was the child poking himself or herself or being poked accidentally by another child, with the home being the most common place of injury. They write that given that children are not entirely responsible for their actions, many of these injuries could have been prevented with greater supervision, education and awareness.
As in other studies, the injuries were predominantly in boys (ratio 3.6:1). The authors noted that younger boys (3 to 5 years) sustained more serious open-globe injuries that often occurred indoors, while older boys (9 to 11 years) suffered more closed-globe injuries that were mostly sports related. This finding is important for the education of children and families and when formulating specific preventive measures.
The rate of enucleation in the study (10.6 percent) was much lower than in adults and similar to rates reported in the previous study at this hospital; however, it was significantly higher than other eye injury studies in children. This may be due to a large number of more serious injuries being referred to this hospital for evaluation and treatment.
The findings of this study and previous studies have prompted development of an Australian project called eyeplaysafe to address prevention of childhood eye injury through improved education and awareness. It features a web-based interactive resource with activities centered on eye safety, located at http://www.eyeplaysafe.org.au.