Open globe injuries in children: factors predictive of a poor final visual acuity

Aims Eye injuries are the leading cause of monocular blindness in children and are challenging to manage. However, limited follow-up studies currently exist. We describe the clinical characteristics and outcomes of open globe injuries presenting to a major UK centre and discuss factors affecting long-term prognosis. Purpose Identification of (1) demographic features, (2) causes, types and location of injuries, (3) initial clinical features and correlation with visual outcome, and (4) predictors of poor visual outcome. Method Retrospective study by reviewing and analysing records of 20 patients, aged 16 years and below, who had undergone repair of an open globe injuries at the Manchester Royal Eye Hospital, UK. Data recorded included demographic data, mechanisms and location of injury, visual acuity, clinical signs on presentation, surgical procedures, postoperative complications, and final visual acuity. Results The study group comprised of 85% male subjects, 15% female subjects. The average age was 9.8 years (range: 1-15). Average follow-up was 16.3 months (range: 3-48 months). Sharp objects (mainly glass or knife) accounted for the majority (65%) of injuries. Initial clinical signs associated with poor visual outcomes included poor initial visual acuity, cataract, RAPD, and no initial red reflex. Younger patients and blunt injuries (especially BB gun injuries) had worse visual outcomes. Conclusion Factors suggesting unfavourable final visual acuity after open globe injuries in children are (1) young age at presentation, (2) poor initial visual acuity, (3) presence of a relative afferent papillary defect, (4) absence of red reflex, (5) cataract, and (6) types and number of surgeries performed. Awareness and education with regard to prevention of paediatric injuries need to be actively implemented.