Ocular manifestations of head injury: a clinical study

AIM

This prospective study aimed to clinically correlate the various ocular findings with the neurological status in cases of closed head injury.

METHODS

A total of 200 consecutive cases of closed head injury admitted to a major teaching hospital underwent a thorough ophthalmic assessment. The Glasgow coma scale (GCS) and the Revised trauma score (RTS) were applied to grade the severity of injury and assess the prognosis. Kendall's tau-b and Fisher's exact test were used in the analysis.

RESULTS

The main causes of head injury were road traffic accidents 52.5% followed by assaults in 34%. Ocular involvement was found in 167(83.5%) cases. These included corneal and scleral tears in 2%, subconjunctival haemorrhage or ecchymosis in 46%, orbital fractures 12%, pupillary involvement 6.5%, papilloedema 5.5%, intraocular trauma 5.5%, proptosis 3%, lateral rectus palsy 2%, lacrimal gland prolapse 1%, and optic nerve trauma 0.5%. All 21 patients (10.5%) who died had eye involvement. In all, 150 cases (75%) with a RTS of 12 had a good prognosis. Of these 124 (82.6%) had ocular involvement of no neurological significance.

CONCLUSIONS

Although sophisticated imaging techniques are available to localize lesions, early ophthalmic assessment in correlation with the GCS aids in prognosticating outcomes. Pupillary involvement, papilloedema, and ocular motor paresis pointed to a more severe head injury. To our knowledge, this is the only prospective study recording ocular findings in the first few hours and attempting a correlation with the final outcome.

Investigation of an epidemic of acute haemorrhagic conjunctivitis in Pune, India

An epidemic of acute haemorrhagic conjunctivitis (AHC) was reported from Pune in August-September, 1996. Conjunctival swabs and scrapings were taken from acute patients attending the OPD of the Ophthalmology department of B. J. Medical College, Pune. Conjunctival swabs were processed in human embryonic lung fibroblasts (HEL) cell line and viral isolates were obtained which were identified as Enterovirus (EV) 70 prime strain using standard in-vitro neutralisation test. Indirect intracellular immunofluorescence test also confirmed the identity of the virus involved in the epidemic.