Epidemiological, clinical and therapeutic features of pediatric ocular injuries in an eye emergency unit in Île-de-France

• Published in: Journal francais d'ophtalmologie Vol. 38; no. 8; p. 743
• Main Authors: Mayouego Kouam, J, Epée, E, Azria, S, Enyama, D, Omgbwa Eballe, A, Ebana Mvogo, C, Cherifi, M
• Format: Journal Article
• Language: French
• Published: France 01-10-2015
• Subjects: Adolescent; Child; Child, Preschool; Emergency Service, Hospital; Eye Injuries - epidemiology; Eye Injuries - etiology; Female; France - epidemiology; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Prospective Studies; France; Ocular injuries; Enfants; Urgences ophtalmologiques; Traumatismes oculaires; Children; Eye emergencies; Management; Prise en charge
• ISSN: 1773-0597
• DOI: 10.1016/j.jfo.2015.04.009

Ocular and orbital trauma is a leading cause of acquired monocular blindness in childhood. These injuries differ from those in adults in some aspects of the management and prognosis, notably the risk of amblyopia. The goal of this study was to analyze the epidemiological, clinical and therapeutic features of ocular trauma in children who consulted in an eye emergency department in Île-de-France.
This was a descriptive, prospective and longitudinal study. Over a period of 6 months, we included children aged 15 years old or less, who consulted during calls for ocular trauma. Each child received an ophthalmologic examination as complete as his or her condition and cooperation permitted. Mechanical injuries of the eyeball and chemical ocular burns were distributed respectively according to the Birmingham Eye Trauma Terminology and Dua's classification. The visual prognosis was defined as the best corrected visual acuity of the affected eye, measured at the conclusion of treatment.
Among 586 children who consulted during the study period, 265 suffered from ocular trauma (45.22%). The male:female ratio was 1.6:1. The main places of occurrence of the injuries were home (64.15%) and school (18.11%). Injuries from finger nail scratch were the most frequent (12.45%). One hundred and fifty-seven patients consulted within 6 hours (59.19%). The cornea was the predominant site of the injury (44.40%). Mechanical injuries of the eyeball accounted for 75% of cases. The incidence of ocular chemical burns was 6.41%. Eyelid and orbital injuries were observed in 22.26% and 2.26% of cases respectively. Surgical treatment was required in 6.79% of cases. The incidence of hospitalization was 3.02% with a mean length of stay of 3 days. Four children developed sequelae, including 2 corneal scars and 2 cataracts. No case of blindness was recorded.
The high frequency of traumatic ocular and orbital pathology in our study may be due to its sudden and accidental onset, leading parents to seek emergency care. Most injuries occurred at home and at school, which reflects the presence in these places of potential hazards, often unrealized or neglected. The low frequency of open-globe injury may be related to the ubiquitous recruitment. Indeed, in studies including only severe trauma, this rate may reach 73.4%. This clinical presentation is associated with a poor prognosis because of the risk of infection and sequelae causing decreased visual acuity and amblyopia. Few children were hospitalized. This could be explained by the predominance of mild to moderate trauma.
Ocular trauma accounts for nearly half of pediatric conditions encountered in the eye emergency unit. Adequate emergency care improves the visual prognosis.