The UK Paediatric Ocular Trauma Study 3 (POTS3): clinical features and initial management of injuries

Abstract

Robert J Barry,1,2 Freda Sii,1,3 Alice Bruynseels,1 Joseph Abbott,4 Richard J Blanch,1–2,5 Caroline J MacEwen,6 Peter Shah1,3,7–81Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 2Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; 3Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 4Department of Ophthalmology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK; 5Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Dundee, UK; 6Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, UK; 7University College London, London, UK; 8Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UKPurpose: Worldwide, as many as 6 million children annually sustain ocular trauma, with up to a quarter of a million children requiring hospitalization. Management of pediatric ocular trauma differs from that in adults, both in terms of initial assessment and acute intervention, with significant variation in practice between different centers. Patterns of healing and long-term outcomes are also very different for children compared to adults. In order to develop effective protocols for management, it is first necessary to understand current trends in presentation and treatment.Methods: We conducted a prospective, observational study of pediatric ocular trauma presenting to UK-based ophthalmologists over a one-year period; reporting cards were distributed by the British Ophthalmic Surveillance Unit, and clinicians were asked to report cases of acute orbital and ocular trauma in children aged 16 years or less requiring inpatient or day-case admission. A validated, standardized questionnaire was sent to reporting ophthalmologists to collect data on clinical features and initial management of injury.Results: Eighty-six episodes of pediatric ocular trauma were reported. Trauma involving the globe was reported in 66/86 patients (76.7%), of which 40/66 (60.1%) were open-globe. Trauma to the anterior segment was reported in 57/86 (66.3%), and posterior segment in 23/86 patients (26.7%). Twenty-five of 86 (29.1%) patients sustained severe trauma defined as having best-corrected visual acuity worse than 6/60 Snellen (incidence 0.19 per 100,000 population).Conclusions: There has been no improvement in the incidence or severity of pediatric ocular injury rates over the past 25 years. Eye-care providers must be able to provide the necessary services for assessment and management of severe pediatric ocular trauma in the emergency setting.Keywords: childhood eye injury, incidence, management, penetrating eye injury, perforating eye injury, presentation, prevention

Keywords

• Childhood eye injury Incidence Management Penetrating eye injury Perforating eye injury Presentation Prevention