Ocular injuries in children after major trauma.

OBJECTIVE

To determine the variety of ocular injuries sustained by children during major trauma.

SUBJECTS AND

METHODS

The pediatric trauma registry of The Children's Hospital in Denver, Colorado, was surveyed for children with ocular injuries and an Injury Severity Score higher than 15. The injuries were tabulated and correlated with mechanisms of injury to determine identifiable injury patterns.

RESULTS

In a pediatric trauma center, ocular injuries were nearly twice as frequent among children with major trauma (Injury Severity Score > 15). Two-thirds of the children with an Injury Severity Score higher than 15 had been involved in a mishap with a motorized or a nonmotorized vehicle. Ocular injuries in children with an Injury Severity Score higher than 15 were characterized by fracture of the surrounding bony structures and contusions. Children with an Injury Severity Score higher than 15 had 50% to 80% fewer open wounds of the ocular adnexa and eyeball than did children with an Injury Severity Score of 15 or lower. The one optic nerve injury and two-thirds of the other ocular cranial nerve injuries occurred in children with an Injury Severity Score higher than 15.

CONCLUSIONS

Serious ocular injury should be suspected in children involved in a motor vehicle accident who have an Injury Severity Score higher than 15 and fractures of the surrounding bony structures, contusions, or both. Absence of an open wound of the ocular adnexa or eyeball does not eliminate the possibility of serious ocular injury.