Mechanism-specific structural patterns in hospitalized severe mechanical open-globe injury: Implications for triage and operative preparedness in a 13-year tertiary referral cohort.

BACKGROUND: Severe mechanical open-globe injury (OGI) is a vision-threatening emergency. Injury mechanism is often available at first contact, whereas definitive structural classification may emerge only after clinical and operative assessment. We examined whether hospitalized severe mechanical OGI shows mechanism-specific structural patterns and whether final structural phenotype is associated with short-term inpatient course.

METHODS: We conducted a single-center retrospective cohort of 1096 index hospitalizations for severe mechanical OGI during 2013-2025 at a tertiary referral center in eastern China. Injury mechanisms were adjudicated from free-text cause fields using a prespecified coding framework. The primary outcome was final Birmingham Eye Trauma Terminology (BETT) phenotype. Mechanism-phenotype associations were assessed using an L2-penalized multinomial logistic model adjusted for age, sex, and calendar year; exponentiated contrasts were reported as adjusted odds ratios. Secondary classification-to-course analyses evaluated early visual status, visual-category improvement, length of stay, procedural burden, and treatment non-completion, with presenting visual acuity added to secondary models.

RESULTS: Industrial metal injury was the dominant mechanism (45.5%), followed by plastic/other foreign-body injury (9.7%) and falls (7.2%). Mechanism was strongly associated with final BETT phenotype (Pearson χ² = 425.62, p < 0.001). Industrial metal injury clustered toward intraocular foreign body (IOFB)-related injury and laceration without IOFB (37.3% and 36.3%), whereas falls and fireworks were rupture-dominant (96.2% and 96.0%). In the adjusted multinomial model, falls were strongly associated with globe rupture rather than laceration without IOFB compared with industrial metal injury (adjusted OR 27.40, 95% CI 12.71-77.54). Globe rupture showed the most severe inpatient course: 79.6% presented with light perception/no light perception, 94.0% had poor discharge visual acuity, and 34.3% had documented treatment non-completion. After additional adjustment for presenting visual acuity, rupture remained associated with poor discharge visual acuity (adjusted OR 5.25, 95% CI 2.84-9.71) and treatment non-completion (adjusted OR 3.78, 95% CI 2.19-6.52).

CONCLUSIONS: Hospitalized severe mechanical OGI exhibited mechanism-specific structural patterns that extended beyond anatomical classification by mapping onto short-term inpatient course. Mechanism may support early structural suspicion, operative preparedness, expectation management, and treatment-pathway counseling, complementing rather than replacing examination, imaging, and operative assessment.