Ocular manifestations in patients with head injury presenting at the neuro-surgery department of Muhimbili Orthopedic institute

Abstract

Background: Head injury refers to any alteration in mental or physical functioning relating to a blow to the head. It may be associated with ocular abnormalities such as ocular adnexal and internal structures injuries, globe injuries, neuro-ophthalmic abnormalities and orbital wall fractures. The eyes are frequently affected in head trauma due to their proximity to the head as well as the neural connections between the eye and the brain. The leading causes of head injuries are motor traffic accidents, assaults and fall from a height among others. Currently in Tanzania, there is an escalated number of motor cycles use among young adults as a source of employment. This has led to corresponding increase in road traffic accidents and significant numbers of patients with head injuries. Early recognition and intervention of ocular involvement can prevent devastating effect of visual disability and improve overall rehabilitations of the patient after head trauma. Aim : The aim of the study was to assess ocular manifestations among patients with head injuries at Muhimbili Orthopedic Institute. Methodology : This was a hospital based descriptive cross-sectional study among adult patients who were admitted at the neuro-surgery department at Muhimbili Orthopedic Institute (MOI) between October 2019 and January 2020. Ethical approval for the study was obtained from the Research and Publication committee of Muhimbili University of Health and Allied Sciences. Permission to conduct the study was obtained from the executive director of Muhimbili Orthopedic Institute. Consecutive sampling technique was employed and data was collected through history taking and ophthalmological assessment. All data were captured in the study questionnaire then analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Data was presented as frequency tables/histogram. Chi squared test was used to compare differences between variables and p values of less than 0.05 was considered significant. Results: A total of 167 patients were included in the analysis. There were 147(82%) males and 30 (18%) females giving a male to female ratio of 5:1. The age range was from 18 to 59 years with a mean of 24.68 years. The commonest causes of head injury were road traffic accidents and assault which involved 117 (70.1%) and 29 (17.4%) patients respectively. Others were falls from height 11 (6.6%), domestic accidents 9 (5.4%) and sports at 1 (0.6%). Ocular abnormalities after head injury were found in 117 (70%) patients and it involved a total of 234 eyes. More than 30% of patients had visual threatening ocular involvement. The most common ocular presenting feature were ocular adnexae lid ecchymosis which occurred in 51 (22%) eyes. Conclusion and recommendation: A significant proportion of patient (70%) with head injury had ocular manifestations. These manifestations involved the globe, adenexae, anterior and posterior segment structures. It is recommended that every patient with head injury should also be examined for eye injuries by an ophthalmologist along with routine management for head injury by neurosurgeon.