Prevalence, patterns and factors associated with Oculo-orbital injuries on computed tomography scan among adults with head trauma at Mulago National Referral Hospital

Abstract

Background Traumatic orbital and ocular injuries pose a serious public health issue, affecting up to 20 million people globally with evidence of increasing numbers. These injuries can leave the victims either completely blind or with a number of preventable complications which are associated with lost productivity and significant morbidity. The burden of these injuries is greater in developing countries like Uganda. Unfortunately, post trauma, studies have shown that there is greater focus and emphasis on cranio-cerebral injuries than there is on oculo-orbital injuries in head trauma patients. Aim To determine the prevalence, patterns and factors associated with oculo-orbital injuries on computed tomography scan among adults with head trauma in Mulago National Referral Hospital, a national referral hospital in Uganda. Methods A quantitative cross-sectional study design was employed and a semi structured questionnaire was the main tool for data collection. Data was collected from participants who met the inclusion criteria by interviewing the patient or care taker, reviewing patients’ medical files, and reviewing their head CT scan images. The collected data was coded and entered into EPIDATA software; cleaned and exported to STATA version 14.0 for analysis. Results A total number of 380 participants with head injuries were enrolled into the study. Majority (74.2%) of the participants were male and the median age was 32 years. The prevalence of oculoorbital injuries was 45.5% with a 95% Confidence interval (CI) = 40.5%─50.5%). Of the oculoorbital injuries, orbital fractures (42.9%) and adnexal injuries (40.2%) were the most common orbital injuries whilst hyphema (47.1%) constituted the majority of the ocular injuries. Zygomaticomaxillary complex (ZMC) fractures were the most common complex fractures followed by Le Fort II. More than half of the patients with oculo-orbital injuries had co-existing hemosinus and the ethmoid sinus was the most commonly affected. Patients who presented with loss of consciousness, partial loss of vision and facial injuries had an increased likelihood of having an oculo-orbital injury. Conclusion and recommendations. Nearly one in every two patients with head trauma had oculo-orbital injuries. Orbital fractures, adnexal injuries and optic nerve injuries were the leading oculo-orbital injuries. Clinical history of LOC, partial loss of vision and facial injuries increased the likelihood of having oculo-orbital injuries. It is therefore paramount that radiologists pay keen interest in identifying these injuries and all head trauma patients should be promptly referred for ophthalmologic review. Keywords: Oculo-orbital injuries, orbital fractures, ocular injuries, Computed Tomography scan.