Busaraben Gandhi¹, Stuti Juneja², Manoj Soman^3,4* and Unnikrishnan Nair^3,4

¹MS Ophthalmology, Medical Retina Research Fellow, London Northwest University Hospital and Research Institute, London, United Kingdom
²MS Ophthalmology, Associate Professor and In-Charge, Head of the Department of Ophthalmology, Medical College Vadodara, Vadodara, Gujarat, India
³MS Ophthalmology, Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India
⁴MS Ophthalmology, Chaithanya Innovation in Technology and Eyecare (Research), Trivandrum, Kerala, India

*Corresponding Author: Manoj Soman; MS Ophthalmology, Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India.

Received: February 12, 2025; Published: February 28, 2025

Abstract

Objective: To evaluate the frequency and severity of different ocular manifestations in head injury and assess the role of optic nerve sheath diameter (ONSD) in predicting mortality, with the goal of reducing overall mortality through early recognition and appropriate interventions.

Design: Prospective study.

Methodology: A study of 180 head injury cases was conducted at a tertiary care hospital over one year to evaluate various ocular manifestations. The Glasgow Coma Scale (GCS) was used to assess head injury severity. Patients were examined for ocular findings, age, sex, mode of injury, and symptoms. Bed side ocular examination, visual acuity, and fundus examination via indirect ophthalmoscopy were performed. ONSD measurements in primary gaze and in supine position using USG B-scan were obtained. Statistical analysis was done using the chi-square test and descriptive statistics. Ocular neurological signs, ONSD values, and GCS scores were correlated with survival outcomes.

Outcome Measures: In this study of 180 head injury patients, 91.11% had ocular complications, with lid edema (85.56%) and ecchymosis (76.11%) being the most common. Most patients were male (88.33%) and between 21-30 years old. Road traffic accidents (81.11%) were the leading cause of injury. Cranial nerve palsies, notably third nerve palsy (2.22%), and pupillary abnormalities (29.44%) were observed. Posterior segment involvement, including papilledema and retinal haemorrhage, was observed in 6.67% of cases. Abnormal pupil reactions, Glasgow Coma Scale (GCS) scores, and optic nerve sheath diameter (ONSD) ≥5mm significantly (P < 0.0001 for each of above) and orbital fractures (P = 0.04) correlated with mortality.

Conclusions: Ocular manifestations were present in 91.11% of head injury cases. Pupillary abnormalities and ONSD ≥5 mm were highly associated with mortality. Increased ONSD could serve as a surrogate bedside measure of prognosis and survival in head injury patients.

 Keywords: Glasgow Coma Scale; Head Injury; Ocular Manifestations; Optic Nerve Sheath Diameter; Mortality Prediction

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Citation

Citation: Manoj Soman., et al. “The Role of Ocular Findings in Prognosticating Mortality in Head Injury Patients: A Prospective Study”. Acta Scientific Neurology 8.3 (2025): 43-52.

Copyright

Copyright: © 2025 Manoj Soman., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.