Closed globe and adnexal eye injuries: Epidemiology, clinical and surgical outcomes, and an economic cost analysis

Abstract

AbstractBackgroundTo examine the epidemiology, visual outcomes, surgical interventions, and socioeconomic costs of closed globe (CGI) and adnexal injuries.MethodsA retrospective 11‐year tertiary‐trauma centre study of 529 consecutive CGI was conducted using the Revised Globe and Adnexal Trauma Terminology classification in individuals aged ≥16 years. Outcome measures included best‐corrected visual acuity (BCVA), operating theatre visits, and socioeconomic costs.ResultsCGI disproportionately impacted young males during work (89.1%) and sports (92.2%), with eye protection only worn in 11.9% and 2.0%, respectively. Home was the most prevalent location (32.5%) due to falls (52.3%) in older females (57.9%). Concomitant adnexal injuries occurred frequently (71.5%), particularly in assaults (88.1%), and included eyelid lacerations (20.8%), orbital injuries (12.5%), and facial fractures (10.2%). Final median BCVA improved to 0.2 logMAR [6/9] (IQR 0–0.2) from 0.5 logMAR [6/18] (IQR 0–0.5) (p < 0.001). Surgery was required in 89 CGI (16.8%) in 123 theatre visits. In multivariable logistical regression modelling, presenting BCVA was predictive of final BCVA (odds ratio [OR] 8.4, 95% confidence interval [95%CI] 2.6–27.8, p < 0.001), while involvement of the lids (OR 2.6, 95%CI 1.3–5.3, p = 0.006), nasolacrimal apparatus (OR 74.9, 95%CI 7.9–707.4, p < 0.001), orbit (OR 5.0, 95%CI 2.2–11.2, p < 0.001), and lens (OR 8.4, 95%CI 2.4–29.7, p < 0.001) predicted for operating theatre visits. Economic costs totalled AUD20.8–32.1 million (USD16.2–25.0 million) and were estimated at AUD44.5–77.0 million (USD34.7–60.1 million) annually for Australia.ConclusionsCGI is a prevalent and preventable burden on patients and the economy. To mitigate this burden, cost‐effective public health strategies should target at‐risk populations.