Clinical Spectrum and Visual Outcomes of Assault-Related Ocular Injuries: A Five-Year Analysis Using the Birmingham Eye Trauma Terminology System

Abstract

Purpose: To determine the demographic and clinical profile of ocular trauma cases presenting to the ophthalmology department of a tertiary care hospital in Pakistan.

Material and Methods: A retrospective analysis of medical records from 340 ocular trauma cases presenting between March 2020 and August 2025 was conducted. Injuries were classified using the Birmingham Eye Trauma Terminology System (BETTS). Primary outcome measures included demographic characteristics, injury patterns, and presenting visual acuity. Secondary outcomes comprised associated injuries and complications.

Results: Males constituted the majority (289, 85%), with a mean age of 35 ± 15 years. Fist blows were the most common injury mechanism (197, 58%). Closed globe injury (CGI) was observed in 243 patients (71.5%), while open globe injury (OGI) occurred in 97 (28.5%). Presenting visual acuity of ≥ 6/12 was documented in 165 (67.9%) CGI cases and 10 (10.3%) OGI cases. Malingering was identified in 24 females (7.1%). Associated findings included adnexal trauma (228, 67.1%), hyphema (112, 32.9%), and orbital fractures (34, 10%). Endophthalmitis was noted in 31 (32%) cases of OGI.

Conclusion: Assault-related ocular trauma predominantly affected young males. The high frequency of associated injuries and secondary complications, particularly the endophthalmitis, mandates an urgent need for enhanced preventive strategies and standardized protocols for documentation and management of ocular trauma.