Demographic and Clinical Factors Associated with Mechanisms of Open Globe Injury in the United States: A Multi-Center Study.

Abstract

Purpose: We sought to examine the demographic and clinical risk factors associated with specific mechanisms of open globe injuries (OGIs) and identify predictors of Zone III injuries across multiple tertiary eye care centers.

Patients and methods: 1570 patients with OGIs presenting to the Wilmer Eye Institute, the Bascom Palmer Eye Institute, Massachusetts Eye and Ear, and Wills Eye Hospital between 2018-2021 were retrospectively reviewed. Multinomial and binomial logistic regression models were used to evaluate associations between demographic and clinical risk factors with injury mechanisms and Zone III injuries.

Results: Among the study population (74.2% male, mean age 48.2 years), falls (21.3%), construction work (16.2%), and assaults (10.0%) were the most common injury mechanisms. Black patients had higher risk of assault-related OGIs (relative risk ratio [RRR], 6.41; 95% confidence interval [CI], 2.06-19.93; p<0.001) and elderly patients >61 years showed increased risk for falls (RRR, 10.45; 95% CI, 2.22-49.10; p=0.003). Eyelid laceration was significantly associated with assaults (RRR, 5.58; 95% CI, 1.59-19.65; p=0.007) and falls (RRR, 4.81; 95% CI, 1.61-14.34; p=0.005), while iris prolapse was associated with assaults (RRR, 3.23; 95% CI, 1.12-9.32; p=0.03) and construction work injuries (RRR, 1.99; 95% CI, 1.12-3.52; p=0.02). Zone III injuries were independently associated with eyelid laceration (prevalence ratio [PR], 1.62; 95% CI, 1.20-2.18; p<0.001), relative afferent pupillary defect (RAPD) (PR, 2.42; 95% CI, 1.71-3.43; p<0.001), and retrobulbar hemorrhage (PR, 2.77; 95% CI, 1.76-4.36; p<0.001).

Conclusion: This multi-institutional study identified distinct demographic risk profiles for different OGI mechanisms and clinical predictors of severe injuries. These findings suggest opportunities for targeted prevention strategies and may aid in early identification and triage of severe OGIs.