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

Abstract

Background: To examine the epidemiology, visual outcomes, surgical interventions, and socioeconomic costs of closed globe (CGI) and adnexal injuries. Methods: A 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. Results: CGI 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. Conclusions: CGI 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.