Ocular Trauma During COVID-19 Pandemic: A Systematic Review and Meta-analysis.

PURPOSE: This study aimed to summarize the latest literature on the trends and incidence of ocular trauma during the COVID-19 pandemic. DESIGN: Systematic review and meta-analysis. METHODS: A systematic literature search was conducted to identify the relevant literature. The search period was between January 1, 2020, and September 20, 2021. The incidence of overall and various types of ocular trauma during the COVID-19 pandemic and the control period was analyzed. The data from different studies were pooled. The odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS: A total of 32 articles were included. After pooling the data from all included studies, the incidence of total and pediatric ocular trauma during the COVID-19 pandemic was 67.7% and 54.3% of those in the control period, respectively. However, the proportion of ocular trauma in eye emergency visits increased during the pandemic (OR, 95% CI: 1.46, 1.04-2.06). The proportion of domestic ocular trauma increased (OR, 95% CI: 3.42, 1.01-11.62), while ocular trauma related to sports and outdoor activities and occupational ocular trauma decreased (OR, 95% CI: 0.64, 0.09-4.29 and 0.18, 0.10-0.33, respectively). It was also reported that chemical injury caused by alcohol-based sanitizers, photokeratitis caused by ultraviolet lamps, and mechanical eye injury caused by masks increased during the COVID-19 pandemic. CONCLUSIONS: There was a reduction in overall eye injuries and substantial differences in the spectrum of ocular trauma during the COVID-19 pandemic. Proper health education and supervision should be strengthened to prevent ocular injuries related to COVID-19 preventive interventions.

A Comparative Evaluation of Globe Trauma Features in a Tertiary Care Hospital Before and During the COVID-19 Pandemic

Objectives: To compare the clinical features, preoperative evaluation, and surgical approaches of globe trauma patients presenting to the emergency department before and during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We retrospectively analyzed 54 eyes of 54 patients with traumatic globe perforation who underwent primary globe repair. The patients were divided into two groups according to the official start of the COVID-19 pandemic in Turkey: Group 1, 1 May 2019-11 March 2020 and Group 2, 11 March 2020-1 January 2021. The demographic features, trauma history, time from trauma to admission and from admission to surgery, COVID-19 serology (polymerase chain reaction [PCR]) result, ophthalmological examination findings at admission, surgical interventions, and postoperative clinical features were obtained from the patients' records. Results: The mean ages of the patients in Group 1 (n=21) and Group 2 (n=33) were 42.76±20.72 and 37.78±23.47 years, respectively (p=0.431). During the pandemic, garden/farm injuries increased while workplace injuries decreased. In Groups 1 and 2 respectively, time from trauma to admission was 461.4±1228.6 and 935.4±2039.6 min (p=0.342), time from admission to surgery was 604.2±679.8 and 392.7±306.9 min (p=0.125), and length of hospital stay was 7.23±4.96, and 3.78±2.28 days (p<0.005). All patients had a COVID-19 PCR test and all resulted negative. There was no significant difference between the groups in terms of the clinical features of the ocular and adnexal injuries, surgical interventions, or postoperative complications (p>0.05). Preoperative visual acuity was found to be an important prognostic factor associated with postoperative visual acuity. Conclusion: Globe injuries require urgent intervention in terms of visual morbidity. Patterns of injury differ during the pandemic due to both restrictions and lifestyle changes. During the pandemic, patients were discharged as soon as possible after emergency treatment to minimize the time spent in the hospital.

Impact of the COVID-19-induced lockdown on the incidence of ocular trauma presenting to a tertiary care hospital.

Objective: To assess the effects of lockdown and unlock phases mandated in view of COVID-19 on the incidence and characteristics of ocular trauma presenting to a tertiary care hospital. Methods and Analysis: The study was carried out as a hospital record based retrospective comparative analysis on patients presenting with ocular trauma in the lockdown period (March-July 2020) compared with the same time frame of the previous year considered as prelockdown period (March-July 2019) and during the unlock phases (August-December 2020). Results: Overall, the casualty department saw 464 patients of ocular trauma in the prelockdown period, 173 in the lockdown and 253 in unlock. The study showed a 44% reduction in patients visiting the casualty department for trauma during the lockdown compared with prelockdown, and a 62% reduction specifically in ocular trauma. The unlock phase showed a 21% reduction in ocular trauma compared with prelockdown and a 41% increase compared with the lockdown. In all three phases, the majority of people affected by ocular trauma were middle aged males from a rural background, sustained by assault. The lockdown saw a decrease in outdoor assaults (45%) and road traffic accidents (22%). Trauma sustained by females (18%) increased in the lockdown, as did home-based assaults (150%) and sexual assaults. The presentation of trauma, especially road traffic accidents and outdoor assaults saw a steady rise during the unlock. Conclusion: The lockdown mandated by the government in response to the COVID-19 pandemic had a significant impact on the trends of trauma presenting to healthcare facilities. There was a decrease in the overall number of patients approaching the casualty during the lockdown. However, during the lockdown, there was an increase in home-based trauma as opposed to outdoor assaults being the primary cause of trauma prior to the lockdown.

Shifting trends in demographic features of chemical eye injuries during COVID-19 pandemic.

OBJECTIVES: To evaluate the etiological cause distribution in chemical eye injuries during COVID-19 pandemic. METHODS: In this retrospective case series, the medical records of patients, who presented with chemical eye injuries between March 30, 2020, and March 1, 2021, were evaluated and compared with the data covering 10 years before the pandemic. RESULTS: Twenty-seven eyes of twenty-three patients (19 adults, 4 children) who presented in pandemic period were included. Alcohol-based hand sanitizer was one of the two most common agents (n = 6 eyes) in the pandemic era. In the last 10 years before the pandemic, 137 eyes of 102 patients were treated for chemical eye injuries. Injuries due to alcohol-based hand sanitizer increased from 3.1 to 21.1% among all patients, and from 0 to 75% among pediatric patients during the pandemic era compared to the pre-pandemic period. The increase was statistically significant both in all patients (p = .003) and in the pediatric patient group (p = .048). CONCLUSION: Due to COVID-19 pandemic, alcohol-based hand sanitizer use became more common. Consequently, the frequency of hand sanitizer related chemical injuries showed a 13-fold increase and the age group affected by such accidents is altered during the pandemic. Three out of four pediatric patients (75%) were injured with alcohol-based hand sanitizers, which draws attention to the fact that improperly placed hand sanitizer stations, being just at the eye level of children, can cause chemical eye injuries in the pediatric population even more.

Changing patterns of posterior segment trauma during the COVID-19 pandemic: A regional analysis from the Bodhya Eye Consortium.

Purpose: To assess changes in the presentation patterns of posterior segment trauma during the COVID-19 pandemic from six tertiary eye care institutes of North and Central India. Methods: A multicenter, hospital-based, retrospective comparative analysis of patients presenting with posterior segment trauma was done during the COVID-19 (Group A) (March 25, 2020 - September 30, 2020) period and the pre-COVID-19 (Group B) (March 25, 2019 - September 30, 2019) period. Results: A total of 405 patients were diagnosed with posterior segment trauma (Group A: 206, Group B: 199). The time interval between onset of trauma and presentation was higher in Group A (16.59 ± 29.87 days) as compared to Group B (9.41 ± 19.19 days) (P = 0.004). A majority of patients in Group A had a history of prior consultation before presentation (P = 0.049). In Group A, 120 (58.2%) patients sustained ocular trauma at home as compared to 80 (40.2%) patients in Group B (P < 0.0001). Patients presenting with light perception were significantly more in Group A (43.7%) as compared to Group B (30.2%) (P = 0.004). In Group B, 37.6% patients had presenting visual acuity of counting finger or better as compared to 27.6% patients in Group A (P = 0.07). Patients in Group A had a significantly higher proportion of post-traumatic endophthalmitis with delayed presentation (P = 0.011) and retinal detachment (P = 0.041). Patients undergoing surgery for foreign-body removal were significantly fewer in Group A (P = 0.05). Conclusion: Although the number of patients presenting with posterior segment trauma was comparable in Groups A and B, a greater number of patients sustained home injuries during the COVID-19 pandemic. A majority of these patients had delayed presentation with poor presenting visual acuity and a higher tendency of retinal detachment.

Paediatric eye injuries during a COVID-19 pandemic lockdown.

CLINICAL RELEVANCE: Eye injuries, both accidental and non-accidental, are a significant cause of long-term visual impairment in children. An understanding of when and how such injuries occur is key to development of adequate prevention strategies. BACKGROUND: To evaluate accidental and non-accidental eye injuries in children presenting to the major tertiary emergency department and outpatient ophthalmology clinic in Western Australia during the nationwide COVID-19 lockdown and to determine whether the frequency or nature of these injuries differed from pre-pandemic presentations. METHODS: Retrospective review of the medical records of paediatric patients presenting to the emergency department and specialist ophthalmology clinic with an ocular injury and those presenting to the hospital Child Protection Unit with physical injuries during March-August 2020 and the same period in 2019. RESULTS: There was no significant difference in the total number of accidental eye injury presentations during the lockdown period despite a significant decrease in emergency department attendance overall. Closed-globe injuries were the most common accidental eye injury presentation during lockdown (70/110, 64%), followed by adnexal injuries (39/110, 35%) and open-globe injuries (1/110, 1%). In contrast, referrals to the hospital Child Protection Unit for suspicious injuries declined during lockdown.Although eye injury presentations have changed in other parts of the world since the start of the pandemic, during COVID-19 lockdown in Western Australia, accidental paediatric ocular and adnexal trauma sustained at home continues to be a significant cause for hospital attendance. Public education regarding in-home eye injury prevention must be ongoing.

Ocular Injury Associated With Prone Positioning in Adult Critical Care: A Systematic Review and Meta-Analysis.

PURPOSE: Prone positioning during the COVID-19 pandemic has become increasingly used as an adjunct to increase oxygenation in critical care patients. It is associated with an adverse event profile. This study sought to investigate the occurrence of ocular injuries reported in prone versus supine groups in adult critical care. DESIGN: Systematic review and meta-analysis. METHODS: A systematic review and meta-analysis were carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, SCOPUS, and the Cochrane Library were searched. The search period was January 1, 1990, to July 1, 2020. RESULTS: Eleven randomized controlled trials were included, with 2,247 patients. Twenty-eight events were recorded in 3 trials (174 patients) and no events in the other 8 trials (2,073 patients). The rates of eye injury were 5 events in 1,158 patients (1.30%) and 13 events in 1,089 patients (1.19%) in the prone and supine groups, respectively, which were reduced to 2 of 1,158 patients (0.17%) and 2 of 1,089 patients (0.18%), respectively, when reports of eye or eyelid edema were removed. Meta-analysis demonstrated no significant differences between groups with (an OR of 1.40 (95% CI: 0.37-5.27) and without (OR: 0.78; 95% CI: 0.11-5.73) reported edema. CONCLUSIONS: This meta-analysis showed no significant difference in the rate of reported ocular injury between prone and supine critical care groups. These rates remain higher than the incidence reported during general anesthesia. There is a need for studies in critical care settings in which ocular injury is an end-point and which include extended patient follow-up.

Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute.

PURPOSE: To evaluate the impact of the COVID-19 pandemic and the national lockdown on the demographic and clinical profile of patients presenting with ocular trauma. METHODS: In this retrospective, hospital-based, comparative analysis, patients presenting to the emergency department with ocular trauma in the following COVID-19 period (March 25, 2020 to July 31, 2020) were compared with patients in the pre-COVID-19 period (March 25, 2019 to July 31, 2019). RESULTS: Overall, 242 patients (COVID-19 period: 71 and pre-COVID-19 period: 171) presented with ocular trauma. The mean age of the patients in COVID-19 and pre-COVID-19 periods were 26.7 ± 17.3 and 34.1 ± 20.3 years, respectively (P = 0.008). A majority of patients (68.6%) in both groups were from the rural background. Home-related injuries were common in the COVID-19 period (78.8%) as compared to pre-COVID-19 period (36.4%) (P < 0.0001). Iron particles (29.5%) were the common inflicting agents in the COVID-19 period while it was plant leaves (25.5%) in the pre-COVID-19 period. The most common ocular diagnosis was open globe injury (40.8%) in the COVID-19 period and microbial keratitis (47.9%) in the pre-COVID-19 period. Surgical intervention was required in 46.4% of patients in the COVID-19 period and 32.1% of patients in the pre-COVID-19 period (P = 0.034). CONCLUSION: During the COVID-19 period.there was a significant decline in the number of patients presenting with ocular trauma. In this period, a majority of patients sustained ocular trauma in home-settings. About half the patients required surgical intervention which was most commonly rendered in the form of primary wound repair.

Pediatric Eye Injuries by Hydroalcoholic Gel in the Context of the Coronavirus Disease 2019 Pandemic.

Importance: The coronavirus disease 2019 (COVID-19) pandemic has made alcohol-based hand sanitizers (ABHS) widely available in public places. This may warrant determining whether cases of unintentional ocular exposure are increasing, especially in children. Objective: To describe the epidemiologic trend of pediatric eye exposures to ABHS and to report the severity of the ocular lesions. Design, Setting, and Participants: Retrospective case series conducted from April 1, 2020, to August 24, 2020. Cases were retrieved from the national database of the French Poison Control Centers (PCC) and from a pediatric ophthalmology referral hospital in Paris, France. Cases of ocular exposure to chemical agents in children younger than 18 years during the study period were reviewed. Cases of ABHS exposure were included. Exposures: The following data were collected: age, sex, circumstances of exposure, symptoms, size of the epithelial defect at first examination, time between the incident and re-epithelialization, and medical and/or surgical management. Main Outcomes and Measures: Comparison of the number of eye exposures to ABHS in children between April to August 2020 and April to August 2019. Results: Between April 1 and August 24, 2020, there were 7 times more pediatric cases of ABHS eye exposures reported in the PCC database compared with the same period in 2019 (9.9% of pediatric eye exposures in 2020 vs 1.3% in 2019; difference, 8.6%; 95% CI, 7.4-9.9; P < .001). The number of cases occurring in public places increased in 2020 (from 16.4% in May to 52.4% in August). Similarly, admissions to the eye hospital for ABHS exposure increased at the same period (16 children in 2020 including 10 boys; mean [SD] age, 3.5 [1.4] years vs 1 boy aged 16 months in 2019). Eight of them presented with a corneal and/or conjunctival ulcer, involving more than 50% of the corneal surface for 6 of them. Two cases required amniotic membrane transplant. Conclusions and Relevance: These data support the likelihood of an increasing number of unintentional ocular exposures to ABHS in the pediatric population. To maintain good public compliance with hand disinfection, these findings support that health authorities should ensure the safe use of these devices and warn the parents and caregivers about their potential danger for children.

Ocular Trauma During the COVID-19 Lockdown.

Purpose: To identify the impact the COVID-19 lockdown had on the presentation and management of sight-threatening ocular trauma.Methods: A retrospective cohort analysis of all patients who presented to the Ophthalmology department of Royal Hallamshire Hospital Sheffield with serious ocular trauma during the COVID-19 lockdown period was performed. Data on mechanism of injury and date of injury, presentation, and surgical repair were collected. This process was repeated for the same dates in the previous 5 years for comparison.Results: During the COVID-19 lockdown period, we saw 10 cases of serious ocular trauma (4 globe ruptures, 4 full-thickness lid lacerations, and 2 intra-ocular foreign bodies). This is 3.33 times the average number of cases over the previous 5 years. The delay between injury and presentation rose to 1.1 days compared to 0.33 days pre-COVID; however, the time taken between presentation to surgery was only slightly affected (12 hours in 2020 compared to 11.38 hours pre-COVID).Conclusion: During the COVID-19 lockdown, the number of serious ocular trauma cases was more than three times the average of the previous 5 years. This increase is partially due to more DIY injuries as people stayed at home, but also surprisingly an increase in falls. There did appear to be a longer delay between injury and presentation, suggesting that patients were reluctant to come into hospital during the pandemic. Surgery was performed within 12 hours on average for both groups, reassuringly indicating that sight-saving surgery was not delayed despite extraordinary circumstances.

[Eye traumatism during the COVID-19 sanitary crisis at Iota-teaching hospital]. / Traumatismes oculaires pendant la crise sanitaire de COVID-19 au CHU de Iota.

INTRODUCTION: During the COVID-19 pandemic, we have witnessed a world-wide lock-down of the population. This government action combined with the application of social distancing should in principle reduce the frequency of occurrence of ocular injuries. The goal of our work is to try to understand the circumstances of the occurrence of ocular injuries at the IOTA Teaching Hospital during the lock-down period of the COVID-19 health crisis. METHODOLOGY: This was a cross-sectional, descriptive study. The data were collected prospectively. Our study covered the period from March to May 2020. All consenting patients seen at the IOTA Teaching Hospital for ocular trauma regardless of gender, age, circumstances in which the trauma occurred or the nature of the injuries were included by non-probability sampling. Excluded from the study were patients who did not consent or who consulted for a non-traumatic ophthalmologic condition. RESULTS: There were a total of 138 cases, of which 84 were male and 54 female, for a gender ratio of M/F=1.5. Children aged 0 to 5 years represented more than 3/4 (79.14%) of our sample. Trauma occurred in 45.83% of cases during leisure activities and 3.60% of cases involved domestic violence. DISCUSSION: According to the authors, measures aimed at limiting public movement, particularly the curfews introduced by the Malian government to contain the spread of the COVID-19 pandemic, may actually result in trauma. CONCLUSION: Raising public awareness of the social and psychological consequences of lock-down through audiovisual means might significantly reduce the frequency of these ocular traumas.

Ocular trauma during COVID-19 stay-at-home orders: a comparative cohort study.

PURPOSE OF REVIEW: The aim of this study was to report characteristics of patients presenting with serious ocular injuries during the COVID-19 stay-at-home orders. RECENT FINDINGS: Of 1058 patients presenting for emergency evaluation during the stay-at-home order, 62 (5.9%) patients [mean (SD) age, 41.1 (19.2) years; 19 (31%) women; 31 (50%) white] presented with severe ocular trauma. The daily mean (SD) number of patients who presented for emergency evaluation decreased from 49.0 (9) to 36.4 (6) during the quarantine (P < 0.001). Patients presenting during the stay-at-home order were less likely to have health insurance [odds ratio (OR), 0.33; 95% confidence interval (95% CI), 0.13-0.90, P = 0.024], more likely to have a delayed presentation (difference, 22.7 h, 95% CI, 5.8-39.5, P < 0.001, more likely to travel farther to seek emergency care (difference, 10.4 miles, 95% CI, 2.6-18.2, P < 0.001) and more likely to have an injury occur at home (OR, 22.8; 95% CI, 9.6-54.2, P < 0.001). Of injuries occurring at home, there was a significant increase in injuries arising from home improvement projects during the stay-at-home order (28 vs. 0%, P = 0.02). SUMMARY: During the COVID-19 pandemic, patients with ocular trauma were more likely to have injuries sustained at home and have additional barriers to care. These changes underscore a need for targeted interventions to optimize emergent eye care during a pandemic.