Department of Ophthalmology, The Alfred, Alfred Health, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004.
Department of Ophthalmology, The Alfred, Alfred Health, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004.
Injury. 2020 Sep;51(9):2009-2015. doi: 10.1016/j.injury.2020.07.029. Epub 2020 Jul 12.
Falls are the leading cause of injury-related emergency presentations, hospital admissions and deaths in Victorians over the age of 65. While there is extensive literature analysing traumatic injuries resulting from falls in older patients, there is little data on ocular injuries in this patient group.
A retrospective audit of all patients over 65 years referred to the Ophthalmology Department of a tertiary hospital following fall from standing height between January 2009 and December 2018 to determine the demographics, injury setting, ophthalmic injuries, interventions and outcomes of ocular trauma secondary to falls.
Two hundred and seventy patients (F = 155, M = 115) were included, with a mean age of 81 years. 180 falls (66.7%) occurred in a residential environment. The most common reason for referral was orbital fracture (n = 155). Severe ocular injuries included globe rupture (n = 23), retro-bulbar haematoma (n = 22), retinal detachment (n = 6) and traumatic optic neuropathy (n = 6). Forty patients (14.8%) presented with a visual acuity (VA) below 6/60 while 34 patients (12.5%) had a non-assessable VA secondary to delirium or intubation. Of these 34, 9 had a significant ocular injury. A total of 28 patients (10.4%) were permanently blinded by their injuries. Twenty-three patients (8.5%) required admission to ICU and 16 patients (5.93%) died during their in-hospital stay. Thirty-six injuries were referred beyond the 24-hour mark, including a globe rupture and a case of traumatic optic neuropathy. With the exception of the missed globe rupture, all other injuries requiring emergency surgery were operated on within 24 h.
Falls in older people may be associated with sight-threatening ocular injuries which are common and easy to miss in this population demographic. The presence of ocular injuries in this patient group is associated with significant rates of in-hospital mortality and poor functional outcomes. It is therefore essential for trauma practitioners to perform a detailed and systematic assessment in order to identify sight-threatening ocular injuries and allow for expedient sight-saving intervention to be performed.
在维多利亚州，65 岁以上的老年人中，跌倒导致的伤害相关急诊就诊、住院和死亡是主要原因。虽然有大量文献分析了老年患者跌倒导致的创伤性损伤，但关于该患者群体眼部损伤的数据很少。
对 2009 年 1 月至 2018 年 12 月期间，因从站立高度跌倒而转诊至三级医院眼科的所有 65 岁以上患者进行回顾性审核，以确定人口统计学、损伤环境、眼部损伤、干预措施和跌倒引起的继发性眼部创伤的结果。
共纳入 270 例患者（F=155，M=115），平均年龄为 81 岁。180 例（66.7%）跌倒发生在居住环境中。转诊的最常见原因是眶壁骨折（n=155）。严重眼部损伤包括眼球破裂（n=23）、球后血肿（n=22）、视网膜脱离（n=6）和创伤性视神经病变（n=6）。40 例（14.8%）患者视力低于 6/60，34 例（12.5%）因谵妄或插管导致视力无法评估。其中 34 例有明显的眼部损伤。共有 28 例（10.4%）因受伤致盲。23 例（8.5%）患者需要入住 ICU，16 例（5.93%）患者在住院期间死亡。36 例损伤在 24 小时后才被转诊，包括一例眼球破裂和一例创伤性视神经病变。除了漏诊的眼球破裂外，所有其他需要急诊手术的损伤都在 24 小时内进行了手术。
老年人跌倒可能导致威胁视力的眼部损伤，在该人群中较为常见且容易漏诊。该患者群体存在眼部损伤与较高的院内死亡率和较差的功能结局相关。因此，创伤医生必须进行详细和系统的评估，以识别威胁视力的眼部损伤，并及时进行挽救视力的干预。
