The management of ocular and peri-ocular trauma needs to be co-ordinated according to ATLS principles and requires multi-disciplinary collaboration

• Published in: Injury 2021-09, Vol.52 (9), p.2606-2610
• Main Authors: Kruse, C., Bruce, J.L., Bekker, W., Clarke, D.L.
• Format: Article
• Language: English
• Subjects: Facial; Head; Ocular; Peri-ocular; Skill set; South Africa; Systems; Trauma
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.02.010

•The violent spectrum of ocular and peri-ocular trauma in South Africa differs greatly from first-world facilities but imitates regions of warfare and civil strife.•The management of trauma to the peri-ocular region must follow a hierarchical needs-based approach.•Acute care is probably best encapsulated in the principles of the ATLS course of the American College of Surgeons.•This care is complex and often involves a number of specialists and sub-specialists who share an interest in the region. Healthcare workers on the frontline require a diverse skill set. : This project set out to focus on ocular (globe) and peri-ocular trauma and to describe the spectrum of injuries seen in a busy South African trauma unit and to document their management and outcome. : During the period November 2012 to April 2020, a total of 12 115 patients were managed by the Pietermaritzburg Metropolitan Trauma Service (PMTS) at Greys Hospital in Pietermaritzburg, South Africa. Of these 2194 (11%) sustained ocular or peri-ocular injury. Of these 2194 patients, 1069 (83%) were male. 83% of injuries (n=1076) were classified as primarily blunt injury and 17% as a primarily sharp/penetrating mechanism. A substantial number of patients required a life-saving emergency intervention. These included resuscitation in 242 cases (19%) and active airway intervention was in 290 (22%). In total 919 (71%) patients required urgent surgery to the peri-ocular region. Slightly over half (55%) of these the surgery was performed by a single discipline. The rest needed procedures by two or more disciplines. The disciplines involved included ophthalmology, maxillofacial, plastic, ENT and neurosurgery. Plastic surgery was involved in 683 cases (53%). A total of 341 distant surgeries were required - These included orthopaedic operations, laparotomy and vascular operations. Of the 1294 cases in this study, 42 (3%) died before discharge and 99 (8%) were discharged with a GCS lower than 10. The primary skill set for management of these injuries is identified. : Although the management of immediate life and organ threatening injuries takes priority, ocular and peri-ocular trauma may damage a number of important structures and their comprehensive management requires a multi-disciplinary team of specialists or, in austere environments, a font-line medical team with a diverse skill set.