The relationship between ocular trauma and substance abuse in emergency department patients

Abstract

Introduction: Eye injury is the second most common cause of visual impairment and a leading cause of monocular blindness in the United States. There are approximately 6 million ED visits related to drug use annually, including misuse or abuse of pharmaceuticals and illicit drug use. The purpose of this study was to assess the relationship between ocular trauma and substance abuse among emergency department patients and to assess that relationship with demographic factors, including age and gender.

Methods: This study was a retrospective, observational study conducted at Miami Valley Hospital, an urban hospital ED, in Dayton, Ohio. Eligible participants included consecutive ocular trauma patients identified by the Trauma Registry from January 2014 through January 2016. Data were collected from the ED medical record including demographic information, mechanism of injury, visual acuity, slit lamp exam findings, ED procedures, inpatient procedures, toxicology results, ED diagnosis, ED disposition, and eye exam.

Results: Among 229 patients, the mean age was 44 (range 14-93). 73% of patients were male. Most patients were White (74%), followed by African American (21%), Hispanic (2%), and other (3%). Most patients arrived by ambulance (62%), followed by helicopter (30%), and walk-ins (18%). Most patients were admitted to the hospital (79%). Mechanisms of injury included motor vehicle accidents (31%) and cases of assault (28%). Most ocular trauma involved the external eye (44%), the anterior chamber (28%), the orbit (25%) and the globe (22%). The incidence of substance abuse in this patient population was high. Of the patients tested for alcohol (N=143), 49% tested positive. Among 98 patients who received a urine toxicologic screen, 63% tested positive for at least one illicit substance, including opiates (39%), cocaine (12%), benzodiazepines (25%), and/or THC (27%). There was no significant association between substance abuse and ED disposition.

Conclusion: Mechanisms of eye injury included primarily motor vehicle accidents and assault. Most ocular trauma involved the external eye, the anterior chamber, the orbit, and the globe. The incidence of alcohol and illicit substance abuse is high among ED patients with ocular trauma.