Abstract
Background
This study retrospectively analysed and summarized the age, causes, clinical characteristics, and treatment of paediatric patients with ocular trauma hospitalized at Hebei Eye Hospital and aimed to provide effective guidance for the prevention and postinjury treatment of paediatric ocular trauma.
Materials and methods
We conducted a systematic retrospective analysis of 704 paediatric patients with ocular trauma who were admitted to the Department of Ocular Trauma at Hebei Eye Hospital from January 2020 to December 2024. Patients included 550 males and 154 females aged 1–17 years, with a mean age of 9.33 ± 4.66 years. A systematic retrospective analysis was conducted on the basis of age, sex, injured eye, initial consultation time, injury location, injury cause, injury type, treatment methods, ocular complications, and visual acuity before and after treatment.
Results
The male-to-female ratio in this study was 3.57:1, with a higher prevalence in boys. The results of this study revealed that the most common location at which childhood ocular trauma occurred was at home (40.3%) and that the most common type of ocular trauma was ocular adnexal trauma, followed by open and closed ocular trauma. In this study, approximately 74.9% of the children underwent primary tissue repair and suturing within 24 h of their initial consultation, and approximately 16.6% of the children underwent secondary surgeries. Fisher’s exact test revealed that accompanying lens damage, accompanying retinal or optic nerve damage, endophthalmitis, admission vision, secondary surgery, and the type of secondary surgery were significantly (P < 0.05). Factors for which P < 0.05 were included in a multivariate binary logistic regression model for analysis. The following factors were statistically significant in the multivariate analysis: lens damage, retinal or optic nerve damage, endophthalmitis, secondary surgery, secondary cataract surgery, and vitrectomy with intraocular lens implantation (P < 0.05).
Conclusion
In summary, ocular trauma in children may lead to irreversible visual impairment. Therefore, preventive measures and increased awareness regarding eye protection among parents are highly important for reducing the incidence of ocular trauma in children.
Keywords: Children, Ocular trauma, Mechanical ocular trauma, Nonmechanical ocular trauma
Introduction
Ocular trauma is caused by mechanical, physical, or chemical factors that directly affect the eye and result in damage to its structure and function. Ocular trauma can be classified as mechanical or nonmechanical according to the causative agent involved. Mechanical ocular trauma typically includes contusions, penetrating injuries, and foreign body injuries, while nonmechanical ocular trauma includes thermal, chemical, radiation, and gas burns [1–3]. Ocular trauma is a leading cause of severe visual impairment. It is estimated that over 18 million people worldwide lose vision in one eye because of ocular trauma [4, 5]. Children account for 20–50% of all patients with ocular trauma, which are a common cause of acquired unilateral blindness in children [6]. Visual impairment caused by ocular trauma not only affects children’s physical and mental health but also imposes a heavy economic burden on families and society. Therefore, understanding the causes, clinical characteristics, and prognosis of childhood ocular trauma and establishing active and effective preventive measures are highly important for reducing the blindness rate caused by childhood ocular trauma. This study retrospectively analysed and summarized the age, causes, clinical characteristics, and treatment of paediatric patients with ocular trauma who were hospitalized at Hebei Eye Hospital. This study also aimed to provide effective guidance for the prevention and postinjury treatment of paediatric ocular trauma.
Materials and methods
Research subjects
We conducted a systematic retrospective analysis of 704 paediatric patients with ocular trauma, including 550 males and 154 females, who were admitted to the Department of Ocular Trauma at Hebei Eye Hospital from January 2020 to December 2024. The age of the participants ranged from 1 to 17 years (mean age: 9.33 ± 4.66 years). This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Hebei Eye Hospital (Ethics Approval No. 2026LW05). Signed informed consent was obtained from the children and their families.
Inclusion and exclusion criteria
The patient inclusion criteria were as follows: (1) age younger than 18 years, as defined by the International Convention on the Rights of the Child, and (2) diagnosis of ocular trauma on the basis of medical history, physical signs, and imaging examinations.
The exclusion criteria were as follows: (1) children with other eye diseases that affected vision, such as retinopathy of prematurity, congenital cataracts, congenital glaucoma, and amblyopia; (2) children with a history of eye surgery that affected vision, such as cataract surgery, glaucoma surgery, and vitreoretinal surgery; (3) children with incomplete medical records; and (4) children who were admitted to the hospital on multiple occasions.
Methods
The case data of the research subjects were retrieved from the case system, and a retrospective study was conducted on the basis of age, sex, injured eye, initial consultation time, injury location, injury cause, injury zone, injury type, treatment methods, ocular complications, and visual acuity before and after treatment among all the patients. This study summarized the epidemiological characteristics, clinical features, and prognosis of paediatric ocular trauma patients.
Ocular trauma refers to damage to the tissues and functions of the eyeball and its adnexa caused by external physical, chemical, and biological factors. Clinically, ocular trauma can be divided into two main categories: nonmechanical and mechanical ocular trauma. Ocular trauma can be further divided into globe trauma and ocular adnexal trauma according to the location of injury. Nonmechanical ocular trauma includes thermal burns, chemical burns, radiation burns, and electrical injury [7]. In accordance with the classification advocated by the Birmingham Eye Trauma Terminology (BETT) in 1996, the eyeball is used as the reference tissue, and the eyeball wall is limited to the cornea and sclera. Mechanical ocular trauma is classified as either closed ocular trauma or open ocular trauma, and each is further subdivided and zoned according to the the injury location. Closed ocular trauma includes blunt trauma and lamellar lacerations, while open ocular trauma includes lacerations, perforations, penetrating injuries, and foreign body injuries [8, 9]. Ocular adnexal trauma refers to injuries caused by blunt or sharp mechanical forces that act directly on the ocular adnexa (eyelids, lacrimal apparatus, orbit, and extraocular muscles). In this study, a mixed injury refers to the simultaneous presence of multiple external injuries or combined external injuries at multiple sites. With respect to zones for open ocular trauma, Zone I injuries are limited to the cornea and limbus, Zone II injuries can extend to the sclera up to 5 mm behind the limbus, and Zone III injuries extend beyond 5 mm behind the limbus. For multiple wounds, the last wound is used as the reference point, while for intraocular foreign bodies, the entry point is used, and for penetrating wounds, the exit point is used as the reference [10].
Treatment of children with ocular trauma
The primary goal of first-stage surgery is to close the wound, restore intraocular pressure, prevent infection, and provide a good foundation for subsequent second-stage surgery. These measures ensure the stability of the eye structure and reduce the occurrence of complications. Second-stage surgery focuses on the reconstruction of the eyeball structure and the restoration of visual function to the greatest extent possible. The goal of this stage is to repair damaged eye tissue and optimize the chances of visual recovery.
Open or foreign body-related ocular trauma should be treated with early stage I (within 12–24 h) debridement and suturing of the open ocular wound or removal of the intraocular foreign body [11]. Most foreign bodies embedded in the cornea and anterior sclera, as well as magnetic foreign bodies located in the anterior chamber, pars plana of the ciliary body, and vitreous body, can be removed during the first stage of debridement and suturing. Magnetic foreign bodies can be attracted by the powerful permanent magnet series designed and developed by Dr. Jia Jinchen, director of the Department of Ocular Trauma at Hebei Eye Hospital [12]. For patients with obvious vitreous opacity, foreign bodies embedded in the retina, retinal detachment, or endophthalmitis, vitrectomy combined with intraocular foreign body removal is recommended.
If a child develops endophthalmitis, anterior chamber irrigation plus intravitreal antibiotic injection (IVAI) can be performed. Vitrectomy plus intravitreal antibiotic injection should be performed immediately under the following circumstances: when a child’s condition deteriorates significantly within 24 h of the initial diagnosis of endophthalmitis, if the condition does not improve within 48 h of the first intravitreal antibiotic injection, and if ultrasound reveals severe vitreous opacity or purulent accumulation [13, 14].
In children with lens damage, localized lens opacity caused by trauma, if it has little impact on vision, can be observed. If the opacity worsens, a second-stage phacoemulsification cataract surgery + intraocular lens (IOL) implantation + anterior vitrectomy is required. If the lens capsule ruptures with cortical leakage, the lens cortex is aspirated through an incision at the limbus during the first-stage surgery, and primary IOL implantation is generally not recommended. Second-stage implantation is performed after the condition of the injured eye has stabilized and when the IOL power can be accurately measured. Observation is possible in cases of incomplete lens dislocation without complications and without causing anisometropia in both eyes, which can be improved with glasses. If the lens is completely dislocated and if it dislocates into the anterior chamber or becomes embedded in the pupillary area, intracapsular lens extraction (lensectomy) + anterior vitrectomy + intraocular lens suspension should be performed as soon as possible. If the lens dislocates into the vitreous cavity, observation can be performed first, and vitrectomy + intraocular lens suspension can be performed after the condition of the injured eye has stabilized [15].
Most severe open ocular trauma is often accompanied by complications such as vitreous haemorrhage, retinal detachment, choroidal detachment, intraocular foreign bodies, and even infectious endophthalmitis. These conditions usually require secondary vitreoretinal surgery. No unified standard for the optimal timing of secondary surgery has been established, but it is generally recommended that surgery be performed 1 to 2 weeks after ocular injury to ensure that the acute inflammatory response is controlled and to provide more stable conditions [15].
Statistical analysis
For vision tests, different tools are used depending on the age group: school-aged children can use the “E” chart, preschool-aged children use the children’s picture chart, and for infants and toddlers, a fixed tracking method is used to assess vision. Regardless of the method used, the opposite eye should be strictly covered during the examination to ensure accuracy.
Visual acuity is divided into five levels: Level 1: 0.5 or better; Level 2: 0.1–0.4; Level 3: 0.005–0.095; Level 4: light perception (LP)/hand movement (HM)/finger counting (CF); Level 5: no light perception (NLP) [5].
With respect to the visual acuity evaluation criteria for prognosis after inpatient treatment, the best corrected visual acuity at discharge is used as the standard. A visual acuity ≥ 0.1 at discharge indicates a good prognosis, whereas a visual acuity < 0.1 at discharge indicates a poor prognosis [16].
Statistical analysis was performed using SPSS 29.0 software. Quantitative data are expressed as the mean ± standard deviation (x ± s), while categorical data are expressed as cases (n) and percentages (%). Paired-samples t test was used to compare variables between groups.Influencing factors were analyzed using Fisher's exact tests and binary logistic regression. A p value < 0.05 was considered to indicate statistical significance.
Results
General characteristics of children with ocular trauma
Among the 704 children with ocular trauma in this study, 550 were males (78.1%), and 154 were females (21.9%), with a male-to-female ratio of 3.57:1. The age range was 1–17 years, with a mean age of 9.33 ± 4.66 years. The children were divided into four main age groups: toddler (0–3 years, 89 cases), preschool-aged (4–6 years, 139 cases), school-aged (7–12 years, 260 cases), and adolescent (13–17 years, 216 cases). Male patients outnumbered female patients in all age groups, and school-aged children accounted for the largest proportion (36.9%) (see Table 1).
Table 1.
Gender and age distribution of 704 children with ocular trauma (n, %)
| Age group | Male | Female | Total |
|---|---|---|---|
| Toddler (0–3 years) | 56 (7.9) | 33 (4.7) | 89 (12.6) |
| Preschool-aged (4-6years) | 104 (14.8) | 35 (5.0) | 139 (19.8) |
| School-aged (7-12years) | 210 (29.8) | 50 (7.1) | 260 (36.9) |
| Adolescent (13-17years) | 180 (25.6) | 36 (5.1) | 216 (30.7) |
| Total | 550 (78.1) | 154 (21.9) | 704 (100) |
Among the injuries, 1 was bilateral, and 703 were unilateral, with a right eye (364 cases): left eye (339 cases) ratio of 1.07:1.
Injury details of children with ocular trauma
Among all the children with ocular injuries, 176 were from urban areas, and 528 were from rural areas. A total of 284 injuries occurred at home, 175 at school, and 245 outdoors. The time from injury to medical attention ranged from a minimum of 1 h to a maximum of 90 days. In total, 431 children were admitted to the hospital within 12 h of injury, 96 within 12–24 h, 57 within 24–48 h, 77 within 48 h to 7 days, and 41 after more than 7 days; the dates on which medical attention was received were unknown in 2 patients. Causes of injury included sharp objects, blunt objects, explosions, animals, plants, flying metal or nonmetallic foreign objects, falls, traffic accidents, assaults, and other external injuries. The top three causes of injury were sharp object injuries (29.5%), falls (19.0%), and blunt object injuries (17.5%) (See Table 2).
Table 2.
Injury characteristics of 704 children with ocular trauma (n, %)
| Characteristic | Group | N | % |
|---|---|---|---|
| Location of injury | Home | 284 | 40.3 |
| School | 175 | 24.9 | |
| Outdoors | 245 | 34.8 | |
| Place of household registration | Urban | 176 | 25.0 |
| Rural | 528 | 75.0 | |
| Consultation time | ≪12 h | 431 | 61.2 |
| > 12-≪24 h | 96 | 13.6 | |
| > 24-≪48 h | 57 | 8.1 | |
| > 48 h-≪7 d | 77 | 10.9 | |
| > 7 d | 41 | 5.8 | |
| None | 2 | 0.3 | |
| Cause of injury | Sharp object injury | 208 | 29.5 |
| Blunt object injury | 123 | 17.5 | |
| Explosion injury | 32 | 4.5 | |
| Spatial injury | 13 | 1.8 | |
| Plant injury | 21 | 3.0 | |
| Animal injury | 7 | 1.0 | |
| Fall injury | 134 | 19.0 | |
| Car accident | 53 | 7.5 | |
| Assault injury | 50 | 7.1 | |
| Other external injury | 63 | 8.9 | |
| Type of injury | Open ocular trauma | 211 | 30.0 |
| Closed ocular trauma | 213 | 30.3 | |
| Nonmechanical ocular trauma | 11 | 1.6 | |
| Ocular adnexal trauma | 269 | 38.2 | |
| Injury zones of open ocular trauma | Zone I | 148 | 70.1 |
| Zone II | 35 | 16.7 | |
| Zone III | 28 | 13.2 |
Among these cases, 11 were nonmechanical ocular trauma, including 9 cases of thermal burns and 2 cases of chemical burns. Moreover, 424 cases of mechanical ocular trauma, including 213 cases of closed ocular trauma (147 cases of blunt trauma, 41 cases of lamellar laceration, 18 cases of superficial foreign body injury, and 7 cases of mixed injury) and 211 cases of open ocular trauma (170 cases of perforation injury, 29 cases of laceration injury, and 12 cases of foreign body injury) were included in this study. In total, 269 cases of ocular adnexal trauma, including 138 simple eyelid lacerations, 28 lacrimal canaliculus ruptures, 54 orbital fractures, 37 optic nerve contusions, and 12 cases of mixed injury were included. Penetrating injury, blunt injury, and eyelid lacerations were the three most common causes of injury. Among the cases of open ocular trauma, 148 were in Zone I, 35 were in Zone II, and 28 were in Zone III (See Table 3).
Table 3.
Types of injuries in 704 children with ocular trauma (n, %)
| Type | n | % | |
|---|---|---|---|
| Open ocular trauma (n = 211) | Perforation injury | 170 | 24.1 |
| Laceration injury | 29 | 4.1 | |
| Intraocular foreign body | 12 | 1.7 | |
| Closed ocular trauma (n = 213) | Blunt trauma | 147 | 20.9 |
| Lamellar laceration | 41 | 5.8 | |
| Superficial foreign body injury | 18 | 2.6 | |
| Mixed injury | 7 | 1.0 | |
| Nonmechanical ocular trauma (n = 11) | Thermal burn | 9 | 1.3 |
| Chemical burn | 2 | 0.3 | |
| Ocular adnexal trauma (n = 269) | Simple eyelid laceration | 138 | 19.6 |
| Lacrimal canaliculus rupture | 28 | 4.0 | |
| Orbital fracture | 54 | 7.7 | |
| Optic nerve contusion | 37 | 5.3 | |
| Mixed injury | 12 | 1.7 | |
Treatment and complications in children with ocular trauma
In this study, 302 children (42.9%) received only conservative treatment, such as superficial tissue and foreign body debridement and topical eye drops after injury. Two children with blunt trauma later developed secondary glaucoma due to hyphema and underwent anterior chamber irrigation. A total of 173 children (24.6%) underwent corneal and scleral debridement plus suturing and ocular debridement. A total of 165 children (23.4%) underwent debridement and suturing of eyelid lacerations, and of these, 28 had concurrent lacrimal canaliculus rupture and underwent lacrimal canaliculus anastomosis. Furthermore, 41 children (5.8%) underwent complex surgeries, such as traumatic cataract extraction, vitrectomy, and intraocular foreign body removal, in the first stage, and 21 children (3.0%) underwent orbital fracture repair.
Complications from open ocular trauma in children are numerous and severe. Common complications of open ocular trauma include iris incarceration, traumatic cataract, vitreous haemorrhage, retinal detachment, and endophthalmitis. A total of 16.6% (117/704) of the children underwent two or more surgeries during hospitalization, including cataract extraction (22.2%, 26/117), vitrectomy (40.2%, 47/117), stage II intraocular lens implantation (19.7%, 23/117), and other surgeries (17.9%, 21/117).
Visual acuity and prognostic factors in children with ocular trauma
In this study, some children experienced difficulty in cooperating with the vision test. A total of 148 children did not complete the vision test upon admission, and 121 children did not complete the vision test upon discharge. Table 4 shows the distribution of visual acuity scores at admission and discharge for 704 patients. A paired-samples t test revealed that the difference between the visual acuity classification level at discharge and that at admission was statistically significant (P < 0.001).
Table 4.
Comparison of 704 children with ocular trauma at admission and discharge (n, %)
| Group | At admission | At discharge |
|---|---|---|
| Level 1 (> 0.5) | 121 (17.2) | 201 (28.6) |
| Level 2 (0. 1 ~ 0. 4) | 210 (29.8) | 235 (33.4) |
| Level 3 (0. 005 ~ 0. 095) | 76 (10.8) | 49 (7.0) |
| Level 4 (LP/HM/CF) | 122 (17.3) | 86 (12.2) |
| Level 5 (NLP) | 27 (3.8) | 12 (1.7) |
| Did not comply with testing | 148 (21.0) | 121 (17.2) |
After excluding the children who did not cooperate with the vision test, 554 children completed the test. Most of these children experienced varying degrees of visual improvement after treatment. Among them, 413 children (74.5%) had a visual acuity ≥ 0.1 at discharge, while 141 children (25.5%) had less than ideal visual recovery due to complex ocular trauma, with an improvement of < 0.1. Fisher’s exact test was performed to analyse sex, age, time of consultation, injury location and type, injury zone, accompanying complications, admission vision, and surgical methods. Statistical analysis revealed that the incidences of accompanying lens damage, accompanying retinal or optic nerve damage, endophthalmitis, admissin vision, secondary surgery, and the type of secondary surgery were significantly (P < 0.05) (see Table 5). Factors for which P < 0.05 were included in a multivariate binary logistic regression model for analysis. The following factors were statistically significant in the multivariate analysis: lens damage, retinal or optic damage, endophthalmitis, secondary surgery, secondary cataract surgery, and vitrectomy with intraocular lens implantation (P < 0.05). These were risk factors for poor visual prognosis in children with ocular trauma. The Hosmer–Lemeshow test showed a good model fit (P> 0.05; see Table 6).
Table 5.
Factors influencing visual prognosis in children with ocular trauma
| Main Factors | # of Patients | Final visual acuity ≥ 0.1 | Final visual acuity < 0.1 | P Value | |
|---|---|---|---|---|---|
| Gender | Male | 452 | 341 | 111 | 0.316 |
| Female | 102 | 72 | 30 | ||
| Age | Toddler | 2 | 2 | 0 | 0.281 |
| Preschool-aged | 89 | 73 | 16 | ||
| School-aged | 249 | 181 | 68 | ||
| Adolescent | 214 | 157 | 57 | ||
| Location of injury | Home | 172 | 123 | 49 | 0.460 |
| School | 164 | 122 | 42 | ||
| Outdoor | 218 | 168 | 50 | ||
| Consultation time | ≪12 h | 334 | 248 | 86 | 0.830 |
| > 12-24 h | 79 | 62 | 17 | ||
| > 24-48 h | 42 | 32 | 10 | ||
| > 48 h-7 d | 66 | 47 | 19 | ||
| > 7 d | 31 | 23 | 8 | ||
| None | 2 | 1 | 1 | ||
| Type of injury | Open ocular trauma | 168 | 120 | 48 | 0.209 |
| Closed ocular trauma | 172 | 123 | 49 | ||
| Nonmechanical ocular trauma | 9 | 7 | 2 | ||
| Adnexal ocular trauma | 205 | 163 | 42 | ||
| Injury zones of open ocular trauma | Zone I | 117 | 79 | 38 | 0.092 |
| Zone II | 28 | 21 | 7 | ||
| Zone III | 23 | 20 | 3 | ||
| Non-open ocular trauma | 386 | 293 | 93 | ||
| Admission vision | Level 1 | 120 | 109 | 11 | < 0.001 |
| Level 2 | 208 | 189 | 19 | ||
| Level 3 | 76 | 48 | 28 | ||
| Level 4 | 121 | 57 | 64 | ||
| Level 5 | 29 | 10 | 19 | ||
| Lens damage | Yes | 137 | 68 | 69 | < 0.001 |
| None | 417 | 345 | 72 | ||
| Retinal or optic nerve damage | Yes | 114 | 61 | 53 | < 0.001 |
| None | 440 | 352 | 88 | ||
| Endophthalmitis | Yes | 17 | 6 | 11 | < 0.001 |
| None | 537 | 407 | 130 | ||
| Stage I surgery | Corneal and scleral debridement and suturing, eyeball debridement | 126 | 69 | 57 | Not significant |
| Eyelid skin laceration debridement and suturing | 107 | 88 | 19 | ||
| Traumatic cataract extraction, vitrectomy, and removal of intraocular foreign bodies. | 33 | 16 | 17 | ||
| Orbital fracture repair surgery | 20 | 18 | 2 | ||
| Conservative treatment | 268 | 222 | 46 | ||
| Performed a second surgery | Yes | 88 | 28 | 60 | < 0.001 |
| None | 466 | 385 | 81 | ||
| Stage II surgery | Cataract surgery | 22 | 12 | 10 | < 0.001 |
| Vitrectomy | 35 | 9 | 26 | ||
| Stage II intraocular lens implantation | 18 | 2 | 16 | ||
| Other surgical methods | 14 | 6 | 8 | ||
| No surgery | 465 | 384 | 81 |
Table 6.
Logistic regression analysis of factors contributing to poor prognosis in children with ocular trauma
| Factor | OR | Standard error | P value | 95% CI |
|---|---|---|---|---|
| Presence of retinal or optic nerve damage | 3.475 | 0.222 | < 0.001 | 2.247–5.374 |
| Presence of lens damage | 4.862 | 0.214 | < 0.001 | 3.194–7.402 |
| Endophthalmitis | 5.740 | 0.517 | < 0.001 | 2.082–15.824 |
| Performed a second surgery | 10.185 | 0.259 | < 0.001 | 6.125–16.937 |
| Cataract surgery | 3.951 | 0.445 | 0.002 | 1.651–9.456 |
| Vitrectomy | 13.695 | 0.406 | < 0.001 | 6.185–30.327 |
| Stage II intraocular lens implantation | 37.926 | 0.760 | < 0.001 | 8.553-168.176 |
Discussion
Ocular trauma refers to various tissue injuries caused by external damage to the eyeball and its adnexa and is among the main causes of blindness [2]. Ocular trauma is more common in underdeveloped and developing countries. In developed countries, ocular trauma accounts for 5% of all cases, while in developing countries, it accounts for approximately 12.9% [17]. Childhood is a critical period of visual development during which eye injuries can lead to the development of deprivation amblyopia, which further exacerbates visual impairment and causes low vision or even blindness. Deprivation amblyopia is the leading cause of unilateral blindness in children [18]. Eye injuries can cause serious damage to both appearance and vision, leading to psychological problems in children that can affect their school life and future employment choices, which may consequently increase the economic burden on families and society [18]. Therefore, understanding the epidemiological and clinical characteristics of childhood ocular trauma and providing timely and targeted preventive measures and treatment plans are highly important for reducing the incidence of childhood ocular trauma and improving disease prognosis in affected children.
The male-to-female ratio in this study was 3.57:1, which is consistent with the findings of previous reports [19, 20]. The higher prevalence in males observed in this study may be because boys are more active and more likely to participate in adventurous games and explore unknown environments; they also have a strong interest in speed-related and high-impact activities, whereas girls tend to participate in relatively quieter activities. This study revealed that the number of eye injuries was greater among boys than among girls across all age groups, with the highest incidence observed among children aged 7–12 years. This may be because children in this age group are in a period of active personality development and exhibit high levels of curiosity (especially boys). Moreover, children in this age group begin to separate from the full care of their parents and lack safety awareness and life experience, which can easily lead to trauma. Therefore, preventive measures for boys (especially those aged 7–12 years) should focus not only on “prohibiting dangerous items” but also on improving their risk identification ability and establishing “safe play areas” in communities and schools to provide supervised spaces for adventurous activities. This study revealed that the probability of injury in both eyes was relatively small, while no significant difference was observed in the probability of injury between the left and right eyes. These results are similar to the findings of Tan [21], who reported that injuries to both eyes are mostly seen as a result of car accidents, explosions, or intentional attacks.
The results of this study revealed that the most common location where childhood eye injuries occurred was at home (40.3%), which is consistent with related research [22]. This may be because children are in a relatively familiar environment at home, parents are less vigilant, and it is easier for children to play alone than outdoors. The next most common locations were outdoors (34.8%) and schools (24.9%). Most injured children belonged to rural areas (75.0%), which is consistent with the findings of previous studies [23]. This finding can be attributed to the fact that rural children tend to play in larger areas, and open spaces contain more dangerous objects, such as agricultural tools and wires. The proportion of left-behind children is relatively high, and their caregivers (mostly grandparents) are older and lack safety education knowledge. Finally, the scarcity of medical emergency resources in rural areas may delay initial treatment.
In this study, closed ocular trauma was slightly more common than open ocular trauma. The types of objects that cause ocular injuries in children are diverse, but most are toys and objects that are frequently encountered in daily life. Blunt force injuries caused by slingshots, springs, and toys were the most common closed ocular trauma, while puncture injuries caused by sharp objects such as scissors, pencils, and glass were the most frequent open ocular trauma, which is consistent with the findings of previous studies [4, 22]. Since the abovementioned items are highly dangerous, a high level of vigilance should be maintained when children are supervised at home. Sharp objects such as scissors and pencils should be kept out of children’s reach, children should be educated about the dangers of various items, and their behaviour should be reinforced with safety education (such as not running while they hold certain objects). In rural areas, sharp objects in yards should be removed, and visual education should be provided to grandparents and other guardians. Safe play areas should also be established in rural schools to reduce the risk of accidents in unsupervised environments.
Multiple studies have shown that most children present to the hospital within 24 h of an injury, which is consistent with the findings of this study [24, 25]. This is closely related to the increased attention that is dedicated to health and safety by society and parents. However, the time of treatment and the injury location have limited influence on the final visual prognosis, which suggests that the quality of first aid for paediatric eye injuries may be more critical than speed.
In this study, the most common type of ocular trauma was ocular adnexal trauma, followed by open and closed ocular trauma. Different types of injuries have significantly different mechanisms and anatomical locations. Closed ocular trauma is caused mainly by blunt force trauma or falls, with injuries concentrated in the eyelids and orbit. These findings are consistent with those of Yardley et al. [26]. Mechanistically, bony structures of the orbit and orbital fat tissue form an effective buffer barrier. When external force is applied, the energy is first absorbed by the eyelid skin, muscles, and orbital bone, thus protecting the eyeball itself. Therefore, although eyelid haematomas, orbital fractures, and other adnexal injuries are common, the internal structures of the eyeball (such as the lens, retina, and optic nerve) are relatively less affected. Among open ocular trauma, perforation is the most common, with 70.1% of injuries located in Zone I within the limbus; the causative agents of perforation are primarily sharp objects such as scissors, pencils, and glass shards. This distribution pattern is consistent with that described in the literature [27], which reflects the high risk of exposure of the anterior segment of the eye to sharp objects during daily activities. Although open ocular trauma disrupts the integrity of the eyeball and is theoretically associated with the highest rate of blindness, this study revealed that the type of injury, the location of injury, and the final visual prognosis were not significantly correlated. Possible explanations include an anatomical buffering effect such as the protective effect of orbital bone and fat, which disperses the impact force in closed injuries, a low incidence of severe intraocular damage, and a better visual prognosis. The damaged area is mostly located in Zone I, where the damage is limited to the cornea or limbus. Most wounds are small, and if they are cleaned and sutured in a timely manner and if the lens, vitreous body or macula is not involved, vision damage is limited.
For open ocular trauma or intraocular foreign body injury, early primary debridement and suturing or foreign body removal are key measures for preserving both the eyeball and visual function [11]. The results of this study revealed that approximately 74.9% of the children underwent primary tissue repair and suturing within 24 h of their initial consultation and that approximately 16.6% of the children underwent two or more surgeries during their hospitalization, including cataract extraction, vitrectomy, and secondary intraocular lens implantation. Further analysis revealed that common complications of childhood eye injuries include corneal damage, lens damage (lens dislocation, traumatic cataract), retinal or optic nerve damage (retinal and optic nerve contusion, retinal detachment), and endophthalmitis. Among them, lens damage, retinal and optic nerve damage, endophthalmitis, two or more surgeries and secondary lens vitrectomy are important risk factors for poor visual prognosis. The above results suggest that damage to the posterior segment of the eye (lens, retina, optic nerve), the presence of intraocular infections, an increased number of surgeries, and an increase in surgical complexity are closely related to the degree of intraocular tissue damage and visual function loss in children. Childhood eye injuries exhibit significant age-specific characteristics in terms of pathophysiology and prognosis, primarily in terms of the following two aspects: First, childhood is a sensitive period of visual development (especially those under 8 years of age), and even mild eye injuries can lead to amblyopia, strabismus, or developmental disorders of binocular vision. Even if the anatomical structure recovers at a later time, visual function is difficult to fully reconstruct. Second, compared with adults, children exhibit active fibroblast proliferation and a fast healing rate after trauma, but they are prone to excessive vitreous hyperplasia and scar formation, which is reflected in the significantly higher incidence of posttraumatic proliferative vitreoretinopathy (PVR). Since this abnormal proliferation can lead to retinal traction, detachment, and even eyeball atrophy, PVR has become a major cause of delayed vision loss. Therefore, after open ocular trauma surgery in children, close follow-up of their vitreoretinal condition and early intervention are necessary. Treatment of paediatric ocular trauma should focus not only on the timeliness of primary repair but also on monitoring and intervention for complications from secondary surgery, especially posterior segment injury and postoperative proliferative reactions. For children with high-risk factors (lens injury, retinal injury, and endophthalmitis), individualized follow-up and surgical strategies should be developed to maximize the preservation of visual function.
In this study, the changes in visual acuity of 704 children at admission and discharge were analysed. The results revealed that most children had an initial visual acuity level of 2, and after treatment, 74.5% of the children achieved a visual acuity ≥ 0.1 at discharge. The visual acuity level at discharge was significantly better than that at admission, which indicates that visual acuity improved significantly after treatment. Further research revealed that visual acuity classification at the initial consultation was not an independent risk factor for poor final visual prognosis, which is not consistent with the literature [28]. The reasons for this are as follows: (1) The types of injuries in this study were mainly open injuries in Zone I and those in the ocular adnexa, which had a good prognosis. Even if initial visual acuity is poor, visual acuity can significantly improve after repair; (2) Children often demonstrate poor cooperation in the emergency room, which leads to measurement bias and an underestimation of initial visual acuity; (3) Modern, timely surgical and drug interventions weaken the predictive value of initial visual acuity; (4) The true factors that influence prognosis are pathological factors such as posterior segment injury and endophthalmitis, and when these variables are included in the analysis, the independent effect of visual acuity at the time of consultation disappears. Therefore, in paediatric ocular trauma, visual acuity at the time of consultation should not be used in isolation to determine the final prognosis; instead, a comprehensive assessment that combines the injury site, complications, and surgical requirements is necessary.
In summary, childhood ocular trauma, which encompasses common conditions that affect the eye, not only causes decreased vision in one or both eyes but also affects the development of binocular vision. Childhood is a critical period for the development of visual function. If the best treatment opportunity is missed in cases of ocular trauma, irreversible visual impairment may occur. Therefore, preventive measures are highly important for reducing the incidence of childhood ocular trauma. However, this was a retrospective, nonrandomized study in which only medical records from the patients’ hospital stay were analysed, which has certain limitations. Future prospective studies are needed to refine postdischarge follow-up data to more accurately evaluate the final visual recovery and the risk of long-term complications among children.
Acknowledgements
None.
Author contributions
Shanyu Li and Jinchen Jia: completed the operation.Xiaoxuan Wang and Dong Han: drafted the manuscript. Aijun Tian, Li Li, Lin Feng: statistic analyzed the data, drew charts.
Funding
This work was supported by the S&T Program of Xingtai (2025ZC047).
Data availability
The data used to support the findings of this study are available from the corresponding author upon request.
Declarations
Ethics approval and consent to participate
This clinical study was conducted following the Declaration of Helsinki and was approved by the Ethics Committee of Hebei Eye Hospital (Ethics Approval Number: 2026LW05). All data and images were used with the consent of the patients’ parents, and signed informed consent forms.
Consent for publication
Not applicable in this study.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data used to support the findings of this study are available from the corresponding author upon request.