Controversies in the management of ophthalmic trauma

Rupesh Agrawal

Despite steady advances in surgical instrumentation and technique, ophthalmic trauma continues to be a leading cause of visual loss worldwide. Controversy persists over the optimal management of the injured eye. Almost half of the patients with posterior penetrating injuries are left with severe visual impairment. Debate persists over surgical repair of severely traumatized eyes with no light perception, use of prophylactic antibiotics either systemic or intracameral or intravitreal, prophylactic cryopexy, and prophylactic scleral buckling. The role and timing of vitrectomy surgery in severe ocular trauma also remain topics of considerable debate, as does the role of vitrectomy in the management of magnetic intraocular foreign bodies. Similarly timing and optimal management of traumatic cataract with intraocular lens implantation and corneal scar management is also practice differently by different surgeons across the world. Management of orbital fractures and lid & adnexal trauma is also area of considerable debate. Role of intravenous methylprednisolone and optic canal decompression in traumatic optic neuropathy is still controversial. Each of these issues will be discussed, with particular emphasis on conflicting views presented in the relevant literature along with critical appraisal of existing international ocular trauma classification.