Blown Pupil in Head Injury: A Key Indication of Severity

Head injuries are a common occurrence, and it's crucial to recognize the importance of ophthalmic assessments in these cases. Many individuals often overlook ophthalmic findings, only presenting later at specialist neuro-ophthalmic clinics. In fact, over 50% of all trauma deaths are associated with head injuries, while close to 60% of vehicular trauma deaths are due to head injuries.

A blown pupil, also known as pupillary involvement, is a significant indicator of the severity of head injury. In a study conducted at a major teaching hospital, researchers found that 150 cases (75%) with a Revised Trauma Score (RTS) of 12 had a good prognosis, while all 21 patients who died had eye involvement.

The study, which recorded ocular findings in the first few hours and correlated them with final outcomes, highlights the importance of early ophthalmic assessment. Pupillary involvement, papilloedema, and ocular motor paresis were found to be indicative of more severe head injuries.

The Glasgow Coma Scale (GCS) and RTS were used to grade the severity of injury and assess prognosis. The study analyzed 200 consecutive cases of closed head injury, with a thorough ophthalmic assessment conducted on each patient.

The findings suggest that ophthalmic involvement is common in head injuries, with 167 cases (83.5%) exhibiting ocular involvement. The main causes of head injury were road traffic accidents (52.5%) and assaults (34%).

In conclusion, a blown pupil in head injury patients should not be ignored. Ophthalmic assessments are crucial in determining the severity of head injury and predicting outcomes. By recognizing the importance of ophthalmic findings, healthcare professionals can provide more effective treatment and improve patient outcomes.

Blown pupil in head injury