Visual outcomes after blunt ocular trauma: clinical findings, management, and prognostic factors

Abstract

Purpose: To characterize ocular findings, management strategies, and factors associated with visual outcomes following blunt ocular trauma, with particular emphasis on the prognostic relevance of macular commotio retinae.

Methods: This retrospective study included 288 patients with BOT who presented to a tertiary referral center between January 2021 and July 2025. Demographic characteristics, injury mechanisms, ocular findings, and treatment modalities were reviewed. Visual acuity (VA) was recorded at presentation and at final follow-up; poor visual outcome was defined as a final VA ≥ 1.0 LogMAR. Macular commotio retinae was graded based on the extent of foveal involvement, and its association with visual outcomes was analyzed.

Results: The median patient age was 36 years (IQR 27-48), and 51.4% were male. Falls (28.8%) and assaults (27.8%) were the most common mechanisms of injury. Traumatic cataract (24.0%) and hyphema (15.6%) were the most frequent anterior segment findings, while commotio retinae (25.7%) was the most common posterior segment lesion. Median VA improved significantly from 0.7 (IQR 0.4-1.3) LogMAR at presentation to 0.4 (IQR 0.22-0.7) LogMAR at final follow-up (p < 0.001); however, 14.2% of eyes had poor final visual outcomes. Higher grades of macular commotio retinae were strongly associated with poor visual outcome (p < 0.001). In contrast, anterior segment findings such as hyphema and traumatic cataract were not predictive in this cohort. Half of the patients (n = 144) were managed conservatively, while phacoemulsification and pars plana vitrectomy were the most commonly performed interventions.

Conclusions: Blunt ocular trauma results in a broad spectrum of anterior and posterior segment injuries with variable visual prognosis. Grading the severity of macular commotio retinae provides clinically meaningful prognostic information, as higher grades are associated with persistent visual impairment. In contrast, many anterior segment injuries are potentially reversible with appropriate treatment. Comprehensive posterior segment evaluation and individualized management are essential to optimize visual outcomes after blunt ocular trauma.

Keywords: Blunt ocular trauma; Macular commotio retinae; Pars plana vitrectomy; Traumatic cataract; Visual prognosis.