Increased Number and Severity of Open Globe Injuries during COVID-19 Stay-at-home Orders

Purpose: To evaluate the occurrence and outcome of open globe injury during state-mandated COVID-19 stay-at-home orders compared to historical averages at a tertiary medical center in Portland, Oregon.

Methods: Open globe injury between January 1, 2015 and December 31, 2020 was identified using relevant procedure codes. The number of injuries, mechanism of trauma, and short-term outcomes of globes repaired during the study period of March 23, 2020 to July 6, 2020 when stay-at-home orders were in effect were compared to a cohort from the same 15-week time frame in 2015-2019. We also evaluated injuries occurring throughout 2020 as compared to the prior 5 years.

Results: 263 consecutive open globe injuries were identified between January 2015 and December 2020. While Oregon's stay-at-home orders were in effect, we observed a significant increase in the number of open globe injuries treated compared to the prior 5 years (p = .004). Twenty-four cases identified during the study period represent a 2-fold increase over the 2015-2019 average of 11.8 globe repairs during the same 15-week time period. Visual acuity < 20/200 at 6 months (p = .008) and secondary enucleation (p < .001) were more frequent during stay-at-home orders, and severity of injury as calculated by the Ocular Trauma Scores (OTS) was higher. Time-to-repair was similar between the two cohorts.

Conclusion: At our center, there was an increased number and severity of open globe injury during the period of mandatory COVID-19 stay-at-home orders. Visual acuity outcomes and risk for secondary enucleation were poorer compared to the reference cohort.Abbreviations: Ocular Trauma Score (OTS), Open globe injury (OGI), Emergency department (ED), Oregon Health and Science University (OHSU).