Prevalence and patterns of ocular injury among patients admitted with head injury at a tertiary referral hospital in Uganda

Background Ocular injuries concomitantly occur among patients with head trauma because of the close anatomical relationship between the cranium and the orbit. Unfortunately, they are often overlooked during acute trauma care and may result in preventable visual loss. There is a dearth of data describing the burden and spectrum of ocular injury among head injury patients in sub-Saharan Africa. We conducted a hospital-based cross-sectional study to determine the prevalence and describe the patterns of ocular injury among adults admitted with head injury at the Accidents and Emergency Unit of Mulago National Referral Hospital, Uganda, from 1st May 2025 to 30th July 2025. Methods Consecutive patients aged 18 years and above with a confirmed head injury diagnosis underwent a structured ophthalmic evaluation comprising visual acuity testing, tonometry, slit-lamp and dilated fundus examination, pupillary and ocular motility assessment, confrontation visual fields, and review of craniofacial computed tomography. Ocular injuries were classified by anatomical site and injury type, and the prevalence was reported with a 95% confidence interval. Results Of 383 patients evaluated (mean age 32.7 {+/-} 12.3 years; 89.3% male), road traffic accidents were the leading mechanism of injury (68.9%) and most patients had mild head injury (72.3%). Overall, 268 patients (70.0%; 95% CI 65.1-74.5) sustained at least one ocular injury. Adnexal injuries were most frequent (64.0%), dominated by periorbital oedema (45.2%), subconjunctival haemorrhage (42.3%) and eyelid ecchymosis (33.2%); orbital fractures occurred in 27.4%. Closed and open globe injuries were present in 13.8% and 0.8% of patients, respectively, and abnormal confrontation visual fields in 28.2%. Conclusion Ocular injury is highly prevalent among patients admitted with head injury in this setting, with adnexal and orbital structures most commonly affected. Routine ophthalmic assessment should be integrated into the initial evaluation of all head injury patients to reduce missed injuries and prevent avoidable visual morbidity.