Binocular vision dysfunction after polytrauma

Abstract Background: Binocular vision dysfunction is frequently overlooked in polytrauma care despite its established impact on reading, driving, and return to work. We aimed to determine the prevalence and patterns of binocular vision dysfunction in polytrauma patients with ocular involvement and to identify independent clinical predictors. Methods: We conducted a retrospective cohort study of adults (aged ۱۸ years or older) admitted to Sina Hospital Trauma Center, Tehran between January ۲۰۲۱ and December ۲۰۲۳ with an Injury Severity Score (ISS) ۱۶ or more and ophthalmology-confirmed ocular involvement. Four binocular parameters; near point of convergence, stereoacuity, fusional vergence amplitudes, and accommodative facility, were extracted from consultation records when available. Prevalence estimates were calculated using the Wilson score method, and multivariable logistic regression identified independent predictors. Results: Among ۲۹۲۳ polytrauma admissions, ۴۳۸ patients (۱۵.۰%) had ocular involvement; ۳۱۲ (۷۱.۲%) had complete binocular data (mean [standard deviation] age ۳۷.۸ [۱۴.۲] years; ۸۴.۶% [n = ۲۶۴] male). At least one binocular dysfunction was identified in ۱۳۴ patients (۴۲.۹%; ۹۵% confidence interval [CI], ۳۷.۴-۴۸.۶). Convergence insufficiency was most common (n = ۱۱۹, ۳۸.۱%; ۹۵% CI, ۳۲.۸–۴۳.۷), followed by reduced stereopsis (n = ۸۷, ۲۷.۹%; ۹۵% CI, ۲۳.۱–۳۳.۲), accommodative dysfunction (n = ۶۷, ۲۱.۵%; ۹۵% CI, ۱۷.۲–۲۶.۴), and reduced fusional vergence amplitude (n = ۵۴, ۱۷.۳%; ۹۵% CI, ۱۳.۴–۲۲.۰). Only ۲۴.۷% (n = ۷۷) of patients received formal optometric referral during acute admission. Independent predictors were blunt orbital trauma (adjusted odds ratio [aOR] ۲.۸۱, ۹۵% CI, ۱.۶۷–۴.۷۳), concomitant traumatic brain injury (aOR ۲.۱۴, ۹۵% CI, ۱.۲۹–۳.۵۵), and age ۱۸-۳۵ years (aOR ۱.۹۲, ۹۵% CI, ۱.۱۲–۳.۲۸) (all P < ۰.۰۵). Conclusions: Binocular vision dysfunction affects nearly half of polytrauma patients with ocular involvement yet is substantially under-recognized and under-referred. Incorporating a brief binocular screening into routine post-trauma ophthalmologic assessment may represent a low-cost strategy to mitigate long-term visual and functional disability. Future prospective, multicenter studies employing standardized optometric assessment protocols and longitudinal follow-up are warranted to better define the natural history of these observed binocular dysfunctions and to evaluate the impact of early detection and targeted intervention on functional outcomes. Keywords: multiple traumas polytrauma injury severity scores ISS score binocular vision ocular convergence stereopsis ocular motility disorder convergence insufficiency retrospective study