OCULAR INJURIES IN AUTOMOBILE CRASHES
Report Number UM-HSRI
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80-22Donald F. Huelke and
James 0 ' Day
Highway S a f e t y Research I n s t i t u t e The U n i v e r s i t y of Michigan
Ann Arbor, Michigan 48109
April 1980
Prepared under Contract DOT-HS-8-01944
National Highway T r a f f i c S a f e t y Admi n i s t r a t i o n Department of Transport a t i on
Tuhaical Report Doctrrmtatioll Page
1. R-t No. 2. G o v o ~ m t Accession No. 3. Reciplmt's Cot0109 No.
4. Tltl* ad Ilubtitlo
Ocular I n j u r i e s i n Automobile Crashes
7. h h d a)
Dona1 d I=. Hue1 key James 0 ' Day
9. P u h r m ~ n g Otgm~zotiom None ard Address
Highway Safety Research I n s t i t u t e The U n i v e r s i t y o f Michigan
Ann Arbor, Michigan 48109
I 12. h s w l n g Agmcy M a e cnd AYr*..
National Highway T r a f f i c Safety A d m i n i s t r a t i o n Department o f Transportation
Washington, D.C. 20590
IS. S ~ p p l - t a t Motor
5. Roport Dote
. May 1980
6. Porforning Orgm~zotio. Cod.
4. Porfom~ng O r g o n ~ x d o n Roport No.
UM-HSRI-80-22
10. W o d U n ~ t No.
11. Controct or Gmnt No.
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4413. Type of Report ond Pertod Coverod
Speci a1
14. S p o n r w ~ n ~ Agency Code
16. Abotvost
Analysis o f t h e National Crash S e v e r i t y Study data on "eye" i n j u r i e s i n d i c a t e s t h a t o f 62,026 passenger c a r occupants i n crashes severe enough t o r e q u i r e t h e cars t o be towed, t h e r e were 45 c a r occupants w i t h a r e p o r t e d "eye" i n j u r y . Only 14 had an eyeball involvement; e i g h t occupants were completely o r par- t i a l l y blinded. More than h a l f o f the i n j u r e d were males; most a1 1 were f r o n t seat occupants. None of t h e occupants were wearing seat b e l t s a t t h e time o f the crash. No s p e c i f i c impact o b j e c t was noted t o be t h e primary cause o f t h e eye i n j u r i e s .
17. Koy Wmvds
Accident, Eye i n j u r y , I n j u r y frequency, I n j u r y cause, Seat be1 t s
18. D i s t r ~ b t i a Stot.m.nt
19. SIQ(riv CIeseif. (of this 1-0
I
13 IINTRODUCTION
Itijuries t o the eye and periorbital structures in automobile
crashes have never been documented as t o injury type and mechanism of
injury, i.e., the specific object impacted within the car. Clinical
records themsel ves general ly do n o t contain i nformati on on the i njury
mechanism, a n d a review of hospital records cannot be used t o detemi ne
nationill estimates of the more serious ocular i n j u r i e s , i.e.,
bl i ndness.
Only recently has a nationwide s t a t i s t i c a l sampling program
col1ect:ing data on automobi 1e crashes been established t o sample occuparit injuries and the causes of stich injuries. This, the National
Crash Severity Study (NCSS) i s a major accident data collection program
of the National Center f o r S t a t i s t i c s and Analysis (NCSA) of the
National Highway Traffic Safety Admi nistration (NHTSA). Field
investigators collect detailed i nformation on passenger cars, and the
occupants, in crashes which were severe enough t o disable the car.
Excluded are crashes involving only trucks, motorcycles, buses, or
pedestrians, and passenger cars not towed from the scene.
---
The data contain information on the vehicle damage i n a codified
form, on the instantaneous change of velocity during the impact phase of
the craish, and descriptions of the occupant injuries and injury contact
areas. Information on other vehicles involved in these accidents
(trucks,, or non-towed passenger cars which were i n crashes w i t h towed
passenger cars) i s included in the data, b u t i s used only t o describe
the crash conditions surrounding the vehicle of interest. Data
collection began in January, 1977, and the data available for t h i s study
cover the period from January 1977 through March, 1977. Crashes are selected by s t r i c t adherence t o a s t r a t i f i e d sampl ing plan. Accidents
el igi ble for i nvestigation are a1 1 poli ce-reported accidents within
defined geographical areas in which at least one occupied passenger
automobile was towed from the scene due t o collision damage. Towed
passenger cars and t h e i r occupants constitute the population under study.
INJURY CODING
The Abbreviated Injury Scale (AIS) i s used i n the NCSS f i l e t o
appropriately categorize the severity of injury ( 2 ) . Most a1 1
periorbital or ocular injuries are a t either of the minor (AIS-1) or
modera-l:e (AIS-2) level. The only severe (AIS-3) "eye" injury would be
optic nerve avulsion. 1
Orieof the body areas which can be identified in the injury classification scheme used in t h i s study i s the eye(1). All cases
involving eye injuries coded as greater t h a n "minor" on the injury
reporti ng scale ( 2 ) were retrieved by computer search. There were 45
persons who had reported "eye" injuries of moderate or greater severity. The origi nal detailed i nvestigation reports were obtained for each of
these and reviewed. O f the 45 occupants, two were killed, each having
massive head/orbital injuries. These two individuals will be omitted from the analysis.
DATA ANALYSIS
Twenty-five of the 43 survi ving eye-i njured occupants were drivers
(13 males, 12 females), 1 2 were front-right passengers, and 6 were the
rear seat occupants. Approximately three o_u_t of four injured occupants
were 25 years of age or younger. As might be expected, most of the injuries were lacerations of the periorbital structures. None of these
injured occupants were wearing seat belts. A summary of the eye
injuries and the impact object t o which the injury was attributed are
presented in Table 1.
There were 14 passenger car occupants who sustained injuries t o the
eyeball or i t s musculature (Table 2 ) . Five of these were completely
blinded in one eye and three were partially blinded. One other person had eyeball muscle paralysis.
The impact areas related t o the injuries i s shown in Table 3. Note
that f o r the 29 occupants without ocular involvement a t least 16 were
injured by contact with the windshield. No other single car structure
he
Abbreviated Injury Scale: 0-No injury , 1-Mi nor, 2-Moderate, 3-was so highly involved. However, when the globe i t s e l f was injured (14 occuparits), no single injury-producing object stood o u t as the most common,, although there were two injuries attributed t o the side glass and three t o the pre-1966 windshield.
TABLE 3
CONTACT AREAS RELATED TO ORBITAL/PERIORBITAL INJURIES
Steering wheel
...
A-pi1 l a r (side
wi nds hi el d support )
Contact Area
Front seat back
I
Number...
No Eyeball Eyeball Injury1
Injury* Side glass ---+---*-+---Rear view mi rror 1
-
U~pper i nstrument panel or
steeri ng wheel
Hood or windshield Side surface of car Uriknown
TOTAL
1
2 91
14---..---
*Numbers in parentheses are individuals with part ia1 or complete bli ndness in one eye.
RELATIVE FREQUENCY OF OCCURRENCE
The total NCSS data (for the fifteen month period) represent
approximately 62,000 occupants of towed passenger cars. The eight cases
of the more serious eye injuries, i.e., blindness in one eye ( 5 ) ,
partial blindness in one eye ( 2 ) , and eye muscle paralysis ( I ) , a l l
occurred in crashes sampled a t the 100% rate, and thus a f i r s t estimate
of the relative frequency of permanent eye impairment might be based on
t h i s ratio: 8162,000. Approximately one-third of the persons i n the
NCSS d a t a have injuries 1 isted as "unknown"--i .e., detailed medical
reports for these persons were not available. I t i s not possible t o
detemi ne whether the incidence of eye problems in t h i s group was the same or di fferent from those actual ly determi ned.
To account f o r the one-third missing data, the eight cases may be
mu1 t i p l i ed by 1.5--yieldi ng an estimate of 1 2 cases of permanent eye
impaimlent (7.5 blind in one eye) among the 62,000.
The number of cases of complete blindness i n one eye i s so small
that extrapolation t o a national population i s hazardous. For the areas
sampled, the time period of the study was 1 5 months. An annual estimate
for these areas may be computed by multiplying the above numbers by
12/15 thus yielding six cases of blindness in one eye annually or 9.6
t o t a l eye-impaired car occupants. These numbers are so small --i
.
e,,
permanent ocular damage in these crashes is so rare--that i t would notbe appropriate t o attempt a national projection. A second year of NCSS
data, and the upcoming National Accident Severity Study data will add
significantly t o the data base and should ultimately lead t o a
defensible national estimate. 2
DISCUSS
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I ONBegi n n i n g with the 1966 models, the windshield construction of
United States manufactured cars was of a "new typeu--a High Penetration
Resistant ( H P R ) windshield, This improved laminated windshield markedly
reduces head penetration through the glass, and decreases the extensive,
' ~ a t a f o r the l a s t 12 months of the NCSS became available l a t e i n
t h i s study of ocular injuries, and have not been included in the
s t a t i s t i c s presented. We note, however, t h a t there i s a somewhat lower
incidence of eyeball injury in the l a t e r data, a n d that the t o t a l
disfiguring facial lacerations previously seen from windshield impacts
(3-7). I n that more t h a n h a l f of theautomobile crashes are frontal
collis-ions, i t i s not surprising t h a t the windshield would be most often
involved with periorbital or ocular injuries for the non-seat belted front seat occupant.
I n England a n d Europe many of the cars have tempered windshields.
When impacted, t h i s glass breaks into small pieces b u t not infrequently
the occupant's face contacts the jagged glass retained i n the lower
windshield frame, the main cause of ocular perforations ( 8 ) . MacKay
(Engl arid) i ndi cated that of seriously i njured front seat occupants 3-5%
have an eye injury with perhaps 1800 car occupants receiving serious injuries in Britain each year. At least 70% of these injuries can be
attributed t o the tempered windscreens ( 9 ) . A review of MacKay's
excel lent summary of the eye injury l i t e r a t u r e indicates that most
authors agree that eyeball injury i s highly related t o the tempered
windshield that has been typical of cars i n Europe, England, Australia,
and Asian countries ( 8 ) . Most authors agree that lap-shoulder belts
will decrease the frequency of eyeball injuries ( 8 ) , and many have
suggested laminated glass f o r the windshield ( 8 ) . Langwieder (Germany)
found only one eye injury from the HPR laminated glass ( o u t of 228
occupants with head injury), and 1 7 eye injury cases from tempered glass
(of 545 head i n j u r i e s ) , a nine-fold increase in cars with tempered
windshields (10).
Holland estimated about 1,000 people per year (1970) sustain severe
eye/eyel id injuries from road accidents i n the Federal Republic of
Germany. I n about 25% of these cases, or about 250 people, the injuries
lead t o almost complete loss of vision f o r one eye, a n d f o r a smaller
group i t results in a loss of b o t h eyes (11). I t has been estimated
that blindness of one or b o t h eyes occurs t o 2,500 people each year in
Europe (12).
CONCLUSIONS
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Tempered windshields commonly used in Europe have been shown t o be
highly related t o ocular injuries. A l t h o u g h windshields of the HPR type
in cars i n North America are not a t a l l significantly involved in ocular
glass. The HPR windshield probably i s the main reason for the
r e l a t i wely 1 ow occurrence of ocular i njuri es i n United States crashes
compared t o these injuries reported from countries with tempered wi ndshi elds.
No ocular injuries were observed among belted occupants i n t h i s
study. Increased use of lap-shoulder belts would decrease the
likelihood f o r occupant contact with the windshield, mirrors, A-Pillar,
steeri rig column and i nstrument panel --about half of the occupant
contacts f o r ocular injury--and thus further reduce the incidence of injuries leading t o decreased vision.
Data from the f i r s t fifteen months of the NCSS program provide a n
estimate of 7.5 cases of blindness in one eye among 62,000 occupants of
REFERENCES
(1) Marsh, J . C. "An Occupant Injury Classification Procedure Incorporating t h e Abbreviated Injury Scale," NATO Committee
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( 3 ) Hue1 ke, . . D. F . , Grabb, W . C., and Dingman, R. O . , "Facial I n j u r i e s in Automobile Accidents." Proceedings, American Association f o r Automotive Medicine, Louisville, Oct. 1964.
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(10) 1 i ~ n o w i ~ d ~ r . K.. " I n t e r i o r Safetv of Automobiles. " Proceedings,
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1970.(12) W.i ndshield Symposium on Eye Injuries: XI 11th FISITA Congress, International Automobi 1 e Safety Conference, Brussels, 1970.