Facial Dog Bite Injuries in Children Affect the Eyes More Often Than Previously Reported

October 29, 2010

October 29, 2010 (Chicago, Illinois) — About 1 in 7 children who receive emergency treatment for dog bite injuries to the face sustain ophthalmic injuries, and these eye injuries are more likely to have complications and need revision surgery than nonophthalmic injuries, a new study has found.

The study's lead author, Henry H. Chen, MD, MBA, from Albany Medical Center in New York, presented the findings in a scientific poster here at the American Academy of Ophthalmology and Middle East Africa Council of Ophthalmology 2010 Joint Meeting.

"These ophthalmic injuries have not been well studied or documented, so we don't have a good idea of the incidence," said Dr. Chen, who conducted the study while he was an otolaryngology resident at the University of Colorado Denver in Aurora.

Their retrospective review studied 537 children who came to the emergency department at The Children's Hospital in Aurora from 2003 through 2008 for the treatment of facial injuries caused by dog bites. Of those, 77 children had ophthalmic injuries, according to the poster. Dr. Chen told Medscape Medical News that this 14% incidence is higher than the 5% to 8% incidence reported in the "limited" published studies of this type of injury.

The authors also found that ophthalmic injuries were associated with complications significantly more often than nonophthalmic injuries (22% vs 5%; P = .005). Their data showed that the most common complications were epiphora and upper eyelid ptosis, each occurring in 6 of 77 patients (8%). Less common complications included eyelid notching, nasolacrimal duct obstruction, and wound dehiscence, each of which occurred in 2 patients.

High Need for Revision Surgery

In addition, a higher percentage of ophthalmic injuries (49%) required surgical repair than nonophthalmic injuries (7%); this difference was statistically significant (P < .001), according to the poster. Children experiencing eye injuries also needed revision surgery significantly more often than those without eye injury (9% vs 3%; P < .001).

"It is daunting that these children do not do well [initially], despite receiving early and appropriate surgical management," Dr. Chen said.

Ophthalmic dog bite injuries were also associated with a significantly higher number of lacerations than nonophthalmic injuries (2.2 vs 1.5; P < .001), and longer hospitalization (1.2 vs 0.6 days; P < .001), the researchers found. Eye injuries occurred more often in younger children (mean, 3.9 years) than other facial injuries (P < .03).

"Children with ophthalmic injuries represent a distinct subset of facial dog bite injuries," Dr. Chen said.

Specialty Evaluation Needed

All 77 ophthalmic injuries affected the eyelid or eyelids, and 21 (27%) involved the canalicular system, the authors found. Dr. Chen advised that "if the injuries are close to the eyelid or canalicular region, the emergency department [or treating] physician should contact an ophthalmologist or oculoplastic surgeon for further evaluation."

"Animal-associated bite injuries to the face can be complex and may require many subspecialists — plastic surgery; ear, nose, and throat; ophthalmology — related to injury patterns, lacerations, structural injury . . . and secondary injury due to crush injury," said Bret Nicks, MD, assistant professor of emergency medicine at Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina. Dr. Nicks did not participate in the study.

"The data presented are consistent with what [emergency medicine physicians] see on a regular basis and, as a specialty, we recognize the frequent need for collaborative care," noted Dr. Nicks.

Dr. Chen called the dog bite injuries "entirely preventable. . . . Young kids should not be left around dogs," he said.

Dr. Chen and Dr. Nicks have disclosed no relevant financial relationships.

American Academy of Ophthalmology (AAO) and Middle East Africa Council of Ophthalmology (MEACO) 2010 Joint Meeting: Abstract PO183. Presented October 17, 2010.

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