To the Editor:

We read with interest the recently published paper on the changing trends of ocular trauma during COVID-19 by Pellegrini et al. [1]. Although the burden of COVID-19 on health systems has increased, many have reported a trend in decreasing attendance to the emergency department; a 57% decrease across the United Kingdom [2, 3]. This was reflected by Pellegrini et al. [1] reporting a 68.4% reduction in the number of eye injuries.

In our retrospective, continuous comparative analysis of all trauma patients who presented to Birmingham and Midland Eye Centre, UK, a tertiary eye emergency department, we focus further on the major injuries that necessitated emergency surgical intervention. These injuries included eyelid lacerations, corneal and globe perforations, and retained intraocular foreign bodies (IOFB). Our study covers a similar time period, however, applies to the UK lockdown period from the 16th of March till the 30th of June 2020 when measures were starting to be relaxed. They were compared with patients during the same time period in the previous year, 2019. All data were extracted from electronic patient records (Medisoft Ophthalmology, Medisoft Limited, Leeds, UK) and analyses were performed using SPSS Statistics for V.25.0 (IBM Corp., Armonk NY).

During this time period, we report 13 surgical trauma cases out of 13,134 attendances in 2019 compared to 14 out of 6254 attendances in 2020. This represents a 52.4% reduction in patients attending the emergency department and a relative increase in surgical trauma cases by 2.3 times (p = 0.048). Table 1 shows the demographics and clinical characteristics of both groups. There was no significant difference in the visual outcomes achieved post-surgery. Pre COVID-19, significantly more of these injuries were being sustained during a fall (0.038), whilst during COVID there were significantly more injuries being sustained at home (p = 0.013), which is reflected by Pellegrini et al. It was however worrying that there was an increase in assault-related injuries, particularly those sustained at home. Several papers have reported an increase in domestic abuse during the lockdown, due to social isolation, external economic pressures and less support available, which may explain the changes noted in our study [4]. Although our study concurs with Pellegrini et al with regards to an overall reduction in attendance with more injuries being sustained at home, we found that those sustaining major injuries were still seeking medical attention. It is therefore reassuring that in the UK, the stay-at-home advice was not discouraging those with eye trauma necessitating surgical intervention to present to the eye department.

Table 1 Demographics and clinical characteristics of cases Pre and Post COVID-19 era.
Full size table