Dear Sir, We read with interest the research article published in your esteemed journal, titled Association of Ocular Injuries in Patients with Head Injury: A Tertiary-Level Armed Forces Experience, by Maheshwari V et al.1 We would like to congratulate the authors for such a well-designed study. The literature highlights the high incidence of ocular injuries in military personnel with head trauma. The severity of head injury could be assessed by applying the Glasgow coma scale, and according to the score obtained, it can be classified as mild, moderate, and severe head injury and different ocular manifestations could be studied according to that and association of ocular signs with the severity of head injury could be established.2 The findings of this study are similar to those of Malik A, Gupta A, Luthra N, and Gupta V et al.3 According to the study of Kulkarni AR et al.,2 pupillary involvement and papilledema are the two ocular signs which are associated with poor prognosis and many times death of the head injury patient. This could have been further studied in detail. Also, lateral rectus palsy and traumatic optic neuropathy are other important neurological manifestations associated with poor prognosis which is confirmed by the present study. Pupillary involvement could be studied in further depth to get more insight into the prognosis. There are four different types of pupillary involvement in Hutchison’s stages I, II, III, IV and traumatic mydriasis. Unilateral miosis is observed in Hutchison’s stage I. Moderate unilateral pupillary dilatation is observed in Hutchison’s stage II pupillary involvement. Unilateral dilatation with miosis of other pupils is observed in Hutchison’s stage III pupillary involvement. Furthermore, bilateral dilated pupil can be observed in Hutchison’s stage IV pupillary involvement. Thus, pupillary involvement could be further studied for further study of the prognosis of the patient. Data availability statement Data sharing is not applicable to this article as no datasets were generated and/or analyzed during the current study. Author’s contribution All authors contributed equally to reviewing the literature; analysis, interpretation of data and drafting the article. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Dange et al. (Wed,) studied this question.