Study Links Recent Systemic Illnesses to Fall-related Open Globe Injuries

Be mindful to advise patients who have a recent history of systemic illness, particularly those managed with systemic medications, of their elevated risk of falls—and hence ocular injury. Photo: Andrew Gurwood, OD. Click image to enlarge. In the general population, falls contribute to 10% of open globe injuries, studies show, but among people over the age of 65, the figure climbs to 65%. In a recent study, researchers examined the relationship between fall-related open globe injuries and systemic health and found that most occur in the context of newly diagnosed systemic illness, worsening of chronic disease or medication changes, and these injuries may signal underlying health deterioration. The findings were reported in Eye.A total of 162 patients with fall-related open globe injuries were identified from a cohort of 1,016 patients treated at a single academic medical center between 2016 and 2024. Incidence of new systemic diagnoses, disease exacerbations and medication changes occurring within 90 days before or after the open globe injuries were examined. Specialist visits within the window and one-year mortality data were secondary measures. Roughly 26.5% of subjects experienced an exacerbation of pre-existing conditions.Approximately 63.6% had at least one new systemic diagnosis likely contributing to the fall, according to the paper on the research. The most common diagnosis categories were infection, arrhythmia, chronic musculoskeletal disease, electrolyte abnormalities/vitamin deficiency and bleeding. If not directly responsible for the fall (i.e., a knee injury that impaired mobility), many of these diagnoses serve to modify the risk for a fall that might be deemed mechanical. “For example, an underlying urinary tract infection or pneumonia is a well-understood contributor to acute encephalopathy, which further increases the risk of falls, particularly in elderly patients,” the researchers wrote in their paper. “Other more serious conditions, including new malignancy diagnoses, pulmonary embolisms and myocardial infarction, occurred at expectedly lower frequencies but confer clear fall risk when diagnosed in the immediate period surrounding a fall.”A total of 351 medication changes were documented, including medication classes with known fall risk. Medication classes of particular risk include those with the potential to precipitate hypotension, altered mental status or cardiac arrhythmia. Studies examining similar medications and risk of falling found that benzodiazepines, antiarrhythmics, neuroleptics, bronchodilators, antacids, cardiac glycosides, and antidepressants were associated with increased risk of falling. “Many of these high-risk medication classes are consistent with the medication changes identified in this study,” the authors wrote in their paper. “Once a fall occurs, our data reinforces the importance of a thorough medication review for each fall-related open globe injury patient to identify risk factors for both the presenting fall and future falls.”Additionally, 43.2% of subjects were seen by a new specialist; 38 of 108 visits (35.2%) were trauma-related, while a significant portion (64.8%) addressed new non-ocular conditions. Pre-injury, the most common specialties referred to were orthopedics, cardiology and oncology, typically for chronic conditions such as osteoarthritis. Following open globe injury, the most common referrals unrelated to trauma were cardiology, urology and oncology for conditions such as new cancer diagnoses and cardiac arrhythmias, suggesting the fall-related evaluation unmasked potentially contributory underlying acute conditions. “Though it was difficult to determine which visits were for incidental conditions vs. those contributing to a fall, the high rate of visits reinforces the importance of primary and specialty care in the post-trauma setting,” the authors explained in their paper.The cohort experienced high one-year mortality rates, which increased with age, reaching 45% for patients older than 85. This wasn’t a surprise to the authors, as falls in the elderly are known to increase the risk of death compared to elderly patients without falls. “One large study of the National Trauma Data Bank shows a 3.2% mortality rate after a ground-level fall in all age groups,” the authors wrote in their paper. “The relatively higher rate of mortality in our population could be related to the severity of a fall that might yield an open globe injury. The high mortality risk following a fall-related open globe injury is consistent with the high rates of new systemic illness and medication changes demonstrated in this study and reinforces the sentinel event nature of the fall-related open globe injuries.”Click here for the journal source. Meshkin RS, Strand ET, Armstrong GW, et al. Fall-related open globe injuries are associated with systemic health changes. Eye. March 3, 2026. [Epub ahead of print.]  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.