Neglected Open-Globe Injury and Limb Amputation Following a Blast Explosion in a Pediatric Polytrauma Patient: An Observational Analytic Case Study on Delayed Ophthalmic Intervention, Ocular Trauma Score Dynamics, and Health System Barriers in Remote Eastern Indonesia
DOI:
https://doi.org/10.37275/bsm.v10i11.1676Keywords:
Archipelagic healthcare barriers, Blast ocular trauma, Corneal keratolysis, Fish bomb explosion, Ocular trauma score, Pediatric open-globe injuryAbstract
Background: Blast-related ocular trauma in children in archipelagic developing regions is a devastating, multimechanistic emergency, often complicated by systemic polytrauma prioritization and geographical referral barriers.
Objective: To characterize the clinical trajectory, Ocular Trauma Score dynamics, and health-system barriers of a neglected pediatric open-globe blast injury with concomitant traumatic hand amputation in remote eastern Indonesia.
Methods: A 13-year-old boy presented 5 days after a homemade fish-bomb explosion. Evaluation used Birmingham Eye Trauma Terminology (BETT) classification, longitudinal biomicroscopy, acoustic B-scan ultrasonography, quantitative Ocular Trauma Score (OTS) and modified Pediatric OTS, and multi-level structural barrier assessment.
Results: At presentation (Day 5), right eye (OD) visual acuity was light perception with intraocular pressure of 7 mmHg, full-thickness superior eyelid margin laceration, total dark hyphema (Grade IV), and traumatic corneal scars, while the left eye (OS) maintained 20/20 vision with multiple corneal foreign bodies. Acoustic B-scan OD revealed complete funnel-shaped retinal detachment tethered to the optic disc and dense vitreous hemorrhage. OD calculated an OTS raw score of 12 (Category 1, 74% no-light-perception probability). Following surgical delays driven by maritime transit and BPJS insurance administrative bottlenecks, 1-week follow-up (Day 12) revealed fulminant corneal keratolysis with diffuse stromal melting, chemosis, and cicatricial eyelid notch, whereas OS achieved complete corneal re-epithelialization.
Conclusion: Neglected pediatric blast ocular trauma leads to accelerated enzymatic keratolysis and irreversible functional amaurosis when systemic polytrauma prioritizes limb salvage over sight. Integrating mandatory ophthalmic triage into rural disaster protocols is critical.
Authors
- Putu Rima Adilitha Widyasari1
- Daniel Johosua Siegers2*
- Putu Yuliawati3
- I Wayan Ardy Paribrajaka2
- 1Ophthalmology Resident, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
- 2Ophthalmologist, Ambon Vlissingen (AV) Eye Clinic, Ambon, Indonesia
- 3Department of Ophthalmology, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Corresponding author Daniel Johosua Siegers — Siegersdaniel@yahoo.com
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Copyright (c) 2026 Putu Rima Adilitha Widyasari, Daniel Johosua Siegers, Putu Yuliawati, I Wayan Ardy Paribrajaka
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