Domestic Violence in Ophthalmology

Authors: Danica R. Kindrachuk 

Author Disclosures: Danica Kindrachuk: None

Abstract Body: 

Purpose: To examine and educate on the scope of domestic violence injuries in ophthalmology, to examine its prevalence, to delineate ophthalmology’s key role in detection and advocacy, and to discuss efficacy of interventions.   

Study Design:   Literature Review   

Methods:   Literature review of all articles published with “domestic violence”, “intimate partner violence” and “ophthalmology” from 2000‐2022.   

Results:   Domestic violence affects both men and women globally, but women are affected at much higher rates (ranging from 10‐69% globally, and 21.5% in North America according to WHO data). It is a greater threat to life than cancer, motor vehicle accidents, or war among the 15‐44 y.o. female group. In Canada, intimate partners are responsible for >25% of all police reported violent crime. Despite its high prevalence, health‐care providers grossly underestimate frequency, with one study showing orthopedic surgeons estimated 1% of all injuries in a cast clinic to be due to domestic violence, when the true proportion was 32%. Staggeringly, of all the injuries caused by domestic violence, 45% involve the eye ‐ these range from lid laceration, corneal abrasion, hyphema, orbital fractures, retinal detachment, commotio retinae, lens dislocation, and ruptured globe. Certain injuries are much more likely to be caused by domestic violence vs. other facial trauma mechanisms, including orbital blowout and zygomatic complex fractures. The left side is involved in 80% of cases, due to the right‐hand dominance in the population. Recommendations for screening for domestic violence vary, with the United States Preventative Services Task Force recommending universal screening, whereas the WHO suggests a case‐based enquiry with presentations compatible with domestic violence. Only 1 in 4 women will voluntarily report, but expect physicians to ask with 92% indicating comfort discussing when prompted. Physician gender had no impact on these results. When discussed, patients are 4.6 times more likely to access an intervention, and 2.6 times more likely to exit the relationship. At 1 year follow up, 49% are no longer in the abusive relationship.   

Conclusions:   Domestic violence is much more common than realized. Approximately 50% of all domestic violence injuries involve the eye. Patients expect their healthcare providers to discuss these issues, regardless of gender, and depending on jurisdiction, physicians may have legal obligations in these cases. Evidence‐based interventions are available and successful. This is an important public health issue where ophthalmologists can save lives.