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Dr Susan Heward-Belle and Dr Brighu Swamy

By Helen Carter


Domestic violence is an important issue for eye health professionals to be aware of because 45 per cent of intimate partner violence-related injuries involve the eye, Sydney ophthalmologist Brighu Swamy says.

Dr Swamy says optometrists have a window of opportunity and an important role in identifying and supporting these ‘vulnerable patients.’

He will discuss ocular and orbital injuries in domestic violence at Optometry NSW/ACT’s Super Sunday conference on March 8, 2020, while leading domestic and family violence researcher, Dr Susan Heward-Belle will discuss seeing domestic violence as a public health issue.

Optometrists as first responders – disclosure occurs in context of trust

‘As people who interface directly with your patients you are potentially the first responders – you might be the first professional that a person tells about domestic and family violence,’ Dr Heward-Belle said.

‘As a health professional you are in a position to scan for the existence of DFV (domestic and family violence.)

‘You may be part of the disclosure process – disclosures can be accidental or purposeful – and they usually occur in a context of trust and connection.’

Dr Swamy, a medical retina and macula subspecialist, is a clinical lecturer at the University of Sydney and a Visiting Medical Officer at Bankstown Hospital. He said intimate partner violence had become a prominent issue in recent years and the ocular manifestation of this was most likely underreported.

‘Intimate partner violence affects patients from all walks of life,’ he said. ‘A minority of women who have sustained injuries secondary to domestic violence openly disclose that they have been the subject of domestic violence.

‘Health professionals do not feel comfortable discussing these issues with patients. But given the potential for further harm, there is a window of opportunity for health professionals including eye health professionals – they have an important role in identifying and providing support for these vulnerable patients.’

Dr Swamy is also co-author of the Eye Emergency Manual, distributed to all NSW hospitals, and included blunt trauma to the eye in the manual.

‘There is overlap in terms of spectrum of eye injuries between intimate partner violence-related injuries and some of the trauma material we covered in the manual,’ he said. ‘Violence in domestic relationships can become cyclic, and involve increasing brutality.

‘Australian statistics suggest that domestic violence is increasing, with 62 women killed by domestic violence in the 12 months prior to 23 November 2018, eight more than the previous year.’

Avulsed optic nerve

Dr Swamy said domestic violence could result in serious ocular and orbital injuries. Some examples of the most common types include:

  • Orbital floor fracture
  • Periorbital haematoma
  • Subconjunctival haemorrhage
  • Ruptured globes
  • Avulsed optic nerve

‘Blunt trauma with a closed fist is commonly the cause of these injuries,’ Dr Swamy said.

 What should optometrists look for in an ocular examination?

Dr Swamy advised that, in an ocular examination, optometrists should:

  • Classify trauma as blunt or penetrating
  • Examine visual acuity, intraocular pressure, reactive afferent pupillary defect
  • Examine eyelids, palpate orbital rim, examine facial sensation
  • Perform full dilated eye exam
  • Good documentation is essential

‘Violence in domestic relationships can become cyclic, and involve increasing brutality,’ Dr Swamy said.

If penetrating eye injury or orbital fracture is suspected referral should be prompt to the closest hospital, he said.

Dr Swamy said victims of general domestic assault were mainly female (69.2 per cent), according to the NSW Bureau of Crime, and offenders mainly male (82 per cent.) Unfortunately, children are also victims of domestic violence.

Males are also victims of domestic violence – one woman a week and one man a month were killed by a current or previous partner in Australia between 2012-2013 and 2013-2014, Dr Heward-Belle said.

Orbital floor fracture

Recognise, respond, refer

Dr Heward-Belle, a senior lecturer in the Social Work and Policy Studies Program at the University of Sydney, has almost 30 years’ experience in the domestic violence and child protection field and has conducted many studies in these areas.

Her presentation will outline what optometrists need to know about domestic violence in order to promote safety and wellbeing for survivors. How to recognise and respond to people living with domestic violence will be discussed as will appropriate referral pathways and reporting requirements.

She advises:

  • Treat people with dignity and respect it takes courage to reach out to another person and tell your story
  • Give people time, listen deeply, do not judge, be supportive
  • Understand that survivors are the experts in their own lives
  • Understand the people who use violence and control are often very skilled at manipulating and grooming professionals
  • Know the physical and non-physical signs of DFV
  • Know your legal obligations regarding reporting
  • Be ‘trauma informed’ as well as ‘domestic violence informed’

Sub conjunctival haemorrhage

Referral pathways

  • There are many legal and support services across Australia that address DFV
  • Each state and territory have different reporting requirements regarding child protection legislation and obtaining protection orders
  • 1800 Respect Australia’s national sexual assault, domestic and family violence counselling service contains the most up to date information for professionals. See also

SUPER SUNDAY 2020: looking to the future on 8 March, 2020 at Luna Park’s Big top in Sydney’s Milsons Point offers a stellar line-up of presenters, 30 CPD points including 15 therapeutic points, an Early Career Optometrists Program, and a Practice Staff Marketing Program in collaboration with ProVision. Bring the family for a fun-filled day with discounted ride tickets. OA members register here and non-OA members register here.

Sub conjunctival haemorrhage

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