• Users Online: 211
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 43-47

Ocular trauma: An epidemiological study in a tertiary center


1 Department of Ophthalmology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
2 Department of Ophthalmology, PGICH, Noida, Uttar Pradesh, India

Date of Submission16-Apr-2022
Date of Decision19-Apr-2022
Date of Acceptance25-Apr-2022
Date of Web Publication21-Jul-2022

Correspondence Address:
Sarita Aggarwal
Santosh Medical College, Ghaziabad, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sujhs.sujhs_17_22

Rights and Permissions
  Abstract 


Background: According to the WHO, ocular injury results in 19 million people to become unilateral blind and 1.6 million to become bilateral blind. Ocular trauma constitutes a major part of preventable blindness. The following study was done to identify the demographic profile of the patients and nature of ocular trauma for developing acceptable methods for better management and early visual rehabilitation of patients.
Aim: The aim was to study various demographic patterns and manifestations of ocular injuries.
Methods: This hospital-based prospective study was carried out in the Department of Ophthalmology. One hundred cases of ocular trauma were included, and written consents were obtained. A detailed history specific to age, occupation, time of injury, type of object causing injury, and socioeconomic status of the patient was obtained through prestructured pretested pro forma. A detailed ocular examination along with a systemic examination was carried out.
Results: In the present study, 24% of the cases were in the age group of 40–50 years. Sixty-five percent of the population was male. Thirty-one percent of the population presented within 24 h of trauma, 61% within 3 days, and 25% presented after 7 days. Ninety-five percent of the patients had unilateral trauma and 5% had bilateral trauma. Sixty-two percent of the patients had suffered from road traffic accidents, 25% had work-related trauma, whereas, in 13% of cases, trauma was at home. Blunt objects, foreign bodies, and sharp objects were the top three causes of trauma, accounting for 26%, 23%, and 15% of trauma cases, respectively; it was found that the anterior segment was involved in 74% of cases, the posterior segment in 4% of cases, and combined injury was in 22% of the cases.
Conclusion: Most of the eye injuries can be prevented by educating people on various modes of ocular trauma, the need for early treatment, and importance of wearing safety eye gear. This study highlights on the epidemiology of ocular trauma as well as various preventive strategies.

Keywords: Blind, eye injury, ocular trauma, road traffic accidents, trauma


How to cite this article:
Pawaiya S, Aggarwal S, Arora R, Sharma V, Kumar A, Rao S, Jawa A. Ocular trauma: An epidemiological study in a tertiary center. Santosh Univ J Health Sci 2022;8:43-7

How to cite this URL:
Pawaiya S, Aggarwal S, Arora R, Sharma V, Kumar A, Rao S, Jawa A. Ocular trauma: An epidemiological study in a tertiary center. Santosh Univ J Health Sci [serial online] 2022 [cited 2022 Aug 11];8:43-7. Available from: http://www.sujhs.org/text.asp?2022/8/1/43/351565




  Introduction Top


Ocular trauma constitutes a major part of eye-related emergencies which ophthalmologists see in their day-to-day practices.[1] According to the WHO, approximately 19 million people are unilaterally blind and 1.6 million are bilaterally blind from eye injuries all over the world.[2] Trauma may range from mild-to-sight-threatening consequences. Conditions which influence the nature and cause of trauma depend on climate, geographical condition, population, and lifestyle of society with their cultural and socioeconomic condition.[2],[3] It has been estimated that 90% of eye injuries are preventable.[4] All ocular structures are prone to injury; however, the location typically depends on the cause and mechanism of ocular injury.[5] The anterior segment of the eye is prone to direct trauma. The posterior ocular structures may be involved in blunt as well as penetrating injuries.[5] The outcome becomes worst with combined anterior and posterior segment injuries, which may result in loss of vision.[6],[7],[[8] Most of the clinical epidemiological studies on ocular trauma have been carried out in developed countries, but as the prevailing condition of our country is different from developed countries, their model cannot be applied in our county. This study was conducted in Delhi NCR so as to identify various causative factors and prognostic factors for better management and visual rehabilitation of the patient.

From a public health perspective, the impact of ocular trauma on society is not portrayed, specifically by simply reporting bilateral or unilateral blindness. Severe trauma needed careful rationalization for a higher understanding of the type of injury and decision that must be made for the management. Requirement of prolonged hospitalization, specialist treatment, multiple follow-ups, and visual rehabilitation increases the economic cost for the patient and the financial burden on society. It is thus important to understand the local patterns of injuries and develop acceptable methods for management and prevention. The first step in prevention is to locate the exact cause of eye injuries and their patterns. This is why it is vital to maintain an injury register that uses the Birmingham Eye Trauma Terminology System (BETTS) classification system and embody age, gender, place, and cause of injury. Assortment of such data at varied centers will eventually facilitate in comparing the results and patterns determined in the several regions and countries, additionally serving to aid in the development of the protocol for the prevention and early interventions to save vision.

Aim and objectives

  • To study various demographic patterns and manifestations of ocular injuries
  • To find out various modes of injury
  • To assess the clinical features of ocular trauma in patients
  • To evaluate the visual outcome in patients with ocular trauma.


Research methods and design

Study design

  • This study was a hospital-based prospective study.


Study setting

This study was conducted from October 1, 2018, to October 31, 2019, in the outpatient department of ophthalmology at Santosh Medical College and Hospital to evaluate the pattern of ocular trauma in Delhi and NCR.

Study population and sampling strategy

A total of 100 cases of ocular trauma were taken. Written consents were obtained from all the patients included in our study. Detailed history specific to age, occupation, time of injury, type of object causing injury, and socioeconomic status of the patient was obtained through prestructured pretested pro forma. A detailed ocular examination including visual acuity on Snellen chart wherever possible and if the vision is <1 m, then counting finger close to face with perception of light PL/PR Projection of rays was checked. Slit-lamp examination was done to know the site of injury as well as the extent of the injury, dilated fundus examination with 90 D, indirect ophthalmoscopy or direct ophthalmoscopy was done to find the posterior segment involvement, gonioscopy, and Seidel test was also carried out in patients according to their presentation. Systemic examination was also done. On the basis of ocular injuries, patients are divided into open globe and closed globe according to the BETTS classification.

Data analysis

Microsoft Excel was used for data analysis. Data were analyzed with the help of frequencies, figures, proportions, measures of central tendency, and appropriate statistical tests.

Ethical considerations

Approval to conduct the study was received from the ethical committee of the college.


  Results Top


A total of 100 patients with ocular injuries were examined in Santosh Medical College, Ghaziabad, from October 1, 2018, to October 31, 2019. In our study, the mean age of our population presenting with ocular trauma was 35 years, with 48% <30 years in age [Table 1]. Sixty-five percent of the population was male and 35% were female [Figure l]. Thirty-one percent of the population in our study presented within 24 h, 61% within 3 days, whereas 25% presented after 7 days [Figure 2]. The present work showed that 95% of the patients had unilateral trauma (55% left eye and 49% right eye) and 5% had bilateral injuries. Sixty-two percent of the patients had road traffic accidents (RTA), 25% had work-related trauma, whereas 13% had trauma at home [Figure 3]. Blunt objects, foreign bodies, and sharp objects were the top three causes of trauma accounting for 26%, 23%, and 15% of trauma cases, respectively [Table 2]. In our study, closed globe injury (80% of cases) was significantly higher than open globe injury (20% of cases) [Figure 4]. We found out that the anterior segment was involved in 74% of cases, the posterior segment in 4% of cases, whereas combined injury was found in 22% of cases [Table 3].
Figure 1: Distribution of cases according to sex

Click here to view
Figure 2: Distribution of cases according to the time of presentation

Click here to view
Figure 3: Distribution of cases according to the place of trauma

Click here to view
Figure 4: Distribution of cases according to the type of ocular injury

Click here to view
Table 1: Distribution of cases according to age group (total n=100)

Click here to view
Table 3: Distribution of cases according to segment involved (total n=100)

Click here to view
{Table 3}


  Discussion Top


In our study, the mean age of our population presenting with ocular trauma was 35 years, with 48% <30 years in age [Table 1]. Sixty-five percent of the population was male and 35% were female [Table 2]. The male:female sex ratio was 1.86, which was comparable with studies done by Kushwaha et al; Titiyal et al., Kaur et al., Adamu and Muhammad; Lavaju et al; Syal et al and Alem et al. Predominant age group affected in these studies was below 30 years.[1],[9],[10],[11],[12],[13],[14],[15] This shows that laborers working in factories and construction sites without wearing protective gear are at more risk of developing ocular trauma, and children are more susceptible to ocular injuries due to the nature of their activities more commonly when they are unsupervised. Thirty-one percent of the population in our study presented within 24 h, 61% within 3 days, whereas 25% presented after 7 days [Table 4]. Our findings were compared with those in Titiyal et al., Mishra et al., Maurya et al., Syal et al., Kaur et al., Adamu and Muhammad, and Lavaju et al., where maximum patients presented within the first 24 h of trauma.[1],[11],[12],[13],[14],[16],[17] Whereas, in studies done by Alem et al. and Shelke et al., very few patients presented in first 24 h to the hospital accounting for 0.78% and 21.33%, respectively.[15],[18] The variations in presentation time might be due to the differences in distance from eye care centers, poverty, lack of awareness, and unsuitable transportation. The present work showed that 95% of the patients had unilateral trauma (55% left eye and 49% right eye) and 5% had bilateral injuries which is comparable with work done by Adamu and Muhammad, Maurya et al., and Kushwaha et al.[9],[12],[17] Titiyal et al. did not find any significant association between the involvement of either eye. The right eye was involved in 72 (43.6%) patients and the left eye was involved in 84 (50.9%) patients; nine patients had bilateral injuries.[1] The slight predominance of the left eye injuries may be explained by the fact that most people are right handed and the left eye of the victim is the one which is more vulnerable to the attack from a right-handed person. Sixty-two percent of the patients had RTA, 25% had work-related trauma, whereas in 13% had trauma at home [Table 5]. Our frequencies for RTA as the most common cause of injury matched with the work done by Titiyal et al., Adamu and Muhammad, Krishna et al., Kushwaha et al., Shelke et al., and Kaur et al.[9],[1],[11],[12],[18],[19] While Mishra et al. reported sports and recreational activities as the most common cause of injury,[16] Maurya et al. also reported sports activities (23.9%) as the most common cause of injury, followed by RTA (23.6%) with a very minor difference.[17] Syal et al. found workplace trauma in 27.5% (maximum) of the patients. The most common among them were laborers.[14] Blunt objects, foreign bodies, and sharp objects were the top three causes of trauma, accounting for 26%, 23%, and 15% of trauma cases, respectively [Table 3]. Adamu and Muhammad also found blunt trauma as the most common cause of injury, followed by penetrating injuries by sharp objects.[12] Whereas, Maurya et al. and Syal et al. reported mechanical trauma as the most common cause of injury with wooden objects and metallic objects as the most common object inflicting injury, respectively.[17],[14]
Table 5: Place of injury

Click here to view
Table 4: Time of presentation

Click here to view


In our study, closed globe injury (80% cases) was significantly higher than open globe injury (20% cases) [Table 6], which was found comparable with Kaur et al., Krishna et al., Kushwaha et al., and Syal et al.[9],[11],[14],[19] Mishra et al. reported a very low percentage of open globe injuries (13.6%) in comparison to other studies.[16] Alem et al. had an almost similar number of cases for open and closed globe injuries accounting for 47.07% and 47.74%, respectively.[15] Whereas, Titiyal et al., Lavaju et al., and Shelke et al. reported maximum cases with open globe injuries.[1],[13],[18]
Table 6: Distribution according to type of injury

Click here to view


We found out that the anterior segment was involved in 74% of cases, the posterior segment in 4% of cases, whereas combined injury was found in 22% of cases [Table 7]. Higher percentage of the anterior segment involvement was found owing to the direct impact of trauma to the anterior segment of the eye. Vitreous and aqueous humor in the posterior and anterior chamber, respectively, also act as shock absorbents decreasing the impact of blunt trauma to the posterior segment. The results were found similar in studies done by Adamu and Muhammad, Kaur et al., and Syal et al., with corneal involvement, conjunctival involvement, and corneoscleral perforation being the most common clinical presentation, respectively.[12],[11],[14] The longer delay in the presentation was significantly associated with complications (poor vision at presentation or secondary infection on site of injury) P = 0.03 in our study. Titiyal et al. also showed a significant association between the duration of presentation and the presence of complications at presentation (Chi-square value = 18.2, degree of freedom = 3, and P = 0.001), which may affect the final visual outcome. The final visual outcome (1 week after treatment) was difficult to analyze as in 21 (12.7%) cases, it was not documented.[1] In the study by Shelke et al. and Kaur et al., the duration of presentation had a significant association with the presence of infection, final visual outcome, and other complications (P < 0.05).[11],[18] All ocular structures are prone to injury; however, the location typically depends on the cause and mechanism of ocular injury.[2] The anterior segment of the eye which consists of the cornea, conjunctiva, trabecular meshwork, anterior chamber, iris, and crystalline lens is prone to direct trauma. The posterior ocular structures include the retina, choroid, and optic nerve, which may be involved in blunt as well as penetrating injuries.[2] The outcome is worst with combined anterior and posterior segment injuries with the chances of losing the vision.[5],[6],[20],[21]
Table 7: Segment distribution

Click here to view



  Summary and Conclusion Top


This hospital-based prospective study of 100 patients of ocular trauma was done to study the clinical and epidemiological profile of ocular trauma. The mean age of the affected population was 35 years, with 48% <30 years of age. Males were more commonly affected than females, as 65% of the population was male. The male-to-female sex ratio was 1:8. Thirty-one percent of the population in our study presented within 24 h of trauma, 61% within 3 days, and 25% presented after 7 days. Ninety-five percent of the patients had unilateral trauma (55% left eye and 49% right eye) and 5% had bilateral injuries. The most common cause of injury was RTA 62%, 25% had work-related trauma, whereas 13% of cases suffered trauma at home. Blunt objects, foreign bodies, and sharp objects were the top three causes of trauma, accounting for 26%, 23%, and 15% of trauma cases, respectively. lt was found that the anterior segment was involved in 74% of cases, the posterior segment only in 4% of cases, and combined injury was observed in 22% of the cases. As assessed in our study, the longer delay in the presentation was significantly associated with complications such as poor vision at presentation or secondary infection at the site of injury as well as poor prognosis. This epidemiological study recommends that people should be educated about the consequences of ocular trauma so that they take proper precautions while working, traveling, or playing and seek medical assistance as early as possible for better visual outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Edwards RS. Ophthalmic emergencies in a district general hospital casualty department. Br J Ophthalmol. 1987;71:938-42. doi: 10.1136/bjo.71.12.938. PMID: 3427004; PMCID: PMC1041349.  Back to cited text no. 1
    
2.
McCormack P. Penetrating injury of the eye. Br J Ophthalmol 1999;83:1101-2.  Back to cited text no. 2
    
3.
Narang S, Gupta V, Simalandhi P, Gupta A, Raj S, Dogra MR. Paediatric open globe injuries. Visual outcome and risk factors for endophthalmitis. Indian J Ophthalmol 2004;52:29-34.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Hutton WL, Fuller DG. Factors influencing final visual results in severely injured eyes. Am J Ophthalmol 1984;97:715-22.  Back to cited text no. 4
    
5.
Edwards RS. Ophthalmic emergencies in a district general hospital casualty department. Br J Ophthalmol 1987;71:938-42. doi: 10.1136/bjo.71.12.938. PMID: 3427004; PMCID: PMC1041349.  Back to cited text no. 5
    
6.
Eagling EM. Perforating injuries of the eye. Br J Ophthalmol 1976;60:732-6.  Back to cited text no. 6
    
7.
McGwin G Jr, Xie A, Owsley C. Rate of eye injury in the United States. Arch Ophthalmol 2005;123:970-6.  Back to cited text no. 7
    
8.
Gyasi M, Amoaku W, Adjuik M. Epidemiology of hospitalized ocular injuries in the upper East region of Ghana. Ghana Med J 2007;41:171-5.  Back to cited text no. 8
    
9.
Kushwaha RN, et al. “Profile of ocular trauma in tertiary care centre”. Journal of Evolution of Medical and Dental Sciences 2013;2:4903-14.  Back to cited text no. 9
    
10.
Titiyal GS, Prakash C, Gupta S, Joshi V. Pattern of ocular trauma in tertiary care hospital of Kumaon Region, Uttarakhand. J Indian Acad Forensic Med 2013;35:116-9.  Back to cited text no. 10
    
11.
Kaur I, et al. Study of clinical and demographic profile of ocular trauma and its effect on visual outcome. J Evol Med Dent Sci 2017;6:3038-45.  Back to cited text no. 11
    
12.
Adamu MD, Muhammad N. Pattern of ocular trauma in Gusau, North West Nigeria. Niger J Ophthalmol 2017;25:l1-3.  Back to cited text no. 12
    
13.
Lavaju P, Badhu BP, Shah S. Clinical profile and factors determining the final visual outcome of patients presenting with ocular trauma. DJO 2018;29:14-9.  Back to cited text no. 13
    
14.
Syal E, Dhawan M, Singh SP. To study the epidemiological and clinical profile of ocular trauma at a tertiary health-care facility. Delta J Ophthalmol 2018;19:259-67.  Back to cited text no. 14
  [Full text]  
15.
Alem KD, Arega DD, Weldegiorgis ST, Agaje BG, Tigneh EG. Profile of ocular trauma in patients presenting to the department of ophthalmology at Hawassa University: Retrospective study. PLoS One 2019;14:e0213893.  Back to cited text no. 15
    
16.
Mishra A, Verma AK, Baranwal VK, Aggarwal S, Bhargava N, Parihar JS. The pattern and visual outcomes of ocular trauma in a large zonal hospital in a non-opera- tional role: A 36 months retrospective analysis. J Clin Ophthalmol Res (Serial Online) 2014;2:141-4.  Back to cited text no. 16
    
17.
Maurya RP, Srivastav T, Singh VP, Mishra CP, Al-Mujaini A. The epidemiology of ocular trauma in Northern India: A teaching hospital study. Oman J Ophthalmol 2019;12:78-83.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Shelke E, Sonpethkar M, Khaire B, Deosarkar P. Study of ocular trauma pattern in a tertiary care hospital in rural area of India. Journal of Evolution of Medical and Dental Sciences 2016;5:7284-8.  Back to cited text no. 18
    
19.
Krishna KS. A study on pattern of ocular trauma at a regional eye hospital. J Evol Med Dent Sci 2018;7:4004-7.  Back to cited text no. 19
    
20.
Gyasi ME, Adjuik MA, Amoaku WM. Epidemiology of hospitalized ocular injuries in the Upper East Region of Ghana. Ghana Med J 2007;41:171-5.  Back to cited text no. 20
    
21.
MacGwin G, Owsley C, Xie A. Rate of eye injury in the United States. Arch Ophthalmol 2005;123:970-6.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Results
Discussion
Summary and Conc...
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed144    
    Printed12    
    Emailed0    
    PDF Downloaded13    
    Comments [Add]    

Recommend this journal