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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 175-178

Prevalence of ocular trauma in KLES Hospital: A 1-year cross-sectional study


Department of Ophthalmology, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

Date of Web Publication29-Sep-2016

Correspondence Address:
Shivanand B Patil
Department of Ophthalmology, Jawaharlal Nehru Medical College, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5006.191262

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  Abstract 

Context: People affected by eye injury often have to face loss of career opportunities, major lifestyle changes, and occasionally permanent disfigurement.
Aims: (1) To find the prevalence of ocular trauma in patients attending our hospital. (2) To find the clinical profile of ocular trauma patients and the cause of trauma in them.
Settings and Design: This was a cross-sectional study conducted at KLE Hospital, Belagavi, Karnataka.
Subjects and Methods: The present 1-year study was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, on 2308 trauma patients presenting to the ophthalmology outpatient department and casualty from January 1, 2014, to December 31, 2014. Out of 2308 patients, 217 patients were identified to have ocular trauma and were examined in a systematic fashion.
Statistical Analysis Used: None.
Results: The prevalence rate of ocular trauma was found to be 9.40%. Maximum patients (27.19%) were in the age group of 21-30 years. A total of 182 (83.87%) patients were male and 35 (16.13%) patients were female.
Conclusions: Most common cause of ocular trauma was found to be road traffic accidents (RTAs), seen most commonly among males in the age group of 21-30 years. Males are commonly injured in RTA which is probably related to both exposure and risk-taking behavior. Several human and environmental risk factors were found to be associated with increased risk of RTA. Apart from RTA, occupational hazard was the next major cause of ocular trauma. Certain laws and legislations and their strict enforcement can curb these two major causes of ocular trauma.

Keywords: Ocular trauma, prevalence, road traffic accident


How to cite this article:
Patil SB, Biala A, Khanna A, Meena A. Prevalence of ocular trauma in KLES Hospital: A 1-year cross-sectional study. Indian J Health Sci Biomed Res 2016;9:175-8

How to cite this URL:
Patil SB, Biala A, Khanna A, Meena A. Prevalence of ocular trauma in KLES Hospital: A 1-year cross-sectional study. Indian J Health Sci Biomed Res [serial online] 2016 [cited 2022 May 17];9:175-8. Available from: https://www.ijournalhs.org/text.asp?2016/9/2/175/191262


  Introduction Top


Although the eyes represent only 0.1% of the total body surface, most of the information reaches humans through vision. Ocular trauma causes a great socioeconomic impact. Population-based epidemiological studies in Andhra Pradesh and Tamil Nadu have found prevalence rates of ocular trauma as 2-10%. In addition to the physical and psychological trauma of eye injuries to the individual, the direct and indirect financial costs to the society are enormous. In the USA, the total cost of disabling and nondisabling eye injuries comes to billions of dollars. The annual incidence rate of hospitalization for eye injuries per lakh population/year is 5-16% worldwide. Blindness resulting from trauma has prevalence rates of 0.6%-0.8%. The use of eye protective devices in India is very low. Prevention of ocular injuries should form the basis of management for which collection of data is a must. Seeing the seriousness and enormity of ocular trauma, this study is undertaken to know the prevalence, cause of injury, and clinical and demographic profile of ocular trauma patients presenting in KLE Hospital, Belagavi, from this region so that strategies can be planned for the prevention and management of ocular trauma in a better way.


  Subjects and Methods Top


This was a cross-sectional study between January 1, 2014, and December 31, 2014, conducted in the Department of Ophthalmology of KLES Dr. Prabhakar Kore Hospital and Medical Research Centre (MRC), Belagavi, on all ocular trauma patients who presented to the casualty and the ophthalmology outpatient department (OPD) during the 1-year period.

The inclusion criteria were all cases of injury to the eyeball, optic nerve, orbit, upper and lower lids, eyebrows, and the lacrimal system.

After finding the suitability as per inclusion and exclusion criteria, patients were selected for the study and briefed about the nature of the study and written informed consent was obtained. Detailed history of trauma was obtained under the following headings:

  • Cause of injury
  • Mechanism of the injury
  • Place of injury
  • Time of injury
  • Unilateral/bilateral
  • Any treatment taken before reaching the hospital.
History was followed by ocular examination that included visual acuity testing for distance using counting finger method in the casualty and using Green's visual acuity chart in the OPD, checking extraocular movements, examination under diffuse light using a torch followed by anterior segment examination with a slit lamp, a dilated fundoscopy (wherever possible) using topical tropicamide and phenylephrine combination (Itrop plus) dilating drops, and intraocular pressure measurement (wherever possible) using Schiotz indentation tonometer. Fluorescein staining of the cornea was done in cases where corneal abrasion was suspected. B-scan of the orbit was performed in penetrating trauma cases, intraocular foreign body cases, and cases where the posterior segment details were not clear due to opaque media. Computed tomography (CT) scan was done in cases of ocular trauma having head trauma also.


  Results Top


This study was conducted on 217 ocular trauma patients who presented either to the casualty or the ophthalmology OPD of KLES Dr. Prabhakar Kore Charitable Hospital and MRC, Belagavi, during the study period. The patients were examined in a systematic manner and necessary investigations were ordered.

In this study of 2308 patients, 217 patients presented with ocular trauma, resulting in a prevalence rate of trauma as 9.40%.

In this study, the mean age of patients was 34.47 ± 19.49 years. Maximum patients (27.19%) were in the age group of 21-30 years, and minimum patients (0.92%) belonged to the age group of 71-80 years.

Out of 217 patients, 182 (83.87%) patients were male and 35 (16.13%) patients were female. Male:female was 5.2:1.

Most common cause of ocular trauma was road traffic accident (RTA) (66.36%), followed by occupational injury (6.91%) and fall from height (6.91%). Foreign bodies entering the eye accounted for 6% of injuries. Other causes which were responsible for 1-2% of injuries included assault, vegetative matter, stick, knife, firecracker, bull horn, glass, ball, sports related, stone chip, and blast injury [Figure 1].
Figure 1: Etiology of trauma


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In this study, time of the day was divided into morning (5 am to 12 pm), afternoon (12-4 pm), evening (4-8 pm), and night (8 pm to 5 am). In our study, 92 (42.40%) patients were injured at night followed by 53 (24.42%) at afternoon, 40 (18.43%) in the evening, and 32 (14.75%) in the morning.

The right eye was involved in 106 (48.85%) patients followed by the left eye in 78 (35.94%). In 33 (15.21%) patients, both eyes were involved.

A total of 145 eyes (58%) had clinically good vision, whereas no perception of light was present in 5 eyes (2%) in our study. Clinically good vision was considered as vision of counting fingers at a distance of more than 3 m. Fifty-one (20.4%) eyes had vision <3/60, 6 (2.4%) eyes had a visual acuity between 3/60 and 5/60, 14 (5.6%) eyes had vision between 6/60 and 6/24, 15 (6%) eyes had vision between 6/18 and 6/9, 10 (4%) eyes had 6/6 vision, and 5 (2%) eyes presented with no perception of light.

Out of 217 ocular trauma patients in our study, 28 (12.90%) patients had orbital fractures.

Out of 269 eyes with eyelid involvement, 142 (57.79%) eyes had ecchymosis, 73 (27.14%) eyes had lid edema, 41 (15.24%) eyes had partial thickness laceration, 3 (1.12%) eyes had full-thickness laceration, and 10 (0.37%) eyes had abrasions over the lid.

Among 209 eyes where the conjunctiva was affected, 78 (37.32%) eyes had subconjunctival hemorrhage, 42 (20.10%) eyes had chemosis, 48 (22.97%) eyes had conjunctival congestion, 34 (16.27%) eyes had ciliary congestion, and 7 (3.35%) eyes had foreign bodies in them.

Out of the 68 eyes with corneal involvement, 20 (57.12%) eyes had full-thickness laceration, 5 (14.29%) eyes had an ulcer, 2 (5.71%) eyes had partial thickness laceration, and another 2 eyes had foreign bodies. Three eyes had corneal scar, exposure keratitis, and corneal edema, respectively.

Out of 54 eyes where the anterior chamber was involved, 13 (37.14%) eyes had a collapsed chamber, 9 (25.71%) eyes had a hyphema, 6 (17.14%) eyes had an irregular chamber depth, 4 (11.43%) eyes had a deep chamber, 2 (5.71%) eyes had shallow chambers, and 1 (2.86%) eye had an intraocular foreign body in the anterior chamber.

Out of 55 eyes with pupillary findings, 22 (40%) eyes had a sluggish reaction to light, 15 (27.27%) eyes had a relative afferent pupillary defect, and 8 (14.55%) eyes had no reaction to light at all. Traumatic mydriasis was present in 7 (12.73%) eyes, and 3 eyes had an eccentric pupil, no pupil due to complete iridodialysis, and a festooned pupil, respectively. Twenty (4.61%) eyes out of 434 eyes of 217 ocular trauma patients developed traumatic optic neuropathy, and all cases were medically treated.

Out of 11 eyes having iris involvement, 3 (27.27) eyes had iridodialysis, iris prolapse, and iridodonesis, respectively. Two (18.18%) eyes had neovascularization of the iris

Out of the 14 eyes with lens findings, 8 (57.14%) eyes developed traumatic cataract, 4 (28.57%) eyes had aphakia secondary to trauma, and 2 (14.29%) eyes developed subluxation of the lens.

Maximum incidence of ocular trauma was seen in August (13.82%) and December (13.36%), and minimum incidence was seen in July (4.61%).

Out of 217 ocular trauma patients, 88 (40.55%) patients underwent investigations. Out of 88 patients, CT scan of the brain plain was done for 45 (51.14%) patients, X-ray of the orbit plain was done for 30 (34.09%) patients, and B-scan was done for 13 (14.77%) patients.

Out of 217 ocular trauma patients, 138 (63.59%) patients underwent medical treatment and the rest 79 (36.41%) patients underwent surgical treatment.


  Discussion Top


The prevalence rate is in conformity with the Andhra Pradesh Eye Disease Study [1] where 824 patients out of 7771 patients had ocular trauma, giving a prevalence rate of 10.6%. The Beaver Dam Eye Study [2] included 4926 patients; out of whom, 972 patients had ocular trauma resulting in a prevalence rate of 19.8%. Another study, The Aravind Comprehensive Eye Study [3] calculated the prevalence rate to be 4.5% which included 5150 patients, out of whom 229 patients had ocular trauma.

According to a study conducted by Desai et al., [4] a bimodal peak occurs in the older age groups. They also reported higher rates of injury in the age group of 15-64 years and lower rates for the age group of 0-14 years and 65 years and older age group. Males were affected in 80% (32 patients) of cases and females in 20% of cases (8 patients), which is consistent with other studies. This is well supported by a study conducted by Gothwal [5] in Hyderabad where males were involved in 86.8% of cases of ocular trauma.

According to Guly et al., [6] 57.3% of ocular injuries were caused due to RTAs. In a study conducted by Vats et al., [7] they found that majority of the ocular injuries were sustained at work and home, and blunt trauma (41.7%) was more commonly implicated than sharp objects (19.6%).

According to the Beaver Dam Eye Study, [2] where both eyes were involved in 15.4%, the right eye in 30.5%, and the left eye in 27.8% of participants. Rest 26.3% of the participants could not remember which eye was involved.

In the Andhra Pradesh Eye Disease Study, [1] 4.61% of patients presented blind (best-corrected distance visual acuity <6/60 in the better eye) due to trauma and another 3.4% had visual impairment worse than 6/12-6/60 in one eye due to trauma. The Aravind Comprehensive Eye Survey [3] identified trauma as the underlying cause for vision impairment (vision between 6/18 and 3/60 after best correction for that eye) in 27.2% eyes including 15.2% of these eyes that were blind (vision worse than 3/60 after best correction for that eye).

As per the Andhra Pradesh Eye Disease Study, [1] among the 39 cases of blindness from ocular trauma, 33.3% of eyes had traumatic cataract, another 33.3% had traumatic corneal scars, 20.5% were phthisical, 10.3% had traumatic optic atrophy, and 2.6% had surgical anophthalmia. In a study conducted by Vats et al., [7] among 158 participants, 39.9% had corneal opacities following trauma, 19.6% had traumatic cataract, 12.1% had iris tears, 3.2% had iridodialysis, 0.6% had hyphema, 1.9% had corneal epithelial defects, 1.3% had subconjunctival hemorrhage, 5.1% had conjunctival tears, 8.2% had lid scars, 4.4% had angle recession, 1.3% had retinal detachment and 0.6% each had a macular hole, a macular scar, and optic neuropathy, 3.2% had subluxated lenses, and 2.6% had phthisis bulbi.


  Conclusions Top


Most of the injuries involved the ocular adnexa, which while causing certain degree of cosmetic disfigurement did lead to permanent visual sequelae in some patients, injuries involving cornea or sclera had bad prognosis and those with optic neuropathy had the worst prognosis.

Most common cause of ocular trauma was found to be RTAs, seen most commonly among males in the age group of 21-30 years. As seen from study data, the people of the most active and productive age groups were involved in RTA which leads to cosmetic disfigurement and serious economic loss to the community. Males are commonly injured in RTA which is probably related to both exposure and risk-taking behavior.

Several human and environmental risk factors were found to be associated with increased risk of RTA, for example, lack of awareness of traffic rules, inadequate enforcement of existing laws, easy accessibility to license, and driving under the influence of alcohol. If we control the factors appropriately, mortality and morbidity can be prevented.

With the help of certain laws, legislations, and public awareness, maximum causes of ocular trauma can be reduced drastically. Hence, with the data of this study, preventive and management strategies can be formulated to manage ocular trauma in a better way.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Krishnaiah S, Nirmalan PK, Shamanna BR, Srinivas M, Rao GN, Thomas R. Ocular trauma in a rural population of Southern India: The Andhra Pradesh Eye Disease Study. Ophthalmology 2006;113:1159-64.  Back to cited text no. 1
    
2.
Wong TY, Klein BE, Klein R. The prevalence and 5-year incidence of ocular trauma. The Beaver Dam Eye Study. Ophthalmology 2000;107:2196-202.  Back to cited text no. 2
    
3.
Nirmalan PK, Katz J, Tielsch JM, Robin AL, Thulasiraj RD, Krishnadas R, et al. Ocular trauma in a rural South Indian population: The Aravind Comprehensive Eye Survey. Ophthalmology 2004;111:1778-81.  Back to cited text no. 3
    
4.
Desai P, MacEwen CJ, Baines P, Minassian DC. Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome. Br J Ophthalmol 1996;80:592-6.  Back to cited text no. 4
    
5.
Gothwal VK, Adolph S, Jalali S, Naduvilath TJ. Demography and prognostic factors of ocular injuries in South India. Aust N Z J Ophthalmol 1999;27:318-25.  Back to cited text no. 5
    
6.
Guly CM, Guly HR, Bouamra O, Gray RH, Lecky FE. Ocular injuries in patients with major trauma. Emerg Med J 2006;23:915-7.  Back to cited text no. 6
    
7.
Vats S, Murthy GV, Chandra M, Gupta SK, Vashist P, Gogoi M. Epidemiological study of ocular trauma in an urban slum population in Delhi, India. Indian J Ophthalmol 2008;56:313-6.  Back to cited text no. 7
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