|Year : 2012 | Volume
| Issue : 4 | Page : 293-296
Ocular morbidity among children at a tertiary eye care hospital in Kolkata, West Bengal
Jaya Biswas1, Indranil Saha2, Debabrata Das3, Sabyasachi Bandyopadhyay1, Biswarup Ray4, Gautam Biswas5
1 Assistant Professor, Department of Ophthalmology, R.G. Kar Medical College, Kolkata, India
2 Assistant Professor, Department of Community Medicine, Burdwan Medical College, Burdwan, India
3 Associate Professor, Department of Ophthalmology, Midnapore Medical College, Medinipur, India
4 Professor and HOD, Department of Ophthalmology, B.S. Medical College, Bankura, India
5 Professor, Regional Institute of Ophthalmology, Medical College, Kolkata, India
|Date of Web Publication||24-Jan-2013|
Assistant Professor, Department of Ophthalmology, R.G. Kar Medical College, Kolkata 98 A, P. Majumdar Road, Flat No. 2AB, Kolkata - 700078, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Eye diseases in childhood are important causes of medical consultation and it affects learning ability, adjustment in school and personality. To determine the pattern of ocular morbidity a cross-sectional observational study was conducted among 714 children, attending Ophthalmology department at a tertiary eye care center in Kolkata, West Bengal. All the children less than 15 years of age, attending in Unit II outpatient department were selected by complete enumeration method for duration of one year (January-December 2010). Distribution of association was analyzed by Chi-square test and difference between two proportions was calculated by z test for proportions. The common ocular morbidity were refractive errors (23.67%) followed by allergic conjunctivitis (17.23%), infection of the eye and adnexa (15.13%), ocular trauma (12.74%), and congenital eye diseases (13.59%). Majority of ocular morbidity is treatable and need early attention through eye screening cum intervention program beginning right from the childhood.
Keywords: Children, Ocular morbidity, Refractive errors, Ocular trauma
|How to cite this article:|
Biswas J, Saha I, Das D, Bandyopadhyay S, Ray B, Biswas G. Ocular morbidity among children at a tertiary eye care hospital in Kolkata, West Bengal. Indian J Public Health 2012;56:293-6
|How to cite this URL:|
Biswas J, Saha I, Das D, Bandyopadhyay S, Ray B, Biswas G. Ocular morbidity among children at a tertiary eye care hospital in Kolkata, West Bengal. Indian J Public Health [serial online] 2012 [cited 2019 Sep 18];56:293-6. Available from: http://www.ijph.in/text.asp?2012/56/4/293/106418
Eye diseases in childhood are important reasons for medical consultations. Ocular morbidity in children affects learning ability, adjustment in school, and personality.  About 30% of blind population of India lose their eyesight before the age of 20 years and many of them are under 5 when they become blind.  Data on causes and prevalence of ocular morbidity in children is essential for planning and evaluation of preventive and curative services for children in a given region. Very few hospital-based studies are available on childhood ocular morbidity. Information obtained from this set up might be useful in improving the existing primary eye care facilities consequently reducing the prevalence of childhood blindness and severe visual impairment. With this background, the present study was conducted with the objective to determine the pattern of ocular morbidity among the children attending in the outpatient department (OPD) of an Ophthalmology unit of a tertiary care hospital of eastern India.
The present cross-sectional study was conducted in the Department of Ophthalmology, of R. G. Kar Medical College and Hospital, Kolkata, West Bengal, for duration of one year from January to December 2010. Ethical clearance to conduct the study was obtained from Ethics Review Board (ERB) of the college.
There are two units (unit I and II) in the Ophthalmology Department, each unit has outdoor activity thrice weekly on alternate days. Out of these two units, Unit II was selected by simple random sampling. All the patients less than 15 years of age attending the unit II OPD during the study period constituted our study population. Thus complete enumeration method was applied. Informed verbal consent was taken from guardians of all children attending OPD for inclusion in the study. A total of 714 children were included in the study.
Diagnostic criteria used were as following:
- All the patients were examined by ophthalmologists and refraction was done by optometrists. The patients underwent the following examinations: Visual acuity measurement with the help of Snellen's chart for distant vision in older and cooperative patients. Any child having visual acuity of 6/9 or worse was examined for refractive error.
- Extraocular movements, Hirschberg test, cover-uncover test for detection of squint.
- Gross examination of cornea, conjunctiva, anterior chamber, iris, and pupil with a torch light.
- Examination of the anterior segment with slit lamp was done when needed.
- Retinoscopy and subjective refraction for all the patients suspected of having refractive error.
- Cycloplegic refraction when needed.
- Examination of fundus with direct ophthalmoscope.
- Indirect ophthalmoscopy when needed.
Multiple ocular diseases were diagnosed by consideration of isolated diagnostic criteria of the disease.
- A diagnosis of congenital disease was made when the disease was present since birth and other diseases were diagnosed as acquired.
- Myopia was recorded if refractive error was worse than -0.5 DS (diopter sphere). A diagnosis of hypermetropia was made if refractive error was worse than +0.5 DS. Similarly, astigmatism was recorded if refractive error was worse than +0.5 DC (diopter cylinder). 
- Amblyopia was diagnosed if the child had visual acuity of 6/9 or worse after careful eye examination was done including dilated fundus evaluation and cycloplegic refraction. 
Data were collected into a predesigned, pretested schedule after interview of the parents, review of the past records (if any) and by clinical examination. Collected data were analyzed by computing proportions. Distribution of association was analyzed by Chi-square test (χ2 ) and difference between two proportions was calculated by z test for proportions. Epi-info software (version 3.2) was used for analysis.
There were a total number of 714 patients including 416 (58.26%) males and 298 (41.74%) females. All the patients were divided into three broad groups, that is, 0-4, 5-9, and 10-14 years. Majority, that is, 70.73% of the study subjects were in the 10-14 years age group. By religion, Hindus were 68.77% (491/714) and the rest 31.23% were Muslims.
Overall, refractive errors were the most common ocular morbidity (23.67%), followed by allergic conjunctivitis (17.23%), infection of the eye and adnexa (15.13%) and ocular trauma (12.74%). The same is being true for 10- 14 years age group also, though in different proportions. Out of the total 123 allergic conjunctivitis patients, male (78, 63.41%) were significantly more (z = 4.08, P = 0.00) than females (45, 36.59%) [Table 1].
|Table 1: Age group distribution of the study subjects by ocular morbidity (n = 714)|
Click here to view
Among the children with refractive errors 81 (47.93%) were male and 88 (52.07%) were female. With increase in the age group, proportion of both male and female patients with refractive errors has increased, though this is not statistically significant (χ2 = 0.18, df = 2, P = 0.91). Refractive error was the maximum, that is, 82.84% (140/169) in the age group of 10-14 years. Overall, myopia was the most frequent type of refractive error affecting 92 (54.44%) patients followed by hypermetropia 42 (24.85%). Astigmatism was noted among 35 (20.71%) of patients. Among 169 children with refractive error only 9 (5.33%) patients had uncorrected vision less than 6/60 while majority (106, 62.72%) had uncorrected visual acuity between 6/9 and 6/18. Visual acuity of 11 (6.51%) patients could not be assessed (patients in 0-4 years age group and 7 un-cooperative patients). [Table 2] depicts distribution of the study subjects by infections of eye and adnexa.
|Table 2: Distribution of the study subjects by infections of eye and adnexa (n = 108)|
Click here to view
In the ocular trauma group, contusion injury was found to be the most common, comprising of 59.34% of ocular trauma. Eye injury was significantly more (z = 5.33, P = 0.00) among boys (64, 70.32%), than girls (27, 29.68%). Overall ocular trauma has been increased from lower to higher age group. Among 54 contusions, there were 3 cases of traumatic hyphema. Injuries other than contusion were lid injury (10, 10.99%), corneal and superior tarsal foreign body (18, 19.78%), open globe injury (4, 4.39%), thermal injury (3, 3.30%) and chemical injury (2, 2.20%).
Out of 97 (13.59%) congenital eye diseases congenital dacryocystitis was most common (25, 25.77%), followed by cataract (16, 16.49%), microphthalmos (8, 8.25%), ptosis (7, 7.22%), squint (6, 6.19%) and iris coloboma (4, 4.12%).
In the present study refractive errors were the most common cause of ocular morbidity, similar to other studies.  The overall occurrence of refractive errors has been reported to vary between 21% and 25% of patients attending the eye out patient departments in India.  Similar prevalence of refractive errors has been observed among school going children in Shimla, Kolkata and also in Ahmedabad.  However, lower prevalence of refractive errors (4.7-14.3%) have been reported by other studies. ,, The higher prevalence in refractive errors among older children may be due to better detection of visual problem by them, suggesting lack of awareness among parents to detect them earlier.
Allergic conjunctivitis remained the second most common cause (17.23%) of ocular morbidity in children. Higher prevalence (3-17.5%) of allergic conjunctivitis has been reported by various other studies. ,, Though allergic conjunctivitis rarely leads to blindness, but it remains a leading cause of school absenteeism due to its discomfort, chronicity, and recurrence. 
Ocular infections are important causes of avoidable blindness and important cause of school absenteeism was the third common cause (15.13%) of ocular morbidity in our study, similar to a study in Nigeria. 
Ocular trauma was responsible for 12.74% of childhood morbidity in present study. Globally, the frequency of ocular trauma is also high.  Globally, the major cause of ocular trauma in children includes unsupervised play and use of dangerous objects. Occurrence in ocular trauma is significantly higher in boys in all countries.  Similar to several other studies closed globe injury was most common injury noted in the present study. 
In conclusion, the present study suggests that refractive errors, allergic conjunctivitis, infections of eye and adnexa and ocular trauma are important causes of childhood ocular morbidity, most of them are either treatable or preventable. Visual impairment due to refractive errors is an important public health problem as it affects performance at school and impairs social and behavioral development of children. The problem can be solved by simple spectacle correction. Ongoing school eye screening program should be strengthened to reduce the prevalence of visual impairment due to refractive errors. Mandatory regular school eye screening program should be implemented. Health education activities in schools should be intensified. Teachers, students, and parents should be educated regarding eye healthcare and ocular hygiene to minimize childhood eye injuries and infections and ensure early treatment of childhood eye disorders. Thus, a large number of childhood visual impairment and blindness can be avoided and the socio-economic health of the nation can also be improved.
| References|| |
|1.||Pratab VB, Lal HB. Pattern of pediatric ocular problem in North India. Indian J Ophthalmol 1989;37:171-2. |
|2.||Danish Assistance to the National Programme for Control of Blindness. New Delhi. India: Vision screening in school children. Training module 1. |
|3.||Raju P, Ramesh SV, Arvind H, George R, Baskaran M, Paul PG, et al. Prevalence of refractive errors in a rural south Indian population. Invest Ophthalmol Vis Sci 2004;45:4268-72. |
|4.||Nepal BP, Koirala S, Adhikary S, Sharma AK. Ocular morbidity in school children in Kathmandu. Br J Ophthalmol 2003;87:531-4. |
|5.||Gupta M, Gupta PB, Chauhan A, Bhardwaj A. Ocular morbidity prevalence among school children in Shimla, Himachal, North India. Indian J Ophthalmol 2009;57:133-8. |
|6.||Goswami A, Ahmed E, Shaha PL, Roy IS. An epidemiologic pattern of cases of refractive errors. J Indian Med Assoc 1979;72:227-8. |
|7.||Onakpoya OH, Adeoye AO. Childhood eye diseases in southwestern Nigeria: A tertiary hospital study. Clinics 2009;64:947-51. |
|8.||Kumar R, Dabas P, Mehra M, Ingle GK, Saha R, Kamlesh. Ocular morbidity amongst primary school children in Delhi. Health Popul Perspect Issues 2007;30:222-9. |
|9.||Khurana AK, Sikka KL, Parmar IP, Aggarwal SK. Ocular morbidity among school children in Rohtak city. Indian J Public Health 1984;28:217-20. |
|10.||Hall A, Shillo B. Vernal Keratoconjunctivitis. Community Eye Health 2005;53:76-8. |
|11.||Rapoport I, Romem M, Kinek M, Koval R, Teller J, Belkin M, et al. Eye Injuries in Children in Israel. A Nationwide collaborative Study. Arch Ophthalmol 1990;108:376-9. |
[Table 1], [Table 2]
|This article has been cited by|
||Prevalence, morbidity and treatment seeking behavior for allergic conjunctivitis in children in a North Indian community
| ||Payal Kahol,Manjula Thakur,Amit Gupta,Sushma Kumari Saini |
| ||Clinical Epidemiology and Global Health. 2018; |
|[Pubmed] | [DOI]|
||A retrospective analysis of eye conditions among children attending St. John Eye Hospital, Hebron, Palestine
| ||Riyad G. Banayot |
| ||BMC Research Notes. 2016; 9(1) |
|[Pubmed] | [DOI]|
||Clinical analysis of preschool children ocular trauma
| ||Wang, L.-M., Feng, W., Feng, X.-M., Hu, N. |
| ||International Eye Science. 2013; 13(7): 1502-1504 |