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BRIEF RESEARCH ARTICLE
Year : 2014  |  Volume : 58  |  Issue : 4  |  Page : 278-280  

Paediatric ocular trauma in a tertiary eye care center in Eastern India


1 Department of Ophthalmology, Calcutta National Medical College, Kolkata, India
2 Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
3 Department of Ophthalmology, Malda Medical College, Malda, West Bengal, India

Date of Web Publication5-Dec-2014

Correspondence Address:
Chandana Chakraborti
Department of Ophthalmology, Calcutta National Medical College and Hospital, Kolkata - 700 014, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.146297

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   Abstract 

A retrospective study was performed to assess the pattern of pediatric ocular trauma in a tertiary eye center in eastern India. Records of 672 patients aged 16 years or less with ocular trauma who attended the outpatient department or emergency or treated as inpatients at a tertiary referral center between April 2009 and March 2010 were reviewed. Boys accounted for 70% cases. Most children were of the 5-10 years age group. Closed globe injury was the commonest (418 patients, 62.19%), followed by open globe injuries (127 patients, 19%), orbital injuries (52 patients, 7.67%), superficial foreign bodies (7.14%) and burn (4.01%). Home was found to be the commonest place of injury (44%), and only 51.9% attended the health facility within 24 h. Conservative management was done in 497 (74%) cases, whereas 175 (26%) cases were treated surgically. Final visual outcome of 443 (66%) patients were between 20/20 and 20/50. Sixty-eight patients had worst visual outcome with monocular blindness of the injured eye. Strategies to reduce the incidence of ocular trauma at home should be directed towards raising the parental education and public awareness.

Keywords: Ocular trauma, pediatric, visual outcome


How to cite this article:
Chakraborti C, Giri D, Choudhury KP, Mondal M, Datta J. Paediatric ocular trauma in a tertiary eye care center in Eastern India. Indian J Public Health 2014;58:278-80

How to cite this URL:
Chakraborti C, Giri D, Choudhury KP, Mondal M, Datta J. Paediatric ocular trauma in a tertiary eye care center in Eastern India. Indian J Public Health [serial online] 2014 [cited 2019 May 21];58:278-80. Available from: http://www.ijph.in/text.asp?2014/58/4/278/146297

Ocular injuries are the most common causes of acquired unilocular blindness in children. [1] It accounts for approximately 8-14% of total injuries in children. [2] Children are at greater risk of ocular trauma because of immature motor skills, careless activities and inability to identify dangerous and harmful objects. [3] The impact of eye injury is devastating as it leads to prolonged suffering, disability as well as increased economic burden. Ninety percent (90%) of ocular trauma are preventable by simple measures. [4]

This study has been conducted in the Department of Ophthalmology in a tertiary care institute of Eastern India. Study period was April 2009 to March 2010. Study population were patients with ocular trauma, 16 years or less, who attended the outpatient department (OPD), emergency or treated as inpatients in that institute in the study period. Demographic information of the patients; date, time and cause of injury; duration between injury and presentation; management and visual outcome were documented. A total of 712 ocular trauma patients of 16 years or less attended the department during the study period, but due to incomplete information records of 40 patients could not be included in the study. The records of visual acuity (VA), anterior segment and fundus findings were noted. VA was measured using the Snellens chart or illiterate E chart for school-aged children and for young children by naming pictures or matching letters. It was classified as category 1 (≥20/200), category 2 (<20/200 to light perception/PL) or category 3 (no light perception).

The definitions and classifications of ocular trauma in the study were modified from the Ocular Trauma Classification Group guidelines and Birmingham Eye Trauma Terminology. [5] Three more categories (orbital injuries, burns and superficial foreign bodies) were included in our classifications. Open globe injuries (OGI) was classified as rupture, penetrating injury, intraocular foreign body (IOFB) or perforating injury. Superficial foreign bodies of conjunctiva and cornea were recorded separately. Follow-up records of the patients till 3 months were analyzed.

Of the 672 ocular trauma patients, 470 (69.9%) patients were boys and rest were girls with a male:female ratio of 2.3:1. Children of 5-10 years were mostly affected. Four hundred seventy (69.9%) patients were from urban areas. Occupation wise, as the study included only pediatric patients, 538 (80%) patients were students and 20 (2.9%) were working.

Three hundred nine (45.9%) had an injury in their right eye whereas 329 (48.9%) had an injury in their left eye. Both eyes were involved in 34 (5.05%) cases.

Closed globe injuries were the commonest (62.2%), followed by OGI (18.9%). Home was found to be the commonest place of injury [Table 1]. Most common cause of CGI was body parts like finger, fist, whereas sewing needle, glass were commonest agents for OGI injuries [Table 2].
Table 1: Place of ocular injury (n = 672)

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Table 2: Mechanisms involved in closed and open globe injuries

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Commonest CGI was subconjunctival hemorrhage (156 patients), followed by the lid involvement (edema, bruise, abrasion, laceration) in 113 cases and corneal abrasion (76 patients). Among the OGI, cornea rupture with or without iris prolapse (65 patients) was most commonly seen followed by traumatic cataract (40 cases) and hyphema (12 cases). IOFB was detected in 8 cases. Endophthalmitis was present in 8 cases, most common offending agent being broomstick, wood stick and needle.

Superficial foreign bodies included sand, vegetable matter, glue and particles from fireworks or incense. Eyelid and canalicular disruption constituted main orbital injury (44 cases), followed by orbital fracture (4 cases), emphysema (2 cases) and intraorbital foreign body (2 cases). Among the 27 burn cases, 70.4% (19 patients) were thermal burns and the rest chemical burns. Offending chemicals were mainly household chuna (lime), bleaching powder and toilet cleaners.

A little more than half of the patients (349; 51.9%) attended a medical facility within 24 h.

Of the 672 cases, 531 (79.01%) were treated on OPD basis, and 141 (21%) were admitted. One hundred seventy-five patients (26.04%) required surgery and rest were treated conservatively. Among the admitted patients, majority (114 cases) were of OGI. Surgery was done in 105 cases with conservative treatment in the rest. Repair of cornea rupture with or without uveal tissue prolapsed constituted maximum number of cases requiring surgery (68), followed by lid and canalicular reconstruction (54 cases) and traumatic cataract surgery with or without intraocular lens implantation (52 cases). Two cases of grossly lacerated eye were enucleated.

At presentation, 403 patients had VA between 20/20 and 20/100 (category 1), 168 had VA between 20/200 to PL positive (category 2), while 34 patients had no PL (category 3). Final VA of 34 patients was between 20/400 to light perception. None of the category 3 patients showed any improvement in 3 months follow-up. Majority of category 2 and 3 were found to have OGI. These 68 patients ended up with monocular blindness of the injured eye.

Ocular trauma is extremely common and especially so in the developing countries. Of all the admissions in developed countries 5% cases [6] result from ocular trauma while in developing world this figure is much higher (12.9%). [7] Children of 5-10 years age group were found to be most prone to ocular injury in our study as supported by others. [8] The lower occurrence of ocular trauma under 2-year-old children can be explained by the parents' greater protection, the children's less independence and risk situations. [9] Males were injured nearly twice as females in this study suggested by the ratio of 2.3:1. Other studies also show a higher incidence of ocular injury in males compared to females. [2],[3],[10] Majority of patients were from urban areas (70%) which was similar to a study by Shoja and Miratashi. [3] In our study, commonest location for ocular injury was home that is consistent with previous studies. [2],[9],[10] Pointed objects, particularly bow and arrow, sewing needle and glass, were the leading agents of OGI in this study like most other studies. [8]

Regarding the health seeking behavior, it was observed that most of the patients attended the hospital within 24 h (52%) while 16% attended between 24 and 72 h. Narang et al. found 45.83% patients attended hospital within 24 h of sustaining trauma, 18.06% between 24 and 72 h and 30.56% beyond 72 h of trauma. [11] Saxena et al. reported 24% cases attended hospital within 6 h, 34.3% after 24 h. [8]

Oum et al. reported 13.6% of injuries were chemically induced. [12] Thirty-three (6.06%) cases in our study were victims of fire crackers injury which were mostly bilateral. Diwali and Ramjan are the peak time in India when children play with firecrackers making them prone to ocular burn indicating a greater need for supervision of children and adoption of protective measures during festivals. Forty (36.72%) cases out of 128 OGI and 7 (1.67%) cases out of 418 CGI ended up with monocular blindness.

Final VA of 443 (65.9%) patients were between 20/20 and 20/50, 60 (8.9%) patients had final VA between 20/60 and 20/100 and 27(4.01%) patients had a final VA 20/200 and 20/400. Sixty-eight patients ended up with monocular blindness of the injured eye. Out of 68 patients 34 (5.05%) had a vision between <20/400 to PL only and another 34 (5.05%) patients had no perception of light. VA of more than 20/50 was achieved in 21.05% of OGI and 79.01% cases of CGI case. Narang et al. [11] reported final ambulatory vision in 52.86% cases which are similar to our findings. The final visual outcome, in general, was found to be better in our study as compared to other reports, probably due to the inclusion of both OPD and admitted patients.

The prevalence of ocular injuries happening at home is perhaps a reflection of less supervision at home. Hence, it is imperative that parents and family members should be made aware about the common modes of trauma, the need of supervision of the objects of play and use of safety eyewear such as safety goggles. Self-protection should be taught to children to prevent possible ocular injuries. Houses, playgrounds and schools must be made safe and common items of trauma such as sharp objects, household lime, acids must be kept out of reach of children. Intensive campaign may be done before festival seasons about safety measures to increase public awareness. Importance of seeking early medical help must be impressed on parents, teachers and guardians. Emergency department physicians and health personnel must be made aware of the basic treatments in case of ocular emergencies and about prompt referral to ophthalmologists when needed.

 
   References Top

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Kaur A, Agrawal A. Paediatric ocular trauma. Curr Sci 2005;89:43-6.  Back to cited text no. 1
    
2.
Brophy M, Sinclair SA, Hostetler SG, Xiang H. Pediatric eye injury-related hospitalizations in the United States. Pediatrics 2006;117:e1263-71.  Back to cited text no. 2
    
3.
Shoja MR, Miratashi AM. Paediatric ocular trauma. Acta Med Iran 2006;44:125-30.  Back to cited text no. 3
    
4.
Nelson LB, Wilson TW, Jeffers JB. Eye injuries in childhood: Demography, etiology, and prevention. Pediatrics 1989;84: 438-41.  Back to cited text no. 4
    
5.
Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham eye trauma terminology system (BETT). J Fr Ophtalmol 2004;27:206-10.  Back to cited text no. 5
    
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Thylefors B. Epidemiological patterns of ocular trauma. Aust N Z J Ophthalmol 1992;20:95-8.  Back to cited text no. 6
[PUBMED]    
7.
Khan MD, Kundi N, Mohammad Z, Nazeer AF. Eye injuries in the North West Frontier Province of Pakistan. Pak J Ophthalmol 1988;4:5-9.  Back to cited text no. 7
    
8.
Saxena R, Sinha R, Purohit A, Dada T, Vajpayee RB, Azad RV. Pattern of pediatric ocular trauma in India. Indian J Pediatr 2002;69:863-7.  Back to cited text no. 8
    
9.
Hosseini H, Masoumpour M, Keshavarz-Fazl F, Razeghinejad MR, Salouti R, Nowroozzadeh MH. Clinical and epidemiologic characteristics of severe childhood ocular injuries in southern iran. Middle East Afr J Ophthalmol 2011;18:136-40.  Back to cited text no. 9
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Aghadoost D, Fazel MR, Aghadoost HR. Pattern of pediatric ocular trauma in kashan. Arch Trauma Res 2012;1:35-7.  Back to cited text no. 10
    
11.
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. 11
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Oum BS, Lee JS, Han YS. Clinical features of ocular trauma in emergency department. Korean J Ophthalmol 2004;18: 70-8.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2]


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