Original Article
Pattern of Ocular Trauma in
Tertiary Care Hospital
Hussain Ahmad Khaqan,
Hassan Raza Chaudhry, Sadia Ilyas, Abdul Hye
Pak J Ophthalmol 2017, Vol. 33, No. 2
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See end of article for authors affiliations
..
.. Correspondence to: Hussain Ahmad Khaqan Eye
Department LGH/PGMI, Lahore E.mail: drkhaqan@hotmail.com |
Purpose:
To analyze the etiology and outcomes of ocular trauma. Study
design: Cross sectional descriptive study. Place
and Duration of Study: Eye Department Lahore General
Hospital, Lahore from 1st January 2016 to 28th February 2017. Material
and Method: A total of 180 patients hospitalized with
ocular trauma were included in the study. Study was conducted at the
Department of Ophthalmology, Lahore General Hospital Lahore from 1st
January 2016 to 28th February 2017 and data was collected through
pre-designed proforma. The data collected composed of age, sex, etiology,
pre-treatment and post-treatment visual acuity. Patients were stratified in 3
groups A, B and C with respect to pre-treatment visual acuity. Results:
A total of 180 patients with ocular trauma were included in the
study. In group A 124 (68.8%) patients had pre-treatment visual acuity PL +ve
to 6/60. After treatment visual acuity improved in all patients including 21 (16%)
patients with visual improvement to 6/36, 90 (72.5%) patients improved to
6/60 and 13 (10.4%) patients gained vision to HM. In group B 43 (23.8%)
patients had pre-treatment visual acuity between 6/36-6/12 out of which 12 (27.9%)
patients had vision improved to 6/12, 20 (46.5%) patients had vision gain to 6/24
and 11 (25.5%) patients gained 6/36 vision. In group C 13 (7.2%)
patients had pre-treatment visual acuity 6/9-6/6 out of which vision of 2
(15.3%) patients improved to 6/6 and 11 (84.6%) patients gained to 6/9
vision. Conclusion:
Metallic foreign body and road traffic accident were the most
common cause of ocular trauma and improvement in post treatment vision was
directly proportional to the severity of pretreatment visual loss. Key worlds: Trauma, Foreign Body, Vision, Etiology, Road traffic accident,
Metallic. |
Ocular trauma is a common and unfortunate but preventable disease1.
Trauma to eyeball forms an important cause of visual impairment in children and
in persons associated with various occupations such as welders, electricians
and people in glass and steel industry. Domestic accidents and assaults each
account for approximately one third of injuries2.
Ocular trauma is the second leading cause of visual loss in US.
According to a survey the incidence of ocular trauma in USA is 2.4 million per
a year2. Ocular trauma includes penetrating and blunt injuries.
Penetrating injuries are at higher risk of developing endophthalmitis as
compared to blunt trauma3. Blunt trauma is associated with skin or
corneal abrasion, hyphema, posterior vitreous detachment, vitreous hemorrhage
and retinal detachment in majority of cases4. Injuries caused by
sharp objects result in better visual outcome than those caused by blunt
objects and injuries limited to anterior segment have better prognosis than
those involving the posterior segment5.
Pediatric age group accounts for a large proportion of ocular
trauma . Most of the times the source of trauma were household objects i.e knives,
fork, Pencil, etc6. In young age group road traffic accidents and
physical abuse came out to be the leading cause of ocular trauma7.
This
study was undertaken to identify etiological factors, prognostic indicators and
determine effective methods of management.
MATERIAL
AND METHOD
Study was conducted at Department of Ophthalmology, unit 2, Lahore
General Hospital Lahore from 1st January 2016 to 28th February
2017. A total of 180 patients with ocular trauma were included in the study.
Pre-operative assessment was done by visual acuity, pupillary reactions,
extra-ocular motility, slit lamp anterior segment examination and indirect
ophthalmoscopy for fundus examination. Each patient with penetrating ocular
injury underwent CT- scan orbit and brain to rule out the presence of foreign
body. B scan was done in patients with no fundus view.
Data was collected on pre designed proforma. Data included name,
age, sex, etiology, pre-treatment VA, type of foreign body, investigations done
and surgical procedure. Patients were stratified in three groups on the basis
of pre-treatment VA. Group A had VA PL+ve- 6/60 and included 124 patients,
Group B had VA 6/36-6/12 and included 43 patients and Group C had VA 6/9-6/6
and included 13 patients. Post treatment visual acuity was recorded in all
patients.
Data
was analyzed by using SPSS (Statistical Package for Social Sciences) version
22. Frequencies and percentages were computed for all categorical variables
while mean and standard deviations were computed for all numerical variables.
RESULTS
52 (28.8%)
patients less than 10 years of age presented with ocular trauma. 147 (81.6%)
male presented with ocular trauma as
compared to females 33 (18.3%). A total of 53 (29.4%) patients had metallic
foreign body trauma, 37 (20.5%) patients had road traffic accident trauma to eye.
In group A 124 (68.8%) patients had pre-treatment visual acuity PL +ve to 6/60.
After treatment visual acuity improved in all patients including 21 (16%) patients
vision improved to 6/36, 90 (72.5%) patients vision improved to 6/60 and 13 (10.4%)
patients vision gain was HM. In group B 43 (23.8%) patients had pre-treatment
visual acuity between 6/36-6/12 out of which 12 (27.9%) patients had vision
improvement to 6/12, 20 (46.5%) patients gained vision to 6/24
and 11 (25.5%) patients gained 6/36 vision. In group C 13 (7.2%)
patients had pre-treatment visual acuity of 6/9-6/6 out of which 2 (15.3%)
patients had vision improvement to 6/6 and 11 (84.6%) patients gained 6/9
vision. There were 109 (44.4%) patients who had right eye trauma while 44 (55.6%)
had left eye trauma. Lid lacerations were associated with all road traffic
accidents.
Table 1: Demographic characteristic of
Patients.
|
Variables |
n (%) |
|
Total Patients admitted (n = 1667) |
|
|
Ocular Trauma Patients |
180 (10.79%) |
|
Eye affected (n = 180) |
|
|
Right Eye |
109 (60.5%) |
|
Left Eye |
71 (39.4%) |
|
Gender |
|
|
Male |
147 (81.6%) |
|
Female |
33 (18.3%) |
Table
2: Stratification
of Visual acuity with respect to pre and post-treatment condition.
|
Visual Acuity |
Pre-treatment |
Post-treatment |
|
PL 6/60 |
124 (68.8%) |
21 (16%)-6/36 90 (72.5%) -6/60 13 (10.4%) HM |
|
6/36 6/12 |
43 (23.8%) |
12 (27.9%)- 6/12 |
|
6/9- 6/6 |
13 (7.2%) |
20 (46.5%)-6/24 11 (25.5%)-6/36 2 (15.3%)-6/6 11 (84.6%)-6/9 |
Table 3: Cause of injury
|
Source |
No of patients (%) |
|
Glass |
6
(7.5%) |
|
Knife |
30
(20.5%) |
|
Screw driver |
2
(2.5%) |
|
Mirror |
3
(3.37%) |
|
Pen |
4
(5.1%) |
|
RTA |
37
(20.5%) |
|
Scissor |
2
(2.5%) |
|
Pencil |
9
(11.2%) |
|
Syringe needle |
1(1.25%) |
|
Needle |
2
(2.5%) |
|
Broken saucer |
1
(1.2%) |
|
Blade |
2
(2.5%) |
|
Knitting needle |
3
(3.75%) |
|
Clipper |
2
(2.5%) |
|
Metal piece ( metal
grinder) |
53 (29.4%) |
|
Beak of bird |
2
(2.5%) |
|
Nail |
13
(7.2%) |
|
Hammering |
9
(5.1%) |
Table 4: Stratification with respect to age group.
|
Age Group (yr) |
Number (%) |
|
≤ 10 |
58 (28.8%) |
|
11 20 |
42 (23.3%) |
|
21 30 |
51 (28.3%) |
|
> 30 |
29 (16.1%) |
As
total 180 cases were enrolled and 53 were metal piece injury and 1 case was of
syringe needle injury so metal piece injury came out to be statistically
significant (p˂ 0.005).
DISCUSSION
Ocular trauma is the leading cause of acquired monocular blindness
in children and young adults with a male preponderance; the former accounting
for 20% to 50% of all ocular injuries8. In our study 88.8% were male
and 24% of patients were lying in less than 10 year of age group. A review,
undertaken for planning purposes in the WHO program for the prevention of blindness,
suggests that around 55 million eye injuries responsible for restricting
activities for more than one day, occur annually; they account for 750,000
hospitalized cases each year while our study included 180 patients suffering
from ocular trauma from Jan 2016 to Feb 2017. There are approximately 200,000 open-globe
injuries; with around 1.6 million people blind from such injuries, 2.3 million people
with bilateral poor
vision from this cause, and almost 19 million people
with unilateral blindness or low
vision9 and in our study 10 patients got HM visual acuity.
Our study focuses on the causes of eye injuries, age group mostly
affected, gender and final visual acuity in these patients. Young and children
are more susceptible to the ocular trauma, in our study 30.5% children and 50%
young age groups were involved because of their occupational hazards, immature
motor skills and curious nature. A marked preponderance of injuries is seen in
6-10 years of age group. Adult supervision has been found to be an important
factor in the prevention of injuries to children. Infants and children of less
than 3 years of age sustain fewer injuries because of close supervision by
parents. In our study the mean age of child was high (8.09 years).
A study was conducted in Cairo where 146 unilateral and 3
bilateral cases of ocular trauma were included10 while unilateral
involvement occurred in 100% of cases in our study. Males are affected more
than females, because boys generally are granted more liberty than girls in our
society and they tend to spend more time outside11. In our study we
also found higher number of males affected compared to females (88.8%). A study
concluded that the most frequent finding among ocular trauma in their setting was
laceration by sharp object and blunt ocular trauma12 and in our
hospital the most frequent finding was corneal laceration and mostly caused by
glass, mirror and knife.
The results obtained suggested that socioeconomic and socio cultural
status and family negligence are important factors in eye injuries in children
that occur during games13. Factors predicting final visual outcome
after open globe trauma include mechanism or type of injury, preoperative
visual acuity14, time lag between trauma and surgery15,
relative afferent pupillary defect16, size and location of the
wound, hyphema17, lens rupture18, vitreous loss, vitreous
hemorrhage, retinal detachment19, intraocular foreign body20.
Prompt visit to hospital and appropriate management21,22 at time is the
key to avoid the loss of preventable vision as well as restoration of anatomy22.
At the
time of presentation the mean visual acuity was less than 6/60 which was
consistent with other surveys held in USA23, Singapore24
and Iran25. The final visual acuity was related to pre-operative
vision. Timely and appropriate
management of ocular trauma may improve the prognostic value and restoration of
ocular anatomy. Damage by ocular trauma may cause blindness which is
preventable. So, after getting injury early treatment may prevent from gross
visual morbidity provided pre-treatment visual acuity is better.
CONCLUSION
Metallic
foreign body and road traffic accident were the most common cause of ocular
trauma and improvement in post treatment vision was directly proportional to
the severity of pretreatment visual loss.
Authors
Affiliation
Dr.
Hussain Ahmad Khaqan
FCPS
(Ophth), FCPS (VR), FRCS
Assistant
Professor
LGH, Lahore
Dr.
Hassan Raza Ch
Post
Graduate Resident
LGH, Lahore
Dr.
Sadia Ilyas
Post
Graduate Resident
LGH, Lahore
Prof.
Abdul Hye
Professor
LGH,
Lahore
Role of
Authors
Dr.
Hussain Ahmad Khaqan
Surgical Procedure, Performa Design
Dr.
Hassan Raza Ch
Data Analysis, Article writing
Dr.
Sadia Ilyas
Data collection
Prof.
Abdul Hye
Proforma
design
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