ORIGINAL ARTICLE  
Visual Outcome of Ocular Trauma  
Presenting in a Tertiary Care Hospital in  
Sahiwal  
Ahmad Zeeshan Jamil1, Muhammad Luqman Ali Bahoo2  
1Department of Ophthalmology, Sahiwal Medical College, Sahiwal  
2Department of Ophthalmology, Cornea Clinic, Shahida Islam Medical College, Lodhran  
ABSTRACT  
Purpose: To find the visual outcome of ocular trauma presenting in a tertiary care hospital in Sahiwal.  
Study Design: Descriptive observational study.  
Place and Duration of Study: This study was conducted at District Headquarter Teaching Hospital affiliated with  
Sahiwal Medical College, Sahiwal from January 2016 to June 2019.  
Material and Methods: Four hundred and thirty five patients were included in the study by convenient sampling  
technique. Patient’s age, gender, occupation, activity at the time of injury, nature of object causing trauma,  
duration of trauma, visual acuity at the time when patient reported to hospital, the time delay before coming to the  
hospital were recorded. Ocular injuries were classified according to Birmingham ocular trauma terminology.  
Detailed ocular examination was performed. Patients were managed and post-management visual acuity at three  
months was recorded.  
Results: Mean age of patients was 29.07 ± 12.53 years. There were 219 (50.3%) closed globe and 216 (49.7%)  
open globe injuries. In 59 (13.6%) cases, cause of injury was metal object. In 146 (33.6%) cases injury was  
classified as contusion. In 164 (37.7%) cases cornea was involved. Majority of the patients were male. Eighty-  
seven patients presented within 1 day after trauma. In 154 (35.4%) patients, visual acuity at the time of  
presentation was 6/12 or better while in 171 (39.3%) cases it was less than 6/60. Chi-square test was used to  
calculate the difference between pre and post-management visual acuity. This difference was statistically  
significant with p-value less than 0.05  
Conclusion: Ocular trauma cases, if properly and timely managed, have a statistically significant increase in  
visual acuity.  
Key Words: Blindness. Ocular trauma. Visual Acuity, contusion.  
How to Cite this Article: Jamil AZ, Bahoo MLA. Visual Outcome of Ocular Trauma Presenting in a Tertiary Care  
Hospital in Sahiwal. Pak J Ophthalmol. 2020, 36 (2): 131-136.  
Doi: 10.36351/pjo.v36i2.987  
INTRODUCTION  
Trauma to the eye and peri-orbital region can cause  
drastic consequences. Fortunately, most of the ocular  
trauma can be prevented1. In fact, ocular trauma is one  
of the leading causes of blindness2-4. Annually about  
1,50,0000 persons become blind because of ocular  
trauma5. Patient’s visit to the hospital as a result of eye  
injuries put a burden to already resource depleted  
health care system6. Patientssufferings from ocular  
trauma are not limited to the physical disabilities, but  
trauma also results in significant psychological and  
Correspondence to: Ahmad Zeeshan Jamil  
Associate Professor of Ophthalmology,  
Sahiwal Medical College, Sahiwal  
Email: ahmadzeeshandr@yahoo.com  
131  
Pakistan Journal of Ophthalmology, 2020, Vol. 36 (2): 131-136  
Visual Outcome of Ocular Trauma Presenting in a Tertiary Care Hospital in Sahiwal  
financial loss7. Eye trauma limits a person’s ability to  
sample size.  
Z2 p(1-p)/M2  
work efficiently. Significant cosmetic disfigurement  
can happen after ocular injuries. As a result, the  
sufferer is depleted in terms of monetary resources and  
he is psychologically dejected. Consequences of ocular  
trauma can be long-lived and that can affect the whole  
family. Suffering incurred on the patient by the loss of  
vision is far more in magnitude than the loss of any  
other sense organ of the body. Eyes are vulnerable to  
get hurt during almost all kinds of daily life activates  
unless they are properly taken care of. One may get  
his/her eyes injured while playing, during daily home  
chores, at the time of work at the office, during  
travelling and due to assault8. It is due to the anatomy  
of the eye that even minor trauma can cause significant  
damage to the eye. Ocular injuries can be occupation-  
specific. Most of the eye injuries occur with objects  
that persons deal most of the times. Every twentieth  
patient coming to an eye specialist for ocular treatment  
is a result of ocular trauma9. Trauma can cause damage  
to the eye immediately or subsequent complications  
like infection or inflammation can lead to vision loss.  
The sequel of ocular trauma can cause significant  
ocular morbidity even after months or years10. Self-  
medication by the patients and intervention by an  
untrained health professional may lead to a suboptimal  
visual recovery in ocular trauma cases. By adopting  
safety-measure in situations when eyes can be injured,  
burden of ocular morbidity and irreversible blindness  
can be lessened. Appropriate management of ocular  
injuries by a trained health professional is of utmost  
importance to maximize visual recovery11.  
S
=
S is the sample size  
Z is Z score its value is 1.96  
P is the population proportion assumed to be 50%  
or 0.5  
M is the margin of error that is taken 5% or 0.05  
S
=
=
=
(1.96)2 (0.5)(1-0.5)/0.05  
384.16  
384  
All patients of ocular trauma admitted in the eye  
department of District Headquarter Teaching Hospital  
Sahiwal were included in the study. Detailed  
information was shared with the patients and informed  
consent was taken. Patient’s age, gender, occupation,  
activity at the time of injury, nature of object causing  
trauma, duration of trauma, visual acuity at the time of  
presentation, time delay before coming to the hospital  
were recorded.  
To classify ocular trauma, Birmingham eye trauma  
terminology was adopted. Generally, eye injuries were  
classified into two broad categories namely open globe  
injuries and closed globe injuries. Closed globe trauma  
was again of two types; lamellar laceration and  
contusion. Laceration and rupture were two types of  
open globe injuries. Blunt injuries resulted in rupture  
of the globe and lacerations were caused by injuries  
with sharp objects. Penetration was a type of laceration  
in which globe wall was cut on one side only and the  
wound of entry was present. Perforation was a type of  
laceration in which globe wall was cut on both sides  
and wound of entry and wound of exit were present.  
Open globe injuries with intraocular foreign bodies  
were a sort of lacerations where one or more foreign  
bodies were present in the globe12. Apart from injuries  
involving the globe, trauma to the eyelids and  
periorbital areas were also recorded. Patients were  
enquired about the time delay between the occurrence  
of injury and their report to the hospital. At the time of  
admission, patients’ visual acuity was recorded. Slit-  
lamp examination was performed in all patients. B-  
scan ultrasound examination was performed to find out  
intraocular foreign bodies and the status of the  
posterior segment in cases of media opacity. X-ray or  
CT scan imaging was performed when or where  
indicated. Patients were managed accordingly. Follow-  
up visits were done at the scheduled interval. At each  
visit, a detailed examination of the patient was  
There is scarcity of data in developing countries  
related to ocular injuries patterns, management  
protocols and visual outcomes. Because eye injury  
aetiology and pattern may vary from region to region,  
we want to know the pattern and characteristics of  
ocular trauma presenting to District Headquarter  
Teaching Hospital Sahiwal. We have tried to find out  
the visual outcome of the patients sustaining eye  
injuries. This will help in defining the characteristics  
of the ocular injuries in patients coming to our  
department. This can further help in designing and  
improving management strategies.  
MATERIAL AND METHODS  
This cross-sectional study was conducted at District  
Headquarter Teaching Hospital affiliated with Sahiwal  
Medical College, Sahiwal from January 2016 to June  
2019. Following formula was used to calculate the  
Pakistan Journal of Ophthalmology, 2020, Vol. 36 (2): 131-136  
132  
Ahmad Zeeshan Jamil, et al  
performed. Visual acuity at three months post-trauma  
was recorded. Patients’ information was collected by  
special proforma. Statistical package for social  
sciences version 23 was used to do statistical analysis.  
For age of the patients, mean and standard deviation  
was used. For gender, types of injuries, etiological  
agents, involved structures, visual acuity at the time of  
presentation and post-management visual acuity,  
frequencies and percentages were calculated. Chi-  
Square test was used to calculate the difference  
between pre and post-management visual acuity.  
Probability was considered significant at or below the  
value of 0.05.  
retinal tear was seen in 14 (3.2%) cases, retinal  
detachment was encountered in 31 (7.1%) cases,  
commotio retinae was found in 25 (5.7%) cases. Optic  
nerve swelling was present in 37 (8.5%) cases. In 133  
(30.6%) cases intraocular contents were prolapsed.  
Table 2: Distribution of cases according to aetiology.  
Causative Agent  
Number  
Percent  
Metal  
59  
56  
29  
40  
11  
20  
20  
17  
16  
21  
12  
19  
10  
30  
8
13.6  
12.9  
6.7  
9.2  
2.5  
4.6  
4.6  
3.9  
3.7  
4.8  
2.8  
4.4  
2.3  
6.9  
1.8  
3.4  
2.8  
5.3  
3.0  
.9  
Wood/Vegetable matter  
Stone/Brick  
Road Accident  
Wielding arc  
Acid (chemical)  
Alkali (chemical)  
Superglue (chemical)  
Oil/Cooking Oil  
Hand trauma  
Fall  
Firework  
Fire  
Pellet gun  
Plant sap  
Insect fall/bite  
Animal attack  
Glass  
Plastic Scale  
Tennis Ball  
Total  
RESULTS  
Four hundred and thirty-five patients with ocular  
trauma were included in the current study. Male  
patients were 301 (69.2%) and female patients were  
134 (30.8%). Mean age of the patients was 29.07 ±  
12.53 years. Table number 1 describes the case  
distribution with respect to gender and age. Two  
hundred and sixteen (49.7%) patients had open globe  
injuries and 219 (50.3%) patients had closed globe  
injuries. Most of the injuries occurred due to trauma  
15  
12  
23  
13  
4
435  
100.0  
Table 1: Distribution of cases according to gender and  
age.  
Table 3: Distribution of cases according to the place of  
Gender of Patient  
Number Mean  
Std. Deviation  
injury.  
Male  
Female  
Total  
301  
134  
435  
28.41  
30.54  
29.07  
14.03  
8.04  
12.52  
Place of Occurrence  
Number  
Percentage  
Workplace  
Road traffic accident  
Home  
93  
50  
103  
34  
21.4  
11.5  
23.7  
7.8  
Sports  
with a metallic piece. Table number 2 shows the  
percentage of trauma with different objects. There  
were 65 (14.9%) cases of penetration, 30 (6.9%) cases  
of intraocular foreign bodies, 146 (33.6%) cases of  
contusion, 108 (24.8%) cases of rupture, 74 (17.0%)  
cases of lamellar laceration and 12 (2.8%) cases of  
globe perforation. Corneal injuries were seen in 164  
(37.7%) cases, sclera was involved in 49 (11.3%)  
cases, the corneo-scleral injury was present in 136  
(31.3%) cases and adnexa injuries were present in 30  
(6.9%) cases. There was lid tear in 14 (3.2%) cases,  
blow out fracture was seen in 2 (0.5%) cases and  
periocular swelling was present in 19 (4.4%) cases. In  
21 (4.8%) cases, posterior segment was a major site of  
injury. Hyphema was seen in 206 (47.4%) cases, lens  
damage occurred in 182 (41.8%) cases, vitreous  
haemorrhage was encountered in 112 (25.7%) cases,  
Assault  
At school  
Outdoor  
64  
27  
64  
435  
14.7  
6.2  
14.7  
100.0  
Total  
Table number 3 shows the percentage of injuries  
occurred in different settings.6/12 or better visual  
acuity was noted in 154 (35.4%) cases at the time of  
presentation to hospital, presenting visual acuity  
between 6/18 and 6/60 was recorded in 110 (25.3%)  
cases and presenting visual acuity less than 6/60 was  
seen in 171 (39.3%). Comparison of visual acuity at  
the time of presentation and post-management visual  
acuity in ocular trauma patients is shown in figure  
number 1. Table number 4 gives the distribution of  
cases according to time to presentation in the hospital.  
133  
Pakistan Journal of Ophthalmology, 2020, Vol. 36 (2): 131-136  
Visual Outcome of Ocular Trauma Presenting in a Tertiary Care Hospital in Sahiwal  
Post management visual acuity was 6/12 or better in  
In our hospital-based study 301 (69.2%) male and  
134 (30.8%) female patients were included. Work  
performed by Sengupta and co-authors also found that  
male patients are more prone to ocular injuries as  
compared to female patients15. Males are busy in  
outdoor activities. That may be the reason for males to  
be involved in ocular injuries more often than  
females16.  
211 (48.5%) cases, 6/18 to 6/60 in 105 (24.1%) cases  
and less than 6/60 in 119 (27.4%) cases. Chi-Square  
test was used to calculate the difference between pre  
and post-management visual acuity. The difference  
was statistically significant with a p-value of 0.000.  
Table 4: Distribution of cases according to time to  
In the present study, 219 (50.3%) patients  
presented with closed globe injuries and 216 (49.7%)  
patients came with open globe injuries. Contusion was  
the most common closed globe trauma. While globe  
rupture was the most common finding in patients  
coming with open globe trauma. Present study  
findings are consistent with the results of other  
studies14,15. Majority of injuries were sustained due to  
trauma with a piece of metal and cornea was injured in  
most of the cases. These findings are also similar to  
presentation in Hospital.  
Time of Presentation  
Number  
Percent  
Within 1 day  
Within 1 week  
After 1 week  
Total  
379  
45  
11  
87.1  
10.3  
2.5  
435  
100.0  
60.00%  
48.50%  
50.00%  
40.00%  
30.00%  
20.00%  
10.00%  
0.00%  
the findings depicted in other studies17,1  
.
39.30%  
It is surprising to note that in our study most of the  
trauma was encountered in home settings. Home is  
considered the most secure place but paradoxically lots  
of trauma to the eye was seen there. Our study showed  
similar results as were recorded by Shaeri and co-  
authors18 where the majority of ocular trauma occurred  
in homes. Our findings are not in accord with the  
results of other researchers’ studies13,19 that showed  
workplaces15 and road traffic accidents13 were the most  
common settings where the majority of ocular trauma  
occurred. An explanation for such a high number of  
ocular injuries at home setting may be the inadequate  
safety measure taken at home. Inadequate knowledge  
of safety measures or lack of access to safety goggles  
and eye shields may be the contributing factors.  
Children and women who spend most of their times in  
homes sustain most of the injuries at home settings.  
Education regarding eye safety and provision of eye  
protective devices should be readily available to  
masses. Use of eye protective devices is as much  
important during household activities as is important  
during work or during driving.  
35.40%  
27.40%  
25.30%  
24.10%  
6/12 Better  
6/18 to 6/60  
Less Than 6/60  
Presenting VA  
Post-Management VA  
Fig. 1: Comparison of Presenting and Post-management Visual  
Acuity in Ocular Trauma Patients.  
DISCUSSION  
Ocular injuries are among the leading causes of  
blindness13. Four hundred and thirty-five patients  
sustaining ocular injuries were studied in this hospital-  
based study. Patients’ mean age was 29.07 ± 12.53  
years. Results of study in Dhulikhel Hospital of  
Kathmandu are in close approximation with the results  
of our study. In their study, most of the ocular injuries  
occurred in the age group of 21 30 years14. In the  
study of Godar and co-authors, most of the ocular  
injuries were encountered in the age group between 21  
to 29 years. Young people are engaged in an active  
lifestyle and they tend to take risks that may be the  
reason for an increased number of ocular trauma seen  
in young people. As young people are bread winners  
for the family, so disabilities incurred as a result of  
ocular trauma has a great impact on the whole family  
finances and quality of life.  
In the current study 379 (87.1%) cases presented  
within one day after ocular trauma, 45 (10.3%) cases  
presented to hospital within 7 days after ocular trauma  
and 11 (2.5%) cases reported to the hospital after 7  
days of sustaining ocular trauma. Findings of our study  
are similar to the findings of the study of Godar and  
coauthors13.  
In the current study 171 (39.3%) patients  
presented with visual acuity of less than 6/60.  
Pakistan Journal of Ophthalmology, 2020, Vol. 36 (2): 131-136  
134  
Ahmad Zeeshan Jamil, et al  
Sengupta and co-authors conducted a study on ocular  
trauma where they found presenting visual acuity was  
less than 3/60 in majority of the cases15. While Iqbal  
and the co-authors19 conducted study on ocular trauma  
patients and found good visual acuity in most of the  
cases. This difference in post-trauma presenting visual  
acuity may be due to selection bias. In the present  
study, patients with severe ocular trauma who required  
hospital admission were included. Minor trauma  
patients who required management on outdoor basis  
were not included in the current study.  
Ethical Approval  
The study was approved by the Institutional review  
board/Ethical review board.  
Conflict of Interest  
Authors declared no conflict of interest  
Author’s Designation and Contribution  
Dr Ahmad Zeeshan Jamil; Associate Professor:  
Concept and design of study. Statistical analysis,  
manuscript writing and interpretation of data.  
Post management visual acuity of 6/12 or better  
was reported in 211 (48.5%), 6/18 to 6/60 was  
reported in 105 (24.1%) patients and less than 6/60  
was noted in 119 (27.4%) cases. Probability (p) value  
was calculated for presenting visual acuity and post-  
management visual acuity difference. This difference  
was found to be statistically significant at a value of  
0.000.  
Dr. Muhammad Luqman Ali Bahoo; Associate  
Professor: Literature search, drafting of the article,  
critical revision and proof reading.  
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Ocular trauma cases, if properly and timely managed,  
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