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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 30  |  Issue : 3  |  Page : 162-165

Epidemiological profile of ocular trauma in a tertiary care facility in Imphal


1 Department of Ophthalmology, Regional Institute of Medical Sciences, Imphal, Manipur
2 Department of Ophthalmology, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur

Date of Web Publication28-Sep-2016

Correspondence Address:
Chingsuingamba Meitei Yumnam
Department of Ophthalmology, Regional Institute of Medical Sciences, Imphal, Manipur

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.191182

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  Abstract 

Background: Ocular trauma is an important cause of preventable ocular morbidity and blindness. Aims: To analyze the epidemiological profile of patients with ocular trauma requiring tertiary care. Materials and Methods: A descriptive study was carried out of all patients with ocular trauma, presenting to emergency and outpatient departments of a tertiary care facility at Imphal, during a 2 year period. Along with a complete ophthalmic workup, the demographic data and the mode of injury for each were recorded from the hospital records. Results: Males (69%) were found to be more commonly affected by trauma. Individuals below 30 years of age (58.5%) suffered most from ocular trauma followed by those between 30 and 60 years of age (35%). Best-corrected visual acuity was found to be better than 6/60 in 68% of cases. Residents of urban areas were found to suffer more often (62%) as compared to rural residents (38%). Occupation-related injuries were found to be the most common cause (38.46%). Lids and lacrimal system were the most commonly injured structures (23.86%) followed by conjunctiva (16.50%). Adnexal injury was found to be the most common type of injury (46.15%), and blunt trauma was found to be the most common mode of injury (20.31%). Conclusion: Ocular trauma is an important cause of blindness and ocular morbidity. The young age, rural status, and illiteracy are probably the factors responsible for delayed presentation and thus more risk of infection. Eyes with intraocular foreign body are more likely to be associated with endophthalmitis. Most ocular injuries are preventable if protection is worn and care is taken.

Keywords: Closed globe injury, globe rupture, ocular trauma, open globe injury


How to cite this article:
Laishram U, Yumnam CM, Gahlot A, Thoudam RS, Keisham SD. Epidemiological profile of ocular trauma in a tertiary care facility in Imphal. J Med Soc 2016;30:162-5

How to cite this URL:
Laishram U, Yumnam CM, Gahlot A, Thoudam RS, Keisham SD. Epidemiological profile of ocular trauma in a tertiary care facility in Imphal. J Med Soc [serial online] 2016 [cited 2020 Oct 27];30:162-5. Available from: https://www.jmedsoc.org/text.asp?2016/30/3/162/191182


  Introduction Top


Ocular trauma is an important cause of preventable ocular morbidity, particularly among the younger age groups. [1],[2],[3],[4] Ocular trauma represents a significant burden of outpatient department cases, and most of them are minor injuries which can be treated in the emergency room or on outpatient basis. Only 2% or less of these cases need inpatient hospital care. [1],[5] Consequently, detailed clinical data are only scant to guide us through the management of moderate to severe cases with potentially sight-threatening sequelae of ocular trauma. A few previous studies relate to specific occupational ocular trauma cases and are not very helpful in the varied scenario of ocular trauma cases presenting to the outpatient department. [6],[7],[8],[9] This study was conducted to provide us with first-hand epidemiological data on ocular trauma cases which require tertiary care.


  Materials and Methods Top


This was a chart review of all admissions of ocular trauma cases under the Department of Ophthalmology in a tertiary care facility at Imphal during the period of 2 years, i.e., from April 2012 to March 2014. All the cases of ocular trauma who presented to the outpatient or emergency department along with the cases referred from community health centers and district hospitals were included in the study.

A total of 260 patients with primary diagnosis of ocular trauma were included in the study. The demographic data of each patient including address (rural/urban) and occupation were recorded. Complete history of the mishap and circumstances along with the nature of injury was noted. Complete details of ophthalmic examination including initial best-corrected visual acuity, lid or facial injury, any pupillary defect, presence or absence of foreign body, and corneal or scleral or corneoscleral perforation were noted. The presence or absence of vitreous hemorrhage, retinal breaks, retinal detachment and choroidal rupture, was noted. Direct ophthalmoscopy, indirect ophthalmoscopy, slit lamp examination, and ocular B-scan ultrasonography were used to examine the anterior and posterior segments and the orbits. Intraocular pressure was measured in all except in fresh open globe injuries.

Operational definitions were according to the Birmingham Eye Trauma Terminology System: [10]

  • Blindness: Visual acuity of <3/60
  • Eye wall: Cornea and sclera
  • Closed globe injury: No full-thickness wound of the eye wall
  • Contusions: No full-thickness wound, direct energy delivery (e.g., choroidal rupture), or due to change in the shape of the globe (e.g., angle recession)
  • Lamellar laceration: Partial-thickness wound of the eye wall
  • Open globe injuries: Full-thickness wound of the eye wall
  • Laceration: Full-thickness wound at the impact site of a sharp object by outside-in mechanism
  • Penetrating: Entrance wound only
  • Perforating: Entrance and exit wound with the same object
  • Intraocular foreign body: technically a penetrating injury but grouped separately because of different clinical implications
  • Rupture: Full-thickness wound by blunt object but inside-out mechanism due to increased intraocular pressure
  • Adnexal injuries: Eyelid and/or conjunctival injuries.



  Results Top


The best-corrected visual acuity recorded at the time of presentation shows that a majority (68.07%) of patients had visual acuity of 6/60 or better. The patients coming with a visual acuity between 6/60 to mere perception of light were 30.76% and those who could not perceive the light were 1.15%. As shown in [Table 1], males outnumbered females by a ratio of 2:1, and most of these cases were from urban areas belonging to the age group of 30 years or younger (58.5%). The results of this study [Figure 1] show that daily wage laborers were most likely (34.46%), and preschool children were least likely (6.15%) to suffer with ocular trauma. Eyelid and lacrimal structures were the most commonly involved structures [Figure 2] and [Figure 3] which were affected in 23.86% cases while vitreoretinal injuries were least commonly seen in this study (0.76%). Adnexal injuries were the most common type of injury which accounted for 46.15% of cases [Figure 4], contusion injuries were the second most common accounting for 31.92% of cases, whereas globe rupture was least commonly seen. Blunt trauma was found to be the most common mode of injury which accounted for 20.31% of the cases under study [Figure 5] followed by projectile injuries which accounted for 19.30% cases. Animal bites (4.23%) and firework injuries (3.46%) were the least common mode of injury. The cause of injury was unknown in 4.19% of cases under the study.
Figure 1: Occupation of the patient

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Figure 2: Structures involved

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Figure 3: Full-thickness laceration of the upper eyelid with fracture of the tarsus

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Figure 4: Types of injury (Birmingham Eye Trauma Terminology classification)[10]

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Figure 5: Modes of injury

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Table 1: Demographic characteristics

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  Discussion Top


Ocular trauma is an important cause of blindness and ocular morbidity. In our study, the prevalence of ocular trauma was found to be 4.31%, which is comparable to previous studies. [11],[12] The mean age at presentation was 27 years showing that ocular trauma is coupled with an element of risk-taking behavior in susceptible group, i.e., young males. [1]

Visual acuity with no perception of light was seen in three cases at presentation, which included a bullet injury, a shrapnel injury due to bomb blast, and a case of occupational projectile injury which had already developed endophthalmitis at presentation. Ocular trauma is predominantly uniocular and localized to the eye, but in our study 1 case was seen who had previously suffered from ocular trauma of the fellow eye.

The overall pattern of serious injuries observed regarding the age group, cause, and type of injury is similar with previous studies reported by Tielsch et al. [11] and Cao et al. [12] Young age, illiteracy, and rural status are probably responsible for episodic and delayed presentation and thus more risk of infection. Eyes with intraocular foreign body were more likely to develop endophthalmitis.

As found in the study of ocular trauma in the rural south Indian population by Nirmalan et al., [13] blunt trauma was found to be the major mode of injury in this study population. Intraocular foreign body, rural setting, and delayed repair have been reported to be associated with endophthalmitis. Of all the cases under our study, 24.2% of cases were treated surgically in addition to medical treatment.

In our study, none of the patients who suffered from occupational ocular trauma were wearing protective gear when the trauma occurred. A similar finding has been previously reported by Vats et al. [14] in their study of ocular trauma in an urban slum population in Delhi, India.

Role of parents and teachers in prevention of eye injuries in children can be understood by the fact that 38% of the study cases up to 12 years of age were at home and 22% were at school when the trauma occurred.

The target groups for prevention of ocular trauma are young males <30 years, students and those involved in mechanical jobs involving machinery. There is paucity of studies on the profile of ocular trauma from the developing countries. Such studies can play an important role in defining the target groups for prevention and education on ocular trauma. This study helps in prognosticating ocular injuries at the time of presentation and in prevention of many unnecessary procedures.


  Conclusion Top


Most of these injuries can be prevented with the use of various protective devices during hazardous work and refraining from letting children play with dangerous toys and other harmful objects. Resources should be mobilized to provide quality ocular emergency care to our rural and illiterate population with emphasis on immediate attention to any ocular trauma.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Macewen CJ. Eye injuries: A prospective survey of 5671 cases. Br J Ophthalmol 1989;73:888-94.  Back to cited text no. 1
    
2.
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Vernon SA. Analysis of all new cases seen in a busy regional centre of an ophthalmic casualty department during a 24 hour period. J Roy Soc Med 1983;76:279-82.  Back to cited text no. 3
    
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Bhopal RS, Parkin DW, Gillie RF, Han KH. Pattern of ophthalmological accidents and emergencies presenting to hospitals. J Epidemiol Community Health 1993;47:382-7.  Back to cited text no. 4
    
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Jones NP, Hayward JM, Khaw PT, Claoué CM, Elkington AR. Function of an ophthalmic accident and emergency department: Results of a six month survey. Br Med J (Clin Res Ed) 1986;292:188-90.  Back to cited text no. 5
    
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Karlson TA, Klein BE. The incidence of acute hospital-treated eye injuries. Arch Ophthalmol 1986;104:1473-6.  Back to cited text no. 6
    
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Jones NP, Griffith GA. Eye injuries at work: A prospective population-based survey within the chemical industry. Eye (Lond) 1992;6(Pt 4):381-5.  Back to cited text no. 7
    
8.
Dannenberg AL, Parver LM, Brechner RJ, Khoo L. Penetration eye injuries in the workplace. The National Eye Trauma System Registry. Arch Ophthalmol 1992;110:843-8.  Back to cited text no. 8
    
9.
Dannenberg AL, Parver LM, Fowler CJ. Penetrating eye injuries related to assault. The National Eye Trauma System Registry. Arch Ophthalmol 1992;110:849-52.  Back to cited text no. 9
    
10.
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. 10
    
11.
Tielsch JM, Parver L, Shankar B. Time trends in the incidence of hospitalized ocular trauma. Arch Ophthalmol 1989;107:519-23.  Back to cited text no. 11
    
12.
Cao H, Li L, Zhang M. Epidemiology of patients hospitalized for ocular trauma in the Chaoshan region of China, 2001-2010. PLoS One 2012;7:e48377.  Back to cited text no. 12
    
13.
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. 13
    
14.
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. 14
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