Profile of Ocular Trauma in Industries-related Hospital

8/21/2019 Profile of Ocular Trauma in Industries-related Hospital

1/14

28/1/2014 Profile of ocular trauma in industries-related hospital

http://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pmc/articles/PMC3877449/?report=printable 1

Indian J Occup Environ Med. 2013 May-Aug; 17(2): 6670.

doi: 10.4103/0019-5278.123168

PMCID: PMC3877449

Profile of ocular trauma in industries-related hospitalP Shashikala, Mohammed Sadiqulla, D Shivakumar, and K H Prakash

Department of Ophthalmology, Employees State Insurance Corporation, Medical College and Post Graduate Institute of Medical Sciences and

Research Center, Rajajinagar, Bangalore, Karnataka, India

Department of Community Medicine, Adhichunchanagiri Institute of Medical Sciences, Bellur, Karnataka, India

For correspondence:Dr. Shashikala P, No. 13, Manuvana, Vijayanagar, Bangalore - 560 040, Karnataka, India. E-mail:

[email protected]

Copyright: Indian Journal of Occupational and Environmental Medicine

This is an open-acces s article distributed under the terms of the Creative Commons A ttribution-Noncommercial-Share Alike 3.0 Unported, w hich

permits unrestr icted use, distribution, and reproduction in any medium, provided the or iginal w ork is properly cited.

Abstract

Introduction:

Ocular trauma is a worldwide cause of visual morbidity, a significant proportion of which occurs in the

industrial workplace and includes a spectrum of simple ocular surface foreign bodies, abrasions to

devastating perforating injuries causing blindness. Being preventable is of social and medical concern.

Aim:

A prospective case series study, to know the profile of ocular trauma at a hospital caters exclusively to

factory employees and their families, to co-relate their demographic and clinical profile and to identify

the risk factors.

Materials and Methods:

Patients with ocular trauma who presented at ESIC Model hospital, Rajajinagar, Bangalore, from June

2010 to May 2011 were taken a detailed demographic data, nature and cause of injury, time interval

between the time of injury and presentation along with any treatment received. Ocular evaluation

including visual acuity, anterior and posterior segment findings, intra-ocular pressure and gonio-scopy

in closed globe injuries, X-rays for intraocular foreign body, B-scan and CT scan were done. Data

analyzed as per the ocular trauma classification group. The rehabilitation undertaken medically or

surgically was analyzed. At follow-up, the final best corrected visual acuity was noted.

Results:

A total of 306 cases of ocular trauma were reported; predominantly in 20-40 year age group (72.2%)

and in men (75%). The work place related cases were 50.7%and of these, fall of foreign bodies led the

list. Visual prognosis was poorer in road traffic accidents rather than work place injuries owing to higher

occurrence of open globe injuries and optic neuropathy. Finally, 11% of injured cases ended up with poor

vision.

Conclusion:

Targeting groups most at risk, providing effective eye protection, and developing workplace safety

1

1
mailto:[email protected]://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pmc/about/copyright.htmlmailto:[email protected]://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pubmed/?term=Prakash%20KH%5Bauth%5Dhttp://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pubmed/?term=Shivakumar%20D%5Bauth%5Dhttp://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pubmed/?term=Sadiqulla%20M%5Bauth%5Dhttp://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pubmed/?term=Shashikala%20P%5Bauth%5Dhttp://hinarilogin.research4life.org/uniquesigdx.doi.org/uniquesig0/10.4103%2F0019-5278.123168


2/14



cultures may together reduce occupational eye injuries.

Keywords: Eye injuries, occupational eye injury, trauma

INTRODUCTION

Ocular trauma is a worldwide cause of visual morbidity, a significant proportion of which occurs in the

workplace and includes a spectrum of simple ocular surface foreign bodies (FBs)/minute corneal

abrasions to devastating perforating injuries causing blindness.[1,2] The significance of the problem is

compounded by the fact that most of these injuries are preventable, thus making it a social and medicalconcern. Management of ocular trauma and visual rehabilitation is different in different scenario.

Aim and objectives

To study: (1) The profile of ocular trauma at a hospital caters exclusively to factory employees and their

relatives, particularly in garments and grinding factories. (2) To correlate the demographic and clinical

profile and to identify the risk factors.

Design

A prospective case series study of ocular trauma was done from June 2010-May 2010.

Criteria

Patients of all ages and both genders with various levels of ocular injuries were included while severe

local and systemic conditions which would alter the outcome of vision like infection, anemia, head

injury, immune compromised status, with preexisting diseases like glaucoma, operated eyes (injury to

previously operated eyes), proliferative vitreoretinopathy of diabetes mellitus, hypertension, Eales and so

on were excluded.

MATERIALS AND METHODS

A total of 306 patients with ocular trauma, presented at eye outpatient department and emergency

services in the ESIC Model Hospital, Rajajinagar, Bangalore, from June 2010 to May 2011 were

included. Institutional ethical committee approval was obtained. A special protocol designed to note

demographic data, nature and cause of injury, time interval between the time of injury, and

presentation along with any treatment received were recorded. Ocular evaluation including visual

acuity, anterior and posterior segment findings (lid or facial injury, subconjunctival hemorrhage or

laceration, presence or absence of corneal/scleral perforation, hyphaema, iris injuries and afferent

pupillary defect, presence or absence of vitreous hemorrhage, retinal detachment or foreign body,

endophthalmitis, retinal breaks, choroidal rupture, and/or macular hole), intraocular pressure and

gonioscopy in closed globe injuries were done. Results of X-rays for intraocular foreign body, B-scan

and computed tomography scan if done were noted. Data analyzed and classified as per the ocular

trauma classification group described by Pieramici et al.[3] The rehabilitation undertaken in the form of

spectacles, contact lenses and/or intraocular surgeries was analyzed. At follow-up, the final bestcorrected visual acuity noted.

RESULTS

The results showed 72.2% of ocular trauma occurred in the age category of 21-40 years and 230 (75%)

cases in men versus 76 (25%) were women [Table 1].

The analysis of place of injury showed that, 155 (50.7%) were work place related while 55 (18%) were at

home, 50 (16.3%) were road traffic accidents (RTAs), 36 (11.8%) other accidental, 10 (3.3%) were due to

assault as depicted in Table 2.
http://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pmc/articles/PMC3877449/table/T2/http://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pmc/articles/PMC3877449/table/T1/


3/14



1. As per ocular trauma classification group, 94.4% were closed globe injuries, while 2.9% were

open globe injuries, and 2.6% were chemical injuries. The spectrum of ocular injuries (few

examples shown in Figures 17) found in this study is shown in Table 3. Of the closed globe

injuries, fall of FBs led this list occurring in 190 (62.1%) cases, followed by cataract in 34

(11.1%), lid and adnexal injuries in 27 (8.7%), corneal abrasions in 19 (6.2%), optic neuropathy

in 7 (2.3%). Fall of FBs seen in 128 of 190 (67.4%) and corneal abrasions seen in 13 of 19

(68.4%) were due to employment injuries (EIs), while traumatic optic neuropathy seen in six of

seven (85.7%) occurred due to non-EIs

2. Of nine open globe injuries, seven (77.8%) were due to RTA3. Of chemical injuries, 6 (75%) occurred at work place and 2 (25%) in domestic place [Table 3].

The time interval between trauma and patient presentation is shown in Table 4. The work place injuries

presented within 3 days in 152 (98.1%) cases, while non-EI injuries presented beyond 3 days in 94

(62.2%).

At work place, 79 (50.9%) were wearing protective glasses at the time injury, 42 (27.1%) were not

wearing, and 34 (21.9%) were not aware of protective glasses [Table 5].

Medical line of treatment was the main stay in 252 (82.4%), anterior segment surgeries like cataract

surgeries, amniotic membrane transplantation (AMT), lid and adnexal surgeries were done in 45

(14.5%), and posterior segment surgeries like pars plana vitrectomy, lens aspiration, RD surgeries, andso on were done in nine (2.9%) cases [Table 6].

Final visual outcome from presentation to post treatment at available follow-up showed that 166

(54.2%) were in good vision (more than or equal to 6/12) in pretreatment phase, while it was 205

(66.9%) in post treatment phase and 62 (20.1%) cases who had poor vision (


4/14



ailment.

The present study showed that only 51% were wearing protective glasses, while 27% were not wearing

though, they were provided with and 22% were not aware of protective glasses. Ocular injuries at work

are preventable and are attributable to the misuse or nonuse of protective eyewear.[12,13] Safety

education has been highlighted by previous studies as they have reported worker noncompliance with

personal protective equipment with up to half of workers not complying with health and safety

regulations.[1,14] To meet these requirements and to reduce accidents, many larger companies in the

construction industry use the Construction Skills Certificate Scheme to improve education and certify

awareness of these issues.

Though, visual outcome did improve after medical and/or surgical management, still 11% were left with

poor vision. The physical disability adds to the social, emotional, and psychological impact on the overall

development of an individual.

CONCLUSION

1. Employees need to be emphasized on work safety cultures, proper training, and use of

protective equipments.

2. Clinicians should be referring the patients as early as possible for eye care after stabilizing

general conditions or else it would be too late to restore the potential vision.

Hence, we conclude that, targeting groups most at risk, increasing worker training, providing effective

eye protection, and developing workplace safety cultures may together reduce occupational eye injuries.

Footnotes

Source of Support:Nil

Conflict of Interest:None declared.

REFERENCES

1. Desai P, MacEwen CJ, Baines P, Minassian DC. Incidence of cases of ocular trauma admitted to

hospital and incidence of blinding outcome. Br J Ophthalmol. 1996;80:5926. [PMCID: PMC505551]

[PubMed: 8795369]

2. Ngo CS, Leo SW. I ndustrial accident-related ocular emergencies in a tertiary hospital in Singapore.

Singapore Med J. 2008;49:2805. [PubMed: 18418518]

3. Pieramici DJ, Sternberg P, Jr, Aaberg TM, Sr, Bridges WZ, Jr, Capone A, Jr, Cardillo JA, et al. A

system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group.

Am J Ophthalmol. 1997;123:82031. [PubMed: 9535627]

4. Shukla IM, Verma RN. A clinical study of ocular injuries. Indian J Ophthalmol. 1979;27:336.

[PubMed: 500178]

5. Qureshi MB. Ocular injury pattern in Turbat, Baluchistan, and Pakistan. Community Eye Health J.

1997;10:578.

6. Schein OD, Hibberd PL, Shingleton BJ, Kunzweiler T, Frambach DA, Seddon JM, et al. The spectrum

and burden of ocular injury. Ophthalmology. 1988;95:3005. [PubMed: 3173996]

7. Katz J, Tielsch JM. Lifetime prevalence of ocular injuries from the baltimore eye survey. Arch

Ophthalmol. 1993;111:15648. [PubMed: 8240115]

8. Jovanovic M, Stefanovic I. Mechanical injuries of the eye: Incidence, structure and possiblilities for

prevention. Br J Ophthalmol. 2010;67:98390.


5/14



9. Gyasuddin S. Ocular injuries in a mountainous, rural area of Gizan, Saudi Arabia. Saudi J

Ophthalmol. 1993;7:10610.

10. Thompson GJ, Mollan SP. Occupational eye injuries: A continuing problem. Occup Med.

2009;59:1235.

11. Karaman K, Gverovic-Antunica A, Rogosic V, Lakos-Krzelj V, Rozga A, Radocaj-Perko S.

Epidemiology of adult eye injuries in Split-Dalmatian country. Croat Med J. 2004;45:3049.

[PubMed: 15185423]

12. Macewen CJ. Eye injuries: A prospective survey of 5671 cases. Br J Ophthalmol. 1989;73:88894.

[PMCID: PMC1041921] [PubMed: 2605143]

13. Loncarek K, Brajac I , Filipovic T, Caljkusic-Mance T, Stalekar H. Cost of treating preventable minor

ocular injuries in Rijeka, Croatia. Croat Med J. 2004;45:3147. [PubMed: 15185425]

14. Ngo CS, Leo SW. Industrial accident-related ocular emergencies in a tertiary hospital in Singapore.

Singapore Med J. 2008;49:2805. [PubMed: 18418518]

Figures and Tables

Table 1

Age and gender distribution in ocular trauma

Table 2

Place of ocular trauma

Figure 1


6/14



Perforating foreign body (preoperative)

Figure 2


7/14



Post remov al of perforating foreign body

Figure 3


8/14



Traumatic cataract with adherent leucoma (preoper ative)

Figure 4


9/14



Post cataract ex traction with intra ocular lens implantation (postoperative)

Figure 5


10/14



Chemical injury with epithelial defect at presentation

Figure 6


11/14



Chemical injury with healing epithelial defect on treatment

Figure 7


12/14



Corneal foreign body

Table 3


13/14



Spectrum of ocular trauma as per ocular trauma classification group

Table 4

Time interval between ocular trauma and presentation

Table 5

Ocular trauma and protective devices

Table 6

Management of ocular trauma cases

Table 7

Visual outcome in ocular trauma cases


14/14


Articles from Indian Journal of Occupational and Environmental Medicine are provided here courtesy of Medknow

Publications

Profile of Ocular Trauma in Industries-related Hospital

Documents

Transcript of Profile of Ocular Trauma in Industries-related Hospital