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ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 41-44

Clinical profile and visual outcome of ocular injuries presenting at a tertiary care hospital in Goa


1 Department of Ophthalmology, Goa Medical College, Goa, India
2 Department of Preventive and Social Medicine, Goa Medical College, Goa, India

Date of Submission13-Mar-2018
Date of Acceptance07-Jan-2019
Date of Web Publication21-Aug-2019

Correspondence Address:
Tanvi A Poy Raiturcar
H. No: 992, Saint Joaquim Road, Borda Margao, Goa - 403 602
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_12_18

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  Abstract 


Context: The study was undertaken to describe the clinical profile and visual outcome of ocular injuries in Goa, as there were no prior systematic data describing the same. Aims and Objectives: The aim is to study the clinical profile of ocular injuries at a tertiary care hospital, to describe pattern of ocular injuries, and identify at-risk groups and to study visual outcomes among such patients. Settings and Design: This was a prospective case series tertiary hospital-based study. Materials and Methods: Five hundred consecutive patients presenting with ocular injuries to the tertiary hospital between September 2014 and August 2015 were studied. Details of history, examination, investigations, and plan of action were noted. Statistical Analysis Used: Proportions and percentages were used for statistical analysis. Results: The most common victims were in the age group of 21–40 years (45%). Injuries among males were more common (88.8%) than females (11.2%). It was noted that 26.8% patients were under the influence of alcohol at the time of injury. The most common etiology was motor vehicle accidents (62.4%), followed by domestic accidents, occupational accidents, assault, and sports injuries. Most patients (77%) presented within 6 h of injury. Isolated anterior segment injuries were seen in 96.4%, 1.4% involved the posterior segment, whereas 2.2% involved both the segments. The final visual acuity of 87.4% patients was better than 6/12.

Keywords: Clinical profile, ocular morbidity, visual outcomes


How to cite this article:
Poy Raiturcar TA, Naik PG, Cacodcar JA. Clinical profile and visual outcome of ocular injuries presenting at a tertiary care hospital in Goa. J Clin Ophthalmol Res 2019;7:41-4

How to cite this URL:
Poy Raiturcar TA, Naik PG, Cacodcar JA. Clinical profile and visual outcome of ocular injuries presenting at a tertiary care hospital in Goa. J Clin Ophthalmol Res [serial online] 2019 [cited 2019 Sep 21];7:41-4. Available from: http://www.jcor.in/text.asp?2019/7/2/41/264887



Ocular trauma is an important cause of ocular morbidity and represents the most common ocular emergency.[1] Ocular injuries range from subconjunctival hemorrhage, without much visual significance to sight-threatening injuries such as globe ruptures and retinal detachments.

Individuals in their productive age are the most common victims, especially children and those involved in sports, industrial, and construction workers, thus imposing a heavy burden on our economy.[1],[2]

Despite their rising incidence, a systematic study has been lacking in Goa. The present study was undertaken to document the clinical spectrum and visual outcome of ocular injuries reporting to the only tertiary care medical college hospital in Goa.


  Materials and Methods Top


Five hundred consecutive patients who presented to the Department Of Ophthalmology, Goa Medical College, directly or through casualty between September 2014 and August 2015 were included in the study. Ethics committee approval was obtained from the Institutional Ethics Committee. Informed consent was obtained from patients or closest relatives of those patients unable to give consent. Demographic data, history of ocular injury, clinical findings, investigations, and plan of action for each patient were duly entered by the interviewer into the pretested study pro forma.

The clinical examination included detailed torch light examination, slit-lamp examination (wherever feasible), visual acuity using Snellen's charts, intraocular pressure recording using Goldmann Applanation Tonometry or non-contact tonometry (except in open globe injuries), fundoscopy using direct ophthalmoscope, and gonioscopy (if required). Additional investigations depending on the type of case included fluorescein staining, X-ray orbit, computed tomography scan, and B-Scan ultrasonography.

All fresh cases of acute trauma presenting within 24 h of injury, anterior as well as posterior segment injuries, and individuals from all age groups and both sexes were included in our study. Cases presenting after 24 h of injury and ocular trauma associated with life-threatening injuries were excluded from the study.


  Results Top


The prevalence of ocular injuries was highest in the age group of 21–40 years (45%). The prevalence of ocular injuries was highest in males (88.8%), whereas 11.2% were females. The most common cause of injuries was following motor vehicle accidents (62.4%), followed by domestic injuries (12.4%), occupational injuries (10.8%), assaults (10.2%), and sport injuries (3.6%). Majority (77%) of the patients presented to the ophthalmologist within 6 h of injury, whereas 13.6% presented between 7 and 12 h of injury.

Motor vehicle accidents constituted 62.4% injuries, whereas others included fall from height (6.2%), wooden stick injuries (5.6%), fall at home (5.4%), fist blow (5.4%), metal foreign body (4%), chemical injuries (2.6%), burns (2.4%), stone (1.6%), pencil (1%), and other injuries (3.2% total) [Table 1]. Majority (90%) of the ocular injuries were closed globe injuries, followed by open globe injuries (5.2%) and chemical injuries (4.8%). Among the 200 participants, 96.4% injuries were restricted to the anterior segment, 1.4% were posterior segment injuries, and 2.2% injuries involved both anterior as well as posterior segment.
Table 1: Distribution of patients according to object causing injury

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Most (86.8%) of the anterior segment injuries involved the lids, followed by the conjunctiva (46.4%), cornea (23%), iris (10.2%), anterior chamber (9%), and lens (5%). The most common posterior segment injuries were retinal detachments or tears (1.8%), followed by traumatic optic neuropathy (1.6%) and vitreous hemorrhage (0.4%). About 87.4% patients had a final visual acuity better than 6/12, whereas only 4.6% had a final visual acuity <6/60.


  Discussion Top


Out of the 500 patients who presented to the Department Of Ophthalmology, Goa Medical College, during a period of 1 year, the youngest patient was 4 years and the oldest was 82 years. The prevalence of ocular injuries was highest in the age group between 21 and 40 years (45%). The second highest was in the group between 41 and 60 years (36.8%). These injuries observed among active individuals were most commonly associated with motor vehicle accidents or occupational accidents.

Patients between 11 and 20 years constituted 11.8%, those between 61 and 80 years constituted 4%, those below 10 years were only 2%, and ocular injuries were rare in individuals above 80 years, constituting a mere 0.4%. Our study findings correlated with that found in similar studies by Karve et al.[3] who showed that 65.25% ocular injuries occurred in the age group of 16–45 years.

Similarly, Mishra et al.[4] in their study also showed that majority of ocular injuries occurred in individuals in the productive age group.

Ocular injuries in children mostly occurred as a result of lack of parental supervision and were mostly during play or as a result of fall from a height or fall at home.

A study done by Katiyar et al.[5] in the pediatric population showed similar results. Singh et al.[6] in their study found that 8%–14% of victims were in the pediatric age group. Ocular injuries in older individuals were as a result of domestic accidents, for example, fall at home as they are inactive and leading a sedentary life. Jain and Soni (1987)[7] in their study reported that the maximum incidence of ocular trauma was seen in the age group between 16 and 30 years (63%).

Majority (88.8%) were male and only 11.2% were female, perhaps because most workers constitute males and because males were involved in hazardous occupations more often than females. In addition, among ocular injuries associated with motor vehicle accidents, there are more male drivers compared to female drivers. Male children are more involved in outdoor sports than female children. In a study by Karve et al.,[3] injuries in males were 3.7 times more common than in females. Similar findings were reported by Misra et al.,[8] Eagling[9] and Wong et al.[10]

Majority of ocular injuries were associated with motor vehicle accidents (62.4%).

Most cases were as a result of rash driving, driving under the influence of alcohol, or driving without the use of protective measures such as seat belts or helmets.

Eagling[9] had reported the incidence of ocular injuries associated with motor vehicle accidents to be only 2% in 1959 which had increased to 31% in1976.

Only 12.4% of the injuries were as a result of domestic injuries such as fall at home or fall from height. Our findings are similar to those reported by Macewen.[11]

Other domestic injuries were as a result of injuries with vegetative matter or wooden stick, which were commonly seen in the female population. Occupational injuries constituted 10.8% of the injuries, which were more in males and as a result of not using protective eyewear.

Assault was a cause of injury in 10.2%. Most cases of assault were seen to be associated with alcohol influence.

Mishra et al.[4] in their study reported that >50% patients were under alcohol influence.

Sports-related injuries were seen in 3.6%, most of which were in children below 10 years and in the age group of 10–20 years.

Burns and firecracker injuries constituted 0.6% of the injuries.

Kolte et al.[3] in their studies found that the incidence of ocular injuries among children involved in sports was 4%.

Majority, i.e., 77% presented to the tertiary care hospital within the first 6 h after the injury. Most of the patients who presented earlier to the department were those with more severe ocular injuries. This shows a greater awareness among the people about the gravity of the injuries, as well as better facilities for transport to the hospital. Only 13.6% presented between 7 and 12 h and only 9.4% presented between 13 and 24 h. Patients who presented later were those with minor injuries or those from remote areas of Goa, where there are inadequate facilities for transport and emergency care. Some patients who presented later were being treated at other government or private health-care facilities. Only a few (0.4%) used home remedies for their treatment. Our study findings are similar to that found by Mishra et al.[4] who reported that 83.6% patients presented to the hospital within 24 h of injury.

Motor vehicle accidents constituted 312 patients (62.4%), whereas 6.2% were due to fall from height; these were mostly reported among laborers and construction workers undertaking hazardous work at heights without protective headgear.

Wooden stick injuries were seen in 5.6% participants; more commonly among homemakers and farmers. Nonmechanized farming in Goa, compels farmers to do manual cutting of crops, digging, etc., placing them at a higher risk. Villagers usually go to the local quacks for treatment or use home remedies due to lack of resources, transport, and health-care facilities in the villages. Blunt injuries as a result of self-fall at home were seen in 5.4%, commonly among elderly patients who are homebound or unable to walk properly. Fist blow which was as a result of assault was seen in 5.4%. Majority of these assaults were under the influence of alcohol. Patients presenting with metal foreign bodies in the eye constituted 4% of the participants. Such patients were mostly laborers, construction workers, and industrial workers, as a result of careless practices at work and not using proper safety measures and protective eyewear.

Chemical injuries among industrial workers, not using protective eyewear, or among students working in laboratories were seen in 2.6% of the participants. Injuries with stone were seen in 1.6%, which were seen among the assault patients. In a study by Jain and Sony,[7] the most common mode of injury was found to be stones. Other objects which were seen to cause ocular injuries included pencil tip (1%), iron rod (0.8%), rice husk (0.6%), knife (0.4%), fingernails (0.4%), firecrackers (0.2%), fish hook (0.2%), and soda bottle cap (0.2%).

Closed globe injuries were seen in 450 (90%); 26 (5.2%) had open globe injuries, and remaining 24 (4.8%) had other injuries, which included chemical injuries and burns.

Blunt injuries comprised ecchymosis, corneal abrasions, sealed perforations, subconjunctival hemorrhage, and hyphema. Penetrating injuries included corneal or sclera tears and globe ruptures. In a study conducted by Shukla et al.,[12] 66.7% had closed globe injuries, whereas 26.7% had open globe injuries.

Studies by Mishra et al.[4] and Kolte et al.[3] showed similar results.

Isolated anterior segment injuries were seen in 96.4%, 1.4% had isolated posterior segment injuries, and 11 patients (2.2%) had combined anterior as well as posterior segment injuries. In a study by Shukla et al.,[12] 86% had anterior segment involvement and 14% had posterior segment injuries, whereas Karve et al.[3] reported 82.75% anterior segment injuries, 7.2% posterior segment injuries, and 4% involving anterior as well as posterior segment.

Lid injuries constituted majority of the anterior segment injuries (86.8%), which included ecchymosis and lid lacerations. Nearly half of the patients with anterior segment injuries had conjunctival injuries, i.e., 46.4% and included subconjunctival hemorrhage, chemosis, and conjunctival tears. Corneal injuries constituted 23%. Majority of corneal injuries were corneal abrasions, followed by corneal tears and foreign bodies.

Iris and pupil injuries such as iridodialysis and traumatic mydriasis were 10.2%.

Anterior chamber pathologies such as hyphema were 9%. Injuries to the lens comprised 5% of all ocular injuries, which included traumatic cataracts, subluxated, and dislocated lens. Our values are low compared to studies by Jain and Sony[7] who reported 11.3% lens injuries in their study population and Shukla et al.[12] who found 27.4% of patients to have lens injuries.

Out of patients with posterior segment injuries, 1.8% had injuries to the retina including retinal detachment/tear, 1.6% had optic nerve injuries including traumatic optic neuropathy or avulsion, and 0.4% had vitreous hemorrhage. The findings of our study are low compared to 14% posterior segment injuries found by Shukla et al.[12] in their study.

The final visual acuity depended on various factors such as nature and extent of injury, time delay between injury and presentation to the hospital, type of treatment provided, and the presence of preexisting ocular comorbidities. Patients with final visual acuity between 6/12 and 6/6 comprised 87.4%, whereas those having final visual acuity between 6/18 and 6/60 were 8%. Such patients were mainly those who had closed globe injuries. Patients having final visual acuity <6/60 were 4.6%, and these were patients who had presented with open globe injuries, globe ruptures, and retinal and optic nerve injuries. Our study findings are comparable to that reported by Mishra et al.[4] who reported that 76.8% had a final visual acuity better than 6/12. The limitations of our study are that it is a hospital-based study and hence the results cannot be applied to the general population because of associated Berksonian bias and the differential rates of admission to the hospital.


  Conclusion Top


Ocular injuries are a major cause of ocular morbidity in Goa. Young males in the productive age group of 21–40 years are commonly affected. Motor vehicle accidents constitute 62.4% of the injuries. It was noted that 26.8% patients were under the influence of alcohol at the time of injury.

Acknowledgment

The authors would like to thank my parents, my teacher, and my colleges for their support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wong TY, Tielsch JM. Epidemiology of ocular trauma. In: Tasman W, Jaeger EA, editors. Duane's Ophthalmology. Philadelphia: Lippincott Williams and Wilkins; 2008.  Back to cited text no. 1
    
2.
Krishnaiah S, Nirmalan PK, Shamanna BR, Srinivas M, Rao GN, Thomas R, et al. Ocular trauma in a rural population of Southern India: The Andhra Pradesh eye disease study. Ophthalmology 2006;113:1159-64.  Back to cited text no. 2
    
3.
Karve S, Kolte A, Alfia A, Rathi H. study of clinical profile of ocular trauma at a tertiary eye care centre. Int J Contemp Med Res 2017;12:4-7.  Back to cited text no. 3
    
4.
Mishra A, Verma AK, Baranwal VK, Aggarwal S, Bhargava N, Parihar JK. The pattern and visual outcomes of ocular trauma in a large Zonal hospital in a non-operational role: A 36 months retrospective analysis. J Clin Ophthalmol Res 2014;2:141-4.  Back to cited text no. 4
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5.
Katiyar V, Bangwal S, Gupta SK, Singh V, Mugdha K, Kishore P. Ocular trauma in Indian paediatric population. J Clin Ophthalmol Res 2016;4:19-23.  Back to cited text no. 5
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6.
Singh S, Sharma B, Kumar K, Dubey A, Ahirwar K. Epidemiology, clinical profile and factors, predicting final visual outcome of pediatric ocular trauma in a tertiary eye care center of central India. Indian J Ophthalmol 2017;65:1192-7.  Back to cited text no. 6
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7.
Jain BS, Soni SR. Ocular injuries: An analytical study in a teaching general hospital. Indian J Ophthalmol 1987;35:112-6.  Back to cited text no. 7
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8.
Misra S, Nandwani R, Gogri P, Misra N. Clinical profile and visual outcome of ocular injuries in a rural area of Western India. Australas Med J 2013;6:560-4.  Back to cited text no. 8
    
9.
Eagling EM. Ocular damage after blunt trauma to the eye. Its relationship to the nature of the injury. Br J Ophthalmol 1974;58:126-40.  Back to cited text no. 9
    
10.
Wong TY, Klein BE, Klein R. The prevalence and 5-year incidence of ocular trauma. The beaver dam eye study. Ophthalmology 2000;107:2196-202.  Back to cited text no. 10
    
11.
Macewen CJ. Eye injuries: A prospective survey of 5671 cases. Br J Ophthalmol 1989;73:888-94.  Back to cited text no. 11
    
12.
Shukla B, Agrawal R, Shukla D, Seen S. Systematic analysis of ocular trauma by a new proposed ocular trauma classification. Indian J Ophthalmol 2017;65:719-22.  Back to cited text no. 12
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