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ORIGINAL ARTICLE
Year : 2015  |  Volume : 3  |  Issue : 3  |  Page : 127-131

Pattern of pediatric ocular trauma in rural area of Marathwada


Department of Ophthalmology, Swami Ramanand Teerth Rural Government Medical College, Ambajogai, Maharashtra, India

Date of Submission15-Jun-2014
Date of Acceptance15-Nov-2014
Date of Web Publication20-Aug-2015

Correspondence Address:
Chandrakishor Hemraj Pardhi
Powar Colony, Khairlanji Road, Tal-Tirora 441911 Gondia (Maharashtra)
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.163256

Clinical trial registration 129 dated 01/01/14

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  Abstract 

Aim: To identify cause, demographic and clinical profile, and evaluate final visual outcome of ocular trauma in pediatric age-group (= < 15 years) patients attending casualty. Materials and Methods: Prospective interventional study was carried out in rural area of Marathwada during July 2012-June 2013 where children up to 15 years with history of ocular trauma attending the casualty were included. Demographic details like age and sex, activity at time of injury, identifiable objects causing injury, presence or absence of supervision during injury were noted with follow-up period of 60 days. Results: In our study, total 79 patients with 94 eyes were enrolled. The age-group more affected was 5 years and above (65%, i. e., 61 eyes) than 5 years and below (35%, i. e., 33 eyes). Boys (57%) were affected more than girls (43%). Adnexal injuries found in 51% eyes, whereas closed and open globe injuries in 41% and 8%, respectively. Most of children reported to casualty within 24 hours (86% eyes), remaining after 24 hours (14% eyes). The objects causing injury were projectile objects (20%), blunt objects (14%), household objects (10%). The other causes of injury were sports (16%), accidental fall (15%), chemical and road traffic accidents (RTA) (8% each), burn (4%), animal bite (3%), and assault (2%). Best corrected visual acuity (VA) of more than 6/18 achieved in 68% eyes, 6/18-6/60 in 12% eyes, < 6/60-counting finger close face (CFCF) in 8% eyes, projection of light (PL) + perception of rays (PR), and no PL in (1%) each eyes. Most of the ocular injuries occurred at home (53%), at playground (16%), accidental fall (14%), and others. Conclusion: The age-group affected was 5 years and above. Boys were affected more than girls. The time of reporting to casualty was within 24 hours. Projectile objects, blunt objects, and household objects were common causes of injury. The places of injury were home, playground, and others. Most of the children achieved best corrected visual acuity (BCVA) more than 6/18.

Keywords: Ocular trauma, open and closed globe injuries, pediatric age-group


How to cite this article:
Pardhi CH, Nandedkar VS, Shelke EB, Bhojane VR, Awatade VP. Pattern of pediatric ocular trauma in rural area of Marathwada. J Clin Ophthalmol Res 2015;3:127-31

How to cite this URL:
Pardhi CH, Nandedkar VS, Shelke EB, Bhojane VR, Awatade VP. Pattern of pediatric ocular trauma in rural area of Marathwada. J Clin Ophthalmol Res [serial online] 2015 [cited 2022 Jul 4];3:127-31. Available from: https://www.jcor.in/text.asp?2015/3/3/127/163256

Pediatric ocular trauma is an important cause of ocular morbidity and non-congenital unilateral blindness in this age-group. [1],[2] Pediatric eye injuries account for approximately 8-14% of total injuries and the most common type requiring hospitalization. [3] Pediatric patients have different pattern of ocular injuries than adult and have age-specific type of injuries. Children below 3 years age-group mostly suffer from handler-related injuries like from fingernails of parents, caretakers, or siblings. [4] While older children have injuries due to sharp objects, toys, tree branches, pencils, sports, stones. [3]

Male children are affected more than females due to their adventurous and aggressive nature. [3] Ocular injuries are of three types: Open globe, closed globe, and adnexal injuries. Most common emergencies are due to open-globe injuries and require immediate interventions. [5],[6] Even small trauma to an eye may lead to permanent visual impairment creating significant impact on future quality of life. Thus, patient and social education regarding eye injuries and its early specialized treatment can give good visual prognosis. [6]

There are few studies conducted regarding pediatric ocular injuries in rural set-up; hence, present study has been planned to analyze the pattern and outcome of pediatric injuries in Marathwada.


  Materials and Methods Top


This was prospective interventional study carried out during June 2012 to July 2013.

Inclusion criteria

All pediatric patients with age-group up to 15 years of either sex having complaint of ocular trauma attending casualty were included in study.

Exclusion criteria

Patients with history of previous established eye diseases like glaucoma, congenital anomalies, other non-traumatic causes and age above 15 years were excluded from study.

Study was conducted after approval from Institutional Ethics Committee and data was collected after written informed consent from parents.

Patient's demographic details such as age and sex, activity at time of injury, identifiable objects causing injury, presence or absence of supervision during injury were noted.

Thorough evaluation of visual acuity by Snellen's (4 years and above) and pediatric acuity chart (below 4 years), slit lamp examination to evaluate anterior segment injuries, and fundus examination by indirect ophthalmoscopy and slit lamp bimicroscopy were done. All patients were appropriately managed in outpatient department (OPD) and if needed in inpatient department (IPD) with required investigations and interventions. Intraocular pressure measured in all eyes except open-globe injuries. Gonioscopy was done in closed-globe injuries. B-scan in hazy media was done to evaluate status of retina. X-ray and computed tomography (CT) scan were done in necessary patients. All patients were followed up on day 1, 7, 30, 45, and 60. The final best corrected visual acuity was taken on day 60.


  Results Top


Total 79 patients with 94 eyes (unilateral 64 and bilateral 30) were studied. Majority of injuries occurred in children 5 years and above (65%) than below 5 years (35%). Most of injuries were reported in boys (57%) than girls (43%) [Table 1]. As per early seeking of treatment, 25% eye injuries were reported within 1 hour, between 1-24 hours 61% eyes reported, and remaining 14% eye injuries reported after 24 hours [Table 2].
Table 1: Age and sex distribution

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Table 2: Time to visit casualty

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Projectile objects (20%), sports (16%), accidental fall (15%), blunt objects (14%) were remained the common causes of injuries, followed by others like household objects (10%), road traffic accidents and chemicals (8%) each, burn trauma (4%), animal bite (3%), and assault (2%) [Table 3] and [Table 4].
Table 3: Age-wise cause of injury

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Table 4: Types of objects causing ocular injuries

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Most of the ocular injuries were adnexal found in 48 eyes (51%) which presented with lid abrasions in 26 eyes, tear [Figure 3] in 13, hematoma [Figure 2] in 5, and burn in 4 eyes.
Figure 1: Traumatic cataract

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Figure 2: Hematoma

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Figure 3: Eyelid chronic lacerated wound (CLW)

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Closed-globe injuries were reported in 39 eyes (41%), presented with hyphema and foreign bodies (conjunctival and corneal) in 9 eyes each, sub-conjunctival hemorrhage [Figure 4] in 8, corneal abrasion in 7, lens injuries [Figure 1] in 2, and partial thickness corneal tear, irido-dialysis, vitreous hemorrhage, conjunctival tear in 1 eye each [Table 5].
Figure 4: Sub-conjunctival hemorrhage

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Table 5: Age-wise tissue injury

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Open-globe injuries found in 7 eyes (8%), among which corneo-scleral tear with uveal tissue prolapsed and vitreous leak found in 3 eyes, full thickness corneal tear [Figure 5] in 3, and globe perforation in 1 eye.
Figure 5: Corneal tear

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Most of injuries occurred at home (53%), while remaining 16% at playground, 12% at other places (unknown), 9% on street, 5% at farm and school each.

Out of 94 eyes, 9 (10%) eyes visual acuity could not taken as they were less than 1 year age-group and uncooperative. On day 60, 64 eyes had visual acuity better than 6/18 (68%), 11 (12%) had 6/18 to 6/60, 8 (8%) had < 6/60-counting finger close to face (CFCF), projection of light (PL) + perception of rays (PR)-, and no PL in 1 (1%) eye each.

Detail history reveals that 76% (71 eyes) injuries occurred in unsupervised conditions and during day time when parents were at work. Every month an average of 155 cases of ocular trauma of all age-groups were reported in our casualty among which pediatric ocular injury found in 22 (14%) eyes. Phthisis bulbi developed in 2 eyes and fortunately infection was nil. Major injuries like animal bite, corneo-scleral tear, globe rupture, etc. had poor visual prognosis.


  Discussion Top


In our study, as per age-specific pattern of ocular injuries, more prevalence is found in age-group 5 years and above than below 5 years which is similar to other studies like MacEwen where it was 84% of ocular injuries in 5-14 years age-group. [1],[7],[9] School-age children are more susceptible than younger age-groups, because of their independent and adventurous spirit involving them in many unsupervised games, making them vulnerable to trauma. Younger age-group children are most of the time under parental supervision and physically less active than older children. So, younger age-groups are more susceptible to handler-related injuries like fingernails of siblings, mother, or caretakers. [4],[7]

Boys tend to affect more commonly than the girls. [3],[6],[7] This shows more adventurous and aggressive behavior of boys for getting severe ocular trauma.

Ocular injuries more commonly occurred at home, followed by playground which are very much similar to MacEwen C (51%) and Desai T et al., (45.62%). [3],[6] Home is the common place of injuries both for preschool and school-going children which reflects the amount of time spend at home. Most of the younger age-groups were injured by domestic utensils or toys.

Early treatment is the key factor for good visual outcome and in our study 25% eyes reported within 1 hour and 61% eyes between 1-24 hours, only 14% eyes after 24 hours which is contradictory with few studies like in Desai T et al., where around 70% presented after 24 hours. Malik R et al., found 47.50% visit within 24 hours and 30.50% in more than 48 hours. [6],[10],[11],[12] It shows changing pattern in our rural set-up due to improved infrastructure like transport, availability of specialized hospitals in remote area, and increasing awareness in parents and society. Those visited late were due to poor parenthood, carelessness, poverty, extremely remote area, and fear factor in children. Those visited within 24 hours had good visual prognosis than others.

The causes of injuries are varies in different geographical areas and age-group. In our study, projectile objects causes more number of eye injuries, followed by sports which are more common in older age-groups (5-15 years). Accidental fall injuries which are more common in younger age-group (0->5 years) where the actual activity at time of injuries and mechanism of injuries were not well-known. Other causes of injuries are blunt objects, household objects, road traffic accidents, chemical injuries, burn trauma, animal bite, and assault. In India, wooden-stick injuries are considered as more common. [3] But now changing pattern found in our study, its incidence was low 5% compare to other studies like Kaur A et al., where wooden stick injuries found in 28.07% eyes. [3],[6] Like in sports injuries, cricket ball and bat injuries (10%) are more common nowadays than gilli-danda and bow-arrow injuries.

Also, in India, festival season have more chances of ophthalmic injuries like fire-cracker injuries (8%) during Diwali and chemical injuries by colored water balloons and lime during Holi. Mostly lack of eye protection is responsible for this. More interestingly in our study due to low socioeconomic status and lack of supervision of parents, animal bite injuries were found in younger age-group. Unlike in developed countries where assault seen in (14%) of total eye injuries, [1] our study shows it in only 2 (2%) eyes.

In our study, closed-globe and adnexal injuries had different incidences 41% and 51%, respectively which are different from other studies like Desai T et al., where incidence of closed globe injuries was 27% and adnexal injuries (32%). The 6 eyes of adnexal injuries associated with other ocular trauma in which 3 eyes with lid abrasions had corneal epithelial defect, 1 chronic lacerated wound (CLW) with corneo-scleral tear, and 2 eyes with hematoma had hyphema.

In our study, incidences of open-globe injuries (8%) were lower. Its incidence varies in different studies in different countries. [1],[6] All open-globe injuries were treated with preservation of normal anatomical structure but had poor visual prognosis.

All patients were treated at our institute with required investigations. In our study, total 21 eyes needed indoor admission. Five eyes with traumatic cataract treated surgically with posterior chamber intraocular lens (PCIOL) implantation. Partial and full thickness corneo-scleral 4 eyes treated with suturing. The globe perforation patient was treated by evisceration and orbital implant. Ocular trauma score (OTS) in our study is 3.

On 60 th day of follow-up, the final visual acuity (VA) in 68% eyes were better than 6/18, 12% eyes had VA of 6/18 to 6/60 and poor visual outcome in remaining eyes [Table 6]. VA of 10% eyes could not be taken as they were less than 1 year age-group and uncooperative. Visual outcome were hampered due to severe ocular injuries, delay in seeking medical help, and poor compliance of patient. Post-treatment development of corneal opacity and disturbance in normal anatomical structure with poor visual acuity affects quality of life, in form of disfigurement, amblyopia, and use of low visual aids.
Table 6: Comparison of visual acuity

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  Conclusion Top


According to our study, most of eye injuries occurred in age group 5 years and above, mostly in unsupervised conditions which can be easily preventable. Due to trauma few patients remain blind which affects patient's quality of life. In our study, most of patients visited within 24 hours had good VA showing early seeking of treatment and good supervision is helpful in better outcome of visual acuity. Boys affected more than girls. Projectile objects, blunt objects, and household objects were common causes of injuries. The places of injuries were home, playground, and others [Table 5] and [Table 6].

 
  References Top

1.
MacEwen CJ, Baines PS, Desai P. Eye injuries in children: The current picture. Br J Ophthalmol 1999;83:933-6.  Back to cited text no. 1
    
2.
National Society for the Prevention of Blindness. Fact sheet. Vision problems in the US. New York: National Society for the Prevention of Blindness; 1980.  Back to cited text no. 2
    
3.
Kaur A, Agrawal A. Paediatric ocular trauma. Curr Sci 2005;89.  Back to cited text no. 3
    
4.
Burgueño Montañés C, Colunga Cueva M, González Fernández E, Cienfuegos García S, Díez-Lage Sánchez A, Diab Safa M. Eye injuries in childhood. An Esp Pediatr 1998;48:625-30.  Back to cited text no. 4
    
5.
MacEwen CJ. Ocular injuries. J R Coll Surg Edinb 1999;44:317-23.  Back to cited text no. 5
    
6.
Desai T, Vyas C, Desai S, Malli S. Pattern of ocular injuries in paediatric population in western India. NHL J Med Sci 2013;2:37-40.  Back to cited text no. 6
    
7.
Dulal S, Ale JB, Sapkota YD. Profile of pediatric ocular trauma in mid western hilly region of Nepal. Nepal J Ophthalmol 2012;4:134-7.  Back to cited text no. 7
    
8.
Lithander J, Al-Kindi H, Tonjum AM. Loss of visual acuity due to eye injuries among 6292 school children in Sultanate of Oman. Acta Ophthalmol Scand 1999;77:697-9.  Back to cited text no. 8
    
9.
Al-Bdour MD, Azab MA. Childhood eye injuries in North Jordan. Int Ophthalmol 1998;22:269-73.  Back to cited text no. 9
    
10.
Malik R, Rahil N, Husssain M, Wajid A, Zaman M, et al. Frequency and visual outcome of anterior segment involved in accidental ocular trauma in children. J of Postgradu Med Inst 2011;95:44-8.  Back to cited text no. 10
    
11.
Khan MD, Mohammad S, Islam ZU, Khattak Mn. An 11 years review of ocular trauma in North West Frontier Provience of Pakistan. Pak J Ophhtahlmol 1991;7:15-18.  Back to cited text no. 11
    
12.
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;123:820-31.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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