Profile of ocular trauma in patients presenting to the department of ophthalmology at Hawassa University: Retrospective study

Seeing the unseen: The low treatment rate of eye emergencies in Africa

BACKGROUND

Emergency medical care is essential in preventing morbidity and mortality, especially when interventions are time-sensitive and require immediate access to supplies and trained personnel.

AIM

To assess the treatment rates of eye emergencies in Africa. Ocular emergencies are particularly delicate due to the eye’s intricate structure and the necessity for its refractive components to remain transparent.

METHODS

This review examines the low treatment rates of eye emergencies in Africa, drawing on 96 records extracted from the PubMed database using predetermined search criteria.

RESULTS

The epidemiology of ocular injuries, as detailed in the studies, reveals significant relationships between the incidence and prevalence of eye injuries and factors such as age, gender, and occupation. The causes of eye emergencies range from accidents to gender-based violence and insect or animal attacks. Management approaches reported in the review include both surgical and non-surgical interventions, from medication to evisceration or enucleation of the eye. Preventive measures emphasize eye health education and the use of protective eyewear and facial protection. However, inadequate healthcare infrastructure and personnel, cultural and geographical barriers, and socioeconomic and behavioral factors hinder the effective prevention, service uptake, and management of eye emergencies.

CONCLUSION

The authors recommend developing eye health policies, enhancing community engagement, improving healthcare personnel training and retention, and increasing funding for eye care programs as solutions to address the low treatment rate of eye emergencies in Africa.

Visual outcome of penetrating ocular trauma among patients visiting University of Gondar comprehensive specialized hospital

Ocular trauma, a preventable public health issue, is one of the common causes of ophthalmic morbidity and monocular blindness worldwide. It can occur in almost any setting and at any age in either sex but largely affects males. The mechanism and type of injury, the extent of damage, and the time-lapse between the occurrence of injury and eye care are among the factors that determine the visual outcome of ocular injuries. This study is designed to assess the clinical profile and visual outcome of patients presenting with penetrating ocular injury. A prospective hospital-based study was conducted among penetrating ocular trauma patients who visited UOG tertiary eye care and training center during the study period. All patients with penetrating ocular trauma who fulfilled the inclusion criteria were included in the study. Data on demography, initial and final visual acuity, type of injury, as well as management, were included in a structured questionnaire. The collected data were processed and analysed using Statistical Packages for the Social Sciences (SPSS) version 25.0. The study included 91 cases of penetrating ocular injuries. The majority of the patients 81.2% were males. The male-to-female ratio was 4.3:1. The left eye was involved in 52.7% of the patients. The median age was 20 years, with an IQR of 10-35. The majority (31.9%) of the cases were in the age range of 5-10 years. nearly half of the study participants (45.1%) sustained the injury at home. The commonest source of injury was wooden sticks 49.5%. Six patients were lost to follow-up at three-month visits. Traumatic cataracts (p = 0.001), and poor initial visual acuity were poor prognostic factors. Still ocular injury is a common cause of monocular blindness. We recommend that more has to be done on the primary prevention and control measures.

Ocular injuries sustained at home in five metropolitan cities: a review of 5008 cases

Background

In Iran, ocular injuries sustained at home are a growing public health issue, and few studies have explored their prevalence and the frequencies of different causes of these injuries. We investigated the features of ocular injuries at home among children and adolescents (aged < 18 years), adults (18 - 64 years), and the elderly ( ≥ 65 years) in five metropolitan cities.

Methods

In this cross-sectional study, we recruited individuals with ocular injuries sustained at home who presented to 12 public/teaching hospitals in five metropolitan cities during a 5-month period. Using clinical records within the emergency department archives, we collected the following data: age, sex, frequency of injuries requiring hospital admission or surgical intervention, and causes of eye injuries, documented as 1) cleaning products, 2) chemical products, 3) kitchen items, 4) cooking activities, 5) toys, 6) falls from height, 7) sports equipment, 8) penetrating or cutting, 9) abrasions, 10) foreign bodies, and 11) direct blows by other individuals.

Results

Of 5008 participants from the five cities, 74% (n = 3711) were male and 26% (n = 1297) were female. The most frequent causes of injury among children and adolescents, adults, and the elderly were toys, kitchen items, and cooking activities, respectively. In children and adolescents, injuries were caused by kitchen items, toys, foreign bodies, and direct blows by other individuals more frequently than in adults or the elderly, and by cleaning products and abrasions more frequently than in the elderly (all P < 0.05). In adults, injuries were caused by cleaning products, cooking activities, falls from height, sports equipment, penetrating or cutting, and abrasions more frequently than in children and adolescents or the elderly (all P < 0.05), and by kitchen items, toys, and blows by other individuals more frequently than in the elderly (all P < 0.05). In the elderly, injuries were caused by chemical products more frequently than in children and adolescents or adults, and by cooking activities, falls from height, and sports equipment more frequently than in children and adolescents (all P < 0.05). In adults, the frequency of ocular injuries was significantly higher in Tehran and lower in Mashhad when comparing each with that of the other four cities (all P < 0.05). We found a significantly higher frequency of ocular injuries by cleaning and chemical products in Tehran, by toys in Shiraz, by falls from height in Isfahan, and by direct blows by other individuals in Ahvaz when comparing each to that of the other four cities (all P < 0.05). Regarding the prevalence of severe ocular injuries among the children/adolescent and adult age groups, conditions were relatively better in Shiraz and relatively unfavorable in Mashhad.

Conclusions

Ocular trauma was more common in male individuals and the younger age groups. Approximately half of the causes were kitchen items, toys, and foreign bodies, which are avoidable by enhancing public eye health awareness. The prevalence of severe ocular injuries in individuals aged < 18 years was high, highlighting the necessity of nationwide preventive strategies for pediatric ocular injuries.

Ocular trauma, visual acuity related to time of referral and psychosocial determinants, during COVID‑19 pandemic: A prospective study

The aim of the present study was to explore the associations between visual outcomes of ocular injury patients in a tertiary hospital unit with clinical and demographic variables and to evaluate the psychosocial impact of the injury on the patients. An 18-month prospective study of 30 eye-injured adult patients was conducted in the General University Hospital of Heraklion, Crete, a tertiary referral hospital. All severe eye injury case information was prospectively collected between February 1, 2020 and August 31, 2021. Best corrected visual acuity (BCVA) was labelled not poor (>0.5/10 or >20/400 on the Snellen scale, <1.3 in LogMAR scale) and poor (≤0.5/10 or ≤20/400 on the Snellen scale, ≥1.3 on the LogMAR equivalent). Data regarding participants' perceived stress levels, by using Perceived Stress Scale 14 (PSS-14), were collected prospectively, one year after study end. Out of 30 ocular injury patients selected, 76.7% were men and most of them were self-employed and private or public sector workers (36.7%). Not poor final BCVA was related to not poor initial BCVA [odds ratio (OR) 1.714; P=0.006]. No statistical associations were found between visual outcome and demographic or clinical factors, but not poor final BCVA was associated with improved self-reported psychological condition of the sufferers, as examined by a questionnaire sheet developed to collect information for study purpose (8.36/10 vs. 6.40/10; P=0.011). No patient reported job loss or changed work status following the injury. Not poor initial BCVA was a significant predictor for not poor final visual outcomes (OR 1.714; P=0.006). Patients with not poor final BCVA expressed higher levels of positive psychology (8.36/10 vs. 6.40/10; P=0.011) and less fear of eye injury repetition (64.0 vs. 100.0%; P=0.286). Not poor final BCVA was associated with low PSS-14 scores one year after study end (77.3 vs. 0.0%, P=0.003). Collaboration between ophthalmologists, mental health professionals and primary care team may be important in order to help patients to cope with the psychosocial burden sequel to eye trauma.

Pediatric Open Globe Injuries Caused by Firecrackers in a Tertiary Eye Care Hospital in Iran

OBJECTIVE

The aim of the study is to determine characteristic features of open globe injuries caused by firecrackers among pediatric population.

METHODS

In this retrospective cross-sectional chart review, medical records of children with ocular trauma who were hospitalized in Isfahan, Iran, during 2013-2017 were reviewed. We analyzed the collected data before and after propensity score (PS) matching.

RESULTS

Of 396 pediatric patients with open globe injury, 22 injuries (5.9%) were caused by firecrackers. Hyphema, iris prolapse, and lens rupture were noted in 15 (68.18%), 10 (45.45%), and 2 (9.09) eyes, respectively. None of patients had endophthalmitis. The mean age of patients in firecracker group was higher and significant (11.86 ± 4.05 in firecracker vs 7.80 ± 4.68 in nonfirecracker, P < 0.001). Furthermore, most boys were in firecracker group (95.5%, P = 0.005). Patients in firecracker group resided more in urban areas (86.4%, P = 0.054) and had more intraocular foreign body (IOFB) in the eyes (40.9%, P < 0.001). After PS matching, patients in firecracker group had higher IOFB ( P = 0.008). In logistic regression models, patients with corneal lacerations had lower odds for long-time admission (≥4 days) than patients with both corneal and scleral lacerations in crude model (odds ratio, 0.35; 95% confidence interval, 0.17-0.69) and adjusted model (odds ratio, 0.37; 95% CI, 0.18 to 0.74). After PS matching, there was no significant association between risk factors and outcomes.

CONCLUSIONS

The present study showed several differences between the pediatric open globe injuries caused by firecrackers and other mechanisms of injuries, including the age, sex, living place, presence of IOFB, and length of hospital stay.

Analysis of Operated Patients with Ocular Trauma: A 10-Year Retrospective Study

Background

Ocular trauma is one of the most common causes of hospitalization in patients with ocular injuries. It imposes many direct and indirect physical and psychological costs on the patient and the community.

Materials and Methods

The present descriptive cross-sectional and retrospective study includes all patients with ocular trauma who underwent surgery in the referral center's ophthalmic operating room for 10 years. A checklist was completed for each patient, including demographic information and the variables required for the study. A total of 927 patients who underwent eye surgery due to ocular trauma were eligible for the study. All descriptive data were reported as the mean plus standard deviation for quantitative variables and distribution tables and frequency percentage for qualitative variables. Inferential tests such as independent t-test and Chi-square test were used to evaluate the research questions.

Results

This study showed that most ocular traumas occur at a young age and mostly in males. The types of trauma in the studied eyes were divided into penetrating and non-penetrating in different age groups. The results showed that the most common type of surgery was corneal laceration repair, and in all patients, visual acuity improved significantly after surgery. In this study, a total of 81% of patients underwent only one operation.

Conclusions

Training and caring for children and adolescents about high-risk behaviors and educating industry professionals to wear goggles, and increase workplace safety can reduce these types of trauma.

Ocular Trauma during the COVID-19 Pandemic in Sanglah Hospital, Denpasar, Bali From March 2020 to March 2021

BACKGROUND: The coronavirus disease 2019 (COVID-19) is an infectious disease characterized by severe acute respiratory syndrome caused by the coronavirus 2. The implementation of lockdown and social distancing is the efforts made by the government to prevent the spread of this virus. The COVID-19 pandemic has affected the incidence rate of ocular trauma in several means. AIM: This study aimed to evaluate the factors that can cause ocular trauma, from the patient’s characteristics, clinical presentation, etiology, and mechanism of ocular trauma of patients who came to the emergency unit of Sanglah Central General Hospital (RSUP) during the COVID-19 pandemic. METHODS: This study is an observational analytic study with simple random sampling method to evaluate the characteristics of patients with ocular trauma from March 2020 to March 2021. The secondary data were obtained from the medical records including age, gender, address, examination data (visual acuity, duration between trauma and time of seeking medical care, diagnosis, trauma etiology, trauma mechanism, and surgery performed on the patient). RESULTS: In this study the most common was the presence of corpus alienum/foreign body in the cornea, chemical trauma, corneal erosion, canaliculi rupture, and keratitis which are usually caused by photoelectric injury. During the COVID-19 pandemic, new regulations were implemented including patient screening, COVID-19 test before undergoing surgery, patient treatment, and also the use of personal protective equipment for the examiners. Moreover, there were behavioral changes of the people caused by the enforcement of lockdown system and also people’s fear of going to the hospital, especially to a COVID-19 referral hospital such as Sanglah General Hospital; therefore, some patients delayed seeking medical treatment and refused to have surgery at Sanglah General Hospital. CONCLUSION: Our study concluded that the trend of ocular trauma in the COVID-19 era tends to occur in the male population and involves trauma to the cornea, with the most common etiology is caused by the presence of foreign bodies such as gram, wood, or metal. Our finding also showed that despite the implementation of social distancing policies in the COVID-19 pandemic situation, ocular trauma can still be found related to the implementation of the lockdown that has been relaxed during this research.

Ocular Trauma Trends in Indonesia: Poor Initial Uncorrected Visual Acuity Associated with Mechanism of Injury

Objectives: To identify ocular trauma trends and to analyze how initial uncorrected visual acuity (VA) is associated with mechanism of injury (MOI) in a referral hospital in Indonesia. Methods: A five-year medical chart review at the Ophthalmology Emergency Department (OED) Dr. Soetomo General Academic Hospital (DSGAH). The information retrieved included sex, age, laterality involvement, initial uncorrected VA, MOI and management. Sex- and age- adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the relationship between poor initial uncorrected VA and MOI, using multivariate logistic regression analysis. Results: A total of 953 patients consisted of 80.3% males and 19.9% females. Ocular trauma predominantly occurred in 21–30 years age group (20.9%). May and November were found to have the highest average number of monthly patients. Closed globe injuries (80.3%) were more prevalent than open globe injuries (17.7%). The most frequent MOIs were sharp objects (311; 32.6%), followed by blunt objects (236; 24.8%). Most cases (89.2%) displayed unilateral involvement and 54.3% cases showed an initial uncorrected VA of better than 6/18. Compared to road dust, blunt object, sharp object and traffic accident were significantly associated with poor initial VA, with adjusted ORs (95% CIs) of 5.24 (2.27-12.10), 4.03 (1.76-9.25) and 8.17 (3.31-20.15), respectively. Conclusions: Initial uncorrected VA and MOI provide earlier information regarding the prognosis. Traffic accident showed a greater tendency to cause a poor initial uncorrected VA. Most ocular trauma is preventable by educating people at risk to avoid common MOIs and to use protection.

Clinical profile and outcomes of rhegmatogenous retinal detachment related to trauma in pediatric population

OBJECTIVE

To analyze the outcomes of trauma-related rhegmatogenous retinal detachment (RD) in pediatric population.

DESIGN

Retrospective observational series.

PARTICIPANTS

All patients under 18 years of age who underwent surgery for RD following trauma from 2010 to 2018.

METHODS

Data were recorded from medical records regarding type of trauma, ocular status at presentation, details of RD (extent, number of breaks, proliferative vitreoretinopathy, choroidal detachment). The surgical intervention (scleral buckling or vitrectomy; tamponade used) and postoperative outcomes, including anatomical success, resurgeries, and visual acuity, were noted.

RESULTS

We included 32 eyes of 32 patients, where closed globe injury was seen in 13 eyes (41%) and open globe injury (OGI) in 19 eyes (59%). At presentation, 50% of the eyes had RD, with total RD in 20 eyes (63%). Scleral buckling was performed in 9 eyes (28%), whereas the remainder (n = 23) underwent pars plana vitrectomy with silicon oil tamponade for RD repair. Silicone oil removal was done in 16 eyes (70%) and recurrent or persistent RD was seen 17 eyes (53%). Final reattachment rate was 75% (n = 24). The final best-corrected visual acuity was better in the closed globe injury group (mean = 5/60 Snellen's vs 1/60 Snellen's in OGI group), though this was only marginally significant statistically. Late complications were seen in 26 eyes (81%), of which 18 (69%) had previous OGI.

CONCLUSION

Pediatric traumatic RDs have very poor anatomical and visual outcomes. OGI fares worse than closed globe. Loss of vision in children can be prevented by better safety measures so as to avoid trauma.