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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 4  |  Page : 178-182

A study on pattern of ocular injuries in Delhi


Deptt. of Ophthalmology, Maulana Azad Medical College, New Delhi, India

Date of Web Publication24-Dec-2007

Correspondence Address:
S.R.K Malik
Deptt. of Ophthalmology, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Malik S, Gupta A K, Chaudhry S. A study on pattern of ocular injuries in Delhi. Indian J Ophthalmol 1968;16:178-82

How to cite this URL:
Malik S, Gupta A K, Chaudhry S. A study on pattern of ocular injuries in Delhi. Indian J Ophthalmol [serial online] 1968 [cited 2020 Aug 9];16:178-82. Available from: http://www.ijo.in/text.asp?1968/16/4/178/37549

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Table 1

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Table 1

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Despite the protection afforded to the eye by nature anatomically by its situation in the elastic fatty tissue of the orbital cavity, overhung on all aspects, except downwards and out­wards by sturdy bony projections of the orbital rim and the nose, and physiologically by the vigilance exer­cised by the blink reflex and head turning reflex on approach of an ob­ject which can be seen, and the copious lacrimation which follows intrusion of any irritant material, injuries of the eye which lead to permanent blindness, are not uncom­mon. It is because of this reason that ocular injuries attain great socio­economic importance in Ophthalo­mology. This subject has been taken up for study because of its ever in­creasing importance in our own country following rapid growth in industrialization. The present paper deals with the pattern of ocular inju­ries we have come across in Irwin Hospital during the past six years so that appropriate measures can be instituted to prevent them.


  Methods and material Top


The present study deals with cases of ocular injuries encountered by us at Irwin Hospital during the last 6 years, 1962-67. This is one of the main hospitals which caters not only to local population of Delhi amount­ing to about 4 millions but also cases referred from surrounding villages and small towns which do not have adequate hospital facilities. During this period of study a total of 6529 cases of ocular injuries were encountered by us. This gives an incidence of 2.7% of all ophthalmic patients attending the hospital. Out of the total number of cases, 6180 patients were cases of minor injuries while 349 cases had major injuries which re­quired admission to the hospital.

The cases of minor injuries e.g. corneal foreign bodies, subconjunc­tival haemorrhages, small conjuncti­val tears, lid abrasions and photoph­thalmia do not require further analysis. Subsequently observations and discussion in the paper deal with cases of major injuries only.


  Observations Top


Observation on 349 cases of major ocular injuries have been summarized in [Table - 1],[Table - 2],[Table - 3] below.


  Discussion Top


General Incidence:

The incidence of ocular injuries varies from country to country de­pending on the degree of industriali­zation of the area and whether the incidence of superficial foreign bodies and minor injuries is included in the estimates or not. It also depends on the location of the hospital in rela­tion to industrial areas. The inci­dence of 2.7 percent seen in our series is relatively low even when compared with the older reports available in the literature - Zander and Geissler (1864), Weidmann (1888), Praun (1899), Cridland (1929). The recent reports on the subject give an incidence of 109 in non-industrialized areas and 30 - 50% in industrial areas (Sorsby - 1964). The relatively low incidence of ocular injuries in our series is due to the fact that our country still lags considerably in in­dustrialization, and some of the patients do not come to the hospital for treatment.

Sex and Age Incidence:

As reported by many other work­ers - Duke Elder (1949), Werner (1952), Holland (1961), Macdonald (1964), the incidence of ocular inju­ries is extremely high in males (86.3% in our series) because they are more exposed to occupational and outdoor hazards - [Table - 1].

79.6% cases of ocular injuries in our series were below the age of 30 years. A high incidence of ocular injuries during this age period is because of higher incidence of accidents amongst children and occupational injuries among adults.

Duration after which patients reported for treatment:

Majority of patients - 83.1% attend­ed the Hospital within 24 hours after receiving the injury. This agrees with the observation of Trevor-Roper (1964), Stevens (1956) and Chisholm (1964).

Type of Ocular injuries:

The incidence of mechanical inju­ries was 92% as compared to chemical and thermal injuries which constitu­ted only 8% total cases of ocular inju­ries. Out of the mechanical injuries 45.2% were perforating injuries, with 3.4% having retained intra-ocular foreign body [Table - 2]. Occupa­tional injuries in our series constitu­ted only 19.7% of the total cases, while Praun (1899) and Garrows (1923) reported the incidence as high as 70%.

Holland (1961) found perforating injuries to be commonest i.e. 39.2% followed by contusions 37.6%. Macdo­nald (1964) found perforating injuries in 51.6% cases, contusions in 41.7% cases while thermal and chemical injuries were found in only 6.7% cases.

Some interesting observations regarding etiology:

Ocular injuries are caused by all types of objects, at times under pecu­liar circumstances. Road side acci­dents and fist blows were commonest causes of contusion injuries - 64 cases [Table - 3]. Ocular injuries due to roadside accidents, assume great importance in Western countries where automobile accidents are the commonest cause of death. There were 151,000 cases of car accidents in U.S.A. during the year 1962 and 9.8% of these cases had associated ocular injuries (Keenay, 1964).

The most striking observation is the immense number of non-occupa­tional injuries as against occupational 280: 69 suggesting that the hazards of a city civil life are no less than that of industry in Delhi. It is worth emphasising that point.

In our series the incidence of ocu­lar injuries under non-occupational causes is 280 (4 times as many) as against only 69 under occupational causes. This brings to light the high degree of hazards in city civil life which do not seem to be any less than in occupational and industrial envi­ronments.

As against mere numbers, when we compare the incidence of perforating injuries we can get an idea of the severity of the injuries. Perforating injuries were in the case of non­-occupational injuries 110 (i.e. only 3 times as many) against 35 under oc­cupational injuries. Thus comparati­vely occupational injuries were of a more severe nature, though non-oc­cupational injuries were by no means trivial.

Perforating injuries both with and without retained intraocular foreign body were commonly due to various tools used (mainly hand hammer and chisel) in different occupations. This constituted 9.1% of all ocular injuries and 46.3% of occupational injuries. Roper-Hall (1964), Stevens (1956), Levy (1958) and Sorsby (1964) found that injury caused while working with hammer and chisel was the common­est cause of perforating injuries especially with retained intra-ocular foreign bodies.

A large number of our cases .i.e. 33 (9.4%) in number, received injury while playing with bow and arrow and guli-danda - a popular game amongst Indian children. Out of these cases, two-thirds received perforating injuries of the eye ball. Incidence of the injury caused by bow and arrow rises considerably during the festival clays when majority of children take to this game as a part of festive ritual,

We observed an isolated case where ocular injury was due to fall during an epileptic fit.

Structural involvement.

The following is the order in which various ocular structures were involved in our series.

(1) Cornea (55.8%), (2) Iris (44.1%), (3) Eye lids (33.2%), (4) Lens (26.3%), (5) Conjunctiva (20.3%), (6) Ant. Chamber (18.0%) (7) Post. Segment (17.0%), (8) Extraocular structures (5.1%).


  Summary Top


A total number of 6529 cases of ocular injuries were encountered by us from 1962-67. 6180 cases were of minor injuries while 349 cases were of major injuries. Only the cases of major injuries have been studied re­garding age and sex incidence, mode of injury and the structural damage.

The hazards of city civil life are exposed to be of a high degree of incidence and severity.[15]

 
  References Top

1.
CRIDLAND (1929) quoted from Duke -Elder Text Book of Ophthalmology, Vol. VI, Henry Kimpton, London.  Back to cited text no. 1
    
2.
CHRISHOLM, I. A. (1964) Brit. Jour. Ophth. 48, 364.  Back to cited text no. 2
    
3.
DUKE ELDER S. S. (1954) - Text Book of Ophthalmology Vol, VI, Henry Kimpton, London.  Back to cited text no. 3
    
4.
HOLLAND, G. Eye and Lid injuries in childhold-(In German) Klin, Mbl. Augenheik, (1391, P. 172 (1961).  Back to cited text no. 4
    
5.
KEENAY A. H. Industrial and Trau­matic Ophthalmology symposium of New Orleans Academy of Ophthalmo­logy. The C. V. Mosby Co-Saint Louis (1964).  Back to cited text no. 5
    
6.
LEVY, W. J. Brit. Jour, Ophthal. 42' 610.  Back to cited text no. 6
    
7.
MACDONALD Jr. R. (1964) quoted from Keenay Industrial and traumatic ophthalmology symposium of New Or­leans Academy of Ophthalmology C. V. Mosby Co-Saint Louis (1964).  Back to cited text no. 7
    
8.
PRAUN (1899) quoted from Duke - Elder S. 3. Text book of Ophthalmology Vol. VI, Henry Kimpton London (1964).  Back to cited text no. 8
    
9.
ROPER HALL, M. J. (1954) Brit. Jour. Ophthal. 38, 65.  Back to cited text no. 9
    
10.
SORSBY - A. Modern Ophthalmology Vol. 3, P. 392. Butterworth London (1964).  Back to cited text no. 10
    
11.
STEVENS, P. R. (1956); Brit. Jour. Ophth. 40, 622, 1956.  Back to cited text no. 11
    
12.
TREVOR-ROPER, P. D. (1944) Brit. Jour. Oph. 28, 361.  Back to cited text no. 12
    
13.
WERNER 1952) Acta Ophthal. xxx, 97.  Back to cited text no. 13
    
14.
WEIDMANN (1888), quoted from Duke - Elder W. S. text book of Ophthalmology. Vol. VI, Henry Kimpton, London (1964).  Back to cited text no. 14
    
15.
ZANDER AND GEISSLER (1864) quoted from Duke - Elder W. S. text book of ophthalmology. Vol. VI, Henry Kimpton, London (1954).  Back to cited text no. 15
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]



 

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