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GUEST EDITORIAL
Year : 1987  |  Volume : 35  |  Issue : 3  |  Page : 110-111

Ocular trauma


Madras, India

Correspondence Address:
S S Badrinath
Madras
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Badrinath S S. Ocular trauma. Indian J Ophthalmol 1987;35:110-1

How to cite this URL:
Badrinath S S. Ocular trauma. Indian J Ophthalmol [serial online] 1987 [cited 2019 Dec 15];35:110-1. Available from: http://www.ijo.in/text.asp?1987/35/3/110/27315

The loss of visual function due to trauma to eye or its adnexa is a great tragedy. In most instances it is a preventable calamity. Dr Arun Elhence, Dr Mythill Sriram and I reported that ocular trauma accounted for 2.58% of all ophthalmic patients seen in our outpatient department bet­ween September 1978 and June 1984. Two thirds of the patients were below the age of 30 years and the male preponderance to females was 5.4 to 1. Domestic accidents (65%) were responsible for the majority of injuries Blunt trauma (46.94%) was more common than the penetrating trauma (32.4%).

The injury may involve lids, lacrimal apparatus, bony orbit, the adjacent structures, the eye ball and the visual pathway. The visual loss is pronoun­ced in penetrating injuries of the eye. The cornea bears the main brunt and lacerations of this result in iris prolapse, endophthalmitis and even phthisis bulbL Lens changes, retinal detachment, macular and optic nerve damage were more common with blunt injury. Vitreous haemorrhage occurred with almost equal frequency in both penetrating and blunt trauma. Nearly 30% of patients in the above survey were blind due to sequelae of ocular trauma

Among the major recent advances in medicine, both ultrasonography and computerized tomo­graphy have greatly improved the preoperative assessment of ophthalmic trauma. The ultra­sound being capable of penetrating eye with hazy media provides information regarding the integrity of posterior capsule in a traumatic cataract it enables the study of vitreous haemorrhage and warns the surgeon of the presence of traction membranes detachment of retina and the pre­sence of intraocular foreign body. The presence of double perforation is also detectable. The study of orbital foreign bodies, bony fractures including that of orbital floor and of the optic canal are best done with the CT Scan

Fundamentals in the management of ocular trauma include a careful history and a systematic and meticulous ocular examination Visual acuity must be elicited in every case before the treatment is started. Prophylaxis against tetanus is instituted while the required first aid is being given One should not waste the "Golden Hour" in trauma care and must arrange for immediate transport­ation of the cases to centres equipped to deal with complicated cases Antibiotic therapy against sepsis should also be started at this hour.

Modern ophthalmic surgery requires use of operating microscope, microsurgical instruments and sutures Facilities for comeal surgery, pars­plana vitrectomy, detachment surgery, manage­ment of intraocular foreign bodies, plastic surgery of lids and orbital surgery must be available in these advanced referral centres

The visual acuity improved by 2 lines or more in 68.72% of patients surgically treated by us The results were better in eyes that needed a single procedure such as Lensectomy, Vitrectomy or scleral buckling alone than those that needed a combination of these procedures Eyes with blunt injury seemed to carry a better prognosis when compared to those with penetrating injuries. The reason for achieving better results in single pro­cedures as well as in blunt injuries that in these the tissue damage is less severe rendering manage­ment easier.

Vitrectomy has ushered in a new era and many eyes considered hopeless and beyond repair previously can now be saved from severe compli­cations of ocular trauma. 65.5% showed an overall improvement in visual acuity following the pars­plana vitreous surgery procedures for vitreous haemorrhage, intraocular foreign body and complicated retinal detachment The success rate was 78.6%, if the site of trauma involved only the anterior segment, 77.78% if it involved only the posterior segment and drastically dropped to 42.31 % if both the anterior and posterior segments were involved clearly reflecting that more severe the initial injury, poorer the prognosis We had good results even when the surgery was performed after a delay of nearly 3 months following the injury though most authorities believe that it is ideal to interfere by parsplana techniques during the 2nd window period

As in most published results, we also found that eyes with good visual acuity prior to treatment maintained good vision following surgery.

The adage "Prevention is Setter than, cure" applies more aptly in the case of ocular trauma If there is mass awareness of inherent dangers of games such as bow and arrow, gilli dandu etc, teachers, parents, elders and children could prevent countless number of perforating injuries occurring in children. Education regarding use of sharp pencils, dividers etc. would likewise have beneficial effect Legislation in certain states of USA that outlawed fireworks has reduced the incidence of ocular fireworks injuries Proper eye safety measures can prevent almost all sports eye injuries The various protectors such as total head protector, full face protector, helmet with separate eye protector, helmets or sports eye protectors of class 1, 2 and 3, must be made freely available in our country. If a prescription lens is required to be worn by the athletes it must be made of polar borate or CR 39 or atleast of shatter proof glass

Ophthalmology has a vital role of play in the emerging new branches of medicine namely sports medicine and industrial/ occupational health medicine The three components of an eye care program in an industry are vision screening, determining the vision requirements and eye hazards and advising on appropriate protective and corrective eye wear. In the screening, the ophthalmologists evaluates the visual acuity, visual fields, binocular fusion, eye muscle balance, color vision and active eye diseases The second component of eye care program in an industry requires determining the visual requirements and eye hazards of the job. One method uses statistics to help define the association between successful job performance and a worker's visual skills (PURDUE VISION STANDARDS). The second method is to observe a job on-site to evaluate the visual danger involved. Visual skills of the worker should always meet the visual requirement of the job. He must wear corrective safety eye wear for the specific distance at which the job task is performed. Any worker with visual acuity of 6/12 or less should be referred to an ophthalmologist Industries must have well trained first aid teams with adequate medicines, irrigating solutions etc to deal with chemical bums.

An Assistant Director General under the DGHS, New Delhi formulates policies regarding trauma for the Govt of India Tamil Nadu Association for Trauma Care founded in 1982 has developed a 3 tier system for management of trauma First tier is a first aid post and the second tier is the casualty receiving station. There are 40 such stations in the 20 districts of Tamil Nadu Complete trauma and emergency care is found in these centres which are equipped with all infrastructures such as building, adequate manpower, finance etc More difficult cases are referred to Teaching Hospitals which have a separate trauma unit with 30 beds and specialists such as Neurosurgeon, Thoracic surgeons etc An Ophthalmologist must be one of the members of the team in second and third tier levels

WHO Statistics indicates that accident rate has increased in India by 7.5% annually and the death rate by 12.3%, indicating the lack of adequate medical facilities The mortality due to road accident is 5-10/1000 vehicles in USA while it is 70-80/1000 in India Stringent laws against defective vehicles on the road and drunken driving will reduce the accidents related to ocular mortality and morbidity.

The Regional Labour Institutes located in Kanpur, Calcutta, Bombay and Madras display and pro­vide information on the availability of safety glasses Industrial Ophthalmology/Optometry needs to be developed as a separate specialty in India The occupational health institute BHEL (Tiruchirapalli, Tamil Nadu) funded by Intonational Labour Organization (A United Nations Organization) and also universities could start a course in "Diploma in Industrial and Occupational health" with special emphasis on ocular trauma and management

In conclusion I believe, better preventive measures and utilisation of recent advances in preoperative assessment and management would greatly reduce ocular morbidity and mortality due to trauma




 

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