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   Table of Contents      
ORIGINAL ARTICLE
Year : 1994  |  Volume : 42  |  Issue : 4  |  Page : 199-201

A review of childhood admission with perforating ocular injuries in a hospital in north-west India


Department of Ophthalmology, Christian Medical College & Hospital, Ludhiana, India

Correspondence Address:
S G Jaison
Department of Ophthalmology, Christian Medical College & Hospital, Ludhiana 141 008
India
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Source of Support: None, Conflict of Interest: None


PMID: 10576997

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  Abstract 

A retrospective study of perforating ocular injuries in children below the age of fifteen years was conducted. Eighty patients (eighty-nine eyes) were included in this study. Male children were more susceptible to ocular injury as compared to females (p = < 0.01). Children of the school-going age were the most affected (73.8%). Majority of the injuries occurred in the sports field (p = < 0.01). Playing with bow and arrow, and gillidanda* accounted for majority of the sport injuries (47.2%). Sixty-eight percent of the perforated eyes had no light perception at the end of treatment. Health education on the preventive aspects of ocular injuries in schools as well as through mass media should reduce the incidence of visual loss due to ocular injuries.

Keywords: Ocular injury - Perforation - Visual loss.


How to cite this article:
Jaison S G, Silas S E, Daniel R, Chopra S K. A review of childhood admission with perforating ocular injuries in a hospital in north-west India. Indian J Ophthalmol 1994;42:199-201

How to cite this URL:
Jaison S G, Silas S E, Daniel R, Chopra S K. A review of childhood admission with perforating ocular injuries in a hospital in north-west India. Indian J Ophthalmol [serial online] 1994 [cited 2019 Oct 14];42:199-201. Available from: http://www.ijo.in/text.asp?1994/42/4/199/25564



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Despite advances in diagnostic and therapeutic methods, ocular trauma remains a significant cause of visual impairment. Visual impairment in child­hood is of greater significance as, in addition to physical disability, it has major impact on social and psychological development of the victim. The other difficulties that might contribute are parents who discontinue treatment, the optical correction of mo­nocular aphakia, and the possibility of amblyopia in children.

The American National Society for Prevention of Blindness has estimated that 55% of ocular injuries occur before the age of twenty-five years and that one-third of eye loss in the first decade of life is due to ocular trauma [1]

Ocular trauma in childhood is of great significance especially from the prophylactic view. It is important to determine the magnitude of the problem and identify the major causes for suggesting preventive strategies. Hence, a review of perforating ocular injuries in children below the age of fifteen years, who were hospitalised in the Department of Ophthal­mology, Christian Medical College and Hospital, Ludhiana, from January 1981 to April 1990, was undertaken. Since hospital admission is mandatory for patients with perforating ocular injuries, patients who refused admission were not included in this study.


  Materials and methods Top


The medical records of patients with the diagnosis of perforating ocular trauma were reviewed. Of these, 80 were of children below 15 years of age. These records were analysed in detail to determine the aetiological factors, the magnitude of visual impairment, and to identify the target group so as to suggest preventive measures.

The visual acuity recorded on Snellen's chart at the first follow-up visit was considered in this study. However, in eight uncooperative children visual acuity could not be determined.


  Results Top


The age and sex distribution of perforating ocu­lar trauma are shown in [Table - 1]. Perforating ocular trauma was more common in male children as compared to females (p= < 0.01). Moreover, 73.8% of the injuries occurred in children of school-going age. Thus, children of school-going age seem to be the most affected by ocular trauma.

Aetiology of ocular trauma in children as observed in this study is shown in detail in [Table - 2]. Majority of the injuries occurred in the sports field (p= < 0.01). Playing with sharp wooden objects like gillidanda, and bow and arrow were the major cause (40/89; 45%) of perforating ocular trauma in the play ground. The domestic injury was caused mostly by glass and knife (15/89; 16.9%). Interestingly, fire crackers though used only during festivals was the cause of nearly 1/6th of the total injuries (15.7%).

The visual outcome and site of perforation are shown in [Table - 3]. In 55 of the 81 eyes (68%) in which the visual acuity was recorded, there was no light perception while only 19 of 81 eyes (23.5%) had visual acuity > 6/36.


  Discussion Top


Though many reports are available on ocular in­juries, [2],[3],[4],[5] only scanty literature is available on ocular injuries in children in our country. As the epidemi­ology of ocular injuries varies from community to community and region to region, the present retro­spective study was undertaken to gather information on the epidemiology and visual outcome of perfo­rating ocular injuries in children under the age of fifteen years in North-West India.

In this study the male children were found to be more vulnerable (p= < 0.01). The ratio of males to females was 3.7:1. The high incidence of ocular injuries in males in this study is consistent with findings of most other such studies. [6],[7],[-8]

A possible explanation for this fact is the greater mobility and activity in male children. The signifi­cantly higher occurrence of ocular injury in male children may also be the result of their greater exposure to injuries in general and a higher incidence of violent outdoor activities among them.

In our study, majority (40%) were children of the 6 to 10-year age group. On statistical analysis comparing the three age groups, the difference did not reach statistical significance, probably because the numbers were small. The higher incidence of 6 to 10­year age group is consistent with the findings of studies done in Lesotho [6]sub and Finland [7] but different from the Brazilian study where the incidence was higher in children below the age of five years. The 6 to 10-year age group (primary school-going) chil­dren in this part of India undertake games like gil­lidanda, and bow and arrow without understanding the dangers of these games and are often left to play unsupersed.

Ocular injuries occurring during sport activities accounted for 52.8% of the injuries in our study, whereas domestic accidents formed only 31.5% (p= < 0.01). These observations are consistent with most of the previous studies [7],[8],[9],[10] except for studies from Malawill [11]sub and Iceland [2] where domestic injuries accounted for most of them. In our study the main sports that resulted in the ocular injury was playing with bow and arrow, and gillidanda (47.2%), which is similar to the finding of Panda et al. [12] However, a study reported from Jaipur [13]sub found fire cracker injury to be the commonest mode among children below the age of 14 years. This study had included only 22 patients and was conducted over a 15-month period which included the festival seasons of 2 years. This probably explains the higher incidence of fire cracker injury in this study.

Visual loss in ocular injuries varies with the extent of ocular damage. In the Western reports around 30% of patients who suffer severe ocular injuries end up with no useful vision (visual acuity < 6/60). [8] In our study, 68% of the children ended up having no light perception. This marked difference in visual outcome is mainly because of the nature of injury. As men­tioned earlier, majority of our patients had injury caused by unsterile pointed wooden objects. Another reason for this marked difference may be the delay in availability of specialised treatment. Thus, on the whole, the visual loss due to ocular injury in chil­dren is almost twice that of the West and all efforts should be made to prevent the sight-threatening injuries.

The current study points to male children of the school-going age as the high-risk group and the play ground as the high-risk site for ocular injuries. With regard to prevention, continual and efficient health education of the children, teachers and parents of this high-risk age group should bring about good preven­tive results. Health education on the preventive aspects of ocular trauma in schools as well as through mass media like television can help in achieving this goal. Nonetheless, health education should lay emphasis on the hazards of games like gillidanda, and bow and arrow. *Gillidanda is a regional sport played with a gilli. Gilli is a spindle-shaped wooden piece 4 to 5 " in length, which is hit with a long stick with great force.



 
  References Top

1.
Koval R, Teller J, Belkin M, et al. The Israeli ocular injuries study: A nationwide collaborative study. Arch Ophthalmol 106:776-780, 1988.  Back to cited text no. 1
    
2.
Thordarson U, Ragnarso AT, Gudbrandsson B. Ocular trauma: Observation in 105 patients. Acta Ophthalmol 57:923-928, 1979.  Back to cited text no. 2
    
3.
Zagelbaum BM, Tostanoski JR, Kerner DJ, et al. Urban eye trauma - A one-year prospective study. Ophthal­mology 100:851-856, 1993.  Back to cited text no. 3
    
4.
Saini JS, Mukherjee AK, Dabral SM, et al. A profile of penetrating eye injuries. Indian J Ophthalmol 33:95-97, 1985.  Back to cited text no. 4
    
5.
Parmar IPS, Nagpal RC, Sunandan S. Pattern of ocular injuries in Haryana. Indian J Ophthalmol 33:141-144, 1985.  Back to cited text no. 5
    
6.
Gorden YJ, Mokete M. Pediatric ocular injuries in Leso­tho. Doc Ophthalmol 53:283-289, 1982.  Back to cited text no. 6
    
7.
Niiranen M, Raivio I. Eye injuries in children. Br J Ophthalmol 65:436-438,1981.  Back to cited text no. 7
    
8.
Moreira CA Jr, Ribeiro MD, Belfort R Jr. Epidemiological study of eye injuries in Brazilian chil­dren. Arch Ophthalmol 106:781-784, 1988.  Back to cited text no. 8
    
9.
Rapoport I, Romem M, Kinek M, et al. Eye injuries in children in Israel. A National Collaborative Study. Arch Ophthalmol 108:376-379, 1990.  Back to cited text no. 9
    
10.
Canavan VM, O'Flaherty MJ, Archer DB, et al. A ten year survey of eye injuries in Northern Ireland. Br J Ophthalmol 64:618-625, 1980.  Back to cited text no. 10
    
11.
Ilsar M, Chirambo M, Belkin M. Ocular injuries in Malawi. Br J Ophthalmol 66:145-148, 1982.  Back to cited text no. 11
    
12.
Panda A, Bhatia IM, Dayal Y. Ocular injuries - A socio -economic importance; Afro Asian J Ophthalmol 111:163-174, 1985.  Back to cited text no. 12
    
13.
Sarda RP, Mehrotra AS, Ratnawat PS, et al. Ocular injuries in childhood. Indian J Ophthalmol 19:67­70,1971.  Back to cited text no. 13
    



 
 
    Tables

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


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