Year : 1979 | Volume
: 27 | Issue : 1 | Page : 33--36
A clinical study of ocular injuries
IM Shukla, RN Verma
Pt. J.N.M. Medical College, Raipur, India
I M Shukla
Professor of Ophthalmology, Pt. J.N.M. Medical College, Raipur, (M.P.)
|How to cite this article:|
Shukla I M, Verma R N. A clinical study of ocular injuries.Indian J Ophthalmol 1979;27:33-36
|How to cite this URL:|
Shukla I M, Verma R N. A clinical study of ocular injuries. Indian J Ophthalmol [serial online] 1979 [cited 2020 Jun 5 ];27:33-36
Available from: http://www.ijo.in/text.asp?1979/27/1/33/31544
The role of ocular injuries in causation of blindness has been a subject of immense importance and will remain so because of the rapid industrialisation and mechanised farming which is coining up in our country. Despite anatomical and physiological natural protection afforded to the eye, injuries of the eye leading to blindness of various degree ranging from little deterioration of vision to permanent blindness are quite common. The area in which this study has been conducted covers about 1/4th of the population of Madhya Pradesh which is not only socio-economically backward but is also full of illiteracy, superstitions and orthodox beliefs. The pattern of injuries found here will be of utility not only in view of methods to be adopted for their protection but also as an eye opener for similar type of population in other parts of our country.
Material and Methods
The present study deals with cases of ocular injuries encountered by us at Pt. J.N.M. Medical College & associated D.K. Hospital, Raipur from November 1976 to May 1978. During this period 400 cases of ocular injuries were recorded giving an incidence of 2.27% of all ophthalmic patients attending the hospital. Out of the 400 cases, 230 cases had minor injuries while 170 cases had major injuries and required hospitalisation.
Observation on 400 cases of ocular injuries have been summarised in [Table 1],[Table 2],[Table 3],[Table 4].
Observations and Discussion
The incidence of ocular injuries varies from place to place depending upon the degree of industrialisation, advanced methods of protection and intelligence of the population and also whether the minor injuries are included in the estimates or not. The incidence of 2.27% of our series is very low as compared to older reports in literature. Zander & Geissler 1.8-9%, Weidmann 10.41%, Praun 4.89%, Cridland 39%, Sorsby 10% in non-industrialised area and 30-35% in industrial areas, Yuasa et al 7.8%, but is quite comparable to the reports available from India Malik et al 2.7%.
Age and Sex Incidence
The incidence of ocular injuries is extremely high in males 83.25% in our series because they are more exposed to occupation and outdoor hazards. Many other workers also agree with this finding. Duke Elder, Werner, Holland and Macdonald Malik et al and Lambah and Olurin all reported an incidence of 83,75,94.3% injuries in males.
Commonest age group for occular injuries in our series was third decade 29.5%. Doshi and Olurin also agree with this. According to them the injury in third decade was 32% and 33% respectively. Malik et al reported the incidence below 30 years of age as 79.5%.
Duration of injury and first observation
Majority of patients attended the hospital within 24 hours after receiving injury. Malik et al reported that 83.1% cases attended with in 24 hours. In the present series, [Table 4] only 31.50% attended the hospital within 24 hours, while majority of cases attended the hospital within 1-7 days. The factors responsible for such a sense of resignation are illiteracy, orthodox beliefs and customs, besides long distances.
Nature of ocular injuries
In our series, occupational injury was much less-29%. The western figures are however much higher in occupational group probably for their advancement in industrial spheres. Praun, Garrow and Duke Elder reported the incidence as high as 70%. In India non-occupational injuries are more (83.3%) as reported by Malik et al. In present series it accounted for 71% of cases.
The incidence of mechanical injury was 94.25% as compared to chemical & thermal injuries which constituted only 4.5% of ocular injuries. Out of mechanical injuries 13.26% were perforating injuries with 1.59% having retained intra-ocular foreign body [Table 3]
Holland found perforating injuries to be commonest 39.2% followed by contusions 37.6%. Macdonald found perforating injuries in 51.6%, contusions in 41.7% while thermal and chemical injuries were found in 6.7% cases. Malik et al sub reported mechanical injury in 92%, chemical and thermal injury 8%. In his series 45.2% were perforating injuries against mechanical injuries with 3.4% retained intraocular foreign bodies. Olurin reported 56% cases of perforation of globe.
In western countries road side accidents are more common. Keenay reported 9.8% of ocular injuries amongst 1,51,000 car accidents in U.S.A. during the year 1962. Eagling found that injuries in road side accidents are less 31%. Malik et al reported only 8.12% and in our present series it was only 2.5%.
Amongst the occupational injuries 46.56% are of agricultural origin in our series and is obviously due to predominance of agriculturers in our country. Injury with paddy leaf, straw and vegetable grass was the commonest injury observed in our agricultural patients. According to Duke Elder common accidents in agricultural group was by hedge trimming, bush cutting and chemical fertilisers. Hedge trimming and bush cutting is neither a common event in our country, nor our farmers use much of chemical fertilisers. Hence these two types of injuries were not seen in our cases. The incidence of quadruped accidents in our series was much higher than that of Smith and Duke Elder and that is obviously due to our agriculturers mostly depending on quadrupeds for ploughing.
Perforating injuries both with and without retained intra-ocular foreign bodies were commonly due to various tools used in different occupations. This accounted for 1.75% of all ocular injuries and 6.03% of occupational injuries. Roper Hall , Stevens Levy and Sorsby found that injury caused while working with hammer and chisel was the commonest cause of perforating injuries especially with retained intra-ocular foreign bodies. Malik et al found that perforating injury due to various tools was 9.1% of all ocular injuries and 46.3% of occupational injuries.
Most commonly affected structure was the conjunctiva 92.5% in present series. According to Malik et al cornea was affected in 55.8% in their series while 64% came with corneal involvement in our series. Other structures were involved in following orders. Lids 21.75%, iris and ciliary body 19.25%, lens 10.5%, retina and choroid 5.5% and sclera 2.75%.
A total number of 400 cases of ocular injuries were recorded by us during November 1976 to May 1978. 230 cases had minor injuries while 170 cases were of major injuries. All the cases of ocular injuries have been studied regarding age and sex incidence, mode of injury and structural damage.
We are very thankful to Dr. S.S. Gupta Dean, Pt. J.N.M. Medical College Raipur for his kind permission to publish this paper.
|1||Chisolam I.A., 1964, Brit. J. Ophthal. 48, 364.|
|2||Cridland, 1929, Brit. Med Jour., 2, 615.|
|3||Doshi, R.R., 1968, Jour. All India Oplithal. Soc. 16,210.|
|4||Duke Elder S.S., 1972, System of Ophthalmology 6, 5, 33 Henry Kimpton London.|
|5||Eagling E.M., 1976, Brit. J. Ophthal., 60, 732.|
|6||Garrow, 1923, Brit. J. Ophthal., 7, 65.|
|7||Holland G., 1961, Klin Mbl. Akugenheil, 139, 72.|
|8||Keenay A. H., 1964, Industrial & Traumatic Ophthalmology, (Symp. New Orleans Acad. Ophthal.) C.V. Mosby St. Louis.|
|9||Lambah, 1968, Trans. Ophthal. Soc. U.K., 88, 661.|
|10||Levy W.J., 1958, Brit. J. Ophthal., 42, 610.|
|11||Macdonald Jr. R., 1964. Industrial and traumatic Ophthalmology, (Symp. New Orleans Acad. Ophthal.) St. Louis, 82.|
|12||Malik S.R.K., Gupta A.K. & Chaudhry S., 1968, Jour. All India Ophthal. Soc, 16, 178.|
|13||Olurin Oyin, 1971, Amer. J. Ophthal, 72, 158.|
|14||Praun, 1899, Quoted Duke Elder System of Ophthalmology 1972, Vol. XIV 5, 52 Henry Kimpton, London.|
|15||Roper Hall M.J., 1954, Brit. J. Ophthal., 38, 65,|
|16||Smith, 1940, Trans. Ophthal. Soc. U.K., 62, 252.|
|17||Sorsby A., 1964, A Modern Ophthalmology, 3, 392 Butterworth, London.|
|18|| Stevens P.R., 1956, Brit. J. Ophthal. 40, 622. |
|19||Trevor-Roper P.D., 1964, Brit. J. Ophthal,, 28,361.|
|20||Weidmann, 1888, Ueber d. Verletzungen d Auges durch Fremdkorper (Dins.) Zurich.|
|21||Werner, 1952, Acta. Ophthal. (Kbh)., 30, 97.|
|22||Yuasa, Bessyo Ishibashi & Seguchi, 1967, Folia Ophthal. Jap., 18, 717.|
|23||Zander & Geissler, 1864, Die Verletzungen des Auges Leipzig.|