Year : 2001 | Volume
: 49 | Issue : 1 | Page : 43--47
Occupational open globe injuries
Usha Vasu1, Andrew Vasnaik1, RR Battu1, Mathew Kurian2, Sony George2,
1 MS. Department of Ophthalmology, St. John's Medical College Hospital, Bangalore, India
2 MBBS. Department of Ophthalmology, St. John's Medical College Hospital, Bangalore, India
MS. Department of Ophthalmology, St. John«SQ»s Medical College Hospital, Bangalore, India
|How to cite this article:|
Vasu U, Vasnaik A, Battu R R, Kurian M, George S. Occupational open globe injuries.Indian J Ophthalmol 2001;49:43-47
|How to cite this URL:|
Vasu U, Vasnaik A, Battu R R, Kurian M, George S. Occupational open globe injuries. Indian J Ophthalmol [serial online] 2001 [cited 2020 Apr 1 ];49:43-47
Available from: http://www.ijo.in/text.asp?2001/49/1/43/22663
Ocular trauma is the cause of blindness or partial loss of vision in more than half a million people worldwide. It is regarded as the most important cause of monocular blindness in the USA.[1,2] About one quarter of all serious eye injuries are related to activities in the workplace. According to a Finnish report, eye injuries account for 12% of all work related injuries Unfortunately, work-related ocular injuries have not received enough attention in India. The Indian statistics on occupational eye trauma are not yet available. In a rapidly industrialising country like India, occupational eye injury is particularly common as the hazards of the workplace are not yet appreciated by workers or their supervisors. In this paper, we present the circumstances under which the occupational open globe injuries were sustained and their clinical findings. We have also outlined the preventive and protective measures that would help reduce the number of occupational eye injuries.
Materials and Methods
We reviewed the in-patient records of 129 patients with open globe injuries attending the Emergency Medicine Department of St. John's Medical College Hospital during 1994-98. Of these, 43 patients with occupational open globe injuries were entered into this study. The demographic and clinical data included:
a) Age and gender;
b) Type of injury, nature of work and associated hazard that caused the eye injury;
c) The type of industry was classified as agricultural, mining, iron and steel and others e.g.,small scale industry);
d) The use of industrial grade protective eye wear at the time of sustaining the injury was noted. If the patient was wearing the eye wear on at the time of injury, we checked whether the eye wear was appropriate for the occupation. We also examined whether it confirmed to the standards set by the Bureau of Indian Standards;
e) A history of alcohol consumption at the time of sustaining the injury was specifically elicited,
f) The severity of the injury was graded on an injury scale. We used the anatomic and physiologic variables specified in the International Ocular Trauma Classification. These factors were: (i) visual acuity at the time of presentation; (ii) pupillary reaction in the affected eye. If this was not possible due to hyphaema, the consensual reaction in the other eye was noted; (iii) the extent of laceration; and (iv) the type of injury: penetrating, perforating and rupture with or without intraocular foreign body.
The severity was graded as mild, moderate or severe on the basis of the score given to each factor as shown in [Table:1], adopted from the Organ Injury Scaling VII described by the American Association for the Surgery of Trauma (AAST).
g) The medical treatment given to the patients was noted.
h) The surgical procedures were classified as primary (performed immediately after admission) and secondary (those done later).
i) Visual acuity at 6 months follow up was noted from outpatient records. The vision was graded good (VA 6/12 or better,) fair (VA between 6/18 and 6/ 60) and poor (VA less than 6/60).
j) Visual outcome at the end of 6 months was correlated with the type of type of industry, the severity of injury, the use of protective eyewear and history of alcohol abuse.
k) The causes of poor vision at the end of 6 months were analysed.
Of 129 consecutive patients of open globe injuries reviewed, 43 (33.3%) were occupation related; 41 (95.35%) were males and 2 (4.65%) females. Thirty-four (79.06%) patients were between 16 and 45 years of age [Figure:1]. The distribution of the patients in the various industries is shown in [Figure:2].
Of the 8 patients from the agricultural industry, 3 each (37.5%) sustained injuries due to sickle and sticks. One (12.5%) patient with a bull gore injury, under the influence of alcohol when injured. None of them wore protective eyewear. In the mining industry, all 8 patients sustained dynamite blast injuries. Six (75%) of these patients were not wearing the recommended protective eyewear. In the iron and steel industry 12 (63.15%) patients suffered injury while working on the lathe machine and 7 (36.84%) while working on the grinding machine. Thirteen (68.42%) patients were not using the recommended eyewear and 4 (21.1%) were under the influence of alcohol. Six (75%) of the 8 patients with eye injuries in the small-scale industries were not wearing the recommended protective glasses. Overall, 33 (76.74%) of the 43 patients did not use any form of eye protection while working and 6 (13.95%) of the patients were under the influence of alcohol [Table:2]
Severe injuries were seen in 1 (12.5%) of 8 patients in the agricultural sector, 7 of 8 patients (87.5%) in the mining industry, 10 of 19 patients (52.63%) in the iron and steel industry and 1 of 8 patients (12.5%) in the small-scale industry [Table:3]. The injuries were mild to moderate in the agricultural sector, moderate in small-scale industry, moderate to severe in the iron and steel sector and severe in the mining industry.
Of the 10 patients wearing recommended industrial eye protection, one (10%) patient suffered severe injury, 5 had (50%) moderate injuries and 4 (40%) had mild injuries. Of the 3 patients wearing only prescription glasses, 2 (66.66%) had severe injuries and one (33.33%) had moderate injury from the glass pieces of the spectacles itself. Of the 30 patients not wearing protective eyewear, 18 (60%) sustained severe injury, and 12 (40%) had moderate injury. [Table:4].
The standard medical treatment for all patients included parenteral antibiotics before and up to one week after primary surgical repair. Postoperatively the patients were put on topical antibiotics, atropine ointment and topical corticosteriods. Antibiotics were changed according to the culture sensitivity results. All patients with a suspected fungal aetiology by history and clinical examination were also started on topical anti-fungal antibiotics.
All patients underwent surgery. Twenty-four (55.81%) patients needed only primary wound closure (corneal or corneo-scleral tear repair as applicable to the case). Ten (23.26%) patients needed lens extraction as well, 6 (13.95%) underwent a primary evisceration and 3 (6.97%) received intravitreal antibiotic injection for suspected endophthalmitis at the time of wound repair. Secondary procedures included extracapsular cataract extraction with posterior chamber lens implantation in 12 (27.91%) patients and evisceration in one patient (2.33%). Six weeks after the trauma, penetrating keratoplasty was done in 4 (9.3%) patients, retinal detachment surgery in 2 (4.65%) patients and vitreous surgery in one (2.33%) patient [Table:5]. All primary surgical repair was done by the anterior segment surgeon alone. No primary vitreoretinal procedure was done.
At the end of 6 months, 8 (18.6%) patients were not available for follow up. Of the 35 patients available for follow up, two (5.7%) patients had good visual they had sustained mild injuries and were wearing recommended protective eyewear at the time of injury [Table:6]. A fair visual outcome was seen in 4 (11.4%) patients, of whom three were wearing the recommended protective goggles and one was wearing prescription spectacles. A poor visual outcome was seen in 29 (82.9%) patients' and none of them were using any protective eyewear. Fifteen (42.85%) patients had no perception of light at the end of 6 months and 12 of them had sustained severe injuries. All 5 patients who had sustained injury while being under influence of alcohol had a poor visual outcome at the end of 6 months. One patient was not available for follow up.
The causes of poor vision at the end of six months were phthisis bulbi in 16 (45.71%) patients and macular scar in 6 (17.14%) patients. No further medical or surgical treatment was attempted in these patients. One patient developed endophthalmitis after primary repair and did not respond to topical and intravitreal antibiotics. This patient subsequently underwent evisceration. Four (11.43%) patients with retinal detachment and 2 (5.71%) patients with vitreous haemorrhage were referred for vitreoretinal surgery. Two others with retinal detachment and one with vitreous haemorrhage could not afford the cost of the surgery [Table:7].
Occupational eye injury is often severe and contributes significantly to loss of productivity. It is also one of the common causes of absence from work. The severity of occupational eye_injury varies from country to country. In developing countries like India activities such as agriculture, carpentry, chiselling and hammering are responsible for many eye injuries. In this five-year study of open globe injuries, 43 (33%) were occupation-related and 34 (79.06%) of these were young adults. This is in agreement which reports from the United States.
This study also emphasizes the need to wear appropriate protective goggles during work, both in agriculture and industry. The possible ocular injuries and hazards in agriculture are not yet listed in the classification of hazards requiring eye and face protection (IS 8520, Clause 2.1). Ocular trauma in the mining industry as a result of explosives is not only related to lack of protective eyewear but also to poor quality of eyewear provided. This is also true in small-scale industry. In this study 33 (76.74%) were not wearing any protective eyewear during work. Comparative statistics of the Bureau of Labour in the USA also show that 59% of the workers do not wear protective eye wear during work. The industrial safety advisory committee recommendations on the use and care of these protective goggles (IS 8940) should be religiously adhered to. In this study, one of 10 patients wearing ISI-certified eye protection had presenting visual acuity <6/60, while 18 of 30 patients (60%) not using protective eyewear had vision <6/60 at presentation. At the end of six months, only those patients using protective eyewear had a good or fair outcome. This implies that use of specified protective eyewear is associated with less severe injuries. American statistics have shown a reduction in the incidence of occupational eye injury from 17.8/million in 1953 to 0 in 1980. Alcohol abuse during work predisposes to serious injuries by slowing down psychomotor responses. Alcohol abuse is not a major factor in work-related injuries in the West. Periodic monitoring of alcohol levels in workers combined with psychosocial measures like counseling will help reduce alcohol-related occupational injuries.
Though this study is too small to draw a meaningful statistical conclusion, it definitely indicates that there is an urgent need to step up safety precautions to prevent such disabling eye injuries. Improved safety features of machines, provision of adequate illumination in working areas, selection of trained workers with adequate vision and alertness, periodic testing for alcohol and finally making, the use of eye protection mandatory, are some of the steps that can be taken towards this goal. We recommend goggles with toughened or laminated glass lenses covering the full face [Figure:3] for agricultural work (eg., cutting wood, plucking fruits, particularly coconuts) and high-impact resistance goggles [Figure:4] for industrial workers. In addition, educating employers and employees can prevent loss of sight following eye injury. These measures will go a long way in promoting eye health and industrial safety.
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