|Year : 1957 | Volume
| Issue : 4 | Page : 93-101
Cataract in industry and the workman
|Date of Web Publication||9-May-2008|
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|How to cite this article:|
Pandit Y. Cataract in industry and the workman. Indian J Ophthalmol 1957;5:93-101
In industry the usual traumatic cataract has received a great deal of attention because of its sudden development and the problem of compensation but little consideration has been given to the slow developing cataracts caused by radiation or handling of physical and chemical agents, which may be wrongly attributed to age.
Traumatic Cataract : This can be caused by perforating injuries caused by penetrating or non-penetrating (contusion) injuries. The cataract is easy to recognise from its shape, position and colour. It occurs within a few days after injury and the latent period is not long. The cataracts are subcapsular, start at the posterior pole and go to the equator. -Davidson (1940). Mostly they localise in segments.
During the past five years, we have observed 19 such cases. Four of these were localised anteriorly and gave a history of injury to the eye 4 to 5 years before they complained of the cataract. Six had opacity of the lens localised to a sector. In five cases the cataract was caused by injuries during sports organised or unorganised, and 4 cases had cataracts from cracker injuries at the time of the Divali festival, which have not been described. The latter develop special characteristic features. Lustrous small opacities are seen within a period of three to four weeks of injury anteriorly in the subcapsular region. The shapes vary from a veil to a spider form or a star pattern. These granules shine under the rays of a slit-lamp like small pieces of mica spread over the lens. The vision in a majority of cases remains satisfactory.
Cataracts From Perforating Injuries.
Penetrating injuries lead to a variety of cataracts. In some the lens becomes intumescent within a short time of the injury, whilst in others there may be nothing more than an opacity persisting in only one sector. In one of our cases we were surprised to find the metallic foreign body lying in a sector of the lens with no opacity of the lens. In another of our cases in a man aged 40 years the foreign body was seen at the anterior face of the vitreous and the lens had become completely absorbed. Rollet (1940) records. Several cases having a stationary cobweb opacity. He was of opinion that such opacities resulted from organisation of exudate On the anterior surface of the lens, which comes from the traumatised iris and ciliary body. Widespread injury of the cornea and hypopyon formation also lead to cataract formation. Some lenses become adherent to the cornea whilst others may show and extensive degeneration Samuels(1943-1942) records deposits of chalk with hyaline and cholesterol degeneration. Butler (1940) records an interesting case of striation of the posterior capsule, bronzed above and striated below.
Retention of the penetrating foreign body produce characteristic changes depending on the chemical composition of the foreign body. The cataract produced by copper (chalcosis) first described by Vogt (1928) comprises of a sunflower-like opacity opposite the pupil, in the anterior layers of the lens, the radiating spikes displaying a grey green or olive green shagreen. Rosen (1949) records cases where the deposit was found on the posterior pole.
At a clinical meeting of the Bombay Opthalmologist. Association Mrs. Sutaria demonstrated a case where a retained intraocular copper foreign body was discovered after the characteristic sunflower opacity was noticed on the slit lamp.
Iron (siderosis) leads to a deposit of an iron oxide-a pigment on the anterior surface of the lens and the other parts of the globe are impregnated with siderosis.
Savin (1947) experimenting with aluminium on the rabbits' eyes experienced imprints on lens and at times capsular opacity with posterior synechiae. After a period of three months some central opacities also developed.
Byrnes (1949) describes a cilia in the lens.
One other form which may be included under penetrating injuries though not necessarily in industry is the cataract resulting from filtering scar operations, particularly after iridoencleisis. It is a slow forming cataract due to a disturbance of the metabolism of the lens following the operation.
Cataract from Irradiation
Several occupations involve the cataract hazard from irradiation. These occupations are glass blowers, chain makers, X-Ray and radium irradiations and atomic explosions.
The X-Ray radiation Cataract has been receiving attention for some time. It can be a real danger which can be avoided by proper measures. Generally there is a plaque like opacity with powdery surroundings at the posterior pole. The maximum density is in the centre. Politzer (1956) produced cataracts in Salamander larvae when irradiation was 400-1,000 r. The changes were seen after a latent period of three to four months. Microscopical studies revealed that the lens became first spherical, the capsule ruptured and the lens fibres entered the anterior chamber. It is absorbed by the fourth month. X-Rays increase the porosity' of the lens and the Opacities are either posterior polar or posterior axial. In his opinion the X radiation should not be more than 400 rat one sitting. (1955). Cataract is less likely in clinical X-Rays but is more likely in work with neutrons. Cogan and Donaldson(1951) showed experimentally on the rabbits that (i) the effect . of irradiation upon the lens had a latent period which was inversely proportional to the density of the radiation; (ii) that the younger rabbits developed cataracts more rapidly than the old ones. They observe that cytological changes can be demonstrated before actual signs (clinical) of cataractous changes are observed.
Atomic bomb radiation : Cataract in atomic bomb radiation develops after a long time. Kimura and Ikui (1951) described it as a late effect among survivors who were heavily irradiated. According to them a characteristic opacity develops at the posterior pole which has sharp borders and is progressive. Warren (1951) says it takes nearly five years to develop and few if any persons show tendency to cataract formation beyond two thirds of a mile from the hypocenter. Kandori et al (1955) report a series of 138 cases of cataract due to atomic bomb explosion in 1945. The opacities are localised and granulated. They appear mostly under the capsule at the posterior pole. One wonders whether they cannot be due to the effect of the blast of the explosion.
As far as we are concerned we have not come across, so far, clinical cases of cataracts due to high-frequency irradiation.
Cataracts from heat radiation
Chief among the workmen to develop cataracts of this kind are chain makers , glass-blowers and stokers.
Chain makers cataract : Generally speaking the workmen that are affected are middle-aged. It occurs amongst workmen who make medium and small sized chains by hand. According to Roberts (1942) it does not occur amongst those who work with electricity.
Glass Blowers cataract : Heistre (1739) was the first to notice it. Such cataracts are found in workers on strong fires or glowing heat, such as gold smelters machinists, millers, iron smelters etc. The period required in this slow developing cataract is 17 to 35 years. According to Legge (1915) the cataract is proportional to (a) the amount of heat produced in the glass that is blown ; (b) degree to which the workman is exposed and (c)the duration for which they use their eyes. The Crookes Committee showed that injury to the lens is from infrared irradiation, from the molten glass.
There is some conflict of opinions as to the mechanism of production of cataracts by these irradiations. Vogt (1928) believes it is due to a specific action of infra-red rays upon the lens while Legge (1915) believes that the changes at the posterior pole could be explained because of the concentration of the rays by the cornea on the posterior pole of the lens. Goldmann (1938) considers it due to the primary action of the rays on the iris and the lenticular changes are secondary in nature. As a point in favour he says that such changes cannot be produced in albino rabbits. Rauh (1940) says that the cataract starts at the posterior pole but there is exfoliation of the lens under the iris and on slit lamp examination one sees opacities floating in the anterior chamber. Gala (1941) reports a rare case of bilateral cataract in a glass blower aged 69 years with separation and splintering of the iris stroma.
In 1951 myself and Dr. Mendonca visited several glass factories in Bombay with a view to study the glass blowers cataract. We carried out a detailed examination of 141 workmen including 24 actual blowers of glass, 17 blowers of borosilicate glass for scientific instruments, 2 blowers on semiautomatic machines-in all 43 blowers. Others exposed to heat like bubblers, gatherers, helpers, cutters, and carriers were also examined. The temperature of a glass furnace is about 1300° to 1400°C while for scientific glass equipment (borosilicate glass) a high temperature of 1850° C is produced by a mixture of gas, oxygen and compressed air. The age group and length of service is shown in a composite table [Table - 1]. We examined 89 persons. We put them under 3 groups according to their ages--I 18-30 years, II 31-40 years, III 41-50 years.
Each of these groups was subdivided into the nature of work done by each and the length of service in that particular job.
As can be seen from the table we examined 89 persons between 18 to 30 years of age. Out of these 10 were blowers, their length of service varied from 6 to 10 years, in 7 persons ; II to 15 years in 2 persons and one workman had a service less than 5 years. In group II, ages between 31 and 40 years, there were 8 blowers; 5 of these had worked for a period of II to 15 years on the same job ; and 3 for a period of 16 to 20 years. In group III ages 41 to 50 years, there were 6 blowers two with a service from II to 15 years, one blower with a service from 16 to 10 years, and three with a service over 20 years.
In the first group cataracts were found in a bubbler, as anterior sutural cataract, posterior vacuoles in a cutter, a sector opacity in a gatherer, and posterior polar opacity in a carrier. One blower had a senile type cataract. In group two we had a case of a posterior polar ring opcaity and a small opacity posteriorly in carriers and a blower with a service of 16-20 years respectively. In group three one blower had a vacuole in both eyes. It is surprising to find that while workmen on borosilicate glass have to keep their eyes constantly on the job and closer than blowers none of them showed any cataract. In this we agree with Dunn (1950). We further examined 20 helpers in the welding section of some factories : these men do not wear any protective goggles, ; none of them showed any lenticular changes.
Conclusion. From this study, heat irradiation does not offer to be significantly important in the causation of cataract.
Cataracts from handling Chemicals.
(a)Mercurialism Cataract : A slit lamp examination reveals a lustrelesbrown reflex from the anterior capsule of the lens. The reflex is due to a depot of mercury on the anterior surface of the lens. This type of cataract occurs in thermometer makers, repairers of electricity meters who handle mercury. We have examined 8 cases in this class but no changes were seen. Atkinson (1943) records 37 cases.
(b) Paradichlorbenzene Cataract :-This is a byproduct in the manufacture of trinitrophenol and is used in protection of clothing and fur, against moths. It is also used against insect pests in gardening. Sallmann (1936) ; Flurry et al (1939) ; consider this as harmless to human beings. Berliner (1939) records slit lamp examination results in two subjects as appearance of water clefts in the cortex. The cataract is considered secondary to the liver damage and may be caused by disturbed metabolism, lack of oxygen or vitamin C.
(c) Dinitrophenol Cataract :-The chemical is used in the manufacture of explosives. The cataract was first observed amongst French soldiers after World War 1. Workmen exposed are : explosive makers, makers of timber preservatives, sulphur black dye workers, and ladies for reducing their obesity. Vacuoles appear in the anterior subcapsular region and a saucer opacity of a brassy or golden colour is seen. Horner (1942) remarks that it can be seen in women a year after they have discontinued the drug.
(d) Naphthelene Cataract :- Workers exposed to this are the asphalt and celluloid workers, workmen in glass works and skin sorters. Napthelene was the first drug to be used for experimental production of cataracts. The lens is deprived of cystein and a cataract is produced. If blood calcium level is high the cataract is not produced.
Adrenaline :-Tuni Suden (1940) was able to produce cataract of a reversible type by injecting adrenaline intraperitoneally in teh mice.
(f) Cataract from Thallium poisoning :- Artificial gem makers, dye makers disinfectant makers, thermometer workers, and makers of filaments for the incandescent lamps develop cataracts which according to Buschke (1943) is a dystrophic cataract. It is seen in the anterior subcapsular regions. Gradually an opacity of the cortex comes along which is progressive. The condition is accompanied by the vascularity of the cornea, iritis and endocrine and nerve lesions.
| The Problems of the Workmen|| |
The above are occupational eye hazards w here cataract due to an occupation can develop. Whether traumatic or senile, once a workman develops a cataract he becomes a problem both to his family and the employer and the State Insurance. In slowly progressing traumatic cataracts, the memory of a past accident or concussion may be lost, and at such be impossible to determine whether compensation should be paid or not.
Under trauma the lenticular changes very often involve a younger person who has a long way to go in the world and whose importance to the family as a bread earner is very great. Often if the eye can be cured by operation and the cataract removed another problem remains : is he fit for the job he was having. A full correction for aphakia will give him a diplopia and he will not be fit for a job where a good binocular vision is required for distance or near. He may be given an alternate choice, but here there is every prospect of losing a part of his wages as the remuneration for the other job may not be the same as for the one he was handling before. The industry too is at a loss as it loses one of its experienced workmen. As regards the senile cataract the problem is still worse. Once a man has been operated upon for both eye she cannot wear a binocular correction, for distance and near in one piece as a bifocal. The lenses are heavy and difficult to bear on the face. Even normally, a presbyopic correction is difficult to fit amongst many of the workmen specially working in cloth mills as weavers. They have to observe the distance and thread combs in cases of breakages or discontinuity. The bar in front is a great barrier to an effective use of the bifocal correction. Secondly the distance is not the same as reading. They have no pensions and work all the life is only alternative and hence in an industry there is no age of retirement. The cataractous change in a workman is a sad epithet to his labours. Something has to be done for him and as yet we have failed to find a solution.
| References|| |
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Bakkar A., (1944) quoted in Bellows book Cataract and Anomalies of the Lens p. 369 Mosby & Co. 1944.
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[Table - 1], [Table - 2]
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