|Year : 1968 | Volume
| Issue : 4 | Page : 186-191
Ocular injuries in coal mines
|Date of Web Publication||24-Dec-2007|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Laxminarayan. Ocular injuries in coal mines. Indian J Ophthalmol 1968;16:186-91
"To produce and to avoid waste through errors and inaccuracies, one must see, have eyes and use them efficiently and to have two eyes or even one eye, one must guard them by suitable physical protective devices." - Dr. Mrs. H. S. Kuhn.
Coal Mining is one of the largest and important industries of the nation employing 426,400 (1967 March) people producing 71,924 million tonnes of coal annually (1967). Out of the total 837 working coal mines in India for the preceding year in 9 States, 468 mines worked in Bihar (Jharia), 203 mines in West Bengal (Ranigunj), 58 in Madhya Pradesh, 30 in Andhra Pradesh and the rest in small numbers, Maharashtra (9), Orissa (8), Assam (17), Madras (1) and Rajasthan (1). Thus, Jharia-Ranigunj is the richest coal belt in India, where mining operations are being done on the surface in open cast mine or quarries and underground mines at various depths, the deepest being at 2500 feet in Ranigunj coalfield (Chinakuri). Mining installations, old and simple, modem and complex, heavy as well as light, can be seen strewn in a distance of 40 miles between Jharia and Ranigunj. A few mines are fully mechanised where coal cutting and loading are all done by complicated cutters, loaders and conveyors. This raw material coal, king among the minerals has been the deciding factor in the location of steel factories at Jamshedpur, Burnpur, Durgapur, Rourkela, Bhilai and Bokaro, which fringe round the coalfields of Bihar and Bengal. There are many allied industries like cokeoven plants, coal washery, coal-tar and of other by-products of coal which are all situated in this area.
A coal-mine is a complex of several activities like haulage, transport of coal, the air-house, the water pump etc. in which a tour at the surface of the mine and underground, familiarises one with different types of heavy machineries where one can see the helmeted black man with his bucket, pick and axe cutting the coal in a world so different from that on the surface. Working in eight hours shift continuously in such an atmosphere, facing all types of hazards physical and mental, passing through the array of weapons alround, exposed to accidents all the time, he is digging up the coal for us to burn and cook, for the industries to produce and the trains to run. The arduous nature of his job, the heavy overhead and underground installations, working with tools of odds and sorts, makes him vulnerable to accidents despite all the safety measures employed and enforced.
Nature of occular injuries occurring in the coal mines.
1. Explosives are used for blasting the mines. Sometimes the unfortunate and unwarranted miner or group of miners are exposed to the explosives, sustaining "Blast Injuries". In this "Blast Injury", the whole body of the miner is studded with coal particles including the eyes, apart from serious and fatal injuries. Along with the coal, sulphur particles in the explosives can be seen inextricably embedded alongwith. The eyes are also exposed to concussion and compression injuries. Such injuries have resulted in from complete loss of both the eyeballs to loss of vision of different degrees in one or both the eyes. The associated fractures of the orbit or facial bones are invariably present depending upon the severity of the blast.
2. Retained foreign bodies (coal) entering the eyeball through anterior or posterior route are difficult to localise by x-ray, being radio-transparent and difficult to remove being non-magnetic. Those which are big enough to be visible, can be taken out with the inevitable result of loss of the contents of the eyeball and consequently complete loss of vision.
3. Metallic foreign bodies in the eyeball and its adnexa are common, as working tools are mostly metallic which get chipped off while cutting coal or stone, causing injuries of varying severity.
4. Infection: according to a report from the Central Mining Research Institute of Dhanbad, the bacterial flora in the mines underground is fairly high. The classification of the organisms and pathogenicity test has not been done so far in a scientific way.
5. These contaminated foreign bodies causing ulcers of the cornea seem to be highly infected. Such ulcers are not ordinarily amenable to the routine treatment and take a fulminating course. In all probability, these foreign bodies possibly are contaminated with fungi as well.
6. Foreign bodies of cornea met with in the coal mines, at times, cause corneal lesions simulating superficial punctate keratitis both nummular and macular type. Such corneal lesions persist for a long time and undergo the usual cycle of remissions and exacerbations. Quite probably, these are contaminated with virus. Such corneal lesions lead to different type of sequallae like degenerative changes of the cornea and atheromatous ulcers with consequential end results.
7. During the fall of roof in an underground mine, the flying and fleeing coal particles catch the miners unaware causing penetrating and non-penetrating, concussion and compression injuries of the eyeball.
| Observations|| |
In the Ranigunj and Jharia coalfields of India, there are two Central Hospitals - one at Dhanbad and the other at Asansol. These two hospitals have fairly well equipped ophthalmic departments, which also cater to the needs of different coalfields of India for most of their ophthalmic problems. From the following graph, it is evident that attendance of new patients is steadily increasing. The attendance of the old patients is usually more than three times the number of new patients. Ocular injuries, minor or major, constitute about 8 per cent of the total attendance.
I. By far the most common cause of ocular injuries is by foreign bodies of the cornea. These foreign bodies are of various size and shape, both coal as well as metallic involving the superficial as well as deeper layers of the cornea. Sometimes, these are very peculiarly situated half in the cornea and the other half in the anterior chamber. In case of non-metallic foreign bodies in the latter situation, removal becomes a tricky as well as difficult problem. At times, these foreign bodies cause lacerated injury of the cornea, tearing of the iris and prolapse, traumatic cataract, subluxation and dislocation of lens. In some severe cases, there is invariably profuse prolapse of vitreous and haemorrhage requiring urgent evisceration.
(a) Metallic foreign bodies of cornea extra and intraocular. These are mostly iron or steel. Such foreign bodies are easily localised but at times very difficult to remove even with a giant magnet. There are a few cases on record in which the foreign bodies have entered through the cornea and gone right into the retroocular space. Extraction in these cases is not necessary as the foreign body is well tolerated in this position. In cases of bigger foreign bodies the result of extraction is not gratifying but in cases of smaller ones favourably situated, removal has saved the eyeball and restored the vision. Foreign bodies unremoved from the eyeball eventually cause siderosis and phthisis bulbi.
(b) Non-metallic, non-magnetic foreign bodies extra and intra-ocular. The commonest and large percentage of foreign bodies in coal industry are coal and stone. Mention has been made earlier concerning the "Blast Injury" in which cornea is studded with coal particles in its entire extent as well as depth. Removal of individual foreign bodies is difficult and well nigh impossible. The choice of treatment in these cases is either lamellar or penetrating keratoplasty.
Due to paucity of donor material at present, a total superficial keratectomy at the right time has given encouraging results. Earlier inexperiences and enthusiastic attempts of picking out the foreign bodies one by one, have left behind bigger dotted corneal opacities than what would have resulted if these small foreign bodies had been left alone. It has been observed that in the course of a couple of months to a year these black coal particles have disappeared without disseminating any colour in the lamellae of the cornea. The resultant corneal opacities too have been smaller, The corneal corpuscles or cells play important role of phagocytosis. These aggregated compressed and elongated corneal cells become fibrocytes (keratocytes) in due course producing visible corneal opacities of different grades. It is suggested that in such cases of blast injuries of the cornea, immediate keratoplasty may be deferred for some time to allow the inflammatory process to settle down, otherwise there are chances of vascularisation, jeopardising the take of the graft.
(c) Among the other non-magnetic foreign bodies, a few cases of injury of cornea by glass have been dealt with. In one case the glass particle was lying in the anterior chamber at the recess of the angle. In a couple of cases embedded intracorneal straw and wood have been removed. Removal is tricky as these foreign bodies have a tendency to slip and sometimes even enter the anterior chamber causing traumatic cateract.
(d) As pointed out, some of these foreign bodies are highly infected and cause corneal ulcers, with or without hypopyon. In a number of cases, virulence of the organisms is so severe that one remains a spectator to a rapidly spreading ulcer. In the absence of proper culture facilities, clinical appearance of the ulcer may give some clue to the practising oculist of the area as to the nature and severity of such fulminating inflammation. It is suggested that a well timed keratectomy with or without keratoplasty may be of some palliative value in a desperate bid to save the eye.
(e) Domestic accidental injuries of the eye in this industrial area are just as common or perhaps of higher incidence than in non-industrial areas.
II. Traumatic cataract comes only next to foreign bodies in its frequency of occurrence as a result of mine injuries. Starting from a dot to complete opacification of lens, all types of intermediary lens opacities are seen. Time lag for such lens opacities to develop cannot be ascertained as it entirely depends upon the extent of injury. Total and complete lens opacities have developed within a matter of few hours to several days after trauma. Cases are on record that localised stationary lental opacities, central or peripheral, due to injury have persisted as such, for long time. The extent of visual disability depended upon the site of such lens opacities. These lens opacities were not capsular or sub capsular only as these could be seen to extend well into the cortex. Such lens opacities should have progressed ordinarily to complete opacification. Quite possibly the rolled in lens capsule in the lens cortex limited further progress of opacity. However, this observation requires further studies and long term follow up of the cases.
III. Injuries to lids and adnexa. Minor abrasions, bruises, ecchymosis and lacerated injuries of one or both the lids are common. Total avulsion of the lid though rare, is encountered. Injuries of medial canthus involve the lacrimal drainage system and that of the outer canthus the lacrimal gland.
Subconjunctival haemorrhages, small and big, lacerated injury of the conjunctiva with impregnated fine and coarse coal particles are met with. In case of such injuries, fine coal dust cannot be picked up and the only course in such cases is to excise the conjunctiva involved.
IV. Injuries to the sclera, chroid and retina. They are fewer but one does come across such severe injuries which ultimately end in the loss of the contents of the eyeball. In cases of perforating injuries of these structures by metallic body or sharp flying coal particles, the wounds are invariably so peculiar that repair is often difficult.
V. Blunt and blast injuries produce concussion and compression of the eyeball exhibiting the classical book picture at times. Immediate corneal oedema, folds in Descemets, blood staining of cornea; hyphmma and "eight Eyeball" syndrome have been frequently observed. Tears of the iris stroma, sphincter pupillae and iridodialysis are quite common. Complications like massive vitreous haemorrhage, choroidal and retinal tears with detachment occur commonly.
VI. Chemical injuries to the cornea and conjunctiva by cement and lime are seen. The course of injury follows like the usual alkali burn depending upon the severity. A few cases have ended in painful blind eyes from complications like extensive corneal leucoma and symblepheron.
VII. Injuries caused by accidents due to fall of roof or a big chunk of coal have caused fractures of the roof or floor of the orbit and the surrounding facial bones. Such injuries have caused enophthalmous and diplopia in case the eyeball and vision are spared. In a recent accident a patient sustained depressed oblique fracture of the right frontal bone. After he recovered from the shock, he complained of dimness of vision in his right eye, which in course of time became blind. Ophthalmoscopy showed complete optic atrophy in the right eye. The fracture seems to have extended upto the optic foramen and canal involving the optic nerve.
VIII. Actinic burn of the cornea by the welders working in the mines are frequent.
| Discussion and conclusion|| |
(i) A brief review of the common types of Eye Injuries in Coal Mining Industry has been given in order of prevalence.
(ii) Coal Mining Industry has its own peculiar problems and require careful handling of the injured eye which is different from routine eye surgery.
I may like to mention a few observations outside the scope of the subject under discussion to seek some valuable advice.
(i) The underground skilled coal miner even after a successful operation for traumatic or senile cataract cannot be employed back to his original job on account of the disabilities associated with the ordinary glass correction for aphakia.
(ii) No suitable protective goggles or lens corrective programme has been introduced in the industry due to the absence of proper design and anti-fog material. At the cutting coal face underground, the glass or quartz gets fogged quickly. The Directorate of Mines Safety are trying their best to prevent all types of accidents and will not hesitate to introduce the proper corrective and Eye Protection Programme if suggested.
(iii) Though embarassing nontheless true, nothing substantial has been done to rehabilitate these unfortunates, who have lost their eyesight as a result of industrial accidents despite the best available safety measures. Having lost their eyes these pitiable human beings are thrown out of employment, seek refuge in the asylum of beggars. The Directorate of Mines Welfare can extend a helping hand to these unfortunates.
May I take the opportunity to appeal to "The National Society for Prevention of Blindness" from this very platform to consider aiding and opening an "Eye Bank" central or regional in this coalfield, so important an industrial belt for the nation where traumatic ocular surgery is so frequent?
The need for extensive and co-ordinated ophthalmic service even in the remotest solitary mine cannot be overemphasized to this august body who can approach and convince the Government agencies and private organisations for such service to justify its name "National Society for the Prevention of Blindness".
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