|Year : 1984 | Volume
| Issue : 5 | Page : 273-276
Perforating injuries in coal mining area
Central Hospital, Dhanbad, India
Central Hospital, Dhanbad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Narain L. Perforating injuries in coal mining area. Indian J Ophthalmol 1984;32:273-6
Most of the occupational injuries are preventable. With expansion of industry, health hazards have increased paripassu. Improved safety measures in mines and control of infections by drugs have gone a long way to prevent and lower ocular morbidity and mortality. Coal Miner's Nystagmus is a documented visual disability. Serious eye injuries in coal mines are reported to Director General of Mines Safety (D.G.M.S.) Govt. of India.
| Materials and methods|| |
175 cases of perforating injuries of the eyes out of total of 1145 major ocular accidents were the subject of study between 1973-83, at Central Hospital, Dhanbad. These have been divided according to the site of perforation which were corneal, corneo-scleral (Limbal) and scleral. In all the three categories management of injury depended upon whether it was simple or complicated involving intraocular structures. Out of 175 cases, 105 were colliery workers and 70 were others. In the later group predominantly it was among the children. Blast injuries of the coal miners required special management. Perforating injuries with IOFB were managed depending upon the location and nature of foreign bodies.
Out of 175 injured eyes, 126 were corneal, 32 timbal and 19 scleral. Types of injuries sustained did not materially vary between the coal mine workers and others, except that industrial injuries were extensive, serious and more often contained IOFB. It was interesting to note that sharp speciie of the coal pierced cornea like needle. Amongst the non-occupational perforating injuries of interest in a patient was a bristle of nail brush which had perforated the cornea and was lying in AC. In three eyes pointed wooden pieces penetrated the eye ball through cornea lying partly outside and partly in AC.
All patients with serious eye injuries werc admitted and treated as emergency. The time interval between injury and admission in the hospital varied from hours to couple of days. In all cases of surgery, urinanalysis, haemogram, drug sensitivity and X -Ray were routinely done. Where introocular foreign body was suspected, further X-Ray's were done to localise the same by corneal ring methods. Surgical intervention in majority of cases was done under general anaesthesia.
All patients who sustained perforating injuries were given injections of Tetanus toxoid and put on suitable local and systemic medical therapy. Use of systemic steroid except for subconjunctival anti-biotic combination, was only considered post operatively. Decision about treatment medical or surgical depended on detailed examination of the injured eye. It may be pointed out that deferred surgical intervention in selected cases had paid dividends while in others early surgery was rewarding. All possible combination of extra and intraocular injury occurred in coal mine accidents. Injuries to bony orbital wall and adenexe were not infrequent.
| Observations|| |
1. Corneal Perforation
126 eyes with corneal injury were admitted. Out of which 27 were simple, in 40 eyes uveal tissue was involved and in the rest 59 eyes lens was injured.
In 27 simple corneal perforation, 17 eyes were repaired surgically and in 10 eyes where co-option of wound margins were good, conservative line of treatment with simple bandage was sufficient for healing. Visual recovery was fairly good except for the resulting corneal scar.
1.2 Involving uveal tissue
In another 40 injured eyes with uveal tissue incarceration 7 had central contact synsechia which responded to medical therapy. In 28 cases prolapsed uveal tissue was excised and wound repaired. In 5 eyes hyphaema precluded detailed examination and surgery had to be deferred. No chance was taken to preserve eyes with extensive prolapse of uveal tissue.
1.3 Involving lens
In 59 eyes, lens was injured. The nature of injury varied from localised opacity to complete opacification, dislocation into anterior chamber, vitreous and even extrusion outside the eye-ball. Out of total 59 lenses injured 18 lenses were dislocated, 32 had to be operated within a week. In 9 eyes the lens got absorbed by itself in course of time. It may be pointed out that delayed surgical interference in cases of lens injury, provided there were no complications, had good visual result.
2. Limbal perforation
Strictly speaking the above type of injury was either extension of corneal or scleral injury. The anatomical configuration of this area has rightly earned the name as "Dangerous Area". Surgical repair of limbalzone, combined both corneal as well as scleral repair. Diathermy and Cryo were frequently used during surgery.
Out of 32 limb al perforations 9 were simple and the rest were complicated with injury to intraocular tissues. In simple cases the result of repair was satisfactory and vision restored to some extent. Attempts at cosmetic repair was thoroughly weighed against subsequent pros and cons. A bold decision to sacrifice severely injured eye was taken on very first surgical intervention. Three patients developed sympathetic ophthalmitis. Among twenty two patients 12 eyes were phthisical on admission and the rest 10 eyes became subsequently, all had to be removed ultimately.
3. Scleral Perforation
These were usually lacerated wounds, involving mostly the temporal half of the eye ball. The extent of damage was such that integrity of the eyes was in jeopardy. Out of total 19 scleral perforation, 16 eyes had to be sacrificed as these were completely disorganised and 10 of these had big intraocular foreign bodies. The Division between anterior and posterior scleral perforation is only theoretical, as injuries invariably involved both segment. In 3 cases of simple injury, sclera was repaired using "Diathermy and Cryo" and scleral buckling. Functional recovery was only perception of light but the eye balls were retained.
4. Blast Injury:
This is a typical coal miner's occupational hazard caused by accidental exposure to explosives, which are very often fatal. The different coats of the affected eye were inextricably studded with innumerable fine grains of coal, stones and sulphur. Depending upon the force of impact, the eyes got perforated and became phthisical. Intraocular tissues were enmeshed with multiple foreign bodies leading ultimately to total loss of vision. Corneal grafting could restore some vision in cases of superficial corneal injury with minimal intraocular disturbance. 20 eyes of blast injury were treated out of which only 50% patients could regain ambulatory vision in one or the other eye.
5. Perforating injuries with Retained foreign body
58 eyes with IOFB were treated during last ten years. Types of foreign bodies were metallic, non-metallic and biologic matters. The different jobs and tools used by coal miners contributed largely to the type of foreign bodies. Radio opaque foreign bodies were localised mostly by corneal ring method after routine X-ray. In small magnetic foreign bodies "duction" test with magnet was useful in localisation as well as removal. Electromagnet and simple hand magnet were used in the removal of the magnetic foreign bodies. In one patient a foreign body was firmly embeded in the optic nerve head which could not be removed and has been allowed to remain. Coal is non-radio opaque, nonreactive and non-magnetic. Density of coal is 0.480 and bone 0.560 as such visualisation on X-Ray is poor.
| Discussion|| |
Coal mining industry is prone to injury because of hazardous nature of job and difficult working environment underground as well as on surface. The percentage of eye injuries to the coal miners is 1.80% where as incidence among general population is 1.25%.
The type of perforating ocular injuries commonly met with in the coal industry can be described as in-between civil and war injuries. The causative agents were metal chips of working tools, broken coal pieces and stones. Blast injuries were like the gun powder injury commonly found in war. In modem hydraulic mining eyes have been injured and even perforated by forceful jet of water.
The rate of enucleation following perforating wounds of the eyes in adults was of the order of 15% to 20% but amongst children between 25% to 30%.,,,. sub In present series 24% eyes had to be removed.
In recent years ocular injuries in the coal mining industry has been lowered down relatively due to better safety measures and health education of the miners. Improved surgical technique and control of infection by drugs have further reduced ocular mortality. Use of protective goggles underground could not be enforced due to fogging and restriction of field of vision. Improved mining methods and better lighting underground have eliminated miner's nystagmus and saved from many accidents.
The site of injury was not the deciding factor in general prognosis but type of injury, involvement of intraocular tissue, time interval between injury and treatment which mattered most. Simple perforating injuries had better prognosis than ruptured eye ball. Moncreiff and Scheribal. had similar observations.
In the present series 3 patients developed sympathetic ophthalmic which comes to 1.80% comparable to about 2% (Duke-Elder) However, steroids and anti-biotics have improved the out look. IOFB in 60% cases of mine injury were metallic, radio-opaque and magnetic. In the rest 40% coal pieces and biologic matters were not radio-sensitive and hence, difficult to localise or remove. In most of the cases the injuries were so severe that the only alternative was removal of the eye ball along with FB. Total of 58 cases of IOFB during the last ten years were treated. V. Smith reported an average of 5 cases of IOFB a year during the last ten years this is comparable to 5.8 a year in the present study. Remky et al; reported that majority of cases of IOFB were through post segment perforation which has been the finding by the author too. Nonoccupational injuries were comparatively less severe. Two patients sustained injury by broken glass pieces and ultimate visual recovery was satisfactory. In one child a nylon bristle of nail brush was found in AC which was removed with uneventful recovery. Water-jet injury in one patient perforated one eye which had to be removed and in the other eye corneal grafting could restore useful vision. No reference of such injury . is available in the literature.
Ocular injuries in coal mines had special problems of compensation and rehabilitation, which were complied as per Covernment rules. Mine workers who become totally blind could not be re-employed and as a social welfare measure one of their relatives was given employment.
| Summary|| |
Each Industry has its own specific and general health hazard. Coal Miner's nystagmus and blast injuries in the coal mines are occupational ocular hazard. Eye injuries sustained by workers were serious and often contained IOFB. Coal Miners were duly compensated for loss of vision or the eye ball.
| References|| |
Ghosal B.C.,1983. Hamari Ankhen, (N.S.P.B. India), 7: 8.
Roper-Hall, 1967. Proc. Roy. Soc. Med., 60: 597
Remky, Kober and Pfeiffer., 1967. An. Inst. Barra quer, 7: 487.
Edmund, 1968. Acta Ophthalmol. (Kbh), 46: 1165.
Jensen, 1968. Acta Ophthalmol. (Kbh), 46: 1194.
Moncreiff and Scheribel, 1945. Amer. J. Ophthalmol., 18: 1212.
Duke Elder S., 1972. System of Ophthalmology, Vol. XIV Pt 1, Henry Kimpton, London.
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