|Year : 1994 | Volume
| Issue : 4 | Page : 199-201
A review of childhood admission with perforating ocular injuries in a hospital in north-west India
SG Jaison, SE Silas, R Daniel, SK Chopra
Department of Ophthalmology, Christian Medical College & Hospital, Ludhiana, India
S G Jaison
Department of Ophthalmology, Christian Medical College & Hospital, Ludhiana 141 008
Source of Support: None, Conflict of Interest: None
A retrospective study of perforating ocular injuries in children below the age of fifteen years was conducted. Eighty patients (eighty-nine eyes) were included in this study. Male children were more susceptible to ocular injury as compared to females (p = < 0.01). Children of the school-going age were the most affected (73.8%). Majority of the injuries occurred in the sports field (p = < 0.01). Playing with bow and arrow, and gillidanda* accounted for majority of the sport injuries (47.2%). Sixty-eight percent of the perforated eyes had no light perception at the end of treatment. Health education on the preventive aspects of ocular injuries in schools as well as through mass media should reduce the incidence of visual loss due to ocular injuries.
Keywords: Ocular injury - Perforation - Visual loss.
|How to cite this article:|
Jaison S G, Silas S E, Daniel R, Chopra S K. A review of childhood admission with perforating ocular injuries in a hospital in north-west India. Indian J Ophthalmol 1994;42:199-201
Despite advances in diagnostic and therapeutic methods, ocular trauma remains a significant cause of visual impairment. Visual impairment in childhood is of greater significance as, in addition to physical disability, it has major impact on social and psychological development of the victim. The other difficulties that might contribute are parents who discontinue treatment, the optical correction of monocular aphakia, and the possibility of amblyopia in children.
The American National Society for Prevention of Blindness has estimated that 55% of ocular injuries occur before the age of twenty-five years and that one-third of eye loss in the first decade of life is due to ocular trauma 
Ocular trauma in childhood is of great significance especially from the prophylactic view. It is important to determine the magnitude of the problem and identify the major causes for suggesting preventive strategies. Hence, a review of perforating ocular injuries in children below the age of fifteen years, who were hospitalised in the Department of Ophthalmology, Christian Medical College and Hospital, Ludhiana, from January 1981 to April 1990, was undertaken. Since hospital admission is mandatory for patients with perforating ocular injuries, patients who refused admission were not included in this study.
| Materials and methods|| |
The medical records of patients with the diagnosis of perforating ocular trauma were reviewed. Of these, 80 were of children below 15 years of age. These records were analysed in detail to determine the aetiological factors, the magnitude of visual impairment, and to identify the target group so as to suggest preventive measures.
The visual acuity recorded on Snellen's chart at the first follow-up visit was considered in this study. However, in eight uncooperative children visual acuity could not be determined.
| Results|| |
The age and sex distribution of perforating ocular trauma are shown in [Table - 1]. Perforating ocular trauma was more common in male children as compared to females (p= < 0.01). Moreover, 73.8% of the injuries occurred in children of school-going age. Thus, children of school-going age seem to be the most affected by ocular trauma.
Aetiology of ocular trauma in children as observed in this study is shown in detail in [Table - 2]. Majority of the injuries occurred in the sports field (p= < 0.01). Playing with sharp wooden objects like gillidanda, and bow and arrow were the major cause (40/89; 45%) of perforating ocular trauma in the play ground. The domestic injury was caused mostly by glass and knife (15/89; 16.9%). Interestingly, fire crackers though used only during festivals was the cause of nearly 1/6th of the total injuries (15.7%).
The visual outcome and site of perforation are shown in [Table - 3]. In 55 of the 81 eyes (68%) in which the visual acuity was recorded, there was no light perception while only 19 of 81 eyes (23.5%) had visual acuity > 6/36.
| Discussion|| |
Though many reports are available on ocular injuries, ,,, only scanty literature is available on ocular injuries in children in our country. As the epidemiology of ocular injuries varies from community to community and region to region, the present retrospective study was undertaken to gather information on the epidemiology and visual outcome of perforating ocular injuries in children under the age of fifteen years in North-West India.
In this study the male children were found to be more vulnerable (p= < 0.01). The ratio of males to females was 3.7:1. The high incidence of ocular injuries in males in this study is consistent with findings of most other such studies. ,,[-8]
A possible explanation for this fact is the greater mobility and activity in male children. The significantly higher occurrence of ocular injury in male children may also be the result of their greater exposure to injuries in general and a higher incidence of violent outdoor activities among them.
In our study, majority (40%) were children of the 6 to 10-year age group. On statistical analysis comparing the three age groups, the difference did not reach statistical significance, probably because the numbers were small. The higher incidence of 6 to 10year age group is consistent with the findings of studies done in Lesotho sub and Finland  but different from the Brazilian study where the incidence was higher in children below the age of five years. The 6 to 10-year age group (primary school-going) children in this part of India undertake games like gillidanda, and bow and arrow without understanding the dangers of these games and are often left to play unsupersed.
Ocular injuries occurring during sport activities accounted for 52.8% of the injuries in our study, whereas domestic accidents formed only 31.5% (p= < 0.01). These observations are consistent with most of the previous studies ,,, except for studies from Malawill sub and Iceland  where domestic injuries accounted for most of them. In our study the main sports that resulted in the ocular injury was playing with bow and arrow, and gillidanda (47.2%), which is similar to the finding of Panda et al.  However, a study reported from Jaipur sub found fire cracker injury to be the commonest mode among children below the age of 14 years. This study had included only 22 patients and was conducted over a 15-month period which included the festival seasons of 2 years. This probably explains the higher incidence of fire cracker injury in this study.
Visual loss in ocular injuries varies with the extent of ocular damage. In the Western reports around 30% of patients who suffer severe ocular injuries end up with no useful vision (visual acuity < 6/60).  In our study, 68% of the children ended up having no light perception. This marked difference in visual outcome is mainly because of the nature of injury. As mentioned earlier, majority of our patients had injury caused by unsterile pointed wooden objects. Another reason for this marked difference may be the delay in availability of specialised treatment. Thus, on the whole, the visual loss due to ocular injury in children is almost twice that of the West and all efforts should be made to prevent the sight-threatening injuries.
The current study points to male children of the school-going age as the high-risk group and the play ground as the high-risk site for ocular injuries. With regard to prevention, continual and efficient health education of the children, teachers and parents of this high-risk age group should bring about good preventive results. Health education on the preventive aspects of ocular trauma in schools as well as through mass media like television can help in achieving this goal. Nonetheless, health education should lay emphasis on the hazards of games like gillidanda, and bow and arrow. *Gillidanda is a regional sport played with a gilli. Gilli is a spindle-shaped wooden piece 4 to 5 " in length, which is hit with a long stick with great force.
| References|| |
Koval R, Teller J, Belkin M, et al. The Israeli ocular injuries study: A nationwide collaborative study. Arch Ophthalmol 106:776-780, 1988.
Thordarson U, Ragnarso AT, Gudbrandsson B. Ocular trauma: Observation in 105 patients. Acta Ophthalmol 57:923-928, 1979.
Zagelbaum BM, Tostanoski JR, Kerner DJ, et al. Urban eye trauma - A one-year prospective study. Ophthalmology 100:851-856, 1993.
Saini JS, Mukherjee AK, Dabral SM, et al. A profile of penetrating eye injuries. Indian J Ophthalmol 33:95-97, 1985.
Parmar IPS, Nagpal RC, Sunandan S. Pattern of ocular injuries in Haryana. Indian J Ophthalmol 33:141-144, 1985.
Gorden YJ, Mokete M. Pediatric ocular injuries in Lesotho. Doc Ophthalmol 53:283-289, 1982.
Niiranen M, Raivio I. Eye injuries in children. Br J Ophthalmol 65:436-438,1981.
Moreira CA Jr, Ribeiro MD, Belfort R Jr. Epidemiological study of eye injuries in Brazilian children. Arch Ophthalmol 106:781-784, 1988.
Rapoport I, Romem M, Kinek M, et al. Eye injuries in children in Israel. A National Collaborative Study. Arch Ophthalmol 108:376-379, 1990.
Canavan VM, O'Flaherty MJ, Archer DB, et al. A ten year survey of eye injuries in Northern Ireland. Br J Ophthalmol 64:618-625, 1980.
Ilsar M, Chirambo M, Belkin M. Ocular injuries in Malawi. Br J Ophthalmol 66:145-148, 1982.
Panda A, Bhatia IM, Dayal Y. Ocular injuries - A socio -economic importance; Afro Asian J Ophthalmol 111:163-174, 1985.
Sarda RP, Mehrotra AS, Ratnawat PS, et al. Ocular injuries in childhood. Indian J Ophthalmol 19:6770,1971.
[Table - 1], [Table - 2], [Table - 3]
|This article has been cited by|
||Case series and variants of ocular injury secondary to firecrackers
| ||Rashid, R.A., Jasman, A.A., Ibrahim, M., Ismail, S., Hazabbah, W., Hitam, W. |
| ||International Journal of Ophthalmology. 2008; 8(3): 467-469 |
||Unusual intraorbital foreign body: A case report
| ||Sukhija, J., Bandyopadhyay, S., Ram, J., Bansal, S., Das, P., Brar, G.S. |
| ||Annals of Ophthalmology. 2006; 38(2): 145-147 |
||Paediatric Open Globe Injuries. Visual Outcome and Risk Factors for Endophthalmitis
| ||Narang, S., Gupta, V., Simalandhi, P., Gupta, A., Raj, S., Dogra, M.R. |
| ||Indian Journal of Ophthalmology. 2004; 52(1): 29-34 |
||A practical guide for sports eye protection
| ||Vinger, P.F. |
| ||Physician and Sportsmedicine. 2000; 28(6): 49-69 |
||Hypodermic needles: A new source of penetrating ocular trauma in Indian children
| ||Jalali, S., Das, T., Majji, A.B. |
| ||Retina. 1999; 19(3): 213-217 |