Research - International Journal of Medical Research & Health Sciences ( 2022) Volume 11, Issue 8
Pattern of Ocular trauma in Pediatric population of Western Odisha
Tarun Kumar Panda1*, Rutayani Dash2 and A.C. Raghu32Department of Ophthalmology, Sundargarh Medical College and Hospital, Odisha, India
3Bhima Bhoi Medical College and Hospital, Odisha, India
Tarun Kumar Panda, Department of Ophthalmology, Bhima Bhoi Medical College and Hospital, Odisha, India, Email: tarunpanda61@gmail.com
Received: 07-Jul-2022, Manuscript No. ijmrhs-22-68813; Accepted Date: Aug 20, 2022 ; Editor assigned: 15-Jul-2022, Pre QC No. ijmrhs-22-68813 (PQ); Reviewed: 18-Jul-2022, QC No. ijmrhs-22-68813 (Q); Revised: 04-Aug-2022, Manuscript No. ijmrhs-22-68813 (R); Published: 30-Aug-2022
Abstract
Background: To assess the clinicodemographic profile and pattern of Ocular trauma in Paediatric (<15 years) patients attending Bhima Bhoi Medical College and Hospital, Balangir. Methods: Hospital-based observational study, over one year, was conducted at BBMCH, Balangir, Odisha. Data regarding the demographic profile, Injury details, clinical profile, and treatment outcomes were noted in children up to 15 years of age with ocular trauma and were subsequently followed up for 6 months. Results: The most common age group affected was between 6 years to 10 years (41% i.e. 47 eyes) followed by 11years to15 years (31% i.e. 36 eyes) and then 0 years to5 years (27% i.e. 31 eyes ). Boys (78% i.e. 89 eyes) were affected more than girls (22% i.e. 25 eyes ). It was found that closed globe injuries were more in the urban population. Most of the children presented to our OPD between 24 hours to 72 hours (54.6%). The maximum number of injuries occurred during outdoor play or activities (53.6%). During the winter season, maximum cases were recorded (56.8%). The object causing mechanical injuries were projectile objects (41%) followed by household objects (21%) and blunt objects 56.2% of patients were managed surgically and the rest 43.8% by conservative treatment. Best connected Visual Acuity (VA) of more than 6/18 was achieved in 72% of cases,6/18-6/60 in 10% of cases. Conclusions: Children between 6 years to 10 years of age are more vulnerable to ocular trauma. Rural background and lack of education and transport facilities were determinants of visual outcome. Awareness is highly needed among parents, health workers, and teachers.
Keywords
Ocular trauma, Demographic pro ile, Open and closed globe injury, Paediatric population
Introduction
Ocular trauma in the Paediatric population leads to the major cause of ocular morbidity and unilateral blindness of acquired origin [1]. Though this age group’s ocular injuries contribute only to 8%-14% of total injuries, still many of them require hospitalization and active intervention [2]. A pattern of clinical presentation is varied, depending on the cause of trauma and the object being involved [3]. Severe complications like amblyopia and endophthalmitis can occur as sequelae of minor eye injuries. Male children are comparatively more affected [4]. Open globe injuries always require active intervention and treatment [5]. Ocular trauma can adversely affect the growth of children i.e. disturbed social relationships, delayed learning, and impaired skills acquisition. Apart from the visual outcome, Paediatric ocular trauma also shows an impact on family members, mental and economic burden, and above all on the quality of life [6]. Most ocular injuries can be prevented by the proper patient and mass education, and the use of protection gadgets. Severe cases, though minimal, still need urgent hospital treatment [7]. No elaborate clinical studies were conducted in past regarding the distribution pattern of ocular injuries in the Western Odisha population, so our present study aimed to evaluate the demographic profile, varied clinical presentation pattern, and visual prognosis in this region.
Methods
This was a hospital-based observational study, conducted in the Department of Ophthalmology BBMCH (Bhima Bhoi Medical College and Hospital), Balangir, Odisha, India. It is a referral hospital covering tribal districts like Nabarangpur, Titlagarh, Sonepur, Boudh, Nuapada, Nayagarh, and the rural population of Balangir too. The present study was conducted over 1 year from October 2020 to September 2021 with a sample size of 114 study subjects.
Inclusion Criteria
All ocular trauma Paediatric patients of ≤ 15 years of age, who attended our eye Outpatient Department (OPD) and casualty with acute presentation and verbal consent.
Exclusion Criteria
Pediatric patients with past ocular trauma, ocular comorbidities, congenital anomalies, coexisting vision-threatening problems, unwilling or disoriented patients. The study was conducted after consent from the patient parents/guardian and the Institutional ethical committee/clearance.
The responders were uniformly accessed with a designed format and with help of trained staff. At first, patients’ demographic profile details like age and sex, residence, socio-economic status, level of education, time and place of injury, mode of injury, an object that caused the injury, any precautions taken before the injury, and mainly the time interval between injury and primary eye interventional treatment.
Detailed ocular examination of all the patients was done by best corrected Visual Acuity (different VA charts), evaluation of anterior segment and measurement of intraocular pressure in closed globe injuries, Gonioscopy, Fundoscopy, Biomicroscopy with 78D/90D lenses. Imaging techniques like USG, UBM, CT Scan, and MRI were done to appreciate injury details and treatment plans. All patients were followed up at end of 1 day, 1 week, 1 month, 3 months, and 6 months, with relevance to their treatment and clinical outcomes and record of final best corrected visual activity. SPSS version 18.0 was used for statistical analysis frequency, percentage, mean and standard deviation by descriptive analysis and significant association by chi-square (X2 ) test. All patients were followed up at end of 1 day, 1 week, 1 month, 3 months, and 6 months, with relevance to their treatment and clinical outcomes and record of final best corrected visual activity. SPSS version 18.0 was used for Statistical analysis. Frequency, Percentage, Mean and Standard deviation were by descriptive analysis and significant association by Chi-square (X2 ) test.
Results
Table 1 shows that out of 114 patients, only 27.2% were in the age group between 0 year to 5 years as compared to 41.3% and 31.5% in the 6 years to 10 years and 11 years to15 years age group. Male children were more commonly affected (81.5%), than female children (18.5%). More cases from rural areas (51.2%) were recorded as compared to Urban (18.9%) and semi-urban (29.9%) areas. Subjects belonging to SC/ST caste presented in a large proportion (46.2%) in comparison to OBC (29.1%) and General category (24.7%).
| Parameters | Number (n=114) | Percentage (%) |
|---|---|---|
| Age | ||
| 0-5 | 31 | 27.2% |
| 6-1 | 47 | 41.3% |
| 11-15 | 36 | 31.5% |
| Sex | ||
| Male | 89 | 81.5% |
| Female | 25 | 18.5% |
| Nativity | ||
| Urban | 21 | 18.9% |
| Semi-urban | 34 | 29.9% |
| Rural | 59 | 51.2% |
| Caste | ||
| SC/ST | 52 | 46.2% |
| OBC | 33 | 29.1% |
| General | 29 | 24.7% |
Table 2 depicts the varied pattern of ocular trauma profile. More Paediatric patients with ocular Injury presented beyond 24 hours and within 3 days (54.6%) followed by 21.8% (within 1 hour), 10.3% ( between 3 days to 7 days), and 10.1% (1 hour to 24 hours), 3.2% (beyond 7 days). Maximum cases of Paediatric injuries occurred at the playground (53.6%), followed by home (23.4%), School (20.1%), work area (2.1%), and others (0.8%). During the winter season, ocular injuries occurred in higher frequency (56.8%), in context to summer (31.1%)) and the rainy season (12.1%). Blunt trauma(46%) was the most common type of injury followed by intermediate and sharp one. i.e. 38% and 16% respectively. Most of the reported objects were solids (83%) and projectile type (51%).
| Parameters | Number (n=114) | Percentage (%) |
|---|---|---|
| Time since injury | ||
| 0-1 hr | 25 | 21.8% |
| 1-24 hrs | 11 | 10.1% |
| 1 day-3 day | 62 | 54.6% |
| 3-7 days | 122 | 10.3% |
| Beyond 7days | 34 | 3.2% |
| Place of injury | ||
| Playground | 61 | 53.6% |
| Home | 27 | 23.4% |
| School | 23 | 20.1% |
| Work area | 2 | 2.1% |
| Others | 1 | 0.8% |
| Season | ||
| Winter | 65 | 56.8% |
| Summer | 35 | 31.1% |
| Rainy | 14 | 12.1% |
| Type of agent | ||
| Blunt | 52 | 46% |
| Intermediate | 43 | 38% |
| Sharp | 19 | 16% |
| State of agent | ||
| Solids | 95 | 83% |
| Fluids/ Others | 19 | 17% |
| Nature of Injury | ||
| Projectile objects | 47 | 41% |
| House held objects | 24 | 21% |
| Blunt objects | 20 | 18% |
| Chemicals | 4 | 4% |
| Sports | 4 | 4% |
| Collision with Persons/Objects | 7 | 6% |
| Insect/ animal bite | 3 | 2% |
| Fall | 3 | 2% |
| Burn/firework | 2 | 2% |
The profile of these 73 patients of MIBC who opted for bladder preservation therapy is given in following Table 1.
Table 3 depicts the age-wise distribution of Paediatric ocular Injuries. An increased number of cases were recorded in the age group between 6 Years to 10 years. Followed by the 11 Year to15 years group and the 0 Year to 5 years age group. Projectile objects were observed to cause the damage.
| Age | Projectile objects | Household objects | Blunt objects | Collision | Sports | Miscellaneous |
|---|---|---|---|---|---|---|
| 0 year to 5 Year | 9 | 16 | 4 | 1 | 0 | 1 |
| 6 year to 10 Year | 26 | 5 | 8 | 2 | 1 | 5 |
| 11 year to 15 Year | 12 | 3 | 8 | 4 | 3 | 6 |
| Total | 47 | 24 | 20 | 7 | 4 | 12 |
Table 4 shows that ocular adnexal injuries were of major proportion followed by foreign body injuries. Globe perforation was seen in 4 cases of Paediatric patients aged less than 5 years. Subconjunctival hemorrhage (2 cases), Corneal tear (1 case), and Hyphaema (1 case) were evenly distributed in different age groups. Vitreous hemorrhage (2 cases) and iridodialysis were relatively seen more in children above 6 years.
| Tissue injury | 0 years to 5 years | 6 years to 10 years | 11 years to 15 years | Total n(%) |
|---|---|---|---|---|
| Eyelid | ||||
| Abrasion | 5 | 10 | 6 | 21(18.4%) |
| Laceration | 2 | 3 | 2 | 7(6.1%) |
| Hematoma | 1 | 3 | 2 | 6(5.2%) |
| Burn | 1 | 2 | 1 | 4(3.5%) |
| Conjunctiva | ||||
| Sub. Conjunctival | 2 | 2 | 2 | 6(5.2%) |
| Tear | 1 | 2 | 2 | 5(4.4%) |
| Foreign body | 2 | 6 | 4 | 12(10.6%) |
| Cornea | ||||
| Abrasion | 1 | 3 | 3 | 7(6.1%) |
| Foreign body | 1 | 2 | 1 | 4(3.5%) |
| Tear | 1 | 1 | 1 | 3(2.6%) |
| Hyphaema | 1 | 1 | 1 | 3(2.6%) |
| Lens | 3 | 4 | 4 | 11(9.8%) |
| Iridodialysis | 2 | 3 | 2 | 7(6.1%) |
| Vitreous hemorrhage | 1 | 2 | 2 | 5(4.5%) |
| Globe perforation | 4 | 1 | 1 | 6(5.2%) |
| Miscellaneous | 3 | 2 | 2 | 7(6.1%) |
Table 5 depicts that the right eye environment is relativity more (68 eyes) as compared to the left eye (46 eyes). Irrespective of the laterality of the eye involved, maximum cases were recorded with visual acuity between 6/60 to no perception of light. Only 6 cases were recorded with visual activity better than 6/12, at the time of presentation, as compared to 24 cases after 2 months of treatment. The visual acuity of thirty-two patients could not be assessed. Patients with relativity better vision (>6/60) needed conservative treatment, unlike more impaired or blind patients (<6/60), who were managed surgically with medical treatment in follow-up. Unassessed patients were due to their less cooperation or reliability and less age.
| Visual acuity (VA) | Pre-treatment VA right eye n (%) | Pre-treatment VA left eye n (%) | Post-treatment VA right eye n (%) | Post-treatment VA left eye n (%) |
|---|---|---|---|---|
| ≥ 6/12 | 4(6.0%) | 2(4.3%) | 16(23.5%) | 8(17.4%) |
| 6/18-6/60 | 16(23.5%) | 12(26.1%) | 14(20.6%) | 10(21.7%) |
| <6/60-PLnegative | 28(41.1%) | 20(43.5%) | 18(26.5%) | 16(34.8%) |
| Un accessible | 20(29.4%) | 12(26.1%) | 20(29.4%) | 12(26.1%) |
Discussion
Though Paediatric ocular injuries contribute in larger proportion to childhood visual impairment and blindness, varied data exists in our reference kinds of literature [8]. More prevalence cases were reported in the age group above 5 years like Mac Ewen, where 84% were covered between 5 years to 14 years age group [1,9,10]. Our study showed maximum male predominance as compared to females in a ratio of 4:1 which is almost similar to another study [11- 14]. The reason behind this is boys are more adventurous and aggressive with more outdoor activities. In our study, the prevalence of Paediatric ocular trauma was relatively less in the age group below 5 years as compared to above age groups, due to constant supervision and precautions, which coincided with Dulal et al study [9]. However, El-Sebaity et al reported maximum trauma cases in the age group between 7 years to 12 years as compared to 12 years to 16 years aged children [14]. This can be better justified by young children’s less ability to judge, lesser coordination abilities, and fewer skills to face danger and escape from it. Most ocular injuries occurred during outdoor play followed by, during home activities which were quite contradictory to Mac Ewen C and Desai T et al studies [1,8]. Because preschool and school-going children spend most of their hours in school, hence this ma be the contributing factor for more prevalent cases outside the home area. Even they were at higher exposure to more toys and devices on school premises. Thompson et al, Luff et al and Kuhn et al too reported home as the commonest place of injury, unlike our study outcome [15-17]. More Paediatric ocular trauma cases were reported during the winter season by other authors too [18-19].
This seasonal variation in presentation is due to fewer outdoor activities in hot climates and school vacations. In winter, sports events and outdoor play are organized on a larger scale. Al-B dour, Schein et al, and Blomdahl et al reported high numbers of sports injuries unlike Luff et al and Kuhn et al. In our study blunt injuries were found in more proportion (46%) coinciding with Mac Ewen et al study. However, Kaur et al, and Krishnan et al, reported penetrating injuries in 74% and 70% of their study cases respectively. Wooden stick injuries are reported as more common in India like Kaur et al study unlike low values in our results. Assault injuries were found less in our study unlike in developed countries [20-26]. In our study, closed globe and adnexal injuries were found in 51% and 38% of cases unlike Desai T et al study, where it was reported as 27% and 32% respectively. One case of corneal tear was associated with iridodialysis and vitreous hemorrhage in one patient, iridodialysis and hyphaema were found together. Those with open globe injuries were treated to restore the anatomical integrity with poor visual prognosis [27-28]. Three lens injury cases were treated surgically with posterior chamber intraocular lens implantation. Corneal tear patients underwent suturing. Globe perforation cases were treated by evisceration and implants. After 2 months of treatment follow-up, 21% of Cases had VA ≥ 6/12 and between 6/18-6/60, unlike 29.8% of cases in the range between 6/60 to no perception of light. Poor visual outcomes in some cases were due to delay in injury presentation, social taboos, the severity of injuries, quack bias, and poor compliance of patient [29-31]. Quality of life is hampered due to disfigurement, less efficiency, Amblyopia, and economic crisis [32].
Strength of the study
This study covers the population belonging to both rural and Urban areas that cater to patients from adjacent states of Eastern India. Sunetra eye program of Odisha implementing free services for preventable blindness is an integral section of this study. Apart from the demographic profile variation, we have registered varied clinical pattern presentations over this study period. The findings contribute to community Ophthalmology preventive measures and comprehensive eye care.
Conclusion
Pediatric ocular trauma is more prevalent and preventable. Because it tends to change personality, skills, and amblyopia, hence active referrals and interventions are highly essential to check visual impairment. Proper health education, awareness in all sectors of society, safety precautions, and supervision can check the morbidity of a larger event.
Declarations
Acknowledgment
We are grateful to the staff of the department of Ophthalmology for their support and cooperation.
Funding
Nil.
Conflict of Interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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