Epidemiology of Ocular Trauma in a Tertiary Hospital Setting

Material and Methods: All patients included in the study had the following data recorded at presentation and follow up; date, age, gender, location and nature of injury, residence place, cause of injury, duration of hospitalization, anatomical site, adjuvant treatment, initial and final best-corrected (Snellen) visual acuity. Data was classified into five groups on the basis of place of eye injury.

cular trauma is an injury or damage to the eye. The injury may have been due to chemical agents, radiation (ultraviolet or ionizing) and mechanical trauma (penetrating or blunt) 1 .
Infiltrating objects can cause slashes of the cornea and sclera, can affect or involve iris, lens, choroid, retina & optic nerve. At times prolapse of vitreous and uvea is also observed 2 . Patients presenting with damage to the posterior segment have a poor prognosis compared to patients with anterior segment damage 3 .
Coup, Countercoup and Ocular Compression are the three underlying mechanisms by which blunt trauma can harm the eye. Local harm at the site of effect is Coup, while countercoup alludes to damage at the contrary side of the eye. Ocular compression may cause scleral burst in eyes at zones where Sclera is thin (At sites of Muscle insertions) 4 .
As per statistics, in young population a chief cause of visual loss is Ocular trauma. Study results of ocular trauma vary based on study design, geographical and societal factors. Every year, approximately 2.5 million eye injuries occur in the United States, of which, more than 40 thousand results in permanent visual impairment. Rates have ranged from 8-57/100,000, when eye injuries require hospital admission [5][6][7] .
A population based investigation in USA showed a prevalence rate of 19.8% and a normal yearly rate of 3.1×1000 population 8 . Different Reports in Australia have assessed the yearly rate of all damages at 11.8/100,000 in rural setting and 15.2/100,000 in urban setting 9 . There are 200,000 open globe injuries a year estimated by the WHO Programme for the Prevention of Blindness [10][11] .
In general, it seems that ocular trauma follows a bimodal age distribution, affects more males than females and occurs more frequently in the lower socioeconomic groups. A higher male prevalence might be relevant to work-related disclosure, interest in unsafe games and pastimes, liquor utilization, and hazard taking behaviour 12,14 .
As most ocular injuries are preventable, epidemiological studies are useful in informing prevention of blindness programs. From a general well being and injury anticipation point of view, current data on eye injury rates can help to devise plans for general public to reduce their occurrence and to give guidelines on safety measures. This can save a major group of public from getting blind because of this preventable cause 13,[15][16][17][18] .
In this paper, we present the clinical profile of patients with ocular trauma presenting to the Ophthalmology Department at DHQ Teaching Hospital, Gujranwala, over a period of one year.

MATERIAL & METHODS
Study area included the city of Gujranwala, located to the north of Lahore in Pakistan. Gujranwala district is spread over an area of 3,622 km Square. Gujranwala is an industrial city with a large portion of population working in factories and related to industry for their household. The current population is just over 5,014,196.
A cross-sectional study was conducted at Ophthalmology Department, DHQ Teaching Hospital Gujranwala from December 2016 -December 2017. All patients who were admitted in Ophthalmology from December 2016 to December 2017 with ocular trauma were included in the study.
Ophthalmic unit of DHQ Hospital is the major adult eye trauma centre which serves as a major referral centre for a large geographic area. Data Collection was done from patient files through a pre devised Performa. There was no discrimination of age and gender among the patients. Patients with history of previous ocular trauma were excluded from the study.
In type of object, 34.7% of trauma was related to sharp objects, 64.2% to blunt objects and 1.1% to liquid ( Table 4).

DISCUSSION
This study found that most injuries occurred in males 80%. Mean age of patients was 32 years. Blunt objects accounted for most of the injuries with the cornea being the most affected tissue followed by eyelids. Open Globe Injuries occurred in 53.4% of patients. Most common place of ocular trauma was Occupational Injuries followed by house hold injuries including fall, door injuries and accidental injuries.
Our study found that Improvement in best corrected visual acuity (BCVA) occurred in 29.5% cases, BCVA became worse in 8 (8.4% ), Pre-operative and post operative BCVA was same in 59 (62.1%). It was also noted that improvement in Post Operative BCVA was more in those falling in age group 18-35 years (53%) as compared to age groups 1-18 years (28.6%) and age group > 35 years (17.9%).
About (80%) of the ocular injuries occurred in men, in age groups 18-35 years of age. This is the most productive age group. Similar results are observed in other studies around the globe.
Kikira, et al., found that, retina, optic nerve injuries and posterior vitreous are accounted for 12.7% of all blunt trauma eye injuries 19 . In another study by Soliman M in Egypt reported that, out of 153 eyes, after blunt trauma, 2.5% had vitreous haemorrhage with retinal detachment 20 .
The site of visual injury in the USA is taking a move from work environment to domestic established wounds. This is because of laws implementing the utilization of defensive wear at the work environment and an expansion in the quantity of elderly individuals 21

CONCLUSION
This study has a number of implications nationally and internationally. On a local level, there needs to be collaboration between the different health-care facilities to collect population-based data and informing the need for establishing an ocular trauma registry where by standardization of documentation is possible.
The young (18-35 years) are more at risk of ocular trauma, and this translates into a higher economic burden to the country at large. Work related injuries, especially among the working class are preventable, and there needs to be a public health initiative to promote the importance of protective eyewear.
Health related education and mindfulness about the quality of life following blindness is required. Delayed presentation need to be addressed. In underdeveloped area of the country this campaign is needed on a large scale. The staff of Basic health care Units and Rural health care Centers should be trained to provide initial care and timely referral to the tertiary health care facilities.