Eye injuries in Nigeria. A review of 433 cases

Ocular injuries in a paediatric population at a child eye health tertiary facility, Ibadan, Nigeria

PURPOSE

To determine the pattern, causes and risk factors for ocular injuries amongst children presenting to a tertiary facility in Ibadan, southwest Nigeria METHODS: A retrospective review of clinical records of patients aged 16 years and below who presented with ocular injuries to the eye emergency unit between May 2010 and April 2016. Information extracted includes patient's demography, location and circumstances of injury, clinical findings, and management. Data was analysed using IBM SPSS Statistics for Windows, Version 26.0. Descriptive and inferential statistics were calculated. Odds ratio were derived from regression models adjusted for confounders. Significance was set at a P-value of 0.05.

RESULTS

A total of 109 children were studied. Majority were boys (male to female ratio=2.9:1). The median age at presentation was 9 years. Injury occurred at home in 67 (61.5%) children, and at school in 30 (27.5%). More than half of the children were injured during play, 18 (16.5%) during corporal punishment, and 34 (31.2%) by accidents during domestic/schoolwork. Majority (73.4%) were closed globe injuries. The odds of injury with sharp objects and ocular trauma score of 4 or less was were 3.2 times (95% Confidence interval {CI}: 1.3-7.7) and 3.9 times (95% CI:1.4-11.4) higher in children aged 0-5 years respectively. The odds of open globe injury was 9.8 times (95% CI: 3.4-28.6) higher in injury from sharp objects. Wood/stick, cane, stone, broomstick and fist/palm/finger were the agents responsible for two-thirds of injuries.

CONCLUSION

This study revealed that children predominantly sustain ocular injuries at home and younger children have greater odds of severe injuries with profound implications for visual disability. Health education, adult supervision and the application of appropriate measures necessary for reducing the incidence and severity of childhood ocular trauma are advocated.

Effects of fasting on intraocular pressure in a black population

Introduction:

There is a dearth of literature available on the effects of fasting on Intraocular pressure (IOP) among all races and worldwide.

Objectives:

To determine the effects of fasting on IOP in a black African population.

Materials and Methods:

A population-based survey utilizing multistage random sampling techniques was carried out among healthy adult Muslims who were examined before and during Ramadan fast in Osogbo, Nigeria. Demographics were obtained, visual acuities, clinical examination of both eyes, and IOPs were done. Weights and waist circumference were measured. Data were analyzed using Statistical Package for Social Sciences ( SPSS) Version 16. Analysis generated frequencies and cross tabulations, whereas statistical significant values were derived using paired sample t-test and P < 0.05.

Results:

A total of 60 subjects with 120 eyes were examined. Mean age was 42.3 years standard deviation (SD) 16.7, and the male to female ratio was 3:2. Majority were professionals (33.3%). Only 18.3% had less than secondary school education. Over 90% had normal vision (6/5-6/18). Before and during fasting, the mean weights were 65.92 kg SD 12.98 and 65.29 kg SD 12.41 with a reduction of 0.63 kg SD 3.82 (P = 0.214, 95% confidence interval (CI): 0.372-1.626); and the mean waist circumference was 87.20 cm SD 12.39 and 81.78 cm SD 11.65 (P = 0.000, 95% CI 4.128-6.720), respectively. Mean IOPs were 15.98 mmHg SD 3.11 and 14.08 mmHg SD 2.71 before and during fasting, respectively (P = 0.000, 95% CI 0.98558-2.82798).

Conclusions:

The study shows that fasting significantly reduced IOP in an ocularly healthy black African population.

Epidemiology of penetrating eye injury in ibadan: a 10-year hospital-based review

PURPOSE

To assess risk factors associated with the occurrence of penetrating ocular injuries among patients presenting to an eye hospital at Ibadan, Nigeria.

MATERIALS AND METHODS

All cases of penetrating ocular injury presenting over a 10 - year period, were identified by retrospective chart review. All current cases of penetrating ocular injury identified were included. All information was obtained retrospectively from the medical records.

RESULTS

The cohort consisted of 135 cases. The follow-up was for an average period of 24.6 weeks (range, 12-312 weeks). Injuries were most likely to occur at home, in a domestic setting (58%). The most common mechanism of injury was projectile missiles hitting the eye. The age range for injuries was 9 months to 70 years. Penetrating ocular injury was most frequent in the 20-29 years group (31.9%) followed by the 0-9 years age group (31.1%). Males were more frequently involved than females (ratio 4:1). The final acuity was better than 6/18 in 14.8% and less than 3/60 in 59.3% of cases.

CONCLUSIONS

Penetrating ocular injury occurs, most frequently, in a domestic setting and mostly as a result of working with sharp objects. Preventive measures are recommended to reduce visual disabilities due to ocular injuries.

Eye injuries in children and adolescents: a report of 205 cases

OBJECTIVE

To investigate the causes, place, type and visual outcome of eye injuries necessitating hospitalization in children and adolescents.

METHODS

Consecutive patients with eye injuries aged <18 years admitted to a tertiary hospital over an 18-month period.

RESULTS

Two-hundred-five patients were hospitalized because of eye injuries over the study period. One-hundred-forty-six (71.2%) were males and 59 (28.9%) were females, for a ratio of 2.5:1. Preschool children made up 14.1% of the cases and 63.9% were in school, while 9.8% were apprentice artisans. Fewer than 23.4% (n=48) patients presented within 24 hours of injury. Injuries sustained at home occurred in 97 cases (47.3%) and at school in 44 (21.5%). Of the 54.6% of whose injuries were inflicted by others, 24.9% were inflicted by adults while meting out corporal punishment. Pointed objects (43.8%) and missiles (25.8%) were the common causative agents of injuries. Such agents were belts, canes, sticks, cutlasses and hoes. Penetrating eye injuries were the commonest type of injury (40.5%), followed by contusions (31.7%). Final visual outcome was < or = 6/60 in 88 (48.4%). Most eyes with poor visual outcome had penetrating injuries. Seventy-four (40.7%) had visual acuity > or = 6/18 and 8 eyes had evisceration.

CONCLUSION

Eye injuries in children and adolescents admitted to this tertiary hospital were severe. They occurred mostly at home and school and in circumstances that could be avoided. Health education and legislation could reduce the burden of injury-related blindness in the study area.

Childhood eye diseases in southwestern Nigeria: a tertiary hospital study

BACKGROUND

Eye diseases are important cause of medical consultation in children, with the spectrum varying in different localities. This study aimed to determine the spectrum of childhood eye diseases in a tertiary hospital serving rural and semi-rural communities.

METHODS

We conducted a retrospective review of all patients less than 15 years old who presented to the eye clinic of Wesley Guild Hospital Ilesa, Nigeria between January 2001 and December 2006. Data on age at presentation, age at onset of disease, sex and diagnosis were collected and analyzed using SPSS. A p value less than 0.05 was considered statistically significant.

RESULTS

We evaluated the reports of 286 children, with a male:female ratio of 1:1.1. Children aged 11-15 years made up the largest group (p=0.013). Ocular trauma (21.7%), allergic conjunctivitis (17.8%), infections of the eye and its adnexa (15.4%) and refractive errors (14.3%) were the most common conditions. Ocular injury was more common in males (p=0.002) and children aged 6-10 years, and 87.1% of these cases were a closed globe injury. Infections were seen more commonly among females and children aged 0-5 years, with keratitis representing 40.9% of these cases. Congenital eye disease represented 13.3% of childhood eye diseases.

CONCLUSION

The prevalent childhood eye diseases recorded here can lead to absenteeism from school and are potentially blinding. Health education aimed at the prevention of ocular trauma and prompt presentation for the management of other eye diseases should be encouraged.

Penetrating eye injuries in South African children: aetiology and visual outcome

PURPOSE

To assess the aetiology, prognosis, and visual outcome of penetrating eye injuries in South African children.

METHODS

In all, 100 consecutive patients, aged 16 years and under, with penetrating ocular injuries undergoing surgery between January 2001 and November 2002 were prospectively evaluated.

RESULTS

Most children (66%) were injured during play. In all, 55% of penetrating eye injuries occurred at home, and all injuries to children under the age of 6 years occurred there. Most injuries occurred in the absence of a caregiver (85%). Sticks, wire, and glass caused half of all injuries (48%). The most common mechanism of injury was impact with a sharp object (46%). Only 25% of injured presented to the hospital within 24 h of injury; the more severe the sustained injury and the younger the patient, the earlier was attendance at the clinic. Most patients (71%) regained best-corrected visual acuity (Snellen equivalent) of 20/200 or better, and 51% regained 20/40 or better. Patient age and delay of presentation were not of prognostic value. Indicators of poor visual outcome were identified as wound size greater than 11 mm in length, mixed corneoscleral type wounding, and involvement of the lens and posterior segment in the injury.

CONCLUSIONS

Penetrating eye injuries in African children, reviewed here, generally occur when children are at play in a domestic setting. Effective prevention should stress parental awareness, careful supervision, greater home safety, safe toys, and avoidance of hazardous games.

The global impact of eye injuries

Using data compiled from the ophthalmic literature and WHO's Blindness Data Bank, the available information on eye injuries from an epidemiological and public health perspective has been extensively reviewed. This collection of data has allowed an analysis of risk factors, incidence, prevalence, and impact of eye injuries in terms of visual outcome. However, most of the estimates are based on information from More Developed Countries (MDCs). The severity of eye injuries can be assessed through proxy indicators such as: (i) potentially blinding bilateral injuries; (ii) open-globe injuries; (iii) endophthalmitis; (iv) enucleation or (v) defined visual impairment. Major risk factors for ocular injuries include age, gender, socioeconomic status and lifestyle. The site where the injury occurs is also related to a risk situation. Available information indicates a very significant impact of eye injuries in terms of medical care, needs for vocational rehabilitation and great socioeconomic costs. The global pattern of eye injuries and their consequences emerging from the present review, undertaken for planning purposes in the WHO Programme for the Prevention of Blindness, suggests that: some 55 million eye injuries restricting activities more than one day occur each year; 750,000 cases will require hospitalization each year, including some 200,000 open-globe injuries; there are approximately 1.6 million blind from injuries, an additional 2.3 million people with bilateral low vision from this cause, and almost 19 million with unilateral blindness or low vision. Further epidemiological studies are needed to permit more accurate planning of prevention and management measures; a standardized international template for reporting on eye injuries might be useful to this effect, along the lines of the reporting occurring through the US Eye Injury Registry.

Causes and visual outcome of childhood eye injuries in Nigeria

Two hundred and twenty-eight children of both sexes (152 males and 76 females) aged between 1 and 15 years treated for eye injuries at the University of Nigeria Teaching Hospital, Enugu, Nigeria were studied. The injuries were commonly sustained during domestic activities (29.8%), at play or sports (23.7%), in the schoolroom (16.7%) and during farm work (10.1%). Causative agents were mostly sticks, followed by stone missiles and other flying objects. There was a general delay in reporting to hospital in all types and degrees of severity of injuries, with only 28.5% reporting in the first 24 hours and as many as 10.5% after 1 month. How quickly the patient came to hospital was determined more by social and economic factors than by sex, age and type of injury. Visual outcome was best in patients with mild non-penetrating injuries and worst in those with severe penetrating injuries. Amongst the latter the outcome was worse when the posterior segment was involved than when the injury involved only the anterior segment. Our study showed that there has been a change in the causation of childhood eye injuries in the country compared with reports of 25 years ago. The visual outcome in our patients was worse than in reports from developed countries. This was due mainly to delay in seeking specialist treatment and lack of sophistication of the treatment, especially in severe cases.

Eye injuries among children in Kuwait: pattern and outcome

One hundred and ninety four children with ocular injuries were admitted to the Eye Department at Ibn Sina Hospital, Kuwait during a 1-year period (1983). They represented 8.7% of total admissions and 56% of all ocular injuries admitted in the same period. These figures are higher than any previously reported figures in comparable series. The risk of severe ocular injury to children was found to be 0.35% per 1000 per year. There were 47 (24%) perforating injuries and 111 (57%) concussion injuries. Catapulted missiles were the commonest cause of injury (26%). Early presentation to hospital accounted for a low rate of secondary infection. Visual outcome of 6/12 or better was achieved in 78.5% of concussion injuries and 27.3% of perforating injuries. Education in organized school programmes has been recommended to reduce the incidence of ocular injuries in children.

Ocular injuries in Africa

Injuries to the eye can cause severe damage because of the delicate structure of ocular tissues. Such injuries may often cause impaired vision or sometimes total loss of vision, in addition to other incapacities. Traumatic blindness therefore assumes an unusual socio-economic dimension. In Africa, injuries have their own peculiarities regarding aetiology, severity and management. More than 80% of injuries occur in rural areas where the necessary services are generally unavailable. This paper surveys the types, occurrence and impact of ocular injuries and suggests how they should be treated.

Ultrastructural studies of traumatic cataractogenesis: observations of a repair process in mouse lens

Lenses of CFI mice were studied with the transmission electron microscope at frequent intervals through 13 months following a transcorneal needle injury to the lens. While this kind of injury causes a high incidence of traumatic cataract in the human and frog, it elicits a repair process in the mouse lens whereby the damaged capsule, epithelium and lens fibers are rapidly renewed and permanent lens opacity seldom occurs. Ultrastructural changes in lens epithelial cells adjacent to the wound, which precede and accompany localized cellular proliferation and production of new capsule, involve a rapid increase or enlargement of organelles associated with protein synthesis and assembly. The capsule and epithelium are repaired within a couple of months. Cortical lens fibers in the wound area undergo conformational changes into smaller, ordered arrays of "membranous sacs". These are replaced within a week by normal appearing lens fibers. There is minimal degeneration or hyperplasia noted, and except for a few fibroblastic cells on the lens surface, little evidence remains of the injury by two months. Ultrastructural differences between mouse and human lens, such as presence or absence of dense bundles of microfilaments and desmosomes are considered in relation to lens shape and tension, and susceptibility to injury-induced cataract.