Pediatric ocular trauma--a clinical presentation.
A year long study of ocular injuries in children below the age of 15 years was conducted in the Ophthalmology Department of a general hospital. Fortyfour cases were studied. Of these 45.45% were in the age group of 6-10 years. The male to female ratio was 5.28 : 1. Pointed objects viz. sticks, wires etc. were found to be the common causative agents; the recent trend being of bow and arrow injuries. Ocular perforation was observed in 28 cases. On follow up of all the cases with ocular trauma, only 12 patients were found to have a visual acuity better than 6/18; perception of light was absent in 7 patients. A need for increased parental awareness and supervision of children is stressed upon.
Eye injuries in children have a significant impact in terms of long-term morbidity. The incidence of ocular injuries in children below the age of 15 years varied in different studies conducted,,,,,. Herein, we have analysed the cases of ocular trauma in children with a view to identify the population at risk, most common object of injury and final visual outcome.
An analysis of cases of ocular trauma in children admitted in the ophthalmic ward during the year 1987-88 was carried out. Data regarding the age and sex of the patient, cause and nature of injury, patients, surgical treatment given, and condition at discharge were recorded. The patients were followed up for at least 3 months when the final visual acuity was determined.
During the study period (1987-88) ocular injuries were reported in 44 children. The maximum incidence of eye injury (45.45%, 20 cases) occurred in the age-group of 6-10 years. Ten children belonged to 0-5 year age group and 14 belonged to 11-15 year age group. The incidence was more common in males at any age group, male to female ratio being 5.28:1.
The right eye was affected in 19 (43%) patients, and the left in 25 (57%)
The causes of injury are listed in [Table - 1]. Pointed objects accounted for 47.7% injuries (21 cases); sticks being the commonest. Bow and arrow injuries were seen in 4 cases. Trauma with blunt objects viz. ball and stone was seen in 11 cases. Explosives like firecracker and vehicular accidents resulted in ocular injury in 5 children each.
The nature of injury caused by these objects are listed in [Table - 2].
Visual acuity could not be determined in 10 children as they were underage. Of the remaining 34 patients, 12 had a final visual acuity better than 6/18; 4 patients had a visual acuity in the range 6/18-6/60; 11 patients had residual vision of less than 6/60; while 7 patients had no perception of light. Six eyeballs were enucleated, 4 for irreparable damage due to perforation and 2 for panophthalmitis.
The diagnosis and treatment of injuries in children, by itself, poses a challenge; at the same time post-operative management and visual rehabilitation is an equally exacting and often futile task due to the development of amblyopia. In our study, majority of (45.5%) injuries were seen in the 6-10 year age group, while only 22.72% cases were seen in the 0-5 age group. This varies considerably from a study in Brazil, which identifies the 0-5 age-group with 61.0% incidence, as the population at highest risk. This may be due to a different social cultural milieu between the two populations.
A higher incidence of eye injuries in boys is consistent with findings of other authors,,,,,,. The higher male to female ratio can be attributed to a greater degree of freedom and stimulus to aggressiveness given to boys in all societies.
The preponderance of left eye is consistent with findings of other authors.
Pointed objects, particularly sticks, were the most common causative agent in this study as well as of others,,,,,. Incidence of bow and arrow injuries is on the increase since the onset of television serials depicting the Ramayana and Mahabharata. Sports objects like balls are a potential hazard. Firecracker injuries show a seasonal peak during Diwali indicating a greater need for supervision of children and adoption of protective measures.
Ocular perforations are more common in children in all studies,,,. Inspite of improved techniques, results are often grave, the severity of injury often necessitating enucleation of the eyeball.
The residual visual acuity is difficult to record in children. In our study, visual prognosis was good in 12 patients, moderate in 4 and poor in 18 patients; 6 eyeballs were enucleated. Compared with studies of Koval et al 4 and Moreira et al, a relatively poor visual outcome in our set up can be attributed to decreased parental awareness, delayed consultation time, increased post-operative complications and poor visual rehabilitation.
A majority of the population in our series belonged to a poor socio-economic class. Even though medical treatment was availed of within 6 hours in a majority of cases (84.09%), 16.0% patients did report to the hospital after 48 hours thus accelerating the complication rate.
One is therefore inclined to agree with Niiranen and Raivio who claim that despite therapeutic advances, visual prognosis in children is still worse than adults. Hence it is necessary to implement mass education programmes regarding effects of ocular trauma, recognition of specific hazards and their prevention.
We wish to thank the Medical Superintendent, Dr. RN Cooper Hospital, for permitting us to publish the Hospital Data.