Pediatric Ocular Trauma in Quetta with Preventable Recommendations

Objectives: To asses frequency and complication of pediatric ocular trauma followed by education of masses for prevention. 
Material & Methods: This retrospective study was conducted in Bolan University of Medical & Health Sciences (BUMHS) in the department of pediatric ophthalmology. We analyzed the 5year data of patients treated at Helper’s Eye Hospital Quetta from Jan 2014 to Dec 2018.
Results: There were Total of 15,824 children having pediatric ocular trauma aging 05 months and maximum age 15 years with mean of 8 years out of total 12620 children were male and 3214 were female. The male to female ratio was 4:1. The most frequently observe mode of injury among children was projectile 7912 (50%), including body parts (finger, fist) 3204(20%) blunt objects 1602(10%), motor vehicles 801(5%),sharp objects 1602(10%) and vegetative materials 801(5%). Majority of children receiving trauma were in the age more than 6 year. The most common causes of visual disability were disorganized globe and corneal opacity.
Conclusion: Pediatric ocular trauma is a common cause of visual impairment majority of patients were young boys (above 8 years) there is a need for education and awareness in the society particularly the parents.

INTRODUCTION.

Beside direct damage to the ocular structure, prolonged deprivation due to refractive errors leading to amblyopia. Due to the outdoor activities the boys above the age of 8 years are more prone to traumatic accidents as compare to the infants and female children less than three years of age are mostly supervised by adults at home, therefore they suffer less than the boys. Older children injure themselves by pencils arrows, needles, stones, and thorns, balls, and bats. Sports related injuries are common in children from five two fifteen years of age injuries by toys are common on Eid and other ceremonial occasions.


1.Associate Prof. Ophth BUMHS 2.3 Assistant Professors (Vit-Ret. Surgeons) BUMHS4. Assistant Professor of Endocrinology5.Prof.& Head of Ophthalmology BUMHS6.Neurosurgeon.


Correspondence: Dr. Shaban Khan Kakar Associate Prof. of
Ophthalmology, BUMHS shabankkr@gmail.com Cell: 03337847303


Received. June-2019 Accepted: Sep-2019


Pediatric ocular trauma can be a devastating injury causing a life time disability in children which can be significantly reduced up the 90% or even avoided completely with proper education of parents, caretakers and teachers who have an important role to prevent these accidents.


In rural areas the more common injure is by agriculture related work that is vegetative materials, wood, Sticks, animal tail, birds and others. We conducted this study for documenting the preventable cause of visual deterioration. Inclusion criteria: The age included in this study ranges the children from 05 months to 15 years. Exclusion Criteria: The Patients having neurological disorder like cerebral palsy, mentally handicapped children were excluded from the study of hospital record. About 15824 patients were treated as revealed the data of hospital record for the 5 years period (Jan 2014 to Dec 2018) Ophthalmologists and other eye care personnel have enormous opportunity to educate patients on the proper prescription and use of protective eyewear. Since infants are well supervised and protected by parents, masses of our society are required to be educated to take compulsory measures such as using proper child seatbelt which has significantly diminished damages leading to visual impairment. Analyzing the mindset of the people.

MATERIALS AND METHODS:

This retrospective study was conducted at the department of pediatric ophthalmology Bolan university of medical and health sciences/ helpers eye hospital Quetta deptt. of pediatric ophthalmology from Jan, 2014-Dec,2018 from the hospital records. We observed male to female ratio was 4:1, becoming higher with age and the place of injury changing according to the age; younger children suffered accidents at home, whereas older children were more prone to experience trauma while practicing sports While the agriculture related trauma was faced by the children of the low socio-economic status. According to the hospital record accident of trauma was observed to increase almost by 15% every year. The types of trauma we found in study:

1.Foreign body in the eye ball and cornea
2.Ruptured globe from fire and explosives
3.Ruptured choroid
4.Traumatic cataract
5.Retinal hemorrhage
6.Detached retina
7.Blood in the anterior chamber (Hyphema)
8. Burns of the cornea from chemicals Infection of the cornea from contact lenses, wood sticks in agriculture work data analyses was performed using SPSS version 18.2, frequency of age, gender and eye involved calculated with mean + standard deviation.

RESULTS:

Ocular trauma in children has remained as one of the major area of focus, since there is an immediate cure required for the prevention of ocular trauma. This study represents both gender distribution of ocular trauma leading from the year 2014 to 2018 however, there has always been a difference observed between the male and female ratio of injury. 15,320 children with ocular trauma were studied from the hospital record with the minimum age was 5 months, whereas the maximum age was 15 years with the mean of 8 years. Out of these 15,834 children 12620 (79.7%) were males and 3,214 (20.29%) were females (able 1.) The minimum percentage of ocular trauma retained was 502 in females in the years 2014, 552, 600, 700 and 800 in the year 2015, 2016, 2017, and 2018, respectively. On the other hand, year 2014 represented male patients with minimum number of injury of about 2010 with an approximate increase of 15% each year. Additionally, table no 2 of the study elaborating age distribution represents the maximum number of injury found in the children of age above 6 years i.e 2250 in the year 2018; however, children under the age of 2 years represented minimum number of ocular trauma of around 10- 15% in the preceding years as compared to children above than 2 years. Meanwhile, the finding of the present study shows a continuous increase in the injuries of eyes in consonant with the ages of children. Several causes have been identified from the history sheet, one of the major causes of ocular trauma is projectile (50%) and body parts (finger, fist), (20%) blunt object (10%) motor vehicles (5%), sharp object (10%) vegetative material (5%), however, there could be several other unusual causes ocular trauma such as rooster attack , pencil tips, exploding of boiling eggs, door-handles, chopsticks and dishwasher detergent. Since children’s activities are quite unfamiliar or abnormal and they are sometimes unpredictable, besides, all these injuries which may lead to a serious visual impairment, apparently non-dangerous to adults or parents.(Sadia, PS, Umair, Israr, & Abdul, 2011) This study found higher number of male children affected i.e (79% ) as compared to female i.e (27%) according to estimates, it has been outlined that 90% of ocular trauma is preventable 18,19since children can be supervised and prevent at home; estimates showed between 44% and 76% of pediatric ocular injuries occur at home 13,14,16,17







DISCUSSION:

Young patients are more prone to the Ocular trauma because of their curious nature and childish motor skills. Visual impairment is the preceding cause of acquired monocular blindness in young patients. Edmondson et al. of ATV accidents highlighted eye and adnexal injuries involving orbital fractures (60%), eye lid laceration (25%) and traumatic optic neurological damage as well as permanent vision loss in patients. However, the incidence of pediatric injuries varies with age1, sex,11, 20 socioeconomic states,8-10season and geography,12besides, more than 20% ocular injuries take place at home. List Man [13] explained the rising number of incidents of paintball injuries in children, which gets inserted in the orbit. Furthermore, the estimate Brophy et al.21examined pediatric eye related hospitalization and figured out that there were more than 7500 admissions in the United States as outcome of eye injuries in 2000. Similar to that Serrano etal.17examined similar data in Columbia, disclosing the world wide issues with similar epidemiology established as previously conducted research data of at least a two to one incidence of male to female in ocular trauma; almost all of the injuries fall out at home or motor vehicle accidents, however the place in injury changes significantly with age. The accidents or mishaps associated with work tend to be infrequent in developed countries, however, developing countries where the tradition of child labor exists and according to the estimates 32% children lost their eye and 53% of then lost light perception during work 7.

Prevention:

Prevention is extremely significant component of an ideal life, children in a very young age are more probable to suffer with visual impairment because of their lack of motor skills and inadequate attentions of adults, this study aims at describing the awareness of masses in order to cope with ocular trauma, since adult supervision is essential in the prevention of injuries to children bur necessary measures are not very popular. A few measure such as the use of face mask protection in sports has overcome eye trauma up to nearly zero 8.9 In Quetta, traditionally, guns and air rifles are often given to children on specific occasions or festivals. Besides that children are more curious in making elastic devices rubber bands, balloons and different weapons to construct slingshots and other types of and projectile launching artifacts. Most parents and adults do not consider these toys are dangerous. Male children are comparatively more affected than females, since boys are more inclined to outdoor activities and they have been granted more liberty than female in our context.

Recommendations:

Proper education of parents, school and madras teacher and counseling role of media is mandatory along with Social mobilization by volunteers to join the crusade of awareness of the society. Legislations to ban the sale and supply of hazardous toys and use of safety glasses while playing games like hockey baseball, tennis and other sports are to undertaken by the Government. Use of protective glasses in rural areas while dealing with vehicles battery, acids, and other chemicals should ne mandatory.

CONCLUSION:

Ocular trauma can be a devastating injury causing a life time disability in children’s, the poor out comes of these injuries can be significantly minimized up to 90% or even can be avoided completely with proper education of the parents, caretakers and teachers who have an important role to prevent these injuries. Education with compulsory measures for eye protection have not been very popular. However, parental supervision is not enough to prevent these injuries.

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