|Year : 2013 | Volume
| Issue : 1 | Page : 10-14
Seasonal variation in ocular injury in a tertiary health center in Benin city
Valentina W Okeigbemen, Vivian B Osaguona
Department of Ophthalmology, University of Benin Teaching Hospital, P.M.B 1111, Benin City, Nigeria
|Date of Web Publication||17-May-2013|
Valentina W Okeigbemen
Department of Ophthalmology, University of Benin Teaching Hospital, P.M.B 1111, Benin City
Background: Ocular trauma is the commonest cause of unilateral blindness. This study aims to determine the seasonal variation in the prevalence and pattern of ocular injury in a tertiary hospital in Benin, Nigeria. Materials and Methods: A 3-year retrospective study was carried out in the eye department of University of Benin Teaching Hospital, Benin City, from January 2009 to December 2011. The information retrieved included age, gender, occupation, type of injury, cause of injury, mechanism of injury, place where injury occurred, month of occurrence, treatment, and initial and final visual acuity. Results: A total of 125 patients made up of 90 (72%) males and 35 (28%) females with a male to female ratio of 2.6:1 were seen. The age range of the patients was from 7 months to 70 years, with a mean age of 25.92 ± 18.16 years (SD). One hundred and twenty-nine eyes were affected with bilateral involvement in 4 patients. The commonest mechanism was blunt injury in 50.4% of the patients. The prevalence of ocular injury was observed to rise from April, peak in June, and there after decline. The second cluster started from October, continued through November to January, and began to decline. Majority of the eye injuries were lacerations (46.4%). Home injuries constituted 31.2%. Conclusion: There is a great need to be more safety-conscious at home and during play. Public enlightenment programs should aim at increasing awareness during the months ocular injury tends to occur.
Keywords: Ocular injury, seasonal variation, Okeigbemen
|How to cite this article:|
Okeigbemen VW, Osaguona VB. Seasonal variation in ocular injury in a tertiary health center in Benin city. Sahel Med J 2013;16:10-4
| Introduction|| |
Ocular trauma, once described as the "neglected disorder", has recently been highlighted as a major cause of visual morbidity.  Globally, there are approximately 1.6 million people blind from eye injuries.  Ocular trauma is the commonest cause of unilateral blindness.  The age distribution for the occurrence of serious ocular trauma is bi-modal, with the maximum incidence in young adults and a second peak in the elderly. ,
Eye injury is more common in males , especially those within the young and active age group. Studies ,,,,,, have also shown that eye injuries tend to occur in the workplace, during unsupervised play and sports among children, and from assault, road traffic injury, and accidents at home and in the farm. In a study on ocular trauma in Benin City, 47 patients (22.17%) out of the 212 patients who presented with ocular trauma sustained injury in the workplace.  In another study in Benin, Ukponmwan et al, reported that the highest number of ocular trauma (55 eyes out of 230 eyes) resulted from domestic accident. In University of Benin Teaching Hospital, a study showed that28.4% of all hospitalized eye patients were as a result of ocular trauma  and 54.3% of eyes that had enucleation or evisceration was due to trauma. 
Olurin  found in her study that locality influenced the type of ocular trauma as agricultural injuries were commoner among farmers in the rural areas than in urban cities. A study by Qureshi  in Pakistan showed a steady rise in the frequency of eye injuries from April with a peak at June and then a gradual decline in October. Eye injuries occurring during this period were related to date farming where harvesting of dates involved climbing trees with the attendant risk of injuries from date leaves and wood. 
In a study by Kapadia et al,  in Massachusetts, open globe injuries were twice as common during summer (within the months of April -September) than during winter (October-March). Work-related injuries and injuries related to home improvement projects were common causes of open globe injuries in both summer (22% each) and winter (24% and 18% respectively) months.  However, injuries related to assaults were more common in summer (14% vs. 0%), while injuries from falls were more common in winter (18% vs. 3%). 
The aim of this study is to determine the seasonal variation in the prevalence of ocular injury, cause, mechanism and pattern of ocular injury in a tertiary health center in Benin City. This information will be useful in planning public health campaigns and will enable more focussed health education, public awareness and safety campaigns during the periods these injuries tend to occur.
| Materials and Methods|| |
A 3-year retrospective study was carried out in the eye department of University of Benin Teaching Hospital, Benin City. The case notes of all patients with ocular injury, seen from January 2009 to December 2011, were documented. A structured questionnaire was used to collate the data. The information retrieved included age, gender, occupation, type of injury, cause of injury, mechanism of injury, place of injury, eye involved, month of occurrence, the time of presentation, treatment, initial visual acuity, and final visual outcome after discharge.
Data collated were analyzed using Statistical Package for Social Sciences (SPSS) 15. Frequency distribution tables were generated for all data collected. The ranges and means were determined. The relationships between categorical data were analyzed using Chi-square test. At the adopted confidence level of 95%, a P value of 0.05(5%) or less was regarded as significant.
| Results|| |
A total of 125 patients presented to the eye department with ocular injury during the study period. There were 90 (72%) males and 35 (28%) females giving a male to female ratio of 2.6:1. The age range of the patients was from 7 months to 70 years with a mean age of 25.92 th + 18.16 years(SD). The age and sex distribution is shown in [Table 1]. The highest number of patients-(34) was in the age group of 0-10 years, comprising 27.2% of the total number of patients. Ninety-nine patients (79.2%) were below 40 years of age, while 26 (20.8%) were aged 40 years and above. The total number of eyes affected was 129 with bilateral involvement in 4 patients. The left eye was involved in 66 patients (52.8%) and the right eye was involved in 55 patients (44%). This difference was not statistically significant (P=0.1289, odds ratio 0.6587, CI 0.4000-1.085).
The occupation of patients is seen in [Table 2]. Fifty-six patients (44.8%) comprising dependants (toddlers, pupils, students) constituted the highest number, followed by traders (13.6%).The commonest mechanism of injury was blunt injury in 63 patients (50.4%) followed by penetrating injury in 46 patients (36.8%). There were 10 cases (8.0%) with superficial foreign body, 3 cases (2.4%) of assault, and 3 cases (2.4%) of chemical injury.
[Table 3] shows the causes of injury. The most common causative agent was wood/stick in 28 patients (22.4%). Sharp objects such as biro, broomstick, nail, knife, broken bottle pieces, razor blade, cutlass, and ceiling fan caused injury in 38 patients (30.4%). Blunt objects such as wood, stick, fist blow, accidentally hitting the wall or door, cane, stone, and football caused injury in 62 patients (49.6%). Small flying missiles such as iron particles and gun pellets caused injury in 10 patients (8%). Road traffic accident and burns from carbide explosion and acid accounted for 10 patients (8%) and 5 patients (4%), respectively.
[Table 4] shows the time of presentation at the hospital following injury.Forty patients (32%) presented within the first 24 h, with 85 patients (68%) presenting after 24 h.
The month of occurrence of ocular injury is seen in [Figure 1]. The prevalence of ocular injury was highest in the months of January (17.1%) and November (13.8%), followed by September (12.2%), June (11.4%), May (9.8%), and December (8.9%). The highest number of injuries between October and January occurred in males (38) compared to females (15). This was not statistically significant (× 2-0.004160, df- = 1, P = 0.4743).
The commonest type of injury as seen in [Table 5] were lacerations (corneal/scleral/ corneoscleral) in 46.4%, followed by traumatic cataract/ dislocated lens in 10.4%.
The commonest place where injury occurred was at home accounting for 39 patients (31.2%), followed by road traffic injury or assault in 22 patients (17.6%), work in 21 patients (16.8%), during play in 20 patients (16%), the farm in 15 patients (12%), school in 5 patients (4%), the shop in 2 patients (1.6%), and during sport activity in 1 patient (0.8%).
A total of 67 patients (53.6%) needed surgical intervention. Corneoscleral repair was the commonest surgical intervention accounting for 45 patients (36%). The other interventions included cataract extraction in 9 patients (7.2%), lid repair in 4 patients (3.2%), repair of ruptured globe in 4 patients (3.2%), foreign body removal in 4 patients (3.2%), and conjunctival repair in 1 patient (0.8%). Conservative (medical) treatment was done in 51 patients (40.8%).
Ninety-nine eyes (76.7%) presented with vision less than 3/60, as seen in [Table 6]. Twenty-four eyes (18.9%) presented with vision of 6/18 and better. The final visual acuity was 6/18 and better in 38 eyes (29.4%).
| Discussion|| |
Previous studies have shown that ocular trauma is an important and preventable cause of monocular visual loss in Benin City. , In this study, there was a male to female ratio of 2.6:1, showing a male preponderance which is in agreement with the findings by other authors. ,,, This is because males are more active than females and are involved in dangerous activities such as fights and occupations which predispose them to ocular trauma. The peak age was in the first decade (27.2%), which is similar to the finding in a previous study carried out in Benin City more than a decade ago.  The susceptibility of children and adolescents to ocular injuries has been reported. ,
In this study, ocular trauma occurred predominantly in those who were in the active and economically productive age of less than 40 years (79.2%). This is in agreement with the findings by other authors. ,,
Dependants (toddlers, pupils, students) were predominantly affected (44.8%), followed by traders (13.6%). In an earlier study by Ukponmwan et al, dependants were found to be predominantly affected. The highest number of ocular trauma was due to domestic accidents. This was similar to the findings in previous reports. ,
The left eye was more commonly affected than the right eye. The trend of left eye preponderance has been observed in various studies. ,, This may be because the left eye is more likely to be hit when slapped with the right hand. In Nigeria, the left eye of drivers is nearer the window in cars and is likely to be involved in trauma during road traffic accident. 
Blunt injuries (50.4%) were more common than penetrating injuries (36.8%) in this study. This was observed in previous studies. , However, Ukponmwan  in Benin City found perforating injury to be more common than blunt injury. This, as explained by one author, may be because activities resulting in blunt injury such as road traffic accidents, fights/assault, and domestic activities are on the increase, while activities such as use of dane guns for game hunting that predispose to perforating injury are on the decline due to improved awareness.  The commonest etiological agents were blunt objects (49.6%) with wood/stick accounting for 22.4%. In the study by Okoye et al, in Enugu, blunt injury from fist blows, slap, and wood accounted for 44.8%.Objects causing injury were similar in both studies.
Early presentation to the hospital after ocular injury cannot be overemphasized. Results are best if cases are seen by an Ophthalmologist within the first 24 h.  In this study, only 32% presented within 24 h of injury. Majority of the patients (68%) presented after 24 h. A similar finding was observed in previous studies. , The prognosis of the initial lesions is adversely affected by delay before proper management or presentation to hospital and by administration of inappropriate home medication. 
A seasonal variation in prevalence of ocular injury was observed. There was a steady rise from April (3.3%), continued through May (9.8%), peaked in June (11.4%), and there after began to decline in July (7.3%). The second cluster started in October (3.3%), continued through November (13.8%) and December (8.9%), peaked in January (17.1%), and there after declined. There was an isolated cluster in September (12.2%). The observation by Qureshi  was similar. Eye injuries were related to injury from flying iron in people who worked on lathe machines without wearing protective devices due to the discomfort of the high summer temperature. In our study, the first observed cluster may be due to farming as this is the period when crops such as maize, cassava, and groundnuts are planted and activities in the farm are on the increase,while thesecond cluster may be due to injury occurring during holiday activities. Children are generally out of school during December and January. They spend more time outside playing with friends with less adult supervision. They may also have access to fireworks and harmful objects. , Road traffic accidents may also account for the increase in ocular injury during November, December, and January when people travel for holidays.
Most injuries in this study occurred within home or were sustained during play as reported in previous studies. ,,, In other studies, work-related injuries were found to be more common. , Road traffic injury and assault was responsible for 17.6% of injuries in our study. The need to enforce the use of seat belts by drivers and their passengers and the use of protective helmets by motorcyclists and their passengers will drastically reduce ocular trauma from road traffic accidents. 
Ninety Ninety-nine eyes (76.7%) were found to be blind (WHO definition) on presentation, while 85 (65.9%) remained blind after treatment. This shows the high risk of vision loss associated with ocular trauma. Rahman et al,  reported that a good visual acuity on presentation correlated with good visual outcome.
There is an urgent need to increase public enlightenment during the months of October-January and April-June, when ocular injuries have been found to be on the increase, on measures of preventing ocular injury. Drivers should be safety-conscious and drive with caution as they take people to their various destinations during the holiday season. Parents, teachers, and caregivers must be educated on the need to create a safe environment for children. Children should be closely supervised while playing, and dangerous objects should be taken out of their reach. Children should also be made aware of the inherent dangers of playing with stones and sharp objects or toys such as sticks, broomsticks, catapaults, biros, pencils, nails, and knives. The home environment should be made safe and accident free. Safety measures and policies should be enforced among those at risk.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]