Delhi Journal of Ophthalmology

Epidemiological Profile of Ocular Trauma in A Mid-Zonal Hospital of Armed Forces in North-East Region of India

Ravi Chauhan,1 Abhinav Singh,2 Sanjay Mishra,3 VK Baranwal4 
1Department of Ophthalmology, Command Hospital, Lucknow, UP, India.
2Department of Ophthalmology, Military Hospital, Agra, UP, India.
3Department of Ophthalmology, Army College Of Medical Sciences & BHDC, New Delhi, India.
4Department of Ophthalmology, Commandant, Military Hospital, Jhansi MP, India.

Corresponding Author:

Abhinav Singh (DNB)
Graded Spl Ophthalmology 
Military Hospital Agra Cantt, Agra, UP, India
Email: docskool@gmail.com

Received: 15-SEP-2020

Accepted: 05-OCT-2020

Published Online: 09-JUL-2021

DOI:http://dx.doi.org/10.7869/djo.659

Abstract
Introduction: ocular trauma is an important cause of preventable ocular morbidity and blindness in addition to socioeconomic and psychological ramifications. The spectrum of ocular trauma ranges from minor injuries to very severe sight threatening injuries. Trauma is inevitable in war zone and routine army exercises. There are very few studies establishing relationship between occupation and ocular trauma in armed forces. This study was conducted to provide us with epidemiological data on ocular trauma cases in a mid-zonal hospital of armed forces in north-east region of India.

Aim: to analyze the epidemiological profile of patients with ocular trauma among the soldiers of armed forces deployed in north eastern zone.

Materials and Methods: a prospective study was carried on 210 eyes of 200 patients of ocular trauma, presenting to emergency department and outpatient department in a mid-zonal hospital located at Dimapur, Nagaland, during twenty four months period. All demographic data, mode of injury along with complete ophthalmic workup was recorded. Classification system of Birmingham eye trauma terminology system was followed and ocular trauma score was calculated.

Results: The best corrected visual acuity at the time of presentation was 6/60 or better among 65%, worse than 6/60 were 25% and 10% were could not perceive light. In gender distribution male outnumbers females 69% and 31% respectively. Most of the cases were belonging to age groups of 30 years and younger 58%. In this study we found out that soldiers working in operations, training, sports and handling machineries (Outdoor) were more prone to trauma > 50% and soldiers of technical trade (Indoor) were least prone 5%. Among the children, school going population was more prone 16% and pre school was less prone being 8%.Adenexal injuries 35% were followed by contusions 25% and perforation being least 2%. Zone I 65% injuries out numbers the zone II and Zone III.

Conclusion: our study shows that whenever zone III is involved, the prognosis always remains guarded.Trauma is inevitable in war scenario, and for those sustaining trauma, multisurgeon intervention is needed. Wearing protective polycarbonate eye wear will minimize work related and sports related injuries.

Keywords :Pneumatic retinopexy cryopexy, head positioning

Introduction
Trauma to the eye is an important cause of preventable ocular morbidity, more commonly in the younger population.1-4 The spectrum of ocular trauma ranges from minor injuries to very severe sight threatening injuries. However, most of the ocular trauma is of minor nature, which can be treated in the Out Patient Department or minor OT itself. The annual global burden of ocular trauma is 55 million out of which 7,50,000 requires hospitalization.5 The ocular trauma can range from superficial corneal foreign body to rupture of globe leading to profound vision loss. The ocular trauma can occur in almost any setting including sports, assault, agriculture and road traffic accidents. Trauma is inevitable in war zone and in routine army exercises. A few previous studies have established a relationship between occupation and ocular trauma,6-9 but there are very few studies establishing relationship between occupation and ocular trauma in armed forces.10,11 This study was conducted to provide us with epidemiological data on ocular trauma cases in a mid-zonal hospital of armed forces in north-east region of India.

Material and methods
This study included 210 eyes of 200 patients of ocular trauma, presenting to the emergency department and out patient department of in a mid zonal hospital at Dimapur, Nagaland between July 2017 to July 2019. It was a cross-sectional study. The clientele were mainly serving personnel, their families and few ex service men. The patient’s demographic data was noted from existing hospital record system by single ophthalmologist. Complete history of mode and place of injury with nature of injury was noted. Complete details of ophthalmic examination including initial best corrected visual acuity (BCVA) at presentation, details of lid or facial injury, any pupillary defect, presence or absence of foreign body, involvement of cornea, corneo-sclera, sclera & uvea were noted. The presence and absence of associated vitreous hemorrhage, retinal tears, retinal detachment & choroidal rupture, if any was documented.Relevant investigations like IOP, USG B scan, CT Scan, MRI and VEP was done, whenever indicated.

The ocular injuries were classified using standardized international classification of ocular trauma, Birmingham eye trauma terminology system12 & Ocular trauma score (OTS) was used to assess the severity of injury. The patients were divided into those managed conservatively and surgically.

Results
The best corrected visual acuity at the time of presentation was 6/60 or better among 65% of patients, worse than 6/60 in 25% of patients and 10% of patients could not perceive light (Table no 1). In gender distribution males outnumbers females 69% and 31% respectively (Table no 2). Mean age was found out to be 26.50± 3.56 yrs. Slightly more than half of the cases (58%) were belonging to the age group of 30 years or younger. (Table no 2). In this study we found out that soldiers working in operations, training, sports and handling machineries (Outdoor) were more prone to trauma > 50% and soldiers of technical trade (Indoor) were the least prone (5%) (Chart no 1). Among the children, school going population was more prone (16%) and pre school was less prone being (8%) (Chart no 1). Conjunctiva and cornea were most frequently involved structures (50%) and retina and vitreous being least (5%) (Chart no 2). Adenexal injuries (35%) were followed by contusions 25% and perforation being the least proportion (2%) (Chart no 3). Zone I (65%) injuries out numbers the zone II and Zone III (Chart no 4). Most common mode of injury was blunt trauma followed by projectile injury and IED blast (Chart no 5).Approx 1/3 of patients (36%) required surgical intervention.
Visual acuity with No PL was seen among ten cases (10) cases at the time of presentation, seven (7) of which consists of open globe trauma with a high moving stone in various different scenario and a case of splinter injury following IED blast which had already developed endophthalmitis at time of presentation. In our study we found that the trend of ocular trauma was predominantly unilateral. However, 10 cases had bilateral ocular trauma.

















Discussion
Ocular trauma is an important preventable cause of ocular morbidity and blindness. In our study, the prevalence of ocular trauma is appx 11.5%, which is higher than from the previous studies13,14. Mean age was found out to be 26.50± 3.56 yrs. suggesting that the ocular trauma is strongly associated with the risk taking behavior in susceptible groups i.e young adults1.

The overall pattern of serious injuries observed in our study regarding age groups, the causes and mode of injury is similar to the studies done in past reported by Tielsh et al.13 and Cao et al.14 However, there is a slight difference in our study being high rates of blast injuries (splinter injuries) as our patients are of armed forces, with high risk taking behavior. More precisely, the job profile and working environment of the soldiers involve handling of explosives during training as well as during operations. The prevalence of ocular trauma remains high among sports persons. 
In our study, we found out that blunt trauma and projectile trauma was found to be one of the major mode of injury, which is supported by Nirmalan et al.15 38% required active multi surgical intervention at higher center in addition to medical treatment and only 30% patients were wearing protective glasses when trauma occurred. Incidence of ocular trauma among the pediatric age was 16% in schoolgoing and 8% in preschool population. It is observed that the patients who sustained occupational trauma, none was wearing protective glasses or gear at the time of injury. A similar finding was observed by Vats et al.16
The target groups for prevention of ocular trauma among soldiers of armed forces are young adults (< 30 Yrs), and those involved in the operations, sports, training and those handling any kind of machinery. The studies involving long term effect of out come of trauma in armed forces are still missing. Such studies can further define target groups more precisely and steps for prevention. This study helps in defining the risk factors, prognosticating ocular injuries at the time of presentation and their prevention among the armed forces group of population.

Conclusion
Our study shows that whenever zone III is involved, the prognosis always remains guarded. As it has been emphasized always preventing ocular trauma is more critical than attempting to restore vision after suffering an injury. Trauma is inevitable in war scenario, and for those sustaining trauma, multisurgeon intervention is needed. Wearing protective polycarbonate eye wear will minimize work related and sports related injuries. Limitation of this study was loss of follow up of few patients to assess final visual outcome.

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Chauhan R, Singh A, Mishra S, Baranwal VKEpidemiological Profile of Ocular Trauma in A Mid-Zonal Hospital of Armed Forces in North-East Region of India.DJO 2021;31:63-66

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Chauhan R, Singh A, Mishra S, Baranwal VKEpidemiological Profile of Ocular Trauma in A Mid-Zonal Hospital of Armed Forces in North-East Region of India.DJO [serial online] 2021[cited 2021 Aug 4];31:63-66. Available from: https://www.djo.org.in/articles/31/4/Epidemiological-Profile-of-Ocular-Trauma-in-A-Mid-Zonal-Hospital-of-Armed-Forces.html