Mechanical injuries of the eye: Incidence, structure and possibilities for prevention

Abstract

Background/Aim. Despite technological advances used in everyday clinical practice, injuries of the eye caused by various agents still produce blindness and poor vision in a significant number of people. The aim of this study was to analyze factors leading to occurrence of mechanical injuries of the eye. Methods. Mechanic injuries of the eye in patients treated at the Institute for Eye Diseases of the Clinical Center of Serbia in Belgrade, in an eight-year period were analyzed. Investigated parameters were: sex and age of patients, their profession, time of injury (months, days and hours), place and way of injury and a visual acuity on admission and dismiss, as well as further follow-up. Type of injury (closed or opened injuries of the eyeball), with all the complications that followed were carefully noted and monitored. The time of primary surgical repair was noted and analyzed, whenever necessary. Results. In the period of eight years, 2701 patients (2 257 males and 444 females) were treated in the hospital due to mechanical injury of the eye. Almost equally, both the right (50.5%) and the left eye (49.5%) were injured, while in 39 (1.4%) patients both eyes were injured at the same time. The injuries occurred in all age groups, but mostly in adults, employed persons, aged from 16 to 65 (70%). Among injured children, 18.8% were beyond the age of 15. Most frequent injuries occurred in workers (39%), and then in pupils (16.3%). Wood was the mean of injury in 23.7% of cases, sharp and pointed objects in 16.1%, hammering and metal particles in 14.4%, glass in 10.1%, and other different objects in the rest of 35.7% of all injured persons. There were other very serious means or mechanisms of eye injuries, like hair band, dog bite, rooster?s beak, rubber bullet, etc. Considering months in the year and days in the week, the injuries were almost equally distributed, and related to the time of day even 75% occurred between 10 a.m. and 10 p.m. Most injuries (38.2%) occurred while doing some work out of professional working place, while only 25.4% injuries occurred at the working place. Most of the patients (30.3%) had visual acuity L+P+ (light perception with correct projection) only, on attendance, but it varied from complete blindness to 1.0. There were 1 282 blunt injuries (contusion) (47.5%) and 1 373 penetrating eyeball injuries (50.8%), while the rest (1.7%) were injuries of ocular adnexa. Most of the primary surgical treatments (63.7%) were done in the first 24 hours from the moment of the injury. At dismiss, visual acuity was normal in 53.2%, the eye was blind in 19.1% injured patients. Conclusion. The results of this study showed that the injuries occurred most frequently in actively working people and pupils, that men were injured five times more often than women; that wood, sharp objects and glass were the most common means, that there was an equal number of blunt injuries and penetrating wounds, and that it was very important to treat injury promptly, preferably within the first 24 hours. By further analysis, it might be concluded that many injuries could have been prevented, avoiding long medical treatment and accompanying costs, and what is most important - permanent invalidity caused by reduced visual function or blindness of the injured eye is avoidable.Uvod/Cilj. Uprkos tehnickim dostignucima koja se koriste u svakodnevnoj klinickoj praksi, mehanicke povrede oka izazvane razlicitim uzrocima jos uvek dovode do slepila i smanjene sposobnosti vida kod znacajnog broja ljudi. Cilj ovog rada bio je analiza faktora koji dovode do mehanicke povrede oka. Metode. Analizirane su mehanicke povrede oka kod bolesnika koji su bolnicki leceni u Institutu za ocne bolesti Klinickog centra Srbije u Beogradu u periodu od osam godina. Od parametara analizirani su pol i starost bolesnika, njihovo zanimanje, vreme kada se povreda desila (po mesecima, danima i satima), mesto i nacin gde su se povrede desile, kao i ostrina vida pri prijemu i pri otpustu ili kasnijim kontrolama. Analizirana je i vrsta povrede (zatvorena ili otvorena povreda ocne jabucice) sa svim komplikacijama. Na kraju je dato i vreme kada je izvrsena primarna hirurska obrada rane na oku, ukoliko je ona bila neophodna. Rezultati. U toku osam godina, zbog mehanicke povrede oka, bolnicki je leceno 2 701 bolesnik (2 257 osoba muskog i 444 osoba zenskog pola). Skoro podjednako bilo je povredjivano i desno (50,5%) i levo oko (49,5%), dok su kod 39 (1,4%) bolesnika bila povredjena oba oka istovremeno. Povrede su se desavale u svim starosnim kategorijama, ali najcesce kod odraslih radno aktivnih osoba starosti od 16 do 65 godina (70,0%). Medju decom uzrasta do 15 godina bilo je 18,8% povredjenih. Najcesce su se povredjivali radnici (39,0%), a zatim ucenici (16,3%). Drvo je bilo uzrok povrede kod 23,7%, ostri i siljati predmeti kod 16,1% ispitanika, cekic i metal kod 14,4%, staklo kod 10,1%, a drugi uzrocnici kod preostalih 35,7% povredjenih ispitanika. Bilo je i vrlo retkih uzrocnika povreda oka, kao sto su rajf, ujed psa, kljun petla, gumeni metak itd. Prema mesecima i danima, povrede su bile skoro podjednako rasporedjene, a prema dobu dana, cak 75,0% povreda desilo se od 10 sati pre podne do 10 sati uvece. Najvise povreda (38,2%) desilo se pri obavljanju posla van profesionalnog radog mesta, dok je na poslu zadobijeno 25,4% povreda. Najveci broj bolesnika (30,3%) pri prijemu imao je vidnu ostrinu L+P+ (osecaj svetla sa tacnom projekcijom), ali je vidna ostrina na prijemu bila od amauroze do 1,0. Zabelezene su 1 282 kontuzione povrede (47,5%) i 1 373 penetrantne povrede ocne jabucice (50,8%), dok su ostale (1,7%) bile povrede pomocnih organa oka. Najveci broj primarnih obrada rane (63,7%) izvrsen je u prva 24 casa od momenta povrede. Pri otpustu vidna ostrina je bila normalna kod 53,2%, dok je amauroza postojala kod 19,1% povredjenih bolesnika. Zakljucak. Rezultati ove studije pokazuju da se najcesce povredjuje radno aktivno stanovnistvo i ucenici, (muskarci pet puta cesce od zena), da su drvo, ostri predmeti i staklo najcesci uzrocnici povreda, da je podjednak broj kontuzionih i penetrantnih povreda i da se neophodna primarna obrada rane preduzima najcesce u prva 24 casa od povrede. Daljom analizom ovih faktora moze se zakljuciti da su se mnoge povrede mogle prevenirati, cime bi se sprecilo dugotrajno lecenje i troskovi lecenja, a ono sto je najvaznije, mogla se izbeci trajna invalidnost zbog smanjenja sposobnosti vida ili slepila na povredjenom oku.