- Editor
- Dr Sudhir Singh
-
- Advisors
- Prof. P.K Mathur
- Dr Pavan Shorey
-
- Editorial Board
- Dr Anshoo Choudhary
- Dr Arun Kshetrapal
Dr L S Jhala
Dr Mayank Agrawal
Dr Mukesh Sharma
Dr Sandeep Arora
Dr Sonu Goel
Dr Subodh Saraf
Dr Sukesh Tandon
Dr Sunil Gupta
- Dr Suresh Kumar Pandey
- Dr Swati Tomar
Dr Virendra Agrawal
|
| |
|
Ocular trauma in road traffic accidents: Experience at Mathura Das Hospital, Jodhpur (Rajasthan).
| |
Aman Sumeet Arora, MBBS; Gajesh Bhargava ,MS; Arvind Chauhan,MS; Punit Singh ,MS
|
| Article Code RJO20110104 |
Corresponding Author:
Dr Aman Sumeet Arora
Resident Doctor
Dept.Of Ophthalmology
M. D. M. Hospital, Jodhpur, Rajasthan
Dr SN Medical College,Jodhpur
|
Abstract
Aim: To study the incidence of various types of ocular injuries in RTA and assess their visual outcome.
Methods: A prospective analysis of 150 patients of RTA with some or the other form of ocular injury evaluated regarding their age, sex, nature of vehicle, use of any safety measure, impact of alcohol, type of injury sustained and visual outcome after a follow-up period of three months.
Results: (107)71.30% were males with maximum incidence in 16-30 yrs age group(47.33%).Most of them,110(73.33%) were two-wheeler drivers with no use of helmet in 84(76.40%) patients and alcohol use in 50(33.33%) patients. Right eye was most common to be injured in 104 patients(69.33%).Closed globe injury was most common found in 134(89.33%) patients with ecchymosis in 83(55.33%) eyes and next being lid tears in 63(42.00%) eyes. Visual acquity at presentation was 6/6-6/18 in 95 eyes (63.33%) and PL- in 32 eyes (21.33%).Management was done according to the injury and the final visual acquity found was 6/6-6/18 in 104 eyes (69.33%).08 patients(5.33%) were lost to follow-up.
Conclusion: Two-wheeler accidents are more common cause with teenagers and early adults, mostly males, being more common affected and more in cases without helmets and seatbelts. It is also associated with alcohol consumption. Closed globe injuries supersede penetrating injuries and final visual outcome depending upon the type and severity of the injury. In order to decrease ocular injuries from RTA, proper road safety measures like wearing helmets and seatbelts, prohibiting alcohol consumption before driving and specifying the speed limits should be made mandatory.
Key words: RTA, Visual acquity, Ocular trauma.
|
| |
INTRODUCTION
Road traffic accidents are common occurrences every day. With ever increasing number of various road transport vehicles and the increasing number of new drivers, traffic accidents keeps on increasing causing mild to severe human injuries including injuries to the eye.
Eye injuries, often resulting in some visual loss, creates enormous costs both to the victim and the society. Although RTA is not the major cause of ocular injury but many such injuries that do occur are preventable by using safety measures and quick referral of the patients. There is great need for more active interest in prevention of eye injuries.
Ocular involvement in RTA may involve the eyelids, lacrimal apparatus, orbital wall, conjunctiva, cornea, sclera, lens, retina, uveal tissue and the extraocular muscles. There may be prolapse of uveal tissue, vitreous loss, traumatic cataract, retinal detachment, vitreous haemorrhage, choroidal rupture, optic nerve avulsion or rupture of the full globe. These injuries may be caused by either blunt force or by penetrating injury. Blunt force injuries causing closed globe injuries are more common.
The aim of the current study was to know about the incidence and the frequency of different types of ocular injuries occurring during RTA in two-wheeler drivers as well as four-wheeler drivers and to assess their final visual outcome after a follow-up period of three months. The study was carried out in the Department of Ophthalmology, Mathura Das Mathur Hospital, Dr. S. N. Medical College, Jodhpur and 150 victims of RTA with some form of ocular injuries, who attended either emergency or the outdoor units of the department, were its subjects.
MATERIALS AND METHODS
Over a period of two years, 150 patients of RTA with some form of ocular injury, who attended our department, were included in the study. Information regarding their age profile, sex distribution, nature of vehicle, safety measure use if any, impact of alcohol and the eye injured was gathered. Detailed clinical examination with torch light, slit lamp and direct/indirect ophthalmoscope was done in cooperative patients and so accordingly the injury sustained was categorized as closed globe or open globe injuries. Also vision at the time of presentation was noted with Snellen’s chart wherever possible in cooperative patients. Then the type of injury sustained was noted and the management was planned and done accordingly. Finally the patients were followed up for a period of three months and their final visual acquity on Snellen’s chart after this follow-up period was recorded.
RESULTS
This study was a statistical analysis of 184 traumatised eyes of 150 patients. 107 patients were males (71.30%) and 43 were females (28.70%).Most of the patients were in the age group of 16-30 years i.e.71(47.33%). The youngest child was of 9 years of age and the oldest person was 66 years old. Persons younger than 30 years accounted for 57.33% of injuries.
The right eye was involved alone in 71 persons (47.33%), the left eye was involved alone in 46 persons (30.66%) and both eyes were injured in 33 persons (22.00%).
Out of all 150 persons involved, 110(73.33%) were driving two-wheelers and the rest 40 persons (26.66%) were four-wheeler drivers.
Regarding the use of safety measures use at the time of driving, only 26(23.60%) two-wheeler drivers were using helmets while driving and only 5(12.5%) four-wheeler drivers were wearing their seatbelts while driving.
Out of 150 persons involved in RTA, 50 persons (33.33%) were under the impact of alcohol while driving.
134 persons (89.33%) got closed globe injuries while 16 persons (10.66%) suffered penetrating or perforating injuries of the eye globe.
Nature of injury
Most of the accidents were due to collision of two-wheelers with other vehicles resulting in either head-on impact or slipping on the road resulting in collision with something on the roadside. Rest were four-wheeler accidents resulting in injury to the eye due to broken pieces of the windscreen or due to impact with dashboard or the steering wheel of the vehicle.
Glass splinters from the windscreen in cases with four-wheelers caused cut wounds to the face, eyelids, conjunctiva, cornea and the sclera resulting in rupture of the globe in 16 patients. Most of the injuries were such that they were limited only to the adnexa of the eye resulting in ecchymosis or lid tears. While the rest of the injuries caused blunt force to the eye resulting in disturbances of the intraocular structures but without compromising the integrity of the eyeball.
The type of injury sustained and the percentage of persons affected are given in table 1.More than one injury was noted in majority of the eyes.
TABLE NO.1: Type of injury
INJURY
|
No. of patients
|
Percent
|
Ecchymosis
|
83
|
55.33%
|
Lid Tears
|
63
|
42.00%
|
Hyphaema
|
22
|
14.66%
|
Iris/Ciliary body trauma
|
11
|
07.33%
|
Injury to the lens
|
30
|
20.00%
|
Vitreous hem. /Detachment
|
14
|
09.33%
|
Retinal hemorrhage / Detachment
|
18
|
12.00%
|
Fracture Orbital walls
|
30
|
20.00%
|
Optic Nerve. injury (R.A.P.D.)
|
27
|
18.00%
|
Associated facial injury
|
57
|
38.00%
|
Corneal tear
|
08
|
05.33%
|
Scleral tear
|
04
|
02.66%
|
Corneo-Scleral tear
|
04
|
02.66%
|
I.O.F.B.
|
02
|
01.33%
|
Visual acquity at presentation
The visual acquity of the affected eyes of 150 persons involved in RTA is given in table 2.Table no. 2 shows that out of total 150 persons , vision of 6/6-6/18 was found in 95 eyes (63.33%) having minor injuries of ocular adnexa only. The worsening grades of vision were found in eyes which got severe or multiple injuries and PL- vision was found in eyes in which Optic N. was found damaged presenting with RAPD.
TABLE NO.2 Visual Acquity of patients at presentation.
VISUAL ACQUITY
|
No. of Patients
|
%
|
6/6-6/18
|
95
|
63.33%
|
<6/18-6/60
|
06
|
04.00%
|
<6/60-3/60
|
01
|
00.66%
|
<3/60-1/60
|
02
|
01.33%
|
<1/60-PL+PR+
|
33
|
22.00%
|
PL-
|
32
|
21.33%
|
Uncooperative
|
14
|
09.33%
|
|
TABLE NO.3 Type of management.
S.
no.
|
Management
|
No. of
patients
|
%age
|
A)
|
Only conservative treatment without any surgical procedure.
|
67
|
44.66%
|
B)
|
Surgical procedure with conservative treatment---
|
83
|
55.33%
|
|
a) Lid tear repair
|
63 eyes
|
42.00%
|
|
b) Hyphaema asp.
|
22 eyes
|
14.66%
|
|
c) Lens removal
with I.O.L.
|
30 eyes
|
20.00%
|
|
d) Corneal tear
repair
|
08 eyes
|
5.33%
|
|
e) Scleral tear
repair
|
04 eyes
|
2.66%
|
|
f) Corneo-scleral
tear repair
|
04 eyes
|
2.66%
|
|
g) Removal of
I.O.F.B.
|
02 eyes
|
1.33%
|
Type of surgery performed
Table no.3 lists the surgical procedures and the conservative management required following different types of injuries.
Final visual acquity after three months
Table no.4 gives the final visual acquity recorded on Snellen’s chart at the end of a follow-up period of three months.
|
TABLE NO.4 Final visual acquity after three months.
|
VISUAL ACQUITY
|
No. of
Patients
|
%age
|
6/6-6/18
|
104
|
69.33%
|
<6/18-6/60
|
09
|
06.00%
|
<6/60-3/60
|
08
|
05.33%
|
<3/60-1/60
|
15
|
10.00%
|
<1/60-
PL+PR+
|
07
|
04.66%
|
PL-
|
32
|
21.33%
|
Lost to
follow-up
|
08
|
05.33%
|
The final visual acquity was affected by type of injury, location and extent of wound, severity of intraocular damage, type of lens damage, presence and severity of vitreous and retinal involvement, initial visual acquity at the time of injury and presence of RAPD that correlated with worst visual outcome of PL negetive
|
DISCUSSION
Ocular trauma has been shown to be one of the major causes of mono-ocular vision loss, low vision and blindness worldwide with significant socio-economic consequences.
A lot of changes have taken place in our environment in recent times. Population growth, apparent financial empowerment and availability of a large number of vehicles without a commensurate development of road networking has resulted in astronomical increase in number of accidents on our roads. In present study the peak age of RTA was found to be in age group of 16-30 years as was founded by I. R. Ezegwui1 in his study on ocular injuries during RTA in Nigeria and by Dr. Prabha Subedi2 in her study.Our study found the majority of ocular injuries during RTA occurring in males with M:F as 2.5:1.The same was cited by P. B. Johnston3 in his study on Eye injuries in Northern Ireland after seatbelt legislation as to be 72.20% in males and 27.80% in females.Regarding the use of any safety measures while driving, the studies in the past had shown the propensity of ocular injury to be more in people who were not using any protective measure while driving.
Our study observed the significant number of ocular injury victims getting the injury while driving under the impact of alcohol which is corroborated by the findings of Millo T., Sharma R. K. et al4 in their study on Incidence of alcohol use in road traffic accidents in South Delhi in fatal cases(34% people were found positive for alcohol when tested).
M. N. Shishko5 and Ron Koval6 described in his study that the eye most common to get injured was right eye (42.00%) as was found in our study.
Closed globe injury was found to be more common in the previous studies as cited by Issam Albataenah7 and C. M. Gully8 in their respective studies. This is in concordance with the results found in our study.Similarly the frequency of different types of ocular injuries in RTA as found in our study corroborate with the results founded in the previous studies as by Dr. M. E. Enock9 , Boo Sup Oum10 and Dr. Kamla Adnani11 who founded in their respective studies, the adnexal injuries to be more common as lid lacerations and ecchymosis than the penetrating injuries and the fractures of the orbital walls, the same that was observed in our study.
|
Recommendations for prevention of ocular injuries in RTA.
1. Persons sitting in front seats more commonly sustain ocular trauma. So-
a) The use of safety seatbelts must be made compulsory.
b) All road vehicles must have laminated windscreens.
2. Road markings, guiding traffic and drivers, need to be re-painted more frequently. Paint should be florescent so as to be visible during darkness.
3. There is urgent need for the education of public through the use of news media and television programmes.
a) The requirement of wearing seatbelts and helmets.
b) Observation of rules of the road.
c) Punishment for reckless driving and dangerous overtaking.
d) Prohibiting strictly the mixture of drinking with driving.
|
REFERENCES
1. I. R. Ezegwui: Eye injuries during road traffic accidents at Abakaliki, Nigeria. International
J.Ophthalmology, vol4, 2004.
2. Dr. Prabha Subedi: Visual outcome in closed globe injuries, Internet.
3. P. B. Johnston: Eye injuries in Northern Ireland; Br. J. Ophthalmology, 1986.
4. Millo T, Sharma R. K.: Study of incidence of alcohol use in road traffic accidents in South
Delhi, 2008, Internet.
5. M. N. Shishko: RTA and ocular trauma; Experience at Tripoli eye hospital, Libya; Int.
6. Ron Koval, Jacob Taylor: The Israeli ocular injuries study; Arch Ophth1988; 106; 776.
7. Issam Albataenah: Incidence and type of eye injuries in patients with major trauma, 2003,
Interenet.
8. C. M. Gully: Ocular injuries in patients with major trauma; Emergency medicine J.; 2006;23; 915-917.
9. Dr. M. E. Enock: Motorcycle related ocular injuries in Irrua specialist teaching hospital,Irrua, Edo state, Nigeria, 2008, Internet.
10. Boo Sup Oum: Clinical features of ocular trauma in emergency department; Korean J.Ophthal,vol.18; 70-78, 2004.
11. Dr. Kamla Adnani, Ocular manifestations of head injury; 2002, Internet.
|
Rajasthan Journal Of Ophthalmology An Official Publication Of The Rajasthan Ophthalmological Society
|
| |
|
No comments:
Post a Comment