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ORIGINAL ARTICLE
Year : 2013  |  Volume : 7  |  Issue : 1  |  Page : 20-23

Orbital and ocular trauma at Ahmadu Bello University Teaching Hospital, Shika-Zaria: A retrospective review


Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria

Date of Web Publication18-Oct-2013

Correspondence Address:
Abdulkadir L Rafindadi
Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Shika, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.119982

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   Abstract 

Background: Orbital and ocular trauma is a major cause of monocular blindness and visual impairment worldwide. The department of ophthalmology of the Ahmadu Bello University Teaching Hospital (ABUTH) only existed at the old Kaduna hospital prior to the full functional take off at the new Shika hospital complex. With the number of orbital/ocular trauma cases and resulting complications on the increase in the eye clinic, a review to determine the incidence, as well as management protocol will lead to improvement in the treatment and visual outcomes of future cases.
Aim: To determine the incidence of orbital/ocular trauma in ABUTH, Shika-Zaria.
Materials and Methods: A retrospective study involving the analyses of all case files of patients who had orbital trauma and were treated at the eye clinic, ABUTH, Shika-Zaria between January 2006 and December 2007. A detailed protocol was used for data entry.
Results: A total of 142 (1.8%) patients with orbital/ocular trauma were seen over a period of 2 years. The male to female ratio was 3:1. The age range was 4 months to 65 years. A unimodal age pattern was observed with peak occurrence in those 16-30 years (33.1%), closely followed by age group 0-15 years (32.4%). Individuals most commonly involved in orbital/ocular trauma were students (32.4%), while the home (42.3%) was the most common location where injury occurred. Mild blunt trauma (49.3%) was the most common diagnosis, followed by severe blunt trauma (30.3%). Severe and mild penetrating injury occurred in (16.2%) and (4.2%) of the patients respectively.
Conclusion: An important cause of ocular morbidity presenting at the eye clinic of the ABUTH, Shika-Zaria is orbital/ocular trauma. Factors associated with increased occurrences of orbital/ocular trauma include younger age, male gender, being a student, and domestic and road traffic accidents. More care should be provided at school play grounds, and adequate supervision should be given to vulnerable groups in homes. Road safety rules and guidelines should be enforced on the highways.

Keywords: Orbital and ocular trauma, retrospective review, risk factors


How to cite this article:
Rafindadi AL, Pam VA, Chinda D, Mahmud-Ajeigbe FA. Orbital and ocular trauma at Ahmadu Bello University Teaching Hospital, Shika-Zaria: A retrospective review. Ann Nigerian Med 2013;7:20-3

How to cite this URL:
Rafindadi AL, Pam VA, Chinda D, Mahmud-Ajeigbe FA. Orbital and ocular trauma at Ahmadu Bello University Teaching Hospital, Shika-Zaria: A retrospective review. Ann Nigerian Med [serial online] 2013 [cited 2020 May 27];7:20-3. Available from: http://www.anmjournal.com/text.asp?2013/7/1/20/119982


   Introduction Top


Ocular trauma is a major cause of monocular blindness and visual impairment worldwide and once described as the neglected disorder. [1] Annually over 2.5 million Americans suffer an eye injury. Worldwide, 55 million people are affected annually with approximately 1.5 million people blind in both eyes, 19 million blind in one eye; and is the commonest cause of unilateral blindness today. [2] The age distribution for occurrence of serious ocular trauma is bimodal with the maximum incidence in young adults (1 st 3 decades), peak incidence at 21 years and a second peak in the elderly. [3],[4] Males are affected more than females. [5] Thus, in addition to the impact on affected individuals, there are profound social implications regarding the loss of productivity by young men and requirement for hospital care for the elderly. The overall financial costs can run into hundreds of millions of Naira annually and indeed it is commonly agreed that most ocular injuries are avoidable. [6],[7],[8]

Approximately half of all patients who present to an ophthalmic casualty department do so because of ocular trauma. [9],[10] Majority of injuries are minor affecting peri-orbital structures, ocular surfaces such as corneal abrasions and superficial foreign bodies. Only 2-3% of all eye injuries require hospital admission. [5],[9]

This study aimed to estimate the incidence of orbital and ocular trauma at the Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria and identify the risk factors for ocular trauma.


   Materials and Methods Top


Data was collected from all case files of patients who had orbital and ocular trauma and were treated at the eye clinic of the A.B.U. Teaching Hospital from 1 st January 2006 to 31 st December 2007. A detailed protocol containing biodata, clinical data, ocular symptoms and signs, other clinical data and diagnosis was used for data entry. The biodata included age, sex, occupation, literacy level, location where injury occurred, locality/L.G.A, and distance travelled to seek treatment. The clinical data included type of offending missile; where, when, and what type of treatment was received. The patients presenting symptoms and clinical findings of ocular examinations including significant physical findings were recorded. Relevant ophthalmic and medical data on all patients in this review was entered into the protocol designed for the study.

Clinical features of the injury were recorded and categorized as mild blunt trauma, severe blunt trauma, mild penetrating eye injury, severe penetrating eye injury and perforating eye injury. [11] Mild injury included lid laceration, superficial foreign body, corneal abrasion, conjunctival tear, subconjunctival hemorrhage, traumatic iritis. Severe injury included corneal ulcer, corneal laceration, sclera laceration, cataract, penetrating foreign body, iridodialysis, iris prolapsed, dislocated lens, hyphema, corneal blood stain, macula/retinal damage. Blunt trauma signified ocular trauma without intraocular penetration while penetrating trauma signified intraocular penetration with no exit wound. Perforating trauma signified exit wound after penetration. The data was analyzed manually by the authors.


   Results Top


Of the 7,726 patients who presented to the eye clinic at the Ahmadu Bello University Teaching Hospital, Shika-Zaria over the 2 year period of this study, 142 (1.8%) had orbital/ocular trauma. One hundred and six (74.7%) were males and 36 (25.3%) were females, with M:F ratio of 3:1. The age range was 4 months to 65 years with mean of 25.3 years [Figure 1]. The annual incidence of orbital and ocular trauma was 0.9%. Orbital/ocular trauma occurred most commonly amongst students followed by skilled workers, traders, farmers, commercial bus drivers and domestic helps; in that order [Figure 2]. The automobile 29 (20.4%) was the most common offending missile, followed by household objects 27 (19%) and fist/assault 16 (11.3%) [Figure 3]a. The home 60 (42.2%) was the most common location where injury occurred followed by the highway 27 (19%), and sports/playground 25 (17.6%) [Figure 3]b.
Figure1: Age distribution amongst patients in this study

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Figure 2: Occupation of the patients in this study

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Figure 3: (a) Type of offending missile (b) Location where injury occurred

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The average duration of symptoms prior to presentation was 66.5 days with a range of 3 h to 2190 days. The common presenting ocular complaints were ocular pain 64 (45%), decreased or nil vision 59 (41.5%), red eye

45 (31.7%), and orbital swelling 35 (24.6%). Some patients had more than one symptom.

One hundred and thirty one (92.3%) of the 142 patients had their visual acuity (VA) measured at presentation. Seventy-one patients (54.2%) had a VA of 6/5 - 6/18, 40 (30.5%) had a VA of <3/60 and 20 (15.3%) had a VA of 3/60- <6/18 [Figure 4]. The 7.7% who did not have their visual acuities measured at presentation was due to severe injury and/or pain.
Figure 4: Visual acuity at presentation

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The categories of injury showed that 70 (49.3%) had mild blunt trauma (MBT), 43 (30.3%) had severe blunt trauma (SBT), 19 (13.4%) severe penetrating injury (SPEN I), 6 (4.2%) had mild penetrating injury (MPEN I), and 4 (2.8%) had perforating injury (PERF) [Figure 5].
Figure 5: Category/class of injuries sustained

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   Discussion Top


The annual incidence of orbital and ocular trauma in this study was 0.9% for all ages and both sexes, which was similar to the incidence reported by Glynn at al. [3] Other studies have, however, reported much lower [11] and higher. [12] incidences. Majority of the patients were male (74.7%) with a male: female ratio of 3:1. This ratio has been observed in other studies. [5],[6],[7],[8],[11],[12] This is, however, not unexpected because in this environment men are much more exposed to risks of trauma than women. The women mainly stay indoors (purdah) and are more likely to be involved in domestic accidents which may largely go unreported. Majority of the patients were under the age of 30 years, and this was similar to results obtained in Greece by Mela et al. [13] Thirty-three percent of the patients were between the ages 16 to 30 years and 32.4% between the ages 0 to 15 years. The usual bimodal peak age incidence with the 2 nd peak occurring in the elderly was not observed in the present study, as was observed in other studies. [3],[4] This may have been due to underreporting and under presenting of cases. Use of alternative/traditional medicine, nonchalance and shorter life expectancy among the populace may also be contributory.

A look at the occupation of the patients shows that students (32.4%) were the majority, followed by skilled professionals (24.7%), farmers (5.6%). These groups are more likely to present to a medical facility for treatment. It is interesting to note that there were no patients from factories or heavy industries as has been reported in a similar study. [11] This may be partly due to presence of few functioning industries in the area as many have closed down due to the economic downturn and lack of power. Another reason may be that most of the functioning industries in the area have well staffed and equipped clinics which handle mild to moderate ocular trauma. The literacy level of the patients in this study was 62.3%, which is not unexpected as they are usually more informed and are more likely to present to a medical facility for treatment. Many illiterate/less educated patients may opt for alternative/traditional medicine out of ignorance or for fear of the bureaucracy and bottlenecks that they may encounter at the major clinics and hospital. Financial reasons may also account for the lower frequency of hospital visit among illiterate /less educated individuals. The authors may speculate that the increase in the number of trained ophthalmic nurses and community health extension workers who are trained to handle mild to moderate ocular emergencies has also led to the reduced number of referrals to the Teaching Hospital.

Orbital and ocular trauma in developing countries has not been studied extensively. This study has highlighted some deficiencies in retrospective studies.

Recommendations

Present

Development of protocols for prospective studies/research of orbital/ocular trauma is recommended. There is also the need to enforce road safety regulations, improve playground safety, legislate on the use of protective eyewear in certain professions and in sports, and to increase awareness of ocular trauma through the promotion of health education.

Future

There is the need to establish a national registry/coordinating center to collate data nationally. Statistical analysis of this data can be used to develop management protocols, to reduce incidence and morbidity, and to add to the body of knowledge of orbital and ocular trauma.

 
   References Top

1.Praver L. Eye trauma. The neglected disorder. Arch Ophtalmol 1986;104:1452-3.  Back to cited text no. 1
    
2.Negrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143-69.  Back to cited text no. 2
    
3.Glynn RJ, Seddon JM, Berlin BM. The incidence of eye injuries in New England. Arch Opthalmol 1988;106:785-9.  Back to cited text no. 3
    
4.Desai P, MacEwen CJ, Baines P, Minaissian DC. Epidemiology and implications of ocular trauma admitted to hospital in Scotland. J Epidemiol. Community Health 1996;50:436-41.  Back to cited text no. 4
    
5.MacEwen CJ. Eye injuries. A retrospective study of 5,671 cases. Br J Ophthalmol 1989;73:888-94.  Back to cited text no. 5
    
6.Johnston SS. Perforating eye injuries. A five year study. Trans Ophthalmol Soc UK 1971;91:895-921.  Back to cited text no. 6
    
7.Lambah P. Some common causes of eye injury in the young. Lancet 1962;29:1351-3.  Back to cited text no. 7
    
8.Abebe B. Causes and visual outcomes of perforating ocular injuries among Ethiopian patients. J Community Eye Health 2001;14:45-6.  Back to cited text no. 8
    
9.Chiapella AP, Rosenthal AR. 1 year in an eye casualty clinic. Br J Ophthalmol 1985;69:865-70.  Back to cited text no. 9
    
10.Vernon SA. Analysis of all new cases seen in a busy regional centre ophthalmic casualty department during 24 week period. J R Soc Med 1983;76:279-82.  Back to cited text no. 10
    
11.Khartry SK, Lewis AE, Schein OD, Thapa MD, Pradhan EK, Katz J. The epidemiology of ocular trauma in rural Nepal. Br J Ophthal 2004;88:456-60.  Back to cited text no. 11
    
12.Badrinath SS. Ocular trauma. Indian J Ophthalmol 1987;35:110-1.  Back to cited text no. 12
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13.Mela EK, Mantzouranis GA, Giakoumis AP, Blastsios G, Andrikopoulos GK, Gartaganis SP. Ocular Trauma in a Greek Population: Review of 899 cases resulting in Hospitalisation. Ophthalmic Epidemiol 2005;12:185-90.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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