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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 106  |  Issue : 4  |  Page : 226-229

Demographics and epidemiology of open globe injuries in children in the age group of 2-16 years


1 Department of Ophthalmology, Cairo University, Cairo, Egypt
2 Department of Community Medicine, Cairo University, Cairo, Egypt

Date of Submission10-Oct-2012
Date of Acceptance09-Feb-2013
Date of Web Publication28-Apr-2014

Correspondence Address:
Dina Elfayoumi
El Fwakehst, El Mohandsin, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2090-0686.131561

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  Abstract 

Purpose
The aim of the study was to review demographic, etiologic, and clinical characteristics of globe injuries in children in the age group of 2-16 years.
Materials and methods
The medical records of 376 patients below the age of 16 years who presented to the Casualty Department in Kasr El-Ainy Hospital, Cairo University with open globe injuries during the period between June 2011 and June 2012 were examined retrospectively. Patients were analyzed with respect to age, sex, place of injury, cause of injury, and clinical signs at the time of presentation.
Results
A total number of 1345 patients with open globe injuries was recorded in 1 year from June 2011 to June 2012; of them, 376 children were in the age group of 2-16 years, this means that children below the age of 16 represented around 28% of the total number of casualty patients. Our study showed that most of the open globe injuries below the age of 16 years occurred in boys (276 boys vs. 100 girls). The mean age was 8.8 ± 4.3 years. The children were classified into three groups: (a) preschoolers including children from 2 years to those below 7 years; (b) school-age children including children from 7 years to those below 11 years; and (c) adolescents including children from 11 years to 16 years. Most patients (44.9%) were in the 2-6-year age group followed by the adolescent age group (11-16 years) (32.4%), then the school-age children (7-10 years) (22.6%). Pointed and sharp objects were found to be the main causative agents. Injuries occurred most frequently in streets (61.9%) followed by homes (31.9%), and then schools (6%).
Conclusion
Open globe injuries in children occur most frequently in preschool boys. The injuries occurred mainly in the streets followed by homes and the least common place for injury was recorded to be the schools.

Keywords: Epidemiology, open globe injuries, preschool boys


How to cite this article:
Elfayoumi D, Zayed M. Demographics and epidemiology of open globe injuries in children in the age group of 2-16 years. J Egypt Ophthalmol Soc 2013;106:226-9

How to cite this URL:
Elfayoumi D, Zayed M. Demographics and epidemiology of open globe injuries in children in the age group of 2-16 years. J Egypt Ophthalmol Soc [serial online] 2013 [cited 2020 Sep 24];106:226-9. Available from: http://www.jeos.eg.net/text.asp?2013/106/4/226/131561


  Introduction Top


Decreased vision or blindness secondary to eye trauma in children severely decreases the quality of life and produces a great economic burden to the society in terms of care and lost productivity [1],[2]. Most open globe injuries require multiple operations and prolonged follow-up. It has been suggested that ocular injury is also associated with psychomorbidity and problems of adjustment [3]. The incidence rates of ocular trauma requiring hospitalization are reported to be 13.2 per 100 000 individuals each year in the USA alone [4]. In children, 35% of eye injuries occur below the age of 16 and 18% occur among those below 12 years of age [5]. In an Egyptian study conducted over 5 years from 2004 to 2008, 8361 ocular emergencies were admitted as inpatients. Open globe injuries were the most prevalent, comprising 33.46% of emergencies. Most patients were male (69%), with the most frequent lesions being open globe injuries. The age group 6-16 years accounted for 24% of emergencies [6].

It is usually difficult in children below 6 years to ascertain how the trauma occurred, to evaluate the visual acuity, to perform clinical examinations and radiologic tests, and to maintain postoperative follow-up. In addition, it is challenging to determine prognosis in children whose eyes are not completely developed. A total number of 1345 patients with open globe injuries was recorded in 1 year from June 2011 to June 2012; of them, 376 children were in the age group of 2-16 years, this means that children under the age of 16 represented around 28% of the total number of casualty patients. We studied demographic, etiologic, and clinical characteristics of open globe injuries affecting those children.


  Materials and methods Top


A retrospective review on consecutive patients in the age group of 2-16 years who presented with open globe injuries between June 2011 and June 2012 was conducted. Enrolled patients had presented to the casualty section of the Ophthalmology Department of Kasr El-Ainy Training Hospital, Cairo University. The study included patients who underwent primary surgical repair and definitive surgical management and patients with complete medical records, including examination findings, who were followed up for at least 6 months.

Demographic information, place of injury, and cause of injury were recorded for each patient. The types of open globe injuries were classified as rupture, penetrating injury (single full-thickness wound of the eye, usually caused by a sharp object whether corneal or scleral or corneoscleral), and perforating injury [two full-thickness lacerations of the eye wall (entrance and exit), usually caused by a projectile object, which was gunshot injuries in our study]. Patients were classified into three age groups: preschoolers (2-6 years), school-aged children (7-10 years), and adolescents (11-16 years) [7].

Clinical signs at the time of presentation were recorded, including the presence or absence of hyphema, uveal tissue prolapse, vitreous prolapse, lens damage, vitreous hemorrhage, intraocular foreign body (IOFB), and lid laceration. The method of primary repair and secondary procedures was documented.

All patients enrolled in this study underwent primary repair under general anesthesia; plain radiographic skull and computed tomographic scans were routinely performed before the repair to detect any foreign bodies. The corneal incisions were sutured with single 10-0 nylon suture, whereas scleral incisions were sutured with single 8-0 vicryl suture. If present, eyelid lacerations were closed using 6-0 silk sutures. Anterior vitrectomy was performed in those with vitreous prolapse at the wound site. In patients with uveal tissue prolapse, necrotic and infected tissues were excised. Lensectomy was performed in eyes with anterior capsular rupture and with lens matter in the anterior chamber. None of the patients underwent enucleation as a primary procedure. After surgical repair, the patients were treated with topical antibiotics (fortified cefazolin, gentamicin, or vancomycin administered hourly in the first week) and topical steroids (prednisolone acetate 1% administered every 2 h) in addition to cycloplegic agents (cyclopentolate or atropine administered twice or thrice daily in the first week). Topical antibiotics and steroids were tapered for another 2 weeks and then discontinued.

Data were computerized and analyzed using SPSS, version 16 software. Simple statistics such as frequencies, percentages, arithmetic means, and SDs were used.


  Results Top


A total of 376 children were included, 276 boys (73.4%) and 100 girls (26.6%). The mean age was 8.8 ± 4.34 years with a range of 2-16 years. The peak age was found to be around 5 years (10.4%) and the distribution of ocular injuries did not vary greatly with age [Table 1].
Table 1: Age distribution of children with open globe injury

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Most cases of injuries (44.9%) occurred in the preschool-age group (2-6 years) followed by adolescents (32.4%), and then the school-age children (22.6%) [Table 2].
Table 2: Distribution of open globe injuries according to the age groups

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In order of frequency, the most common cause of open globe injuries in children were penetrating injuries (330 patients, 87.7%) that was inflicted by pointed objects poked by the child into his or her own eye or thrown at the child from a distance. Metallic sharp or pointed objects that were reported included knives, scissors, forks, nails, and wires, whereas wooden objects causing injury included pencils or tree branches. This was followed by open globe injuries caused by blunt trauma, that is rupture globe (40 patients, 10.6%). Blunt objects that were recorded included stones, toys, or bottle caps thrown at the child's face. Perforating injuries (six patients, 1.6%) represented the least common cause of injury; the main causative agent was gunshot injuries and resulted in IOFBs. Traffic accidents (nine patients, 2.3%) can lead to open globe injury through either a penetrating or blunt trauma mechanism. In our study, traffic accidents in children resulted in open globe injury through penetrating trauma, with either pieces of glass or pointed metallic objects [Figure 1].
Figure 1:

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The most common scene of injury was street where we recorded 233 patients (61.9%), followed by home in 120 patients (31.9%), and the least injuries were recorded in schools in 23 patients (6%) [Figure 2].
Figure 2:

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The clinical variables that were recorded at the time the children presented to the Casualty Department included:

  1. Open globe injuries (corneal or scleral or corneoscleral wound) without prolapse of intraocular structures such as uveal tissue and/or vitreous in 335 patients (89.1%),
  2. Open globe injuries with prolapse of intraocular structures such as uveal tissue and/or vitreous in 16 patients (4.3%),
  3. Open globe injuries with traumatic cataract in 11 patients (2.9%),
  4. Open globe injuries with hyphema in eight patients (2.1%), and
  5. Open globe injuries with IOFB in six patients (1.6%) [Table 3].
Table 3: Distribution of the clinical presentations of open globe injuries in children

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The commonest clinical presentation in the preschool age was open globe injuries without prolapse of intraocular structures (40.6%) and the least common clinical presentation was perforating globe injury due to gunshot with IOFB (0.3%) [Table 4].
Table 4: Distribution of the clinical presentations of open globe injuries according to the age groups

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In this study, the male : female ratio was found to be nearly 3 : 1. The most common clinical presentation was open globe injuries without prolapse of intraocular structures among male patients (65.7%), whereas the least common presentation was open globe injuries with IOFB due to gunshot among female patients (one patient, 0.26%) [Table 5].
Table 5: Distribution of the different clinical presentations of open globe injuries according to sex

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Many patients required additional procedures during their ocular rehabilitation. Some required a combination of lens extraction and intraocular lens implantation, whereas others required pars plana vitrectomy to tackle IOFB or retinal detachment or both.


  Discussion Top


Ophthalmic trauma is one of the most common causes of acquired unilateral blindness in children. The mean age of children with open globe injuries was 8.8 years. Although many studies have noted that school-age children are more vulnerable than younger children [8],[9], in the present study the highest percentage of open globe injuries was recorded among the preschool-age children (2-6 years). This is probably because of the lack of proper family care and supervision in this age group. Children get pretty occupied in their schools and are kept away from the streets that represent the commonest place of injury; hence, the least number of injuries was recorded among the school-age children (7-10 years). This is also partly related to the level of education and the socioeconomic standard of the patients referred to Kasr El-Ainy Hospital. As the level of illiteracy is high and the socioeconomic standard is low, the preschool-age children are left playing unattended in the streets where they met with a variety of agents causing injuries.

The preponderance of injuries in boys, with the male : female ratio of nearly 3 : 1, in the present study is similar to that reported in other studies, with the male : female ratio varying from 2 : 1 to 4 : 1 [10],[11].

Podbielski et al. [12] reported that most pediatric eye injuries occur when children are playing (44%) or participating in sports activities (14%). In our study, we reported that most common injuries occurred to children while playing in the streets (61.9%) followed by homes (31.9%), and the least number of injuries occurred in schools (0.6%). MacEwen et al. [13] emphasized that sports was the most common cause of injury among children of age group 5-14 years. The majority of ocular trauma in our Egyptian population was because of assaultive injuries occurring mainly in male individuals. Open globe injuries were more common than closed globe injuries, and globe lacerations were more common than ruptured globes [14].

One of the limitations to our study was the inability to record visual acuity at the time of injury and to record visual acuity later on. Preoperative evaluation of children is often hindered by inadequate history and poor patient cooperation during the physical examination. In addition, follow-up is often short, particularly in eyes with less severe injuries. Difficulties in the examination of young children persist during the follow-up period. Consequently, there are only limited studies regarding the anatomic and functional outcomes following eye injury in children.

One unique aspect of pediatric ocular trauma is the risk for amblyopia. Vigorous treatment for amblyopia should be pursued when the state of visual rehabilitation permits. Refractive errors should be corrected with eyeglasses or contact lenses, and occlusion therapy should be undertaken, if warranted. Finally, we can say that eye injuries in children are preventable; hence, this reflects the importance of health education, adult supervision, and application of appropriate measures that is necessary for reducing the incidence and severity of trauma.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.Hsieh DA, Stout JW, Lee RB, Gaydos JC. The incidence of eye injuries at three U.S. Army installations. Mil Med 2003; 168 :101-105.  Back to cited text no. 1
    
2.Brophy M, Sinclair SA, Hostetler SG, Xiang H. Pediatric eye injury related hospitalizations in the United States. Pediatrics 2006; 117 :1263-1271.  Back to cited text no. 2
    
3.Alexander DA, Kemp RV, Klein S, Forrester JV. Psychiatric sequelae and psychosocial adjustment following ocular trauma: a retrospective pilot study. Br J Ophthalmol 2001; 85 :560-562.  Back to cited text no. 3
    
4.Klopfer J, Tielsch JM, Vitale S. Ocular trauma in the United States: eye injuries resulting in hospitalization, 1984 through 1987. Arch Ophthalmol 1992; 110 :838-842.  Back to cited text no. 4
    
5.Salvin HJ. Systematic approach to pediatric ocular trauma. Curr Opin Ophthalmol 2007; 18 :366-372.  Back to cited text no. 5
    
6.El-Mekawey HE, Abu El Einen KG, Abdelmaboud M, Khafagy A, Eltahawy EM. Epidemiology of ocular emergencies in the Egyptian population: a five-year retrospective study. Clin Ophthalmol 2011; 5 :955-960.   Back to cited text no. 6
    
7.Cariello AJ, Moraes NS, Mitne S, Oita CS, Fontes BM, Melo LA Jr. Epidemiological findings of ocular trauma in childhood. Arq Bras Oftalmol 2007; 70 :271-275.  Back to cited text no. 7
    
8.Strahlman E, Elman M, Daub E, Baker S. Causes of pediatric eye injuries. A population-based study. Arch Ophthalmol 1990; 108 :603-606.  Back to cited text no. 8
    
9.Cillino S, Casuccio A. A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area. BMC Ophthalmol 2008; 8 :6.  Back to cited text no. 9
    
10.LaRoche GR, McIntyre L, Schertzer RM. Epidemiology of severe eye injuries in childhood. Ophthalmology 1988; 95 :1603-1607.  Back to cited text no. 10
    
11.Luff AJ, Hodgkins PR, Baxter RJ, Morrell AJ, Calder I. Aetiology of perforating eye injury. Arch Dis Child 1993; 68 :682-683.  Back to cited text no. 11
    
12.Podbielski DW, Surkont M, Tehrani NN, Ratnapalan S. Pediatric eye injuries in a Canadian emergency department. Can J Ophthalmol 2009; 44 :519-522.  Back to cited text no. 12
    
13.MacEwen CJ, Baines PS, Desai P. Eye injuries in children: the current picture. Br J Ophthalmol 1999; 83 :933-936.  Back to cited text no. 13
    
14.Soliman MM, Macky TA. Pattern of ocular trauma in Egypt. Graefes Arch Clin Ex Ophthalmol 2008; 246 :205-212.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

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



 

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