Ocular injury pattern in Turbat, Baluchistan, Pakistan
Injury is the commonest cause of monocular blindness.1 Though not a main cause of bilateral blindness in developing countries, effort should be made towards prevention. Time lost from work and the expense of treatment further emphasise the importance of prevention. Despite this, education, public awareness and safety campaigns have not received much attention. Ocular injury in Turbat, a rural area in Baluchistan, Pakistan, presents a great challenge and emphasises the need to educate the community on the prevention of eye injuries.
A one year study was carried out from January 1993 to December 1993 at the Eye Department of Turbat Medical Centre. All patients who attended the outpatient department with ocular injury were included in the study. A specific history was taken about occupation, time of injury, the type of object causing injury and distance travelled to obtain treatment. Patients with minor injuries were treated as outpatients. More serious cases were investigated, admitted into the hospital and managed accordingly. Although an attempt was made to follow-up patients in order to determine longer term outcomes, this proved to be impossible for most patients.
The results are summarised in Tables 1 to 5. A total of 105 patients with ocular injury were seen, 93 males and 12 females. The predominant age group was 21-30 years accounting for 60 patients of whom 57 (95%) were males. All of these injuries affected one eye only.
Half (50.4%) of the injuries were due to fragments of iron from lathe and iron grinding machines; 23.9% were related to date leaves and twigs; 6.6% were due to wood; 4.8% were caused by air gun pellets and a further 4.8% were the result of stone injuries. Road traffic accidents resulted in 5.7% of injuries and 3.8% had other causes.
Distance from the clinic/time of presentation
It was found that 42.8% of people were from Turbat city or its immediate surroundings (0-20 kilometres), while 57.2% had to travel from 21 to over 100 kilometres in search of ophthalmic assistance. The time of attendance of patients after injury was inversely related to the distance. Only 28.6% of the patients presented within one day after the initial injury. Most patients (38.1%) presented on the second day, while 33.3% presented on the third day and later.
The maximum number of people presented in the month of June (26.7%). A gradual rise was seen from April (7.7%) with a peak in June, falling to just over 9% in both August and September.
Eye injury was found more often among males in all age groups but particularly in those aged 21-30 years of age. Ocular trauma often occurs in the young and active, and has economic as well as health implications.1, 3, 4 Our study confirms this statement. A third of females with eye injuries were aged 1-10 years. The same trend was found in Tanzania where 40% of females with injuries were in the same age group.3
Our study indicates that most eye injuries happen at the work place, where lack of protection and negligence are common. An earlier study by Khan et al stated that criminally negligent attitudes, lack of protective devices and severe aggression, were the cause of much ocular trauma in the North West Frontier Province of Pakistan.6 This study shows some similar trends in Baluchistan, contrary to the study in Malawi,4 where industrial injuries were rare.
Air gun pellets, the cause of 4.8% of our ocular injuries, were mainly due to the careless use of weapons, especially amongst youngsters. Higher numbers have been reported from the North West Frontier Province in Pakistan6 which are in contrast to figures reported by Percival (2.8%).7
More than half of the patients had to travel over 20 kilometres to reach an ophthalmic facility. This has very important implications for the development of eye care services. This probably explains why approximately 71% of the patients presented at least 24 hours after injury.
An interesting finding was the seasonal variation, showing a steady rise from April (7.7%) with a peak in June (26.7%) and then a gradual decline to October (3.8 %). During the summer the most common occupation is date farming. We concluded that most eye injuries at this time were related to the harvesting of dates which involved climbing trees and the risk of injuries from date leaves and wood. Further, with summer temperatures of 45-50 degrees Celsius, wearing protective devices is more difficult, with the result that people working on lathe machines are more prone to injuries from flying iron during these months.
Table 1. Age and sex distribution
|Age||No.of Patients||Percentage %||Male||Female|
Table 2. Causes of ocular trauma
No. of Eyes
|Flying iron and particles||53||50.4|
|Date leaves and twigs||25||23.9|
|Air gun pellets||5||4.8|
|Road traffic accidents||6||5.7|
Table 3. Distance from the clinic
|Distance in Kms||No.of Patients||Percentage %|
|City 0 – 20||45||42.9|
|21 – 40||25||23.8|
|41 – 60||15||14.3|
|61 – 80||12||11.4|
|81 – 100||4||3.8|
Table 4. Time of presentation after the injury
|Time of Presentation||No.of Patients||Percentage %|
|Over 3 days||15||14.3|
1. Eye safety campaigns organised by government and non-governmental organisations.
2. Public awareness raising and health education using radio, leaflets and teaching in schools, through role plays and skits.
3. Legislation requiring people at risk to wear protective eye gear.
4. Provision of better eye care services at the primary level and an emphasis on the training of paramedical staff in the recognition and treatment of minor injuries and referral of major ones.
1 Editorial. Progress in surgical management of ocular trauma. Br J Ophthalmol 1976; 60: 731.
2 Schwab L. Blindness from Trauma in Developing Nations. International Ophthalmology Clinics 1990; 30(1):28-9.
3 Eagling EM. Perforating injuries of the eye. Br J Ophthalmol 1976; 60:732-6.
4 Ilsar M, Chirambo M, Belkin M Ocular injuries in Malawi Br J Ophthalmol 1982, 66:145-8
5 Masesa DE Pattern of ocular trauma in Dar es Salaam East African J Ophthalmol 1986,7(1):26-30
6 Khan MD, Kundi N, Mohammed Z, Nazeer A. A 6 1/2 years survey of intraocular and intraorbital foreign bodies in the North West Frontier Province, Pakistan. Br J Ophthalmol 1987; 71: 716-9.
7 Percival SPD. A decade of intraocular foreign bodies. Br J Ophthalmol 1972; 56: 454-61.