We found that males (55.9%) were more affected than females (44.1%), which is consistent with most related studies [8–11]. The majority of our patients were aged 15–49 years (40%), followed by 50–69 years (30%), ≥ 70 years (20%), and < 15 years (10%). This finding differs from those of some studies that reported higher rates of ocular trauma in children [8] or elderly individuals [9, 10]. The possible reasons for this difference could be differences in sample size, definition of ocular trauma, or sociocultural factors.
We also observed that more patients in rural areas (70%) than in urban areas (30%), which is similar to the findings of Syal et al. [9]. This could be attributed to the lack of awareness, education, and access to eye care services in rural areas. The most common states/UTs where our patients came from were Uttar Pradesh (12.3%), Maharashtra (10.5%), Bihar (8.7%), West Bengal (7.4%), and Madhya Pradesh (6.8%). The remaining 54.3% were from other states/UTs. This reflects the population distribution and geographic diversity of India.
The leading causes of ocular trauma in our study were trauma (32.8%), infection/inflammation (34.5%), glaucoma (24.7%), and others (8%). Trauma was caused mainly by blunt objects, sharp objects, or chemical substances. Infection/inflammation was mostly due to bacterial or viral infections, such as conjunctivitis or keratitis. Glaucoma was mainly due to angle-closure glaucoma or secondary glaucoma. Other causes included cataracts, diabetic retinopathy, macular degeneration, etc. Our results are similar to those of Akgun and Selver [8], who reported trauma and infection/inflammation as the most common causes of ocular injury. However, our results differ from those of Blaszkowska et al. [10] and Miller et al. [11], who reported penetrating injuries and open-globe injuries as the most frequent causes of ocular trauma.
Our results show the demographic and clinical characteristics of patients with ocular trauma in India. We compared our findings with those of the following studies from different regions and periods.
Kate et al. reported that males, young adults, and urban residents in India have more acute ocular burns, with chemical injury being the most common cause [12]. A study by Przybek-Skrzypecka et al. revealed that COVID-19 lockdowns in Poland reduced eye emergency department visits by 50% but increased uveitis and optic neuritis cases, suggesting delayed diagnosis and treatment [13]. Ahmadi et al. reported that males, children aged 6–10 years, and rural residents are more prone to pediatric ocular trauma in northern Iran. The most common cause is blunt objects, followed by sharp objects and fireworks [14]. Salvetat et al. reported a 75% decrease in ophthalmic emergency visits in Italy due to COVID-19 lockdowns but an increase in severe cases. Males, elderly patients, and urban residents were more common visitors. However, their findings differed in sex, age group, location, and diagnostic distribution [15].
Roy et al. reported that despite a 40% decrease in cases during the COVID-19 lockdown in India, the severity and incidence of complications increased, with male sex, middle-aged patients, and rural residency being more common and trauma being the most common risk factor [16].
We categorized the patients according to their sex, age group, location, state/UT, and cause of injury. We then compared our findings with those of several previous studies from different regions and countries.
The present study revealed that males (54.9%) were more affected than females (44.1%), with the majority of patients aged 15–49 years (40%). Most patients were from rural areas (70%), possibly due to a lack of awareness and safety measures. The most common states/UTs where patients resided were Uttar Pradesh (12.3%), Maharashtra (10.5%), Bihar (8.7%), West Bengal (7.4%), and Madhya Pradesh (6.8%).
The main causes of ocular trauma in our study were trauma (32.8%), infection/inflammation (34.5%), glaucoma (24.7%), and others (8%). Trauma was mostly due to accidents, falls, assaults, or foreign bodies. Infection/inflammation was caused mainly by bacterial, fungal, or viral keratitis or uveitis. Glaucoma was mostly secondary to trauma, infection/inflammation, or primary open-angle glaucoma. Other causes included cataracts, diabetic retinopathy, macular degeneration, or retinal detachment. Our results are similar to those of several studies reporting trauma and infection/inflammation as the leading causes of ocular emergencies [17, 19] but differ from those of other studies reporting glaucoma as the most common cause [18]. The variation in the etiology of ocular trauma may depend on environmental factors, socioeconomic status, cultural habits, and preventive measures in different regions and countries.
One of the notable differences between our study and the others is the higher percentage of male patients (55.9%) in our sample, which is consistent with previous reports from India [1]. In contrast, some studies from the U.S. [20, 22] and Saudi Arabia [27] reported a more balanced sex ratio or even a slight female predominance. This may also reflect the different sociocultural factors and occupational exposures that affect the risk of ocular injuries in different populations.
Another difference is the age distribution of our patients. We found that most ocular injuries occurred in the 15–49 years age group (40%), followed by the 50–69 years age group (30%). This finding is similar to the findings of Pham et al. [20] and Patel et al. [22], who also reported a peak incidence of ocular trauma in the working-age population. However, some studies from Saudi Arabia [27] have shown a greater frequency of ocular injuries in children under 15 years old, which may be due to the lack of parental supervision and safety awareness among this age group.
We also observed that most of our patients were from rural areas (70%), which is in contrast to the findings of some studies from China [2, 3] and Saudi Arabia [27]. Studies have shown that urban residents in India are more likely to sustain ocular injuries due to better access to eye care services and fewer risk factors, such as agricultural work and fireworks. Uttar Pradesh, Maharashtra, Bihar, West Bengal, and Madhya Pradesh had the highest frequency of ocular injuries, while lower-income states such as Jammu and Kashmir had higher rates. The most common cause of ocular injuries in our study was trauma (32.8%), followed by infection/inflammation (34.5%) and glaucoma (24.7%). Trauma was also the leading cause of ocular injuries in most of the other studies we reviewed [20–22, 27]. except for Gomes et al. [24], who reported that keratoconus was the most prevalent eye disease in their sample from Brazil. The high frequency of trauma-related ocular injuries may be attributed to the various sources of mechanical, chemical or thermal injury that can affect the eye, such as road traffic accidents, sports activities, occupational hazards, domestic violence, animal attacks and environmental factors.
Infection/inflammation was another major cause of ocular injuries in our study, which may be related to poor hygiene conditions and low immunization coverage in some parts of India. Some of the common infectious agents that can cause eye damage include herpes zoster virus [23], COVID-19 [25, 26] and bacterial or fungal pathogens [4]. Inflammation can also result from autoimmune disorders or allergic reactions that affect the eye [6]. Glaucoma was the third most common cause of ocular injury in our study, which is consistent with the findings of some studies from China [2, 3]. Glaucoma is a chronic condition that causes increased intraocular pressure and progressive optic nerve damage, leading to irreversible vision loss if left untreated. Glaucoma can be primary or secondary to other eye diseases or systemic conditions [7–8]. The high prevalence of glaucoma in our study may reflect the lack of screening and early diagnosis among our patients.
Other causes of ocular injuries in our study included cataracts (4%), diabetic retinopathy (2%), macular degeneration (1%) and others (1%). These are mostly age-related or metabolic disorders that affect the lens, retina or macula of the eye [9]. The low frequency of these causes may be due to the younger age profile of our patients or the underreporting of these conditions due to their asymptomatic nature or lack of awareness. Our study showed that males were more likely to suffer from eye injuries than females were, with a ratio of 55.9–44.1%. This finding is consistent with most of the related literature, such as the studies by Turgut et al. [28], Lin et al. [29], and Kang et al. [30], which reported a male predominance in eye trauma patients. However, our ratio is lower than some of the reported values, such as 69.4% by Turgut et al. [28] and 75.3% by Kang et al. [30]. This may also reflect the different cultural and social factors that influence the exposure to and risk of eye injuries in different populations.
Our study revealed that patients aged 15–49 years had the highest frequency of eye injuries, accounting for 40% of the patients. This finding is similar to the findings of Turgut et al. [28] and Kang et al. [30], who also reported that the majority of eye injuries occurred in young and middle-aged adults. However, our study differed from that of Lin et al. [29], who reported that elderly individuals (≥ 65 years) had the highest proportion of eye injuries, followed by children (< 15 years). This may be due to the different sources and types of eye injuries in their study, which mainly focused on air pollution-related ocular diseases.
Our study also revealed that, compared with urban areas, rural areas had a greater frequency of eye injuries, with a ratio of 70–30%. This finding is contrary to the findings of Lin et al. [29] and Kang et al. [30], who reported that urban areas had more eye injuries than did rural areas. This may be explained by the different availability and accessibility of healthcare services and facilities in rural and urban areas, as well as the different occupational and environmental hazards that may affect eye health.
The study revealed that Uttar Pradesh, Maharashtra, Bihar, West Bengal, and Madhya Pradesh are the five states/UTs with the highest frequency of eye injuries in India, accounting for 45.7% of the total cases. Factors such as traffic accidents, industrial accidents, domestic violence, and fireworks increase the likelihood of eye injuries. The main causes of eye injuries were trauma (32.8%), infection/inflammation (34.5%), and glaucoma (24.7%) [28–30].
Strengths
This study may lead a series of articles on ocular emergencies and blindness in India and describe the latest programs, projects, education and training being developed to combat and decrease ocular emergencies and blindness.
Limitations
Further study is required to provide additional benchmarks and trend data to gauge not only what is happening but also what is being done and how effectively programs, projects, education and training are effective at minimizing ocular emergencies.