Ocular trauma is an uncommon event that can leave devastating effects and sometimes cause blindness. 14 This study highlights the profile of patients presenting with ocular trauma to the National Referral Hospital in Asmara, Eritrea.
Males were found to have more ocular injury than females. Studies on the incidence of ocular trauma have found two important factors associated with ocular injury are age and gender especially in people under 30 years of age and the male gender. 15,16 Ocular trauma studies done in done in Africa and Asia found that ocular trauma occurs in the young and more in males. 11,17−22 Most ocular injury in males tend to occur at the street and highway and workplace. The greater tendency for men to sustain eye injury is multifactorial which includes aggressive behavior, work-related, assault-related, alcohol abuse and unwillingness to use protective devices at work. 23
The mean age of ocular trauma patients was 27.3 ± 17.9 years with no statistically significant differences in gender. Different studies on ocular injury showed that frequent occurrence of ocular injury is seen among ages 20–35 years. 10,11, 18–22,24 This age group may be more prone to ocular trauma due to being more involved in hazardous activities which could be adventurous and aggressive. 25,26 The injury can result in huge disability adjusted life years for the young individuals as they have long life ahead of them.
The study showed ocular trauma occurred more at home among women and children, 0–17 years as well as street and highway plus work place among men [50% (n = 140/280)]. Women and children are observed to stay more at home and men more outdoors. In Addis Ababa, Ethiopia, home constituted 37% of ocular injury while workplace contributed 30.7%. 11 However, ocular injury in rural Nepal was 32% at home and 37% workplace. 19 and was in the farm (37.2%) and at home (35.9%) in the elderly of South-Western Nigeria.10 The street was where the majority of ocular trauma occurred in New York, USA. 27 The differences in the different countries could be due to nature of occupation, preventive practices and whether it’s rural or urban settings. There is great need to focus preventive ocular trauma strategies/ education on the home, street and highways and work place.
Ocular trauma was commonly caused by blunt objects (37.5%) followed by sharp objects (31.1%, metallic and wooden) and then fall (12.5%). The blunt objects injury was mainly caused by sticks, thrown stones and less frequently fist fights and injuries during sports. Stick was the main cause of eye injury in Nigeria,10 Tanzania 21 and in Ethiopia.11,24 Blunt objects was the cause of ocular trauma in other studies. 27–29 However, sharp objects were found to be of higher incidence in ocular trauma studies done in Ethiopia, Egypt and Singapore. 17,20,30 It was noted that children in the city usually play with stones and throw stones at each other. There is negligible civil disturbance in Eritrea which reduce the risk of sharp objects.
Work related injuries occurred in 25% of participants. The common occupations involved were farmers, metal workers (hammering, grinding, and welding) and wood workers. Eighty nine percent of workers involved in work-related injury did not wear protective devices while working. This may be due to negligence on their part and unwillingness to wear protective devices as some workers become more confident that they cannot have injuries to the eyes because they are now ‘expert’. In Malaysia 31 and Ethiopia, 11 none of the participants wore protective devices during the eye injury, while in Southern India, 97.8% did not wear any eye protection at the time of injury. 32
Accidental injuries (70.4%) occurred more than assault injuries (28.6 %). In Malaysia, 92% of ocular injuries were accidental and 7.7 % from assault. 31. Though most accidents are preventable, unintentional accidents occur as a result of ignorance, haste, negligence, carelessness and lack of knowledge. Laterality in ocular injuries also tends to vary in different studies. the right eye was involved in 46.8% of patients while left eye was involved in 50% of the patients in this study. Similar findings occurred in Uttarakhand where left eye occurred more than right eye. 7 It is possible that right handedness may contribute to this. Bilateral injury was seen in 3.2%. This is similar to injuries in Egypt ( 4.1%) 20 and Malaysia (10.3% ), 31 where ocular trauma plays a minor role in bilateral blindness compared to its major role in unilateral blindness.
Post traumatic blindness was associated with rural residence (p < 0.0001), presentation greater than 24 hours post injury (p = 0.04), non-use of eye protection goggles (p = 0.007), open globe injury (p = 0.018), posterior segment involvement (p < 0.0001) and hospitalization (p < 0.0001) in univariate analysis. However, in logistic regression analysis, only rural residency and OGI were associated with blindness. This may be because people with ocular trauma living in rural areas may present late, and those with open globe injury may have involvement of the posterior segment and vital structures that may compromise vision. In Ethiopia, 11 rural residence was associated with blindness post ocular trauma. Poor vision post eye injury was associated to male gender and advancing age in India 32 and to increasing age and OGI in Nepal. 19
Strength and Limitation
The main strength of our study is its novelty the first of its kind in Eritrea. The study was also undertaken in the only national referral eye hospital in the country and may thus give a fairly good account of the profile of patient with ocular trauma.
Nonetheless, the study has some limitations. The short study period may not reflect the actual profile of cases for the whole year. Also, the study was a hospital-based study, the study subjects were not representative of the population at risk. This makes it difficult to determine the prevalence of ocular injury accurately. The study covered patients only from the eye hospital and hence, patients who had eye injuries along with other life-threatening injuries may have been missed. Though the study setting was only the government hospital, there are no private eye clinics in Asmara which makes the data more complete. The minor injuries from urban and rural areas may not have presented to hospital further missing more information.