SOCIO-DEMOGRAPHIC AND CLINICAL PROFILE OF PEDIATRIC OCULAR TRAUMA: A HOSPITAL BASED PROSPECTIVE STUDY

Objectives: This present study was to evaluate the clinical and socio-demographical study in cases of paediatrics ocular injuries. Methods: A detail assessment and relevant investigations were performed to all paediatrics OCT. And globe injuries were recorded according to the BETT. Occular injury was examined by using equipment model OCT 2000 by TOPCON at IGIMS, Patna. Treatment was given depending on type and severity of injuries. Patients were followed up on day 1, day 7, 1 month, and at 6 months. Initial best corrected visual acuity was evaluated on first day of follow up. And final best corrected visual acuity (BCVA) was evaluated on last day of follow up after 6 months. Results: Data was analysed by using simple statistical methods with the help of MS-office software. All data was tabulated and percentage was calculated. Conclusions: Age group 0-10 years and males were more prone to ocular trauma. Stick, stone RTA and fall were more causative risk for OCT. School, home, Road traffic accident were the common places for ocular trauma. Open globe injury and close globe injury were commonly seen in ocular trauma cases. Close globe injury patients were shows the better BCVA with respect to OGI, lids and lacrimal apparatus injury and non-mechanical injury. Hence, we should aware the parents and family members about the common modes of trauma, the need of supervision of the objects of play. Selfprotection should be taught to children to prevent possible ocular injuries. Houses, playgrounds and schools must be made safe and common items of trauma such as sharp objects, household lime, acids must be kept out of reach of children. Intensive campaign may be done before festival seasons about safety measures to increase public awareness. Ocular trauma is a frequent reason for emergency room visits. Evaluation of eye injuries should start with visual acuity and continue with prompt referral to an ophthalmologist as indicated.


Introduction
Trauma is one of the leading causes of monocular blindness worldwide there are approximately 1.6 million people blind from eye injuries and 2.3 million bilaterally visually impaired and 19 million with unilateral visual loss; this being a most common cause of unilateral blindness today [1,2].
According to estimates of world health organization (WHO), the global annual incidence of ocular trauma is around 55 million [3,4] and worldwide blindness in 1.6 million people is due to ocular trauma [5,6]. It may occur at any age in either sex [7,8], especially among pediatric and elderly population [7]. Both hospital and population based studies indicate a large preponderance of traumas affecting males [ 8,5].
Ocular trauma is one of the leading causes of treatable visual morbidity and blindness [9] with children at a greater risk due to careless activities and inability in understanding the nature of dangerous objects [10]. Ocular trauma is associated with a great amount of emotional stress as well as frequent hospital visits and increasing economic burden [11,12]. Ninety percent of eye trauma is preventable by taking care of minor things [13].
Corneal tear, sclera tear and lens damage are the most frequently observed morbidities of ocular trauma [6] followed by lid and canalicular laceration, uveal prolapse, anterior chamber (AC) abnormality, retinal detachment and optic nerve avulsion [6,14]. Majority of the patients were presented in to eye health facilities after 24 hours from time of trauma [15]. Patients reported within 24 hours of eye injury showed better visual outcome as compared to later than 24 hours presentation [16].
Most injuries stem from sports, recreation, military, occupational, or automotive. Patient education is highly recommended, as well as prevention by use of protective polycarbonate eyewear. An objective of our study was to evaluate the incidence and clinical profile of ocular trauma in paediatrics.

MATERIALS AND METHODS
This present study was conducted in Department of Ophthalmology, SKMCH, Muzaffarpur, Bihar, with collaboration of VIMS, Pawapuri, Bihar and IGIMS, Patna, Bihar, India during a period from March 2019 to November 2019.
Attendants/Entire subjects signed an informed consent approved by institutional ethical committee was sought. Data was collected by random sampling methods with irrespective of sex. A total of 50 cases with age group 0 to 15 years were enrolled in this study. A detail history, clinical examinations and relevant investigations were performed to all cases. Patients who were diagnosed with history and signs of blunt ocular trauma according to Birmingham Eye Trauma Terminology (BETT) were included. Exclusion Criteria of this study had the patients who were difficult for assessment due to severe head injury and with reduced level of consciousness. And history of any past ocular pathology, which impairs bestcorrected visual acuity (BCVA).

Methods:
A detail assessment was performed. It included patients' demographics, the patient's initial complaint, interval between the time of trauma and time of presentation, trauma details: date, time, location, type, and mechanism, clinical examination findings of the injured eye, the visual acuity, and globe injury according to the BETT. Ocular injury was examined by using equipment model OCT 2000 by TOPCON at IGIMS, Patna. And visual acuity in preverbal children was evaluated with tests offixation and following/central steady maintenance. Ocular trauma score (OTS) was assigned to all patients.
Laboratory Investigations to all patients were performed. It includes routine haematological investigations haemoglobin, CBC, total count, differential count. X-ray orbit AP and Lateral view for PNS-Orbital fractures, intraocular foreign bodies (IOFB) and intraorbital foreign bodies were done. Computed Tomography scan, Ultrasonography were performed when needed.
Procedures: Thorough eyewash were performed for foreign bodies and chemical injuries. Cleaning and dressing of the wounds were done. Applied shield in open globe injuries. Tetanus immunization was done. Systemic Analgesics and antibiotics were prescribed. Treatment was given depending on type and severity of injuries. Patients were followed up on day 1, day 7, 1 month, and at 6 months. Initial best corrected visual acuity was evaluated on first day of follow up. And final best corrected visual acuity (BCVA) was evaluated after 6 months (last day of follow up).

STATISTICAL ANALYSIS
Data was analysed by using simple statistical methods with the help of MS-office software. All data was tabulated and percentage was calculated.

DISCUSSIONS
Ocular injury is very common, more so in the under privileged and developing countries. Ocular trauma constitutes 5% of all cases admitted in developed countries and about 12.9% in developing under privileged and developing countries [17]. In our study, it was found that the most common age group involved was 6-10years. And open globe injury 20(40%) was more common than close globe injury 18(36%), lids and lacrimal apparatus injury 9(18%) and non mechanical injury 3(6%).
A review, undertaken for planning purposes in the WHO Programme for the Prevention of Blindness, suggests that around 55 million eye injuries responsible for restricting activities for more than one day, occur annually; they account for 750,000 hospitalized cases each year. These include approximately 200,000 open-globe injuries; with around 1.6 million people blind from such injuries, 2.3 million people with bilateral low vision from this cause, and almost 19 million people with unilateral blindness or low vision [18]. In our study, males 35(70%) were found to be at a greater risk of ocular injury, with a male to female ratio of 7:3. This is consistent with local studies carried out in Lahore [19,20] and Karachi [21], and internationally as well in India [22]. Australia [23], Nepal [24], UK [25] and Egypt [26].
The definitions and classifications of ocular trauma in the study were modified from the Ocular Trauma Classification Group guidelines and Birmingham Eye Trauma Terminology [27]. Three more categories (orbital injuries, burns and superficial foreign bodies) were included in our classifications. Open globe injuries (OGI) was classified as rupture, penetrating injury, intraocular foreign body (IOFB) or perforating injury. Superficial foreign bodies of conjunctiva and cornea were recorded separately. Follow-up records of the patients till 6 months were analysed [29].
In this present study, stick 18(36%), stone 6(12%), fall 5(10%), RTA 5(10%) and metal 4(8%) were more common risk factors of ocular trauma. Among the cases of open globe injury and close globe injury, major risk factors was stick. And for lid and lacrimal apparatus injury major risk factors was fall. which were consistent with other studies [28]. The main contributing factor for the higher proportion of workrelated injury is the local work tasks including grinding, welding, hammering, drilling, metal cutting, and nailing, which commonly involve high-powered tools that generate metal fragments at high velocities. When the objects shoot people, the effective action area is small. But with the hard body, the energy it delivered is very large and often has devastating effects on the eyes. Home 17(34%), school, 13(26%) road traffic accident 13(26%) were the common places for ocular trauma. Most of the cases of ocular trauma were belonged in category 3 and category 4 of severity.
In a study of Chakraborti C et al. [29]  In our study, out of total ocular trauma cases, 16(32%) cases were regained visual acuity. Good visual acuity was regained in cases of close globe injury, among them 9(50%) cases were regained vision. Thus, Ocular trauma is extremely common and especially so in the developing countries. Of all the admissions in developed countries 5% cases [31] result from ocular trauma while in developing world this figure is much higher (12.9%) [32]. Children of 5-10 years age group were found to be most prone to ocular injury in our study as supported by others. [33] The lower occurrence of ocular trauma under 2-yearold children can be explained by the parents' greater protection, the children's less independence and risk situations [34].

CONCLUSIONS
This present study concluded that the age group 0-10 years and males were more prone to ocular trauma. Stick, stone RTA and fall were more causative risk for OCT. School, home, Road traffic accident were the common places for ocular trauma. Open globe injury and close globe injury were commonly seen in ocular trauma cases. Close globe injury patients were shows the better BCVA with respect to OGI, lids and lacrimal apparatus injury and non-mechanical injury. Hence, we should aware the parents and family members about the common modes of trauma, the need of supervision of the objects of play. Self-protection should be taught to children to prevent possible ocular injuries. Houses, playgrounds and schools must be made safe and common items of trauma such as sharp objects, household lime, acids must be kept out of reach of children. Intensive campaign may be done before festival seasons about safety measures to increase public awareness. Ocular trauma is a frequent reason for emergency room visits. Evaluation of eye injuries should start with visual acuity and continue with prompt referral to an ophthalmologist as indicated.