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Original Research (Original Article) 


Saud Hatem Aman et al, 2019;3(7):565–569.

International Journal of Medicine in Developing Countries.

The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia

Saud Hatem Aman1, Duha Daif Allah Alloqmani2*, Abdullah Mana Alqahtani3, Muhammad Abdullah Almalki4, Abdulmajeed Haddaj Alruwaili4, Saqqar Abdulelah Alanazi5, Najd Khalid Aljuaid6, Faisal Fawzi Abuhalimeh1, Ruba Saud Alkabani7, Munera Abdullah Albalawi6, Rakan Abdullah Almusallam8

Correspondence to: Duha Daif Allah Alloqmani

*Taibah University, Medina, Saudi Arabia.

Email: duha.loq [at] gmail.com

Full list of author information is available at the end of the article.

Received: 28 January 2019 | Accepted: 13 February 2019


ABSTRACT

Background:

Eyes are ranked as the third most common organ affected by traumatic injuries representing one of the major worldwide causes for acquired unilateral blindness.


Methodology:

A cross-sectional, non-interventional study was carried out on children aged 18 years or younger who had been exposed to eye injuries and were attending the Emergency or the Outpatient Clinics of Al-Yamamah hospital, Riyadh, Saudi Arabia during the year 2017. The demographic characteristics, details of the injury events, the initial and 3 months post-injury visual acuity, and eye status were investigated.


Results:

One hundred and twenty-four children were included in this study. Most of the eye injuries occurred in children aged less than 6 years (42.7%). These included 92 (74.2%) boys and 32 (25.8%) girls. The highest proportion of eye injuries were due to street injuries (41.9%) followed by domestic injuries (26.6%). Open-eye globe injuries constituted 35.5% out of total eye injuries, closed-eye globe occurred in 64.5%, chemical injuries constituted 2.4% of all ophthalmological injuries.


Conclusion:

This study highlights the importance and need for eye injuries prevention programs among the children to avoid injuries during their daily life.


Keywords:

Eye injuries, unilateral blindness, domestic eye injuries.


Introduction

Although both eyes constitute only 0.2% of the total and 0.52% of the anterior surface area of the human body, they are the third most common organ affected by traumatic injuries after hands and feet [1]. Childhood period eye injuries are one of the commonest causes of acquired unilateral blindness. Worldwide, there are nearly 1.6 million subjects blind due to eye injuries and around 2.3 million who had post-injurious visual disabilities in one or both eyes [2]. About 20% to 59% of all eye injuries occur during the childhood period which is much higher when compared with adulthood. This is major because of their developing physical coordination, limited ability to discover risky environmental events, and more vulnerable facial morphology [3,4]. In the developing countries, treatment of traumatic eye injuries are often inadequate or delayed, and thus the outcomes are significantly worse than those in the developed nations [5].

Studies that spotlight on the traumatic eye injuries among children in Saudi Arabia is very limited, as each region has its own sociodemographic characteristics. Knowing the social and behavioral profile of children as well as the clinical pattern of ocular injuries will help in understanding various aspects related to the pediatric ocular injuries in Saudi Arabia. This information is essential to make long-term strategies and policies to prevent ocular injuries in the future.


Subjects and Methods

This is a hospital-based, cross-sectional, and non-interventional study. It was conducted at the Emergency and Outpatient Clinics of Al-Yamamah hospital, Riyadh, Saudi Arabia. Al-Yamamah hospital is a teaching hospital belonging to Al Yamamah University (YU). The University is supervised by the Ministry of Higher Education. The hospital has a highly qualified medical staff, fairly equipped with facilities, and encouraging referral from near as well as distant areas. The study included children aged 18 years or younger attending the hospital during the year 2017. The objectives of this study were explained using a verbal process. Written/verbal consent by the patients and their family and agreement to participate in the study were obtained. Children who had birth injuries, superficial injuries (e.g., conjunctival foreign body), and ocular injuries with more than 1-month duration, injuries repaired elsewhere or who had injuries in blind/atrophic eyes, and comatose or unconscious patients were excluded from the study.

A reliable validated semi-structured, Arabic-based questionnaire was used to study different variables such as age, sex, socio-demographic profile, and factors related to the nature of the injury. All patients had a baseline clinical examination by the ophthalmologist. The ophthalmological examination included: (1) Snellen visual acuity examination by Illiterate C chart; naming picture or matching letters for young children; (2) slit lamp examination of the anterior segment; (3) intraocular pressure measurement using tonometry in closed injuries; and (4) Fundus biomicroscopy with volk 90 and 78 diopter lenses, and dilated fundus examination with indirect ophthalmoscopy, if possible. Anterior and posterior segment was evaluated. The extent of the injury and the pupillary reaction was noted. X-ray, computerized tomography (CT), magnetic resonance imaging (MRI scan) was done when required. Visual outcome was noted on the day of presentation to the hospital. Ocular Trauma Classification Group guidelines and Birmingham Eye Trauma Terminology were used for the definitions and classifications of different ocular injuries [6,7]. The patients who had serious eye injuries were admitted for proper management. However, others were managed on an outpatient basis. The approval of the ethical committee of Al-Yamamah hospital was obtained and the procedures followed were in accordance with the ethical standards of the responsible committee. The study adhered to the guidelines of the Declaration of Helsinki 7 and was conducted after the Al-Yamamah Hospital institutional review board approval.

Data were collected using the Microsoft Excel program. Collected data were coded, validated, and statistically analyzed by the Statistical Package of Social Science software program version 22 (SPSS Inc. Chicago, IL). Qualitative data were expressed as number and percent. Chi-Square test was used to compare qualitative variables. A p-value <5% was considered an indicator of statistical significance.


Results

In this study, 48.4% of pediatric eye injuries occurred among children less than 6 years, followed by those aged 6–12 years (28.2%), with the lowest incidence (23.4%) in children aged 12–18 years (Table 1). Among the total subjects, 67.7% of patients were males with a male-to-female ratio of 2.1:1 (Table 2; Figure 2).

The most common sociodemographic feature involved was the rural class (40.3%) followed by the urban (34.7%). Most of the patients came from families with an average income (52.4%) followed by high-income families (24.2%) and low-income families (23.4%). A large majority of patients came from preparatory school educated families (46.9%) followed by primary school educated families (24.2%), secondary school educated family (20.2%) and lastly, illiterate families (9.7%) (Table 2).

Table 1. Sex distribution of studied patients.

Age in years Males Females Total p-value
No % No % No %
0–6 42 70.0 18 30.0 60 100 <0.05*
>6–12 27 77.1 8 22.9 35 100 <0.05*
>12–18 15 51.7 14 48.3 29 100 <0.05*
Total 84 67.7 40 32.3 124 100 <0.05*

Figure 1. Prevalence of eye injuries among studied patients.

The most commonly injured part was cornea injuries with corneal wounds (29.8%) followed by the lid and periocular injuries (17.8%), mixed eye injuries (14.5%) However, the least type was rupture globe (4.1%) (Table 3).

Table 2. Sociodemographic characteristics of studied patients.

Characteristics No %
Age groups
0–6 60 48.4
>6-12 35 28.2
>12–18 29 23.4
Habitat
Rural 50 40.3
Semi-urban 31 25.0
Urban 43 34.7
Level of education
Illiterate 12 9.7
Primary school 30 24.2
Preparatory school 57 46.9
Secondary school 25 20.2
Family income
Low 29 23.4
Average 65 52.4
High 30 24.2

Figure 2. Distribution of eye injuries regarding gender.

In this study, mechanical injuries represent 75% among different eye injuries studied. However, the thermal was 14.5% and the least is the chemical injuries (10.5%) (Table 4).

Table 3. Types of injuries among studied patients.

Type of injury* No %
Corneal injuries 37 29.8
Lid & periocular injury 22 17.8
Mixed eye injuries 18 14.5
Corneal and conjunctival foreign body 17 13.7
Endophthalmitis induced injuries 12 9.7
Intraocular foreign body (IOFB) 7 5.6
Lens with traumatic cataract 6 4.8
Globe rupture 5 4.1

Table 4. Characteristics of ocular injuries among studied patients.

Characteristics No %
Site of occurrence
Home 33 26.6
Playground 22 17.8
Road–street 52 41.9
School 17 13.7
Time of injuries
Morning 38 30.6
Mid-day 64 51.6
Evening 22 11.8
Type of injuries
Mechanical injury 93 75.0
Thermal 18 14.5
Chemical 13 10.5
Type of mechanical injuries
Blunt object 21 16.9
Sharp object 64 51.6
Fall 15 2.1
Hit 24 19.4

Finally, visual acuity in our study was: no perception of light (NPL)–<3/60 in 22.6% of cases, 3/60–<6/18 in 24.2%, and 6/18–6/6 in 40.3% (Table 5).


Discussion

Eye injuries constitute an important cause of avoidable and predominantly monocular visual disabilities in children. Generally, children are more liable to eye injuries because of their immature motor skills, and their tendency to imitate adult behavior without evaluating risks and dangers [8]. The current study is a hospital-based study conducted on the children attending the Emergency Department as well as Outpatient Clinics at Al Yamamah Hospital. The results of this study clarified that the percentage of pediatric eye injuries among children attending the hospital during a period of 1 year was 4%. This result is in agreement with Dandona et al. [9] who found that the rate of ocular trauma among their studied participants to be 3.97%.

Table 5. Distribution of initial and final visual acuity among studied patients.

Visual acuity At presentation After treatment p
No % No %
6/6–6/18 50 40.3 32 25.8 <0.05*
<6/18–3/60 30 24.2 32 25.8 <0.05*
<3/60–NPL 28 22.6 35 28.2 <0.05*
Unknown 16 12.9 25 20.2 <0.05*
Total 124 100.0 124 100.0

*Chi-Square test showed a significant difference.

Socioeconomic and sociocultural status and family negligence are important factors in eye injuries in children which are in agreement with an Egyptian study which showed that patients from Upper Egypt represented 56.2% of ocular emergencies in an extended 5-year-long study on the epidemiological features of ocular emergenci=es among Egyptian people [10]. Young children have a common physical vulnerability, lack of coordination, and limited ability to avoid or escape from dangerous events. Also, young children show curiosity and a desire to explore the world around, which may expose them to serious hazards. Abraham et al. [11] found that one-third of eye injuries occurred in those less than the age of 20 years.

High male incidence may be due to several social and or environmental factors, as males are allowed to go outdoors more and also do hard tasks with more physical contact. The hyperactive nature of males may also play a major role as seen in a similar Egyptian study on ocular trauma that reported similar nature of injuries [10]. In lower socioeconomic standards, there was a delay in the period between the occurrence of the injury and seeking medical management. This may reflect the deficient parental supervision in the lower societies reflecting negligence and lack of supervision during recreations and playing, and increased participation in outdoor activities without strict adult supervision. In a study by Bejiga et al. [12] found that hyphema to be the most common outcome in blunt trauma, and corneal laceration in perforating injuries.

Penetrating injuries, in general, carry a poor prognosis [13] and they are more likely to require surgery and subsequently result in long-term visual impairment. Great percentages of children in this study ended up legally blind according to the definition of legal blindness in the USA [14]. The poor visual results agree with Niiranen and Raivio [15] who noted that despite therapeutic advances, visual prognosis in children is still worse than adults due to the nature of the injuries and amblyopic problems. It is necessary to have public education campaigns about ocular trauma, and recognition of specific hazards and their prevention. Health education and safety strategies should target the home as well as the street as high-risk environments. Improving family health services by providing them with facilities and equipment is necessary for urgent management of ocular trauma. Good training in how to deal with different types of ocular trauma is important for resident ophthalmologists. Clinicians can provide parents with information about the risk of eye injury caused by different objects. Disseminators of information might include pediatricians, community leaders, and school teachers.

Our data support the need for eye injury prevention efforts, taking into consideration the developmental stages of children. Eye injuries, as well as many other health problems, would be positively influenced by the improvement of the socioeconomic levels of the entire population.


Conclusion

This study highlighted the incidence and different types of eye injuries that indicate the need for construction of a well-planned public policies successful interventions and acquiring healthy behaviors in order to reduce the incidence of eye injuries and promote protection.


List of Abbreviations

CTComputerized tomography
MRIMagnetic resonance imaging
SPSSStatistical Package of Social Science software program
YUAl Yamamah University

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

Ethical Approval was obtained from Al-Yamamah Hospital, administration ref 100/275.


Author details

Saud Hatem Aman1, Duha Daif Allah Alloqmani2, Abdullah Mana Alqahtani3, Muhammad Abdullah Almalki4, Abdulmajeed Haddaj Alruwaili4, Saqqar Abdulelah Alanazi5, Najd Khalid Aljuaid6, Faisal Fawzi Abuhalimeh1, Ruba Saud Alkabani7, Munera Abdullah Albalawi6, Rakan Abdullah Almusallam8

  1. Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
  2. Taibah University, Medina, Saudi Arabia
  3. King Khalid University, Abha, Saudi Arabia
  4. Northern Border University, Arar, Saudi Arabia
  5. Jordan University of Science and Technology, Ramtha, Jordan
  6. Ibn Sina National College for Medical studies, Jeddah, Saudi Arabia
  7. Al-Mareefa University, Dariya, Saudi Arabia
  8. Al Yamamah Hospital, Riyadh, Saudi Arabia

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How to Cite this Article
Pubmed Style

Aman SH, Alloqmani DDA, Alqahtani AM, Almalki MA, Alruwaili AH, Alanazi SA, Aljuaid NK, Abuhalimeh FF, Alkabani RS, Albalawi MA, Almusallam RA, . The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia. IJMDC. 2019; 3(7): 565-569. doi:10.24911/IJMDC.51-1545996297


Web Style

Aman SH, Alloqmani DDA, Alqahtani AM, Almalki MA, Alruwaili AH, Alanazi SA, Aljuaid NK, Abuhalimeh FF, Alkabani RS, Albalawi MA, Almusallam RA, . The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia. http://www.ijmdc.com/?mno=23643 [Access: August 20, 2019]. doi:10.24911/IJMDC.51-1545996297


AMA (American Medical Association) Style

Aman SH, Alloqmani DDA, Alqahtani AM, Almalki MA, Alruwaili AH, Alanazi SA, Aljuaid NK, Abuhalimeh FF, Alkabani RS, Albalawi MA, Almusallam RA, . The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia. IJMDC. 2019; 3(7): 565-569. doi:10.24911/IJMDC.51-1545996297



Vancouver/ICMJE Style

Aman SH, Alloqmani DDA, Alqahtani AM, Almalki MA, Alruwaili AH, Alanazi SA, Aljuaid NK, Abuhalimeh FF, Alkabani RS, Albalawi MA, Almusallam RA, . The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia. IJMDC. (2019), [cited August 20, 2019]; 3(7): 565-569. doi:10.24911/IJMDC.51-1545996297



Harvard Style

Aman, S. H., Alloqmani, . D. D. A., Alqahtani, . A. M., Almalki, . M. A., Alruwaili, . A. H., Alanazi, . S. A., Aljuaid, . N. K., Abuhalimeh, . F. F., Alkabani, . R. S., Albalawi, . M. A., Almusallam, . R. A. & (2019) The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia. IJMDC, 3 (7), 565-569. doi:10.24911/IJMDC.51-1545996297



Turabian Style

Aman, Saud Hatem, Duha Daif Allah Alloqmani, Abdullah Mana Alqahtani, Muhammad Abdullah Almalki, Abdulmajeed Haddaj Alruwaili, Saqqar Abdulelah Alanazi, Najd Khalid Aljuaid, Faisal Fawzi Abuhalimeh, Ruba Saud Alkabani, Munera Abdullah Albalawi, Rakan Abdullah Almusallam, and . 2019. The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (7), 565-569. doi:10.24911/IJMDC.51-1545996297



Chicago Style

Aman, Saud Hatem, Duha Daif Allah Alloqmani, Abdullah Mana Alqahtani, Muhammad Abdullah Almalki, Abdulmajeed Haddaj Alruwaili, Saqqar Abdulelah Alanazi, Najd Khalid Aljuaid, Faisal Fawzi Abuhalimeh, Ruba Saud Alkabani, Munera Abdullah Albalawi, Rakan Abdullah Almusallam, and . "The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 565-569. doi:10.24911/IJMDC.51-1545996297



MLA (The Modern Language Association) Style

Aman, Saud Hatem, Duha Daif Allah Alloqmani, Abdullah Mana Alqahtani, Muhammad Abdullah Almalki, Abdulmajeed Haddaj Alruwaili, Saqqar Abdulelah Alanazi, Najd Khalid Aljuaid, Faisal Fawzi Abuhalimeh, Ruba Saud Alkabani, Munera Abdullah Albalawi, Rakan Abdullah Almusallam, and . "The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia." International Journal of Medicine in Developing Countries 3.7 (2019), 565-569. Print. doi:10.24911/IJMDC.51-1545996297



APA (American Psychological Association) Style

Aman, S. H., Alloqmani, . D. D. A., Alqahtani, . A. M., Almalki, . M. A., Alruwaili, . A. H., Alanazi, . S. A., Aljuaid, . N. K., Abuhalimeh, . F. F., Alkabani, . R. S., Albalawi, . M. A., Almusallam, . R. A. & (2019) The pattern of eye injuries among children attending Al-Yamamah hospital, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (7), 565-569. doi:10.24911/IJMDC.51-1545996297