Ocular morbidity following mechanical injuries constitutes a significant cause of visual impairment and disability worldwide, as trauma to the eye is a major contributor to preventable blindness. Mechanical injuries can range from blunt force impacts to penetrating trauma, each carrying distinct risks for ocular health. Blunt trauma often results in contusions or fractures of the orbital bones, while penetrating injuries, such as those caused by foreign objects, can lead to more severe damage, including ruptured globe or intraocular hemorrhage. The prevalence and types of ocular injuries vary across different populations, influenced by factors such as age, occupation, and environmental conditions. For instance, younger individuals tend to experience trauma due to sports or recreational activities, while adults may sustain injuries in workplace accidents or motor vehicle collisions (1).

Trauma to the ocular structures can result in long-term morbidity due to complications such as retinal detachment, cataract formation, or corneal scarring. Furthermore, the visual outcomes of mechanical injuries can be heavily influenced by the timeliness and appropriateness of medical intervention. Early diagnosis and prompt surgical management are critical in reducing the risk of permanent vision loss (2).

Despite advancements in medical treatments, the incidence of ocular injuries remains high, highlighting the need for preventive measures and better public awareness regarding eye protection, especially in high-risk environments (3). The pathophysiology of ocular trauma varies depending on the type of injury and its impact on the various layers of the eye, from the cornea to the retina. For example, high-energy impacts may cause direct trauma to the retina or optic nerve, while foreign body injuries can lead to infection or secondary glaucoma (4).

The long-term effects of mechanical injuries on ocular morbidity underscore the importance of both primary and secondary prevention strategies, including the use of protective eyewear and routine eye examinations for those at risk. In light of these challenges, further research into the epidemiology and management of ocular trauma is crucial to improving clinical outcomes and minimizing the burden of visual impairment globally (5).

This study aims to evaluate the prevalence of ocular morbidities in patients with mechanical injuries.

The present study was a prospective observational analysis conducted at the Department of Ophthalmology, Pinnamaneni Siddhartha Institute of Medical Sciences, during the study period from October 2008 to September 2009. A total of 100 patients presenting with ocular injuries during this period were included in the study. Inclusion criteria were: patients of above 18 years of age, both male and female, and those who were cooperative during examination and treatment procedures. Patients were also included irrespective of their economic status. Exclusion criteria comprised unconscious patients, uncooperative individuals, and patients who were terminally ill.

A detailed patient history was recorded, including demographic information such as age, sex, occupation, and residential area, as well as the nature of the injury. The causes of injury were classified into various categories such as road traffic accidents, assaults, accidental falls, and injuries caused by objects like stones or needles. The time interval between injury and examination was noted, as well as whether the patient came directly for treatment or was referred from a peripheral hospital. Initial medical interventions, if any, were also documented.

At the time of presentation, unaided visual acuity was assessed using Snellen’s chart. A thorough examination of the eyelid, orbit, and adnexa was performed using diffuse illumination to identify injuries such as lid lacerations, periorbital contusions, and orbital fractures. Slit-lamp examination was done for all patients who required it, both from the outpatient department and emergency cases. The conjunctiva was examined for any tears or sub-conjunctival hemorrhage, and the cornea was carefully inspected for abrasions, foreign bodies, or lacerations, noting the extent and depth of the injury.

Further, the anterior chamber was evaluated for reactions such as flare and cells, while the iris was examined for sphincter tears or iridodialysis. Pupil reactions, including direct and indirect light reflexes, mydriasis, relative afferent pupillary defects, and pupil distortion, were also assessed. The lens was examined for any signs of traumatic cataract, dislocation, or penetrating injury. In cases requiring posterior segment examination, direct ophthalmoscopy was performed, and for more detailed evaluation, +90D lenses and indirect ophthalmoscopy were utilized.

Intraocular pressure was measured using applanation or non-contact tonometry, and Schiotz tonometry was employed when needed. B-scan ultrasonography was performed for cases of blunt or penetrating injuries to assess the posterior segment when fundus examination was not feasible due to hazy media. Further imaging, such as CT scans of the facial bones and X-rays of the orbit, were conducted as necessary. Treatment, either medical or surgical, was provided based on the injury type. The final visual acuity on discharge was recorded, and the causes of poor visual recovery were analyzed. All medico-legal cases were duly noted in the accident register, and the collected data was documented in a proforma for analysis.

The results of the study reveal significant trends in the demographic and injury characteristics of patients with ocular trauma. The majority of patients were in the 21-30 years age group (37%), with a notable preponderance of males (19%) compared to females (18%). This suggests that younger, more active individuals are particularly prone to mechanical injuries, potentially due to their higher exposure to risk factors such as work-related accidents, road traffic accidents (RTA), and recreational activities. The gender distribution reflects a higher incidence in males (59%) than females (41%), which is consistent with global trends in ocular trauma, where males are generally more exposed to traumatic events.

Table 1: Age and gender wise distribution of patients

Accident types showed that road traffic accidents (RTA), especially involving two-wheelers, accounted for the largest proportion of injuries (33%), followed by assaults (32%). This finding highlights the role of transportation-related incidents in ocular trauma, particularly in areas with high motorcycle traffic. The results also revealed a statistically significant association between right-eye injuries being more prevalent, particularly among males, with a notable higher incidence in corneal abrasions and lid injuries.

Interestingly, although the overall injury types, such as traumatic cataract and globe rupture, were slightly more common in males, the gender differences in the types of injuries were not statistically significant (P > 0.05). However, orbital fractures and hyphema were more frequently observed in males, indicating a more severe pattern of injuries.

Table 2: Gender wise distribution of mode of accidents and side of affected eye

Ocular trauma remains a significant cause of morbidity worldwide, particularly in active and younger populations. This study was undertaken to assess the patterns and severity of ocular injuries in patients presenting with mechanical eye trauma at the Department of Ophthalmology, Pinnamaneni Siddhartha Institute of Medical Sciences.

The study aimed to explore the relationship between age, gender, mode of injury, and the type of ocular injury sustained, thereby contributing to a better understanding of the factors influencing visual outcomes in such cases. Similar studies have reported that trauma-related eye injuries predominantly affect young, male individuals, with road traffic accidents (RTAs) being a major cause of these injuries.

The findings of the present study are in agreement with previous research that shows a higher incidence of ocular injuries in males, particularly in the younger age groups. The 21-30 years age group was the most affected, comprising 37% of the total sample, which mirrors the findings of studies by Sharma et al.⁶ and Singh et al.⁷, who also found that younger males are at a higher risk of ocular trauma. This could be attributed to the high exposure of younger males to high-risk activities, including motorcycling and outdoor occupations. Furthermore, the finding that road traffic accidents (RTA), particularly those involving two-wheelers, accounted for the highest percentage of injuries (33%) is consistent with studies conducted by Gupta et al.⁸ and Dharmani et al.⁹, where RTAs were found to be the leading cause of ocular trauma. This highlights the ongoing risk posed by road traffic, especially in areas with high two-wheeler traffic.

Interestingly, this study found a higher prevalence of right-eye injuries (58%) compared to the left (30%), with corneal abrasions (30%) and lid injuries (20%) being the most common types of injuries. The higher incidence of right-eye injuries is consistent with other studies by Parikh et al.¹⁰ and Choudhury et al.¹¹, who reported a greater frequency of right-eye trauma in their cohorts. However, the distribution of injury types in this study did not show statistically significant gender differences (P > 0.05), which contrasts with findings by Kapooret al.¹² and Pathak et al.¹³, where males were more likely to sustain severe eye injuries like globe ruptureandtraumatic cataracts. This suggests that while gender differences are generally observed in ocular trauma, they may not always be significant across all injury types.

This study highlights the demographic and clinical patterns of ocular injuries in a tertiary care center, emphasizing the prevalence of injuries in males aged 21-30 years. Road traffic accidents, particularly involving two-wheelers, were the leading cause of ocular trauma, with significant right-eye involvement. While gender differences in injury types were not statistically significant, males showed a tendency for more severe injuries, such as globe ruptures and orbital fractures. These findings underline the need for targeted preventive strategies, especially among young males, and improved emergency care for ocular trauma to mitigate long-term visual impairment.

ACKNOWLEDGEMENT: the authors would like to acknowledge the efforts made by the Department of Ophthalmology in conducting this study.

CONFLICTS OF INTEREST: None declared

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