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Indian Pediatr 2021;58: 589-590 |
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Epidemiology of Ocular
Trauma in a Pediatric Referral Unit, Sao Paulo, Brazil
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Ricardo Mendes Pereira,1 Melanie Berchara Paschoalato,1
Andressa Oliveira Peixoto,1
Fernando Augusto Lima Marson,2
Andrea de Melo Alexandre Fraga1*
1Department of Pediatrics, School of Medical Sciences,
University of Campinas, Tessália Vieira de Camargo, 126, Barão Geraldo,
Cidade Universitária Zeferino Vaz, Campinas; 2Post graduate Program in
Health Science, Laboratory of Cell and Molecular Tumor Biology and
Bioactive Compounds and Laboratory of Human and Medical Genetics,
University of São Francisco, Avenida São Francisco de Assis, 218, Jardim
São José, CEP: 12916-900, Bragança Paulista; São Paulo, Brazil.
Email:
[email protected]
Published
online: December 26, 2020;
PII: S097475591600262
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We performed a retrospective study of hospital records of children
younger than 14 years with ocular trauma seen at our center in Sao
Paulo, Brazil, between 2011 and 2012. From the total number of cases,
224 (89.2%) could be easily avoided. Accidents occurred with 5 children
under 1 year of age; with one baby as young as 2 months. Also, there was
a higher prevalence of ocular trauma in 2-to-6-year-old male patients,
mainly caused by accidents resulting from the patient’s own actions and
occurred at home, usually in the presence of an adult. The average time
(range) between the accident and seeking medical care was 17.4 hours (10
minutes to 14 days). There is a need to educate parents for preventing
ocular trauma.
Keywords: Accident, Blindness, Injury,
Outcome, Prevention.
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Childhood ocular trauma mainly occurs within the
family environment and is the major cause of unilateral blindness and
amblyopia [1,2]. Two types of ocular trauma are described: open-globe
injury (outermost tunica is disrupted) and closed-globe injury (corneoscleral wall of
the globe remains intact) [3]. Of the registered OTs, 20-50% occur in
children, most of them are male [1,3-5]. The assessment of children
involved in accidents should be systematic in order to prevent a
vision-threatening pathology from going unnoticed [6]. Epidemio-logical
data on ocular trauma in countries like Brazil are scarce. We herein
report on profile of ocular trauma from a single center in Brazil.
A retrospective study was performed by analyzing the
medical records of patients under 14 years old presenting to a referral
emergency unit (REU) in Sao Paulo, Brazil with ocular trauma between
2011 and 2012.
There were 251 cases (62.6% males) of ocular trauma
being the most affected the pre-school (2-6 y) [105 (41.8%)] age (Table
I). Accidents occurred with 5 children under 1 year of age; with one
baby as young as 2 months. From the total number of cases, 224 (89.2%)
could be easily avoided being 29% caused by patient (15.4% by super
glue; 17% by furniture; 4.6% by wire; and 14% by toys); 22.8% by IFB;
12.9% by physical aggression [mainly, 24.1% by stone throwing; 34.5% by
classmates; 27.5% by siblings]; 12.1% by burn; 5.3% by scratch/bite (75%
dogs; 25% cats); 4.1% by fall. The average time (range) between the
accident and seeking medical care was 17.4 hours (10 minutes to 14
days). An adult was present at the time of the accident in 56.8% of
cases, mainly the mother (60.5%).
Table I Characteristics of Children With Ocular Trauma Treated at a Referral Emergency Unit, Brazil (N=251)
| Characteristic |
No (%) |
| Age |
|
| Children (£2 y) |
28 (11.2) |
| Pre-school (2-6 y) |
105 (41.8) |
| School age (7-10 y) |
64 (25.5) |
| Teenagers (11-14 y) |
54 (21.5) |
| Injured eye, n=230 |
|
| Right |
104 (45.2) |
| Left |
124 (54.0) |
| Both |
2 (0.8) |
| Type of injury, n=218 |
|
| Open globe |
18 (8.2) |
| Closed globe |
158 (72.5) |
| Eyelid |
42 (19.3) |
| Activity during the accident,
n=97 |
|
| Playinga |
49 (50.6) |
|
Inappropriate activityb |
24 (24.7) |
|
Playing with the ballc |
10 (10.3) |
|
No activitiesd |
14 (14.4) |
| Place of accident, n=133 |
|
| At home |
99 (74.4) |
| On the street |
25 (18.8) |
| At school |
9 (6.8) |
| Trauma caused by, n=224 |
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Intraocular foreign bodiesf |
65 (29.0) |
|
Physical aggressionh |
51 (22.8) |
| Accidente |
31 (13.8) |
| Burn |
29 (12.9) |
| Falls |
27 (12.1) |
| Pets |
12 (5.3) |
|
Another persong |
9 (4.1) |
| Interval between accident and
medical care, n=184 |
|
| Less than 1 h |
12 (6.5) |
| From 1 h to 4 h |
80 (43.5) |
| From 5 h to 1 d |
54 (29.3) |
| More than 1d |
38 (20.7) |
| arunning,
climbing furniture, making and flying a kite, riding a
scooter or bike; bclimbing up a bunk bed,
playing with alcohol and fire, playing with an iron bar
and wooden club, fixing a bicycle, fighting, jumping on
the bed, jumping over a bonfire, running with scissors
and playing with glue; cplaying volleyball,
soccer and basketball; dsitting, sleeping,
crawling, cutting a nail, staying or sitting under a
tree and brushing the teeth; enail
scratching, finger in the eye, hit by stone, hit by a
ball, hook, stab, explosive, detergent and toothbrush;
fhit something in the eye or hit an eye on
furniture and super glue; fspeck, sand, wood,
glass, earth, sparks, dust, wood, marbles and vegetable;
gbrother, father or classmates; hcaused
by stone, toy, beans, stick and broom. |
The most commonly affected age group was preschool
children, and thus require more attention from parents and caregivers.
We must also take into account that the younger the child, the faster
and deeper amblyopia is likely to be, which will eventually lead to
visual deprivation [7].
A larger proportion of boys could be explained by
their propensity for violent/dangerous games, and participation in
inappropriate activities. Other authors also report similar sex
predilection [8-11]. Most of the traumas were caused by the patients
themselves and at home, which could be avoided with supervision of
parents and caregivers during their activities. Furthermore, the high
number of physical aggression against children reveals a social problem.
Most of them occurred among classmates/neighbors (41%) and among
siblings (17%).
The average time to seek medical care over 12 hours
reveals the population´s lack of knowledge regarding ocular trauma, and
this number is likely to decrease if awareness activities are undertaken
among the population.
Our results contrast from a demographic data from
ocular trauma in Indian children at a tertiary eye care center in
central Maharashtra, where the children aged 6–10 years (39.3%) were
most commonly affected followed by children from 11 to 15 years (36.1%)
[12]. We described a higher number of cases with closed-globe injury
contrasting with the Indian children where the most (63.9%) had
open-globe injury which required immediate surgical intervention in
92.3% of the cases [12].
A standard protocol for data collection in pediatric
ocular trauma epidemiological studies is of utmost importance and should
include: incidence, demographic characteristics, causes/ mechanisms,
places of the accident and sites of injury, clinical treatment and
visual results of injured children [13]. In addition, special attention
should be paid to the family environment, where the prevalence of
pediatric ocular trauma is high [14].
In the literature, the most common causes of reduced
visual acuity after ocular trauma in children are amblyopia and the
presence of corneal opacity. The main risk factors associated with this
reduction in visual acuity are younger age at the time of the trauma,
presence of low initial visual acuity, location of the lesion in zone 3
(posterior region), extent of the lesion, lens involvement, vitreous
hemorrhage, retinal displacement and endophthalmitis [15]. Standardized
scores to classify ocular trauma in children [16] are available.
As study limitations, the authors were not able to
perform a description for visual disability or loss of sight in our
patients; also, a follow-up study was not done in our sample and an
ocular trauma score was not evaluated.
There was a higher prevalence of trauma in
2-to-6-year-old male patients, mainly caused by accidents resulting from
the patient’s own actions. Most of the patients treated had closed-globe
injuries and the accident occurred at home. In most cases, an adult was
present at the time the trauma occurred. Prevention is vital and in
order to be effective, needs more awareness activities and structured
management.
Ethics clearance: Ethics Committee [CAAE -
92754318.7.0000. 5404].
Contribution: RMP, MBP, AOP, FALM, AMAF:
collected patients´ data, wrote the manuscript, revised the manuscript,
edited the results, made the bibliographic survey. All authors approved
the final version of manuscript.
Funding: None; Competing interest: None
stated.
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