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Original Article
Pattern of pediatric ocular trauma in rural area of Marathwada
Chandrakishor Hemraj Pardhi, Varsha Sharadrao Nandedkar, Eknath Biroba Shelke, Vidya Ramnath Bhojane,
Vaibhav Popat Awatade
Aim: To identify cause, demographic and clinical profile, and evaluate final visual outcome of ocular trauma in
pediatric age-group (= < 15 years) patients attending casualty. Materials and Methods: Prospective interventional
study was carried out in rural area of Marathwada during July 2012June 2013 where children up to 15 years with
history of ocular trauma attending the casualty were included. Demographic details like age and sex, activity at time of
injury, identifiable objects causing injury, presence or absence of supervision during injury were noted with follow-up
period of 60 days. Results: In our study, total 79 patients with 94 eyes were enrolled. The age-group more affected
was 5 years and above (65%, i. e., 61 eyes) than 5 years and below (35%, i. e., 33 eyes). Boys (57%) were affected
more than girls (43%). Adnexal injuries found in 51% eyes, whereas closed and open globe injuries in 41% and 8%,
respectively. Most of children reported to casualty within 24 hours (86% eyes), remaining after 24 hours (14% eyes).
The objects causing injury were projectile objects (20%), blunt objects (14%), household objects (10%). The other
causes of injury were sports (16%), accidental fall (15%), chemical and road traffic accidents (RTA) (8% each), burn
(4%), animal bite (3%), and assault (2%). Best corrected visual acuity (VA) of more than 6/18 achieved in 68% eyes,
6/18-6/60 in 12% eyes, < 6/60counting finger close face (CFCF) in 8% eyes, projection of light (PL) + perception
of rays (PR), and no PL in (1%) each eyes. Most of the ocular injuries occurred at home (53%), at playground (16%),
accidental fall (14%), and others. Conclusion: The age-group affected was 5 years and above. Boys were affected
more than girls. The time of reporting to casualty was within 24 hours. Projectile objects, blunt objects, and household
objects were common causes of injury. The places of injury were home, playground, and others. Most of the children
achieved best corrected visual acuity (BCVA) more than 6/18.

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DOI:
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Key words: Ocular trauma, open and closed globe injuries, pediatric age-group

Pediatric ocular trauma is an important cause of ocular

morbidity and non-congenital unilateral blindness in this
age-group.[1,2] Pediatric eye injuries account for approximately
8-14% of total injuries and the most common type requiring
hospitalization.[3] Pediatric patients have different pattern
of ocular injuries than adult and have age-specific type of
injuries. Children below 3 years age-group mostly suffer
from handler-related injuries like from fingernails of parents,
caretakers, or siblings.[4] While older children have injuries
due to sharp objects, toys, tree branches, pencils, sports,
stones.[3]
Male children are affected more than females due to
their adventurous and aggressive nature.[3] Ocular injuries
are of three types: Open globe, closed globe, and adnexal
injuries. Most common emergencies are due to open-globe
injuries and require immediate interventions. [5,6] Even
small trauma to an eye may lead to permanent visual
impairment creating significant impact on future quality
of life. Thus, patient and social education regarding eye
injuries and its early specialized treatment can give good
visual prognosis.[6]
Department of Ophthalmology, Swami Ramanand Teerth Rural
Government Medical College, Ambajogai, Maharashtra, India
Address for correspondence: Dr. Chandrakishor Hemraj Pardhi, Powar
Colony, Khairlanji Road, Tal-Tirora 441911 Gondia (Maharashtra), India.
E-mail: drchp82@gmail.com
Manuscript received: 15.06.2014; Revision accepted: 15.11.2014
Journal of Clinical Ophthalmology and Research - Sep-Dec 2015 - Volume 3 - Issue 3

There are few studies conducted regarding pediatric ocular

injuries in rural set-up; hence, present study has been planned
to analyze the pattern and outcome of pediatric injuries in
Marathwada.

Materials and Methods

This was prospective interventional study carried out during
June 2012 to July 2013.
Inclusion criteria

All pediatric patients with age-group up to 15 years of either

sex having complaint of ocular trauma attending casualty
were included in study.
Exclusion criteria

Patients with history of previous established eye diseases like

glaucoma, congenital anomalies, other non-traumatic causes
and age above 15 years were excluded from study.
Study was conducted after approval from Institutional
Ethics Committee and data was collected after written
informed consent from parents.
Patients demographic details such as age and sex, activity
at time of injury, identifiable objects causing injury, presence
or absence of supervision during injury were noted.
Thorough evaluation of visual acuity by Snellens (4 years
and above) and pediatric acuity chart (below 4 years), slit
lamp examination to evaluate anterior segment injuries,
and fundus examination by indirect ophthalmoscopy and slit
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Pardhi, et al.: Pattern of pediatric ocular trauma

lamp bimicroscopy were done. All patients were appropriately

managed in outpatient department (OPD) and if needed in
inpatient department (IPD) with required investigations and
interventions. Intraocular pressure measured in all eyes except
open-globe injuries. Gonioscopy was done in closed-globe
injuries. B-scan in hazy media was done to evaluate status of
retina. X-ray and computed tomography (CT) scan were done
in necessary patients. All patients were followed up on day
1, 7, 30, 45, and 60. The final best corrected visual acuity was
taken on day 60.

Results
Total 79 patients with 94 eyes (unilateral 64 and bilateral 30)
were studied. Majority of injuries occurred in children 5 years
and above (65%) than below 5 years (35%). Most of injuries
were reported in boys (57%) than girls (43%) [Table 1]. As per
early seeking of treatment, 25% eye injuries were reported
within 1 hour, between 124 hours 61% eyes reported, and
remaining 14% eye injuries reported after 24 hours [Table 2].
Projectile objects (20%), sports (16%), accidental fall (15%),
blunt objects (14%) were remained the common causes of
Table 1: Age and sex distribution
Age-group

Male (%)

Female (%)

Total (%)

<5 years

18

15

33 (35)

5-15 years

36

25

61 (65)

54 (57)

40 (43)

94

Total

injuries, followed by others like household objects (10%), road

traffic accidents and chemicals (8%) each, burn trauma (4%),
animal bite (3%), and assault (2%) [Tables 3 and 4].
Most of the ocular injuries were adnexal found in 48 eyes
(51%) which presented with lid abrasions in 26 eyes, tear
[Figure 3] in 13, hematoma [Figure 2] in 5, and burn in 4 eyes.
Closed-globe injuries were reported in 39 eyes (41%),
presented with hyphema and foreign bodies (conjunctival
and corneal) in 9 eyes each, sub-conjunctival hemorrhage
[Figure4] in 8, corneal abrasion in 7, lens injuries [Figure 1]
in2, and partial thickness corneal tear, irido-dialysis, vitreous
hemorrhage, conjunctival tear in 1 eye each [Table 5].
Table 4: Types of objects causing ocular injuries
Nature of
injury

Objects

No. of
eyes (%)

Chemicals

Holi color

06 (6)

Lime

02 (2)

Wooden stick/tree branches

05 (5)

Stones

03 (3)

Iron rod

01 (1)

Hands by other person

04 (4)

Metal wire

01 (1)

Pencil and pen

04 (4)

Household utensils

02 (2)

Scissors

02 (2)

Toys

02 (2)

Blast injury

01 (1)

Foreign bodies

07 (7)

Blunt objects

Household
objects

Projectile
objects

Table 2: Time to visit casualty

Time

No. of eyes

Percentage

Within 1 hour

24

25

1-24 hours

57

61

1-7 days

10

11

More than 7 days

Table 3: Age-wise cause of injury

Cause

0< 1
years
(%)

1< 5
years
(%)

5< 10
years
(%)

1015
years
(%)

Total
(%)

House hold objects

01

06

01

01

09 (10)

Chemicals

02

03

03

08 (8)

Blunt objects

01

06

06

13 (14)

Sports

05

10

15 (16)

Projectile objects

01

04

08

05

18 (20)

Road traffic
accidents (RTA)

01

02

05

08 (8)

Accidental fall

04

09

01

14 (15)

Animal bite

03

03 (3)

Assault

01

01

02 (2)

Burn trauma

01

03

04 (4)

09 (10)

24 (25)

27 (29)

34 (36)

128

Fire cracker injury

08 (8)

Cricket ball/bat injury

10 (10)

Football

03 (3)

Gulli-danda

01 (1)

Bow and arrow

01 (1)

Road traffic
accidents (RTA)

RTA

08 (8)

Animal bites

Animal bites

03 (3)

Accidental fall

Unknown cause

14 (14)

Assault

Assault

02 (2)

Burn trauma

Burn

04 (4)

Sports

Figure 1: Traumatic cataract

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Pardhi, et al.: Pattern of pediatric ocular trauma

Open-globe injuries found in 7 eyes (8%), among which

corneo-scleral tear with uveal tissue prolapsed and vitreous
leak found in 3 eyes, full thickness corneal tear [Figure 5] in
3, and globe perforation in 1 eye.
Most of injuries occurred at home (53%), while remaining
16% at playground, 12% at other places (unknown), 9% on
street, 5% at farm and school each.
Out of 94 eyes, 9 (10%) eyes visual acuity could not taken
as they were less than 1 year age-group and uncooperative.
On day 60, 64 eyes had visual acuity better than 6/18 (68%),
11 (12%) had 6/18 to 6/60, 8 (8%) had < 6/60counting finger
close to face (CFCF), projection of light (PL) + perception of
rays (PR)-, and no PL in 1 (1%) eye each.
Detail history reveals that 76% (71 eyes) injuries occurred
in unsupervised conditions and during day time when parents
were at work. Every month an average of 155 cases of ocular
trauma of all age-groups were reported in our casualty among
which pediatric ocular injury found in 22 (14%) eyes. Phthisis
bulbi developed in 2 eyes and fortunately infection was nil.
Major injuries like animal bite, corneo-scleral tear, globe
rupture, etc. had poor visual prognosis.

Discussion

them in many unsupervised games, making them vulnerable

to trauma. Younger age-group children are most of the time
under parental supervision and physically less active than
older children. So, younger age-groups are more susceptible
to handler-related injuries like fingernails of siblings, mother,
or caretakers.[4,7]
Boys tend to affect more commonly than the girls.[3,6,7] This
shows more adventurous and aggressive behavior of boys for
getting severe ocular trauma.
Ocular injuries more commonly occurred at home, followed
by playground which are very much similar to MacEwen C
(51%) and Desai T et al., (45.62%).[3,6] Home is the common
place of injuries both for preschool and school-going children
which reflects the amount of time spend at home. Most of the
younger age-groups were injured by domestic utensils or toys.
Early treatment is the key factor for good visual outcome
and in our study 25% eyes reported within 1 hour and 61%
eyes between 1-24 hours, only 14% eyes after 24 hours
which is contradictory with few studies like in Desai T et al.,
where around 70% presented after 24 hours. Malik R et al.,
found 47.50% visit within 24 hours and 30.50% in more than
48hours.[6,10-12] It shows changing pattern in our rural set-up
due to improved infrastructure like transport, availability of

In our study, as per age-specific pattern of ocular injuries, more

prevalence is found in age-group 5 years and above than below
5 years which is similar to other studies like MacEwen where it
was 84% of ocular injuries in 5-14 years age-group.[1,7,9] Schoolage children are more susceptible than younger age-groups,
because of their independent and adventurous spirit involving

Figure 3: Eyelid chronic lacerated wound (CLW)

Figure 2: Hematoma

Figure 4: Sub-conjunctival hemorrhage

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Figure 5: Corneal tear

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Pardhi, et al.: Pattern of pediatric ocular trauma

specialized hospitals in remote area, and increasing awareness

in parents and society. Those visited late were due to poor
parenthood, carelessness, poverty, extremely remote area, and
fear factor in children. Those visited within 24 hours had good
visual prognosis than others.

globe injuries was 27% and adnexal injuries (32%). The 6 eyes
of adnexal injuries associated with other ocular trauma in
which 3 eyes with lid abrasions had corneal epithelial defect,
1 chronic lacerated wound (CLW) with corneo-scleral tear, and
2 eyes with hematoma had hyphema.

The causes of injuries are varies in different geographical

areas and age-group. In our study, projectile objects causes
more number of eye injuries, followed by sports which are
more common in older age-groups (5-15 years). Accidental
fall injuries which are more common in younger age-group
(0>5 years) where the actual activity at time of injuries and
mechanism of injuries were not well-known. Other causes
of injuries are blunt objects, household objects, road traffic
accidents, chemical injuries, burn trauma, animal bite, and
assault. In India, wooden-stick injuries are considered as more
common.[3] But now changing pattern found in our study, its
incidence was low 5% compare to other studies like Kaur A et
al., where wooden stick injuries found in 28.07% eyes.[3,6] Like
in sports injuries, cricket ball and bat injuries (10%) are more
common nowadays than gilli-danda and bow-arrow injuries.

In our study, incidences of open-globe injuries (8%) were

lower. Its incidence varies in different studies in different
countries. [1,6] All open-globe injuries were treated with
preservation of normal anatomical structure but had poor
visual prognosis.
All patients were treated at our institute with required
investigations. In our study, total 21 eyes needed indoor admission.
Five eyes with traumatic cataract treated surgically with posterior
chamber intraocular lens (PCIOL) implantation. Partial and full
thickness corneo-scleral 4 eyes treated with suturing. The globe
perforation patient was treated by evisceration and orbital
implant. Ocular trauma score (OTS) in our study is 3.
On 60th day of follow-up, the final visual acuity (VA) in 68%
eyes were better than 6/18, 12% eyes had VA of 6/18 to 6/60
and poor visual outcome in remaining eyes [Table 6]. VA of
10% eyes could not be taken as they were less than 1 year
age-group and uncooperative. Visual outcome were hampered
due to severe ocular injuries, delay in seeking medical help,
and poor compliance of patient. Post-treatment development
of corneal opacity and disturbance in normal anatomical
structure with poor visual acuity affects quality of life, in
form of disfigurement, amblyopia, and use of low visual aids.

Also, in India, festival season have more chances of

ophthalmic injuries like fire-cracker injuries (8%) during Diwali
and chemical injuries by colored water balloons and lime
during Holi. Mostly lack of eye protection is responsible for
this. More interestingly in our study due to low socioeconomic
status and lack of supervision of parents, animal bite injuries
were found in younger age-group. Unlike in developed
countries where assault seen in (14%) of total eye injuries,[1]
our study shows it in only 2 (2%) eyes.

Conclusion

In our study, closed-globe and adnexal injuries had different

incidences 41% and 51%, respectively which are different from
other studies like Desai T et al., where incidence of closed

According to our study, most of eye injuries occurred in age

group 5 years and above, mostly in unsupervised conditions
which can be easily preventable. Due to trauma few patients

Table 5: Age-wise tissue injury

Tissue injury

0<1 year (%)

1<5 years (%)

5<10 years (%)

1015 years (%)

Total (%)

Eyelid abrasion

03

05

07

11

26 (28)

Eyelid chronic lacerated wound (CLW)

03

05

02

03

13 (14)

Eyelid hematoma

01

01

01

02

05 (5)

Eyelid burn

01

03

04 (4)

Sub-conjunctival hemorrhage (SCH)

01

03

01

03

08 (9)

Conjunctival tear

01

01 (1)

Conjunctival foreign body (FB)

03

02

01

06 (6)

Corneal abrasion

01

04

02

07 (8)

Corneal FB

01

02

03 (3)

Corneal tear partial tear (PT)

01

01(1)

Corneo-scleral tear

02

01

03 (3)

Hyphema

04

05

09 (10)

Lens injury

02

02

01

05 (5)

Iridodialysis

01

01 (1)

Vitreous hemorrhage (VH)

01

01 (1)

Globe perforation

01

01 (1)

09 (10)

24 (26)

27 (28)

34 (36)

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Pardhi, et al.: Pattern of pediatric ocular trauma
3. Kaur A, Agrawal A. Paediatric ocular trauma. Curr Sci 2005;89.

Table 6: Comparison of visual acuity

Visual acuity

Pretreatment (%) Post-treatment (%)

Better than 6/18

31 (33)

64 (68)

6/186/60

26 (28)

11 (12)

<6/60-counting finger
close to face (CFCF)

22 (23)

08 (8)

Projection of light (PL) +

perception of rays (PR) +

04 (4)

PL + PR -

01 (1)

01 (1)

No PL

01 (1)

01 (1)

Not recordable

09 (10)

09 (10)

remain blind which affects patients quality of life. In our study,

most of patients visited within 24 hours had good VA showing
early seeking of treatment and good supervision is helpful in
better outcome of visual acuity. Boys affected more than girls.
Projectile objects, blunt objects, and household objects were
common causes of injuries. The places of injuries were home,
playground, and others [Tables 5 and 6].

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Cite this article as: Pardhi CH, Nandedkar VS, Shelke EB, Bhojane VR,
Awatade VP. Pattern of pediatric ocular trauma in rural area of Marathwada.
J Clin Ophthalmol Res 2015;3:127-31.
Source of Support: Nil. Conflicts of Interest: None declared.

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