作者：Mehdi NiliAhmadabadi,SyedJafar Oskouee,MohammadNasser Hashemian, MohammadBagher Abbaszadeh, Ramak Rouhipour, MohammadTaher Rajabi
作者单位：伊朗德黑兰德黑兰大学医学院眼科；南开利开尔，Farabi眼科医院，德黑兰大学眼科研究中心
【摘要】目的：回顾过去1a，德黑兰转诊眼科中心穿通性眼外伤的发病特征，并发症和流行病学。
方法：调查2002年伊朗德黑兰Farabi眼科医院的959例眼外伤住院患者的医疗记录，记录信息包括人口统计资料（年龄，性别和所从事职业），受伤原因，伤口类型，最初视力，受损部位，伴随症状和体征以及所采取的治疗方式。
结果：患者的平均年龄是(22.6±16.4)a，男性患者的年龄峰值为21～25a，女性患者为小于5a。男女性别比例为4.2∶1。62.4%的患者为穿通伤，33.9%的患者为钝挫伤，3.7%的患者为混合伤或化学烧伤。金属物是造成眼球穿通伤的最常见原因，与之相比，石块是眼钝挫伤最为常见的原因。在23.4%的病例中发现了异物，最常见的破裂部位为角膜（46.7%）。
结论：本研究认为，穿通伤较钝挫伤常见，年轻人更易发生眼外伤，角膜是最常见的损伤部位。
【关键词】 流行病学 眼外伤 眼球穿通伤 钝挫伤
INTRODUCTION
Ocular trauma is frequently disabling and associated with a heavy burden for the patient and the society. Despite increased awareness about ocular trauma and its prevention, these injuries continue to constitute a major cause of blindness.[13] Therefore, a good knowledge of offending agents and modes of prevention along with necessary examination and treatment in case of occurrence of an ocular trauma can greatly reduce complication rates[4]. Children and adolescents are major victims of ocular injures so that ocular trauma is known as the most common etiology of unilateral loss of vision in this age group[1]. They also most frequently suffer from severe ocular trauma[5]. Vehicle accidents, sports, occupational accidents, and toys are main causes of severe ocular injury. About 90% of ocular injuries are preventable and supervision of parents and teachers plays a major role in this regard[4].
Due to a lack of largescale similar studies in Iran, this study was conducted in Farabi Eye Hospital, a major eye hospital in Iran, in order to determine the frequency of ocular injuries and their etiology and complications in hope to defining efficient preventive measures.
MATERIALS AND METHODS
We retrospectively studied the medical records of 959 patients with ocular trauma who were hospitalized in Farabi Eye Hospital, Tehran, Iran in 2002. Demographic data including age, sex and occupation, type and cause of trauma, location where trauma occurred, initial visual acuity, clinical manifestations, and types of treatment provided were recorded.
Subsequently, data were processed statistically. Descriptive and analytical statistics were obtained to the obtained dataset.
This study was a retrospective observational study with no intervention and the ethics committee of the faculty of medicine approved the study.
RESULTS
Complete data were available for 959 hospitalized patients including 776 (80.9%) males and 183 (19.1%) females. The ratio of male to female was 4.2∶1. The age distribution of ocular trauma is shown in Figure 1. Mean age of patients was (22.6±16.4) years. 86.7% of patients were younger than 40 and 51.4% were under 20. The peak age was 2125 years for males and under 5 years for females. In the group younger than 10 years 48.6% of victims were girls.
Penetrating and blunt trauma were observed in 62.4% and 33.9% of cases, respectively. Foreign body was observed in 23.4% of cases. Of patients with foreign body 94.2% were male and this sex proportion was statistically significant (P<0.01). In 13.3% of cases, projecting trauma was detected.
Cutting and sharp tools together constituted 21.3% of causes and metal shavings were the etiology in 13.3% of cases.
Causes of penetrating and blunt trauma are shown in Table 1 and 2. Metal shavings were the most common cause of penetrating ocular trauma in men (25.6%), while cutting tools like knife were the most common cause in women (36.4%). In the blunt trauma type, stone (17.4%) and accidents (18.3%) were the most common causes in men and women, respectively.
Distribution of ocular injury sites is depicted in Figure 2. Cornea was the most common site of rupture (46.7%) followed by mixed corneal and scleral rupture (22.2%), and lid and canalicular rupture (19.2%).
Initial visual acuity was not measurable in 54 (5.7%) of injured eyes because of poor cooperation or low age of the patients. Of total patients, 40.3% had visual acuity of hand motion (HM) or less [light perception (LP) or no light perception (NLP)], while 24.5% had visual acuity more than 5/10 (Table 3 and Figure 3).
Primary repair was the most frequent surgical intervention (40.8%) followed by removal of foreign body (22.7%) (regardless of the type of surgery used) and primary repair accompanied by vitrectomy and lensectomy (21.4%). Enucleation was more common in the blunt trauma group than in the penetrating trauma group (8% vs. 4.7%, P=0.041).
DISCUSSION
According to this study men were almost four times more commonly affected than women. 86.7% of patients were younger than 40 and 51.4% were under 20. The age distribution for the occurrence of serious ocular trauma is similar to other studies[6,7].
Both hospital and population based studies indicate that a large number of injuries affect males and the site of injury is more common at work and the dominance of men is largely because they are the majority of the work force[810].
Dannenberg et al[11] reported an average age of 28 years. In their study 77% of cases were younger than 40 and 17% were younger than 20.
In our study, patients younger than 10 years old were the most common patients at risk of ocular trauma. In a similar study by the author that included fewer cases, 25% of injuries had occurred in patients younger than 10 years old.
Accordingly, the age of occurrence of ocular injury in Iran seems to be lower than that stated in the literature[2] .This finding points to the vulnerability of children and adolescents to traumatic agents. This fact underscores the role of family education in preventing ocular accidents.
On the other hand, girls with less than 10 years were 2.2 times more commonly injured compared to other age groups. This finding is supported by the fact that girls spent more time at home.
Blunt trauma lead to more number of enucleation, so it seems that when blunt trauma leads to globe rupture and patient admission, the prognosis can be even poorer than penetrating trauma.
Table 1 Causes of penetrating ocular trauma at Farabi Eye Hospital, Tehran, Iran in 2002（略）
Table 2 Causes of blunt ocular trauma at Farabi Eye Hospital, Tehran, Iran in 2002（略）
Table 3 Visual acuity in patients with ocular trauma in Farabi Eye Hospital, Tehran, Iran in 2002（略）
1Finger count (≥1m); 2 Hand motion; 3 Light perception; 4 No light perception; 5 Central steady maintain;6 Meter counting finger (<1m)
Figure 1 Age distribution of ocular trauma in Farabi Eye Hospital, Tehran, Iran in 2002（略）
Figure 2 Sites of ocular injury in patients hospitalized at Farabi Hospital, Tehran, Iran in 2002（略）
Figure 3 Distribution of initial visual acuity in 918 patients with ocular trauma in Farabi Hospital, Tehran, Iran in 2002（略）
The most common cause of trauma was sharp and incisive tools (31.2%). Similar studies have shown that children and adolescents make up a significant proportion of ocular injuries[7] and that 30% of all ocular injuries have occurred among children[1]. Twentyfive percent of these injuries have occurred in children younger that 10 years old and knife has been the most common etiology[2].
Esmaeli et al[12] reported that the groups most commonly affected by ocular trauma were students, children, workers, and artisans and the prevailing causes were metal rods and incisive tools like knife and scissors. However, Alfaro et al[5] reported that the most common causes of ocular trauma were glass particles and toys. This is probably due to the fact that their study was limited to children younger than ten years old. In another study by Dannenberg et al[11]. Glass particles, metal rods, knife, and scissors were mentioned as the most common causes of ocular trauma.
In our study, 25% of victims were industrial workers and young adults constituted the major proportion. This finding is supported by other studies[13]. Workrelated injuries have been responsible for 22% of ocular trauma and 66% of patients with occupational eye injuries were men aging between 20 and 39 years[13]. In recent years, in other countries the home has replaced the workplace as the most common site for serious eye injuries, thereby increasing risk for ocular trauma to the general population, particularly children. Almost 100 years ago more than 70% of all serious injuries occurred in the workplace[14]. With heavy industry and no knowledge of protective devices industrial accidents were common. The type of injury sustained was usually a metallic intraocular foreign body and the prognosis for vision was poor. Appropriate standards for eye protection were introduced and decline of heavy industry further reduced this cause and type of injury[1520].
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