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Punnonen et al[21] in 1989 reported that penetrating ocular trauma is a major cause of vision loss in working age group. Therefore, in addition to the impact on affected individuals there are profound social problems regarding the loss of productivity by young men and requirement of facilities to rehabilitate them.
As expected, the majority of injuries are minor, affecting the periorbital structures or the ocular surface such as corneal abrasions or superficial corneal foreign bodies. Only 23% of all eye injuries require hospital admission[10,22]. Currently, in Scotland, the cumulative incidence of ocular trauma requiring hospital admission is 8.14 per 100 000 of the population annually[12]. Over 10% of these people will lose useful vision in the injured eye[23].
Penetrating injuries, overall, carry a poorer prognosis than blunt injuries, although the extent of damage depends on where and how far the object enters the eye[24]. According to our results, 62.4% of injuries were penetrating; metal shavings being the most common cause. Wong et al[25] observed that more than half of ocular injuries were a result of penetrating trauma.
The importance of using protective goggles at work, care for individual and mental health of the adolescent and youth, and especially provision of a health and safe environment for preventing ocular injuries in this productive group cannot be overemphasized. Further research is required regarding the role of protective equipment in the working environment.
Foreign bodies were observed in 23.4% of patients. Another unpublished study in Iran showed that foreign body was present in 46.6% of ocular injuries and men, especially aged between 15 and 45 years old, constituted 97.4% of victims; patients aging (29.6±9.6) were most commonly affected.
In the current study, cutting and sharp tools together were on the top of the list of causes of ocular trauma followed by metal shavings, and accidents.
In this study, initial visual acuity was equal to HM or less (NLP and LP) in 40.3% of cases and 6/10 in 24.5%, which indicates the severity of trauma. In the study by Dannenberg et al[11] a visual acuity of HM or worse was reported in 74% of victims. This disparity may be a result of difference in offending agents, a delay in seeking medical care, shortage of emergency services, delay in performing primary invasive interventions, or lack of followup on the side of the patient.
The cornea was the most common site of rupture in our study; a finding repeated in other researches[13,26]. Scleral rupture was observed in 13.9% of penetrating traumatic cases. Hyphaema (regardless of grade) and traumatic cataract were observed in 38.3% and 41% of cases, respectively. Rates of 13% and 35% for hyphema and 24% and 32% for traumatic cataract have been reported in other studies[13]. It is obvious that these patients need longterm follow up. 40.8% of our patients were managed by primary repair alone because there was no other complication that need other interventions and 5.8% needed enucleation because of blind eye and to prevent sympathic ophthalmia. Another study reported a rate of 66% for primary repair[5,12].
Findings showed that blunt ocular trauma was more frequently associated with enucleation than penetrating trauma (8% vs. 4.7%). Punnonen et al[21] carried out enucleation for 89% of blunt injuries compared to only 11% for penetrating injuries. This shows that blunt injuries are also extremely important in causing severe impaired vision. This finding is opposed to other studies that says penetrating eye injury contributes to poor visual outcome and ocular survival[27,28]. Poor visual outcome is also related to multiple ocular structure injury and severity of initial injury[29,30], and still ocular trauma in children is a major cause of monocular blindness and a common cause of enucleation in children[31].
In our study, 21.4% of patients underwent vitrectomy and lensectomy in addition to primary repair. Vitrectomy, lensectomy, and primary repair plus vitrectomy were performed in 1.6%, 3.4%, and 11.2% of cases, respectively.
Observing the unequal gender ratio in ocular trauma, the most commonly affected age groups (children, adolescents, and youth), and occupations (industrial workers) provides clues for better protection. More vigilant care for children, provision of safer play grounds, removal of traumatogenic objects like wood or metal rods and cutting tools from the environment, use of protective goggles, and observation of general safety standards in industrial environments can dramatically reduce the number of ocular injuries that might otherwise lead to irreversible complications and blindness in the productive and young population.
The retrospective nature of the current study is its major limitation. The recorded data might have been less than perfectly reported by the patient or inadequately registered. Moreover, only initial visual acuity was measured in our study and this is not a reliable indicator of final eyesight achieved after completion of medical and surgical treatments. Other limitations of this study are; ignoring some ocular findings regarding nature, size, location and complications of intraocular foreign bodies and complications of their removal; ignoring the relation between visual acuity and site of entry of the foreign body; lack of a comparison between the visual acuity of the injured and the normal eye; lack of information regarding extra ocular muscles involvement, especially in orbital fractures; not mentioning the grade of hyphema and type of traumarelated surgery; and finally, lack of inquiry about use of protective equipment at the time of trauma and socioeconomic status of the victims.
Further research addressing the abovementioned issues is necessary. Additional fields of interest that can form a basis for future research are; determining the prognosis of ocular trauma [according to The Birmingham Eye Trauma Terminology (BETT system)]; the impact of initial visual acuity on final prognosis; evaluating final visual acuity; symptom specific prognosis and post operative followup; the role of parent and child education about complications of ocular injuries; and the role of protective gears in industrial environments.
Research has consistently documented that 90% of eye injuries could have been prevented or decreased in severity with better education, appropriate use of safety eyewear, and removal of common and dangerous risk factors[3235].
In view of the decreased productivity and even disability associated with ocular injuries, practice of more vigilant care and use of protective gears and obligation of education in all levels can reduce the rate of such injuries. Timely and aggressive treatment of all such injuries is of utmost importance.
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