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was unknown. At first emergency visit: Penetration through cornea was 62.7% (27 eyes), limbus 25.6% (11 eyes), and sclera extending posterior to equator 11.7% (5 eyes). The additional findings were: Lid swelling (33 eyes), lid swelling with subcutaneous hemorrhage(14 eyes), lid cut (6 eyes), trauma to lower lacrimal system (2 eyes), subconjunctival hemorrhage (21 eyes), iris prolapse (23 eyes), uveal prolapse (18 eyes), traumatic cataract (12 eyes), hyphema (17 eyes), vitreous hemorrhage(14 eyes), retinal detachment (9 eyes), endophthalmitis (12 eyes), periorbital swelling (7 eyes).
Out of forty three registered patients, 23 (53.4%) children presented on the day of injury. Remaining 20 (46.6%) subjects reported after first 24 hours. Seven patients were not willing to receive surgery and left for some other place. The surgical repair was done on thirty six patients. Out of which 19 (52.7%) subjects had surgical repair in first 24 hours (Figure 3, 4). Seventeen (47.2%) children received repair after 1st 24 hours. Eleven (30.5%) subjects were referred to viteroretinal department for management of posterior segment.
Out of 43 children, the initial visual acuity (IVA) at admission was, 6/60 and above in nine (20.9%) subjects, 6/24 in four (9.3%), 6/12 in one (2.3%) patient. Thirteen (30.3%) patients presented with only the hand movement at one meter distance. In nine (20.9%) children, the IVA was restricted to perception of light. Seven (16.3%) patients did not fully cooperate for IVA.
Figure 3Right eye corneoscleral perforation wound repair on 2nd post operative day
Figure 4Left eye limbal repair on 2nd post operative day
Out of 36 patients underwent operation, only 29 (80.5%) subjects completed six weeks postoperative follow up. Regarding final visual acuity (FVA) after correction at the end of sixth week in 29 subjects, three (10.4%) patients had FVA 3/60. Seven (24.2%) had FVA of 6/60. Five (17.2%) children had FVA of 6/24 and above. One (3.4%) patient had FVA of 6/12, and in ten (34.4%) children the FVA was restricted to perception of light. Three (10.4%) patients developed phthisis bulbi.
DISCUSSION
Penetrating eye injury in children can result into irreversible damage to the functional capability of eye leading to severe visual impairment. Most of the injuries occur at home, fall during play, farming, child abuse etc. Among all age groups, children are more prone to subject to ocular trauma[10]. The incidence of eye injuries presenting to the hospital(per 100000 populations per year) was 12.6% in Singapore [11], 15.2% in Sweden [12], 13.2% in United States [13], and in Pakistan the hospital data revealed about 12.9%[14]. In a local study conducted in 2006, about 43.5% children were reported to have serious eye injury . In our study 55.1% children were registered having perforating ocular trauma. More male subjects are usually affected than females[15], probably due to maximum outdoor activities of boys than girls. In this study 67.4% of victims were boys. This male to female ratio correlates with the study from India where 65.1% of sufferers were boys, and in another local study where the male preponderance was 76.9%[1]. Most of the injured subjects live in rural areas, perhaps due to more laborious job, and frequent exposure to dangerous activities. In this series 60.4% of children with serious ocular trauma had rural residency. Such an escalated proportion of eye injury in rural population is quite consistent with the study from Nepal in 2004[16]. The violence related eye injury is also an important factor in children. In one study the author reported ocular trauma due to violence in 31.2% subjects. In another study, the violence related injury was observed in 17% cases[17]. In the present study, the injury by stick was 23.2% and 9.4% by throwing stones. In this study 46.6% of patients presented to the hospital after first 24 hours of injury. According to one study in 2006, the author reported 67.3% subjects of severe ocular trauma presented one week after injury [1]. In another study from India in 2002, 34% of patients with eye injury reported after first 24 hours[18]. This delayed approach to eye care centre was perhaps due to lack of awareness and long distances from hospitals.
The severity and site of ocular trauma are the common prognostic factors used to predict final visual outcome. In this study the penetration of globe at cornea was observed in 62.7% subjects. These results are consistent with one local study that reported higher incidence of corneal route of penetration[19].
The nature of object, damage to the posterior segment such as lens dislocation, vitreous hemorrhage, and intraocular foreign body etc are the factors for poor visual prognosis. In this series, 17.2% subjects achieved 6/24 or better corrected visual acuity, while 34.4% had perception of light. Such a low final visual outcome was perhaps due to severity of ocular trauma, lack of awareness, late presentation, and poor compliance to treatment.
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