Ocular Injuries and Visual Related Occupational Problems

among Construction Workers in Malaysia

Priscilla Thomas, Mohd Zaki Awg Isa
Optometry & Vision Science, Faculty of Health and Life Sciences, Management and Science University

Corresponding authors:
priscilla_2407@hotmail.com

Abstract
Evidence suggests that high exposure to the hazards is among the most important factors causing ocular
injuries and visual problems at the workplace. Individual studies show variations in prevalence, but high
prevalence is reported in Asian countries. Very little is currently known about ocular injuries and visual
problems of workers in construction industries in Malaysia. This study was conducted to determine the
factors causing the ocular injuries and visual problems of the construction workers. Data were obtained
from a cross-sectional study using purposive sampling method on 385 (770 eyes) workers. The
comprehensive ocular assessment was done by using Reichert Portable Slit Lamp and a questionnaire was
designed to ascertain the environmental hazards and behavior factors. Out of 770 eyes examined, 42.5%
(n=327 eyes) had ocular injuries. The chemical, tools and dust exposures were among the major causes of
ocular injuries and visual problems to the construction workers. There were significant differences found
between the occurrence of ocular injuries to chemical (p=0.002), tools (p=0.005) and dust exposure
(p=0.050). Poor knowledge on personal protective eyeglasses (PPE) (62.9%, n=242), low compliancy to
wearing PPE (48.3%, n=186) and poor awareness on the environmental ocular hazards (47.0%, n=181)
were observed. Our finding indicates that high prevalence of ocular injuries among construction workers,
and the need to improve on the awareness, closed monitoring of occupational safety and health and
identification for visual rehabilitation and return to work program.

Keywords:
Construction workers, Ocular injuries, Visual problems, Environment, Behavior

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 Introduction
In the current world, the main setting that affects a vital part of an individual’s wellbeing is at their
office place or establishment. The surroundings of the work area in any field and the behaviors of the
workers can impact the medical state and productivity of workers (Chauhan et al., 2014). When comparing
work environments, the most physically challenging and hazardous environment is in the construction
sites. Construction workers are exposed to all kinds of environmental hazards, which arise due to manual
handling, tools, small areas, work handled from high heights, excavations, irregular working hours and
exposed to different weather conditions. Exposure to these environmental factors may cause industrial
accidents to occur (Mock et al., 2017). Behavioral factors such as the lack of awareness or knowledge of the
hazards at work and not wearing personal protective equipment also can increase the chances of a worker
to develop injuries. It was found that these factors contributed to health consequences 10-20 times more
in economically developing countries than those in developed countries (Jazari et al., 2018). The
environmental factors and behavioral factors can increase the chances of getting injuries. Out of all organs,
the eye, if injured, may cause drastic effects to a worker. It can vary from an abrasion to the cornea, to
subconjunctival hemorrhage or a lacerated globe. Severe injuries on the eye can cause blindness, which can
cause workers to lose their jobs (Kumari & Daigavane, 2017).
In Malaysia, it was found that out of 935 cases with ocular injuries, 440 of them were of work-
related ocular injuries, majorly from workers in the construction industry. This was due to environmental
factors and their behavioral compliancy towards wearing personal protective eyewear. A total of 86.59%
of the workers did not wear personal protective eyewear (Min et al., 2016). Studies have shown that the
workers who have a higher possibility of getting injured are immigrants, rather than native-born laborers.
Immigrants are currently over-populated in construction work (Adhikary et al., 2017). The construction
laborers are essentially bounded in exploitative conditions, restraining them with policies that does not
offer much protection (Dutta, 2017). The existing knowledge and awareness about the safety of the
surroundings at work is insufficient. It is imperative to increase one’s understanding through applying safe
working practices to avoid industrial accidents from occurring (Netto & Hamedon, 2017).
The eye injuries such as subconjunctival hemorrhage, penetrating intraocular foreign body,
chemical burns and lacerations, commonly occurred due to environmental hazard exposure and workers’
behaviors in terms of ignorance and compliancy towards wearing personal protective equipment (Almoosa
et al., 2017). Despite extensive efforts that have been made to reduce the possibility of getting injuries in
the construction industry, many studies are not comprehensive in this respect (Soltanzadeh et al., 2016).
Hence, it is imperative to find the root causes so that safety measures can be done to avoid or prevent the
occurrence of the ocular injury (Kumari & Daigavane, 2017).

Methods

Study Design
The research is a mixed method, whereby the data is collected qualitatively and quantitatively. A
cross-sectional survey was done using purposive sampling technique. Workers were evaluated using a
validated structured questionnaire and an ocular observation using the appropriate equipment to
determine the ocular health status of construction workers who were exposed to occupational hazards at
a point of time, between June 2018 to February 2019.

Unit of Analysis
As the research was intended to determine the environmental and behavioral factors causing the
ocular injuries and visual problems, data was collected from each construction worker and hence, the unit
of analysis is the individual.

Sampling Frame and Sample Size

The sampling frame defines all elements in the population from which the samples are drawn. The
sampling frame for this research were construction workers, in Malaysia. They were identified through
phone calls and meetings with the site supervisor, project engineer or person-in-charge. The sample size

Vol. 1 No. 2 June, 2020 | Journal of Optometry, Eye and Health Research 8
was decided based on scientific table guidelines given by Krejcie and Morgan (1970). As the population of
construction workers in Malaysia are beyond 100 000, the sample size required to establish
representativeness for generalizability was 384.

Sampling Technique
This study used a purposive sampling technique, whereby only specific target groups will be
selected based on their expertise. The sampling was confined to construction site workers, which had been
exposed to any environmental hazard at their working environment, as they are the individuals that are
able to provide the desired information required for this research.

Inclusion Criteria
The target population falls under the inclusive criteria, whereby construction workers in the age
range of 18-55 years, with no systemic disease, and have been working at the site for more than five months.
The participants voluntarily agreed to participate in the study and were allowed to withdraw at any time.
Prior to that, a consent form was given beforehand to the participants.

Exclusion Criteria
The exclusion criteria were participants suffering from any systemic disease such as diabetes
mellitus, hypertension or atherosclerosis as it may alter the accuracy of the results. Besides that,
participants who are not construction site workers were excluded from the study.

Research Instrument
The instrument that was used to assess the ocular health of the participants is the slit lamp
biomicroscope and Snellen chart. The assessment of the eye was done by observing the appearance of
eyelids, lashes, cornea, and conjunctiva, while the visual acuity was assessed through the Snellen chart.
Prior to the examination, a brief history taking was done to assess the patients’ condition or disease.

Reliability Testing
A questionnaire was given to assess the environmental and behavioral factors contributing to the
ocular injuries. Reliability test was used to measure the internal consistency of the behavior of the
construction workers, which consisted of five questions. The scale showed a high level of internal
consistency, in which the Cronbach's alpha was of 0.735.

Data Collection
The data collection for this research was conducted from June 2018 to February 2019. The
participants are individuals exposed to any type of occupational hazards at the construction site, in the age
range of 18 years old to 55 years old. A consent form was given to the participants prior to the examinations.
The results were obtained by assessing the ocular health status of the individuals exposed to occupational
hazards. Presence of any ocular injuries from the eyelids, lashes, cornea, conjunctiva and crystalline lens
were assessed.

Data Analysis
The data collected was analyzed through the Statistical Package for Social Sciences (SPSS). It
provided evidence on the significant effects of occupational hazards exposure. Descriptive and Chi square
analysis was made. The association between the ocular injuries and the occupations was assessed. The
conclusion was made based on the outcome of the data that was collected and analyzed. Hence, the
correlation of the possibility of the occurrence of ocular injuries and the compliance of wearing personal
protective equipment was determined.

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Ethical Consideration
Ethical approval to conduct this study was obtained from the Postgraduate School in Management
and Science University, Shah Alam. The consent to perform the assessments to the construction workers
from the appropriate companies was obtained. Before conducting the assessments, the construction
workers involved in this project were given a consent form.

Possible Risk/Discomfort
As the workers are grossly examined externally there will be no harm, potential risks or discomfort
caused to the participants participating in this study.

Privileges
After examining the eyes of the construction workers, the participants obtained a brief explanation
about the condition of their eyes and knowledge regarding the importance of wearing safety goggles during
working hours.

Confidentiality
All data collected from the construction workers via the questionnaire and ocular assessments is
considered private and confidential and will strictly not be used in any other publications.

Freedom to Decline
The construction workers had the freedom to stop or withdraw from this research at any point in
time.

Conceptual Framework
The research was done to determine the environmental and behavioral factors causing the ocular
injuries and visual problems in construction workers is based on a few theories. The independent variables
were derived from the multiple causation theory in which, it is believed that accidents come not from a
single act, but mainly two (Asanka & Ranasinghe, 2015). Hence, for this research, the independent variables
consist of unsafe environment and unsafe behaviors, that are contributing to the occurrence of ocular
injuries and visual problems, which are the dependent variables. The unsafe environment mainly
consisting of dust exposure, chemical exposure, radiation exposure and heat exposure. Unsafe behavior
comprises of the compliancy, knowledge, awareness of the construction workers. The lack of awareness of
construction workers is the moderating variable. The lack of awareness is derived from the Reason’s Swiss
Cheese Model, in which injuries can occur with missing categories such as unsafe behavior, unsafe acts and
the lack of awareness (Larouzée & Guarnieri, 2015). Hence, the hypotheses were made based on the
conceptual framework.

Results
Out of the 385 construction workers, it was found that 285 of them were Bangladeshi’s (74.22%),
followed by Indonesians (9.64%), Malaysians (8.33%), Pakistanis (4.17%), Myanmar’s (3.13%) and Nepal
(0.52%). Personal protective eyewear was given to 63.9% of the workers, while 36.1% were not given
personal protective eyewear. After the eye assessments, it was found that 42.5% (n=327 eyes) of the
construction workers had ocular injuries. When assessing the type of injuries obtained, 57.19% of the
workers had pterygium, followed by foreign body (22.02%), subconjunctival hemorrhage (9.48%), corneal
haze (7.03%), laceration (2.14%), corneal burn (1.53%) and traumatic cataract (0.61%). Out of 770 eyes,
80.5% (n=620) had a good visual acuity of less than 6/9. A total of 18.6% (n=143) had a visual acuity below
6/12. Only a small number of construction workers, of 0.9% (n=7) had poor visual acuity, worse than 6/36.
The chemical, tools and dust exposures causing the ocular injuries to the construction workers had p values
of less than 0.05. Hence, it is statistically significant to the occurrence of the ocular injuries. However, heat
and fall are not statistically significant to the occurrence of the ocular injuries to the construction workers
as the p value is above 0.05. The behavior in terms of the knowledge on personal protective eyewear,

Vol. 1 No. 2 June, 2020 | Journal of Optometry, Eye and Health Research 10
adequate training provided, compliancy towards wearing PPE and awareness of the hazards were assessed
using Likert scale. It was found that the knowledge (62.9%), compliancy (48.3%) and awareness (47.0%)
were of neutral for majority of the workers. When asked whether the workers have received adequate
training, it was found that many of them agreed (51.2%) that they have had adequate training. About 67.8%
of the construction workers felt pressured at work.

Conclusion
The prevalence of ocular injuries and visual problems were determined through this research and
environmental factors such as chemical exposure, dust exposure and handling of tools showed statistical
significance to the occurrence of ocular injuries and visual problems, while behavioral factors that
contributed to the ocular injuries were poor knowledge, low compliancy and poor awareness towards the
environmental hazards. Hence, through this research, organizations as well as the government will
determine the severity of the existing situation and hence, implement newer policies in Malaysia to lessen
the occurrence of injuries. Not only will the newer policies reduce the occurrence of ocular conditions, but
it will also reduce the overall injuries of the construction worker. As construction workers obtain more
information regarding their ocular health status, they will take the appropriate steps to prevent injuries
from occurring and be more aware of environmental hazards at the construction sites. Students will also
benefit from this research as it will help them gain more insights in the body of knowledge.

Acknowledgement
The author would like to express sincere appreciation and deepest gratitude to Raymond Xavier, Ben Puah
and Lee Jia Wei who majorly helped in finding the construction sites that was required for this research.
Grateful to all safety engineers and site supervisors that assisted throughout the data collection and special
thanks to Associate Prof Dr Zaki Awg Isa, for the advices, guidance, endless support throughout the entire
journey.

Vol. 1 No. 2 June, 2020 | Journal of Optometry, Eye and Health Research 11
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Tables and Figures

Table 1: Summary of construction workers’ characteristics

Construction worker Frequency Valid Percent

Local 32 8.3%
Immigrant 353 91.7%
Total 385 100.0%

Nationality
Bangladeshi 285 74.22%
Indonesian 37 9.64%
Malaysian 32 8.33%
Pakistan 16 4.17%
Myanmar 12 3.13%
Nepal 2 0.52%

PPE Provided
Yes 246 63.9%
No 139 36.1%

OI (770 Eyes)
Yes 327 42.5%
No 443 57.5%

Ocular Injuries
Pterygium 187 57.19%
Foreign body 72 22.02%
Subconjunctival 31 9.48%
Hemmorhage
Corneal haze 23 7.03%
Laceration 7 2.14%
Corneal burn 5 1.53%
Traumatic cataract 2 0.61%

Visual Outcome (770

eyes)
<6/9 620 80.5%
<6/12 143 18.6%
<6/36 7 0.9%
>6/36 0 0.00%

Vol. 1 No. 2 June, 2020 | Journal of Optometry, Eye and Health Research 15
Table 2: Environmental Hazards Causing Ocular Injuries

Hazards Causing OI P Value

Dust 0.050
Chemical 0.002
Tools 0.005
Heat 0.286
Fall 1.000

Table 3: Behaviors of Construction Workers

Strongly Disagree Neutral Agree Strongly

Disagree Agree
Knowledge 0.0% 0.3% 62.9% 29.9% 7.0%

Training 0.0% 0.5% 36.6% 51.2% 11.7%

Compliancy 0.0% 28.1% 48.3% 20.3% 3.4%

Awareness 1.3% 27.0% 47.0% 19.7% 4.9%

Pressured at work 0.0% 9.9% 67.8% 18.2% 4.2%

Vol. 1 No. 2 June, 2020 | Journal of Optometry, Eye and Health Research 16