Scientific analysis article

Ocular injuries in a pediatric population at a child eye health tertiary facility, Ibadan,
Nigeria
Authors: Mary Ogbenyi Ugalahi Steve Oluwaseun Adebusoye Bolutife Ayokunnu
Olusanya, Aderonke Baiyeroju
Journal: Injury
4 January 2023
Link: https://doi.org/10.1016/j.injury.2023.01.014
Miguel Angel Culman Flórez
Code: 50191039
2023

Objective
The study sought to determine the characteristics, causes and standard of eye trauma
according to the circumstances in which it occurred, based on record of eye injury care in
children attended at an emergency unit of the University College Hospital in the city of
Ibadan, Nigeria. The authors explain that about 6 million cases of eye trauma in children are
reported every year, so knowing the epidemiology of these injuries can help to prevent them
from occurring.
Thematic analysis
For the study, it was used 109 records of children, aged between 1 to 16 years, treated at
hospital between May 2010 and April 2016. The children were categorized into 3 groups:
from 0 to 5 years – infants and preschool children; from 6 to 11 years – primary school age;
and lastly, from 12 to 16 years – secondary school age.

Of the total number of records, 81 were boys, corresponding to 74.3% of all, while, 28 ere
girls, corresponding to 25.7% of the cases. According to the comparison of the records, the
months with the highest number of cases were from July to September, during the school
vacation period, as shown in graphic 1.

Characteristics of 109 patients

Characteristics Male Female Total
Affected eye
Right eye 37 14 51
Left eye 44 14 58
Age range (years old)
0–5 24 9 33
 6 – 11 29 16 45
12 – 16 28 3 31
Residence location
Urban 59 18 77
Suburban 5 2 7
Rural 17 8 25
Injury location
Home 49 18 67
School 22 8 30
Playground/street 10 2 12
Table 1. Own elaboration based on: https://doi.org/10.1016/j.injury.2023.01.014

The table above shows the general characteristics and demographics of the injuries; in all
descriptions it is evident that boys outnumbered girls in the number of cases. The age range
with the highest number of cases was 6 to 11 years; and the urban areas and the home were
where most cases of injuries were reported.

Graphic 1. Taken from: https://doi.org/10.1016/j.injury.2023.01.014

It can be seen that injuries in places different than school are maintained in greater proportion
as well as, the records are higher in places in the vacation months. In general, 61 of the
children were injured while playing being the main cause of injury; followed by 28 cases due
to accident for activities at home or school; 18 cases due to corporal punishment and 2 cases
due to fights.
Of the total number of cases, 79 children were closed eye traumas, mostly contusions; the
causative agents with the highest number of these injuries were: wood, cane, stone and
fist/fingers. 27 children were open ocular traumas; the ocular surface areas with the highest
number of injuries were; conjunctiva, followed by the irirs, ciliary body and camerular angle,
and, cornea; the causatives agents with the highest number of these injuries were: broomstick,
glass and pencil/pen. Finally, 3 children suffered trauma only to the eyelids.
In other findings, it was reported that 36 patients had hyphema or hypopyon, 12 cases had
lesions on the crystalline lens, 6 cases had retinal detachment and 2 cases had
endophthalmitis, all derived from an open ocular trauma. However, the authors report that
the number of cases with posterior pole involvement could have been higher, but most of the
patients did not undergo complementary examinations.
Of the total number of cases, 64 patients had visual acuity less than 20/40, however, in the
first week more than half of them reported improvement in visual acuity greater than 20/40-
In children with open trauma, visual acuity was more affected than in children with closed
trauma. Visual loss in these cases was caused by corneal lacerations and lesions in the lens
or posterior segment eye.
Only 26 of the patients presented in the first 24 hours after the injury, while the remaining
83 presented some time later, mostly at 72 hours after the injury. When asked why they had
presented 24 hours before the injury (graphic 2), 46% indicated that they had first used a
home treatment; 27% indicated that they had first attended in another medical center or had
been transferred; 22% did not present due to economic factors and the remaining 5% did not
present because the child did not report symptoms.

Graphic 2. Taken from: https://doi.org/10.1016/j.injury.2023.01.014

Among other factor reported by patients was the distance to travel to the hospital, 99 of the
children living within 50 km or more of the hospital.
Conclusions
According to what was found, most of these injuries can be prevented by limiting the access
and use that children have to objects that can be risky to manipulate, in additions, to mainting
supervision in the activities that children perform at home, school and even in the street or
parks. It was evidenced that children 0 to 5 years were the second group with the highest
number of cases and most of them were open traumas, the authors explain that it is because
their protective reflexes and motor skills have not been fully developed and they do not
anticipate the concomitant risks when playing with sharp objects or other childrens.
The reason why the boys reported a greater number of injuries is due to the way and
participation of the games that they play, even so, it is considered that the socioeconomic
status plays an important role because in low income areas children use objects to make their
toys and these can cause accidents or injuries to them.
The study seeks to call for care and supervision of children to protect their visual health,
because when they are playing or performing an activity they are often unaware of the danger
it can bring. As well as, the seriousness that an ocular trauma can bring and the importance
of attending immediately to a medical center for professional attention.

Contribution to professional practice

As a future professional it is important to know the epidemiology reports of visual. In this
case, we are talking about ocular traumas in children, a population that is very vulnerable to
suffer accidents and whose treatment must be more careful than that an adult. Knowing how
these injuries behave in another territory, it is necessary to know if in the national territory
there is the same behavior considering that about 30% of the populations of the country are
children and adolescents. Also, it’s a way to encourage the development of studies on the
prevalence of these injuries in this population, as well as, design campaigns for their
prevention.
Contribution to practice scenario
Considering that the practice scenario is in a rural area, open and closed eye trauma care may
have a higher prevalence than in the city as well as the agents that cause these injuries are
different from those found in an urban area. In addition, it should be considered that activities
in the countryside may be more likely to cause eyes injuries and their treatment may be more
difficult to obtain because access to health is difficult in these areas. For this reason, must be
know and provided to prevent these injuries in all ages of the populations, and addition, to
be aware of treatments and the action to be taken when these cases happen.