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Journal of Trauma and Care
Research Article *Corresponding author
Emmanuel Olu Megbelayin, Department of

Pattern and Causes of Ocular Ophthalmology, University of Uyo Teaching Hospital,

Uyo, Akwa-Ibom State, Nigeria; Telephone: 234-
8036670920; Email: favouredolu@yahoo.com

Injuries in Calabar, Cross River Submitted: 13 September 2016

Accepted: 29 September 2016

State, Nigeria Published: 03 October 2016

Copyright
© 2016 Megbelayin et al.
Emmanuel Olu Megbelayin1*, Dennis George Nkanga2, Affiong
OPEN ACCESS
Ibanga2, and Sunday Nnamdi Okonkwo2
1

2
Department of Ophthalmology, University of Uyo, Nigeria Keywords
Department of Ophthalmology, University of Calabar, Nigeria • Ocular Injuries
• Calabar
Abstract • Nigeria

This study aim was to determine the pattern and causes of eye injuries in patients
attending out-patient eye department of an urban eye center in southern Nigeria. It
was a one-year retrospective study was conducted at University of Calabar Teaching
Hospital, Department of Ophthalmology. Based on research objectives, an instrument
was designed and all records of patients with ocular injuries were reviewed. A total
of 104 patients who had ocular injuries were analyzed. The mean age was 26.8
years with a standard deviation of +/- 14.74. Male constituted 80.8% (84 patients)
and female 19.2% (20 patients) with a male to female ratio of 1: 0.24. Trauma was
unilateral in 100 (97.2%). Age, sex and occupation had no association with which eye
was injured with p values of 0.28 (95% CI = 0.19-0.37), 0.27 (95% CI = 0.18-0.35)
and 0.54 (95% CI = 0.44-0.63) respectively. Four tribes (Ibibio, Efik, Igbo and Ekoi)
constituted over 60%. Sources of injury covered a wide range of objects with the
highest frequency from fists during fights 17.3% (18 patients). Closed globe injury
occurred in 94 (90.4%) patients. The conclusion was that blunt ocular injury was the
commonest form of ocular trauma comprising mainly non-occupational related injuries.

INTRODUCTION
The eyes as organs of vision are positioned at a vantage
part of the body to gain maximum advantage for their task.
This demands that they are exposed even though partly housed
in the bony orbits. The exposure makes them susceptible to
injuries unlike other sense organs that are well protected. Indeed
Nordber [1] reported that the eyes came third to hand and feet
in body injuries despite constituting only 0.27% of the total body
surface area and 4% of the facial area.
Ocular injuries occur world-wide contributing 2.3 million and
19 million to bilateral and unilateral visual disability respectively
[2]. Sadly, most of the causes of ocular injuries are either
preventable or avoidable with developing countries bearing
the burden and consequences [3,4]. Compounded by paucity of
economic wherewithal [5], injudicious use of non-orthodox eye
medications [6], undue delay to present at eye care facilities [7]
and pervasive quackery [8], the outcome of eye injuries are often
bleak. The causes of eye traumas are variable and have been
linked with occupation [9], sex [10], Age [4], culture [1] and civil
unrest [12].
Besides loss of vision, earnings and productivity, there is
attendant increase in the cost to society because of exorbitant
healthcare spending [13]. Negel et al. [2], in their findings showed
that in the United State alone an estimated 2.5 million ocular
injuries occur annually, with hospital charges amounting to
$200 million. This sum exceeds $ 5 billion yearly with direct and
indirect costs combined. The global economic effect of this health
challenge is therefore enormous. In an earlier comprehensive
review of global eye injury, Negel [14] reported that an estimated
55 million people could not perform their daily paid jobs, while
over 750 thousand people were hospitalized. Unfortunately
developing countries carry the largest burden of ocular trauma
and yet the least able to afford the costs [3].
Public health approach has been identified as a viable means of
reducing ocular injuries [15]. And one public health intervention
strategy is provision of epidemiological data through well-
designed retrospective or prospective studies especially in areas
where such are scarce. This study became necessary because of
the need to determine the pattern and causes of ocular trauma
among the patients who patronized our eye health facility in a
previous year. It is hoped that the information obtained will guide
the populace and policy makers on how best to prevent unsafe
ocular practices thereby maintaining needed ocular health.
MATERIAL AND METHOD
This study was hospital-based and retrospective in design. It
was conducted in the department of ophthalmology, University

Cite this article: Megbelayin EO, Nkanga DG, Ibanga A, Okonkwo SN (2016) Pattern and Causes of Ocular Injuries in Calabar, Cross River State, Nigeria. J
Trauma Care 2(1): 1012.
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of Calabar Teaching Hospital, Nigeria from January 2011 to Table 1: Age and Sex Distribution.
December 2011. Instrument was developed in line with the study SN Patients’ Characteristics Number Percent
objectives and included a section on demography and another AGE
on various parts of ocular injuries according to Birmingham Eye 1 1-10 16 15.4
Trauma Terminology System Classification [16]. Visual acuity was 2 11-20 22 21.2
evaluated using the Snellen’s chart for the literates and illiterate 3 21-30 28 26.9
E chart for the illiterates. Anterior segment was examined 4 31-40 17 16.3
with the help of pen torch and slit lamp bio-microscope. The
5 41-50 14 13.5
study followed the guidelines of the Helsinki Declaration for
6 >50 07 6.70
retrospective research. Patients received treatments based on
TOTAL 104 100.0
ocular assessment and diagnosis with 15 of them having surgical
SEX
intervention.
1 Male 84 80.8
Categories were created for the following variables: age, 2 Female 20 19.2
occupation, duration of injury, cause of injury, place of injury, TOTAL 104 100.0
visual acuity, and type of injury. Mean age was calculated.
Frequencies were calculated as percentage for gender, type of
Table 2: Occupational Distribution of Patients.
injuries, objects of injuries. Association of globe injuries with
Occupation Frequency Percent
gender were examined individually on 2X2 tables with associated
1 Civil Servants 15 14.4
χ2 statistics. Association of presenting visual acuities with
2 Trading 15 14.4
duration of presentation was also examined individually on 2X2
3 Students 29 27.9
tables with associated χ2 statistics. SPSS software version 20.0
4 Cyclists 6 5.8
package (SPSS Inc., Chicago, IL, USA) was used. All p values were
5 Contractors 1 1.0
two sided and p values less than 0.05 were considered statistical
6 Lecturers 1 1.0
significant at 95% confidence interval (CI).
7 Applicants 3 2.9
RESULTS 8 Palm Wine Tappers 1 1.0
9 Apprentices 2 1.9
There were a total of 104 patients who had ocular injuries
in the year under review. The mean age was 26.8 years with a 10 Drivers 6 5.8
standard deviation of +/- 14.74. With an age range of 1 to 63 11 Welders 4 3.8
years, there was a bi-modal distribution of 20 years (10 patients) 12 Farming 3 3.9
and a clustering between 40 to 45 years (14 patients). 13 Cattle Rearing 1 1.0
14 Fishing 1 1.0
Male constituted 80.8% (84 patients) and female 19.2% (20 15 Child (Minor) 16 15.4
patients) with a male to female ratio of 1: 0.24. Details of age and Total 104 100.0
sex distribution are presented in table 1. Right Eyes were affected
in 35 (33.7%), left eye 65 (62.5%) and both eyes in 4 (3.8%).
Table 3: Distribution Based on Tribes.
Age, sex and occupation had no association with which eye was
injured with p values of 0.28 (95% CI = 0.19-0.37), 0.27 (95% CI Tribes Frequency Percent
= 0.18-0.35) and 0.54 (95% CI = 0.44-0.63) respectively. Age, sex 1 Ibibio 28 26.9
and occupation were not also significantly associated with types 2 Efik 16 15.4
of the eye injury patients sustained with p values of 0.39 (95% CI 3 Oron 5 4.8
= 0.30-0.48), 1.00 (95% CI = 0.97-1.00) and 0.16 (95% CI = 0.054- 4 Annang 5 4.8
0.177) respectively. 5 Igbo 16 15.4
6 Ekoi 13 12.5
The analysis of the occupation of the patients as shown
7 Bekwara 4 3.8
in table 2 revealed that students, civil servants and traders
8 Qua 2 1.9
constituted 56.7% (59 patients) with students contributing the
9 Hausa 1 1.0
highest (29%).
10 Obubra 1 1.0
Ethinicity, as presented in table 3, had 4 tribes (Ibibio, Efik, 11 Ijaw 1 1.0
Igbo and Ekoi) constituting over 60%. Sources of injury, as seen 12 Idoma 2 1.9
in table 4, covered a wide range of objects with the highest 13 Eket 1 1.0
frequency from fists during fights 17.3% (18 patients). Closed 14 Abi 2 1.9
globe injury occurred in 94 (90.4%) patients. 15 Boki 3 2.9
Table 5 shows that the association between type of trauma 16 Mbitu 1 1.0
and gender did not reach statistical significance with a p value 17 Ejagam 1 1.0
of 0.95 (95% CI = 0.89-1.02). Sixty one (58.7%) presented at the 18 Cameron 1 1.0
hospital between 2 to 7 days of sustaining eye injury (Figure 1). 19 Ugep 1 1.0
TOTAL 104 100.0
The best and the worst presenting VAs were between 2 to

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7 days of the eye injury. Those presenting after one month had
significant ocular morbidity with 11(41.4%) having VAs <3/60
to No perception of Light (table 6). Only 1 (0.9%) patient used
protective glasses at work, 98 (94.2%) did not use and in 5 (4.9%)
it was not stated in the record.

DISCUSSION
This study was conducted in a tertiary health center that
attends to referrals from lower cadres of eye care in the entire
state and its environs. It is a federal health institution with
affordable charges than private eye clinics explaining its broad
clientele base. This background may account for some of the Figure 1 Time of presentation to health facility.
information to be discussed subsequently.
Ocular injuries appear common in certain age groups as on health care system is also immense.
demonstrated across multiple studies in different geographical
areas [12,17,18]. In this study the mean age was around 27 The risk of men sustaining ocular injury has been found to be
years with bimodal peaks. This outlook links ocular injuries between 2 and 5 times higher than that of female across several
to younger ages when individuals are agile and involved in studies [20-23]. This study shows similar findings - male: female
economic activities. This was the trend in Kashmir, India [12], ratio of 1: 0.24. Males had 4 times higher risk of injury related
Enugu, Nigeria [17], and Kuching, Malaysia [18]. In a similar blindness. This, among others, has been attributed to higher
hospital-based study in United State, Klopfer et al. [19], reported tendency to risk-taking behavior. It is likely however those females
a bimodal peak but the peaks were at about 20 years and over 70 have more unreported cases of ocular injuries especially arising
years as against the peaks of the current study of 20 years and from domestic chores and the possibility of being hampered by
around 40 years. The marginal difference could be accounted for economic constraints. These under-reported reasons may also
by the larger population size of the earlier study which was a 10 account for the disproportionate male-female difference in eye
year review. Young age means lengthy blind years which carry an injuries across many studies.
added significance when the effects of permanent disability on The source and mechanism of injury are plausible indicators
their quality of life are considered. Loss of productivity and cost of which eye will be involved. The preponderance of left eye
involvement in the current study is averse to several studies
Table 4: Sources of Eye Injuries. [17,18,24,25]. Reason adduced for right eyes being commonly
SN Sources Number Percent involved is that most people are right-handed [24]. This
1 BLUNT OBJECTS presupposition appears insufficient because eyes are not used
a Flying objects 10 10.6 like the hands and quality of vision is not innately lateralized
b Insects 4 3.7 to an eye. What perhaps determines which eye is involved in an
c Stones 4 3.7 injurious scenario is the quality of vision. The eye with a better
d Football 3 2.9 vision is more likely to “face” the injurious agent as the individual
e Cloth hanger 3 2.9 wants to take advantage of the better eye at all times. Indeed if
f Bag of rice 1 0.9 the right-handed hypothesis is to apply, the left eye should be
g Side mirror 1 0.9
more prone to injury especially arising from assaults and fights.
Because the right hand is more likely to be used to hit the left face
h Unintended (fist) 4 3.8
and eye in combats. The current study has combats, fights and
2 SHARP OBJECTS
unintended fist injury as chief contributors to eye injuries and
a Sticks 11 10.6
could have accounted for the predominant left eye involvement.
b Pen 5 4.8
c Iron filling 4 3.7 A study has reported changing patterns of eye injuries in
d Cow horn 3 2.8 Nigeria in which preponderance of war-related injuries in the
e Mopping stick 2 1.9 early 70s was replaced by home and school related injuries as
f Nail 1 0.9 well as industrial trauma. Furthermore with the rising incidence
g Spanner 1 0.9 of armed robbery and civilian-armed combats in Nigeria, gunshot
h Metal protector 1 0.9 injuries are becoming more common [26]. This trend still
i Bottles 3 2.9 continues a decade after the observation was made as noted in
3 COMBATS this study. The wave of global violence with uprising of various
a Fighting 18 17.3 militia groups has not spared Nigeria with it various geographical
b Assaults 13 12.5
parts reporting sectarian crisis or student restiveness. Security
c Robbery 2 1.9
agencies are called to dispel violent student protests with
attendant injurious consequences.
4 UNKNOWN 1 0.9
5 ROAD TRAFFIC ACCIDENTS 9 8.6 Majority of the patients reported after 24 hours and within
TOTAL 104 100 one week with fairly good vision indicating vision alone might

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Table 5: Association of types of globe injuries and gender.

M F TOTAL χ2
Number Percent Number Percent Number Percent (P-value)
CLOSED GLOBE 76 73.1 18 17.3 94 90.4
OPEN GLOBE 8 7.7 2 1.9 10 9.6
0.004
TOTAL 84 80.8 20 19.2 104 100
(0.95)
M =male, F = female, χ2 = Chi-square

Table 6: Presenting Visual Acuity in Relation to Duration of Presentation.

Presenting Visual Acuity
Duration of
χ2
Presentation 6/6-6/18 <6/18-6/60 <6/60-3/60 <3/60-NPL Total
(p-value)
<24 hours 3 (6.5%) 2 (16.6%) 6 (54.5%) 8 (22.9%) 19 (18.3%)
2-7 days 33 (71.7%) 5 (41.7%) 3 (27.3%) 13 (37.1%) 54 (51.9%)
8-30 days 6 (13.1%) 3 (25%) 1 (9.1%) 3 (8.6%) 13 (12.5%)
>30 days 4 (8.7%) 2 (16.7%) 1 (9.1%) 11 (41.4%) 18 (17.3%)

130.429 (0.375)
Total 46(100%) 12 (100%) 11(100%) 35(100%) 104 (100%)

not be the primary indication for patient to present to hospital.
Ocular pains, redness, tearing and foreign body sensation among
other reasons may make patient with eye injury come to hospital
despite a good vision. Omolase et al. [24], reported that most of the
subjects reported within 24 hours which eventually accounted for
good visual outcome. The reason giving for early presentation was
proximity to health center. This study was conducted in a center
that has wider patient coverage which could have explained the
extra few days delay. Babar et al. [26], Mackiewicz et al. [27], and
Yaya et al. [28], reported late presentation of patients which was
thought to be due to the long distance of health facilities from the
patients. In this study, majority that came after one month had
very poor vision. McGwin et al. [29], and Schmidseder et al. [30],
reported late presentation is associated with poor vision.
Closed globe injury was by far the commonest type of injury
similar to what Omolase et al. [24], reported in a hospital-based
study. But in another southern Nigerian study, Okoye et al. [17],
reported preponderance of open globe injury. This difference
could have been because of study design which focused on eye
injured patients that were hospitalized. The possibility of open
globe cases being admitted in the hospital is higher to enable
globe exploration, repair and post-operative recovery.
The use of protective goggles was abysmally low in this study
considering that there were workers who should have used them
during the course of their duties. In another Nigerian study [24],
no subject wore protective glasses. This reflects poor eye safety
consciousness among the research population and underscores
the need for educating people regarding the use of protective
eyewear to decrease visual loss due to trauma.
The obvious limitations of this study are that it was
retrospective and consequently the dependent and independent
variables were not controlled by the researchers. It was hospital-
based such that patients’ selection was skewed only to those who
could not tolerate their complaints. Finally, studies on trauma are
seasonal and may not reflect the pattern in subsequent years or
the same year in another location.
In summary, sources of ocular injuries are ubiquitous
and could occur on any occasion during human activities.
Unfortunately, many of such injuries are accidental arising from
not necessarily hazardous practices. It seems likely that the trend
and prevalence of ocular injuries are determined by prevailing
socio-economic situation. But public health strategies are time
tested avenues for cost-effective prevention of visual loss from
avoidable causes.
It is therefore recommended that primary eye care service be
available at all health institutions in Cross River state and other
states of Nigeria. Secondly, appropriate and efficient referral
system that prioritizes ocular injuries should be put in place. In
addition, occupational health and safety rules and regulations
protecting people at risk need to be designed and implemented.
Finally, workers should be informed about the risk of eye injuries
within their occupation. Hence appropriate and comfortable
protective device with regular use must be advocated.
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Cite this article

Megbelayin EO, Nkanga DG, Ibanga A, Okonkwo SN (2016) Pattern and Causes of Ocular Injuries in Calabar, Cross River State, Nigeria. J Trauma Care 2(1):
1012.

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