Elsevier

Survey of Ophthalmology

Volume 58, Issue 5, September–October 2013, Pages 476-485
Survey of Ophthalmology

Public health and the eye
The epidemiology and etiology of pediatric ocular trauma

https://doi.org/10.1016/j.survophthal.2012.10.007Get rights and content

Abstract

Eighteen million people worldwide have uniocular blindness from traumatic injury. Injuries occur disproportionally commonly in childhood. Every year a quarter of a million children present with serious ocular trauma. For the vast majority the injury is preventable. We review the international literature that identifies high-risk circumstances.

Introduction

Potentially preventable ocular trauma in children remains a significant cause of visual morbidity. Estimates of the incidence of serious ocular trauma vary from 8.8529 to 15.2109 per 100,000 per year (Table 1). Extrapolations using global population dataA suggest that every year 160,000 to 280,000 of children under 15 years of age sustain ocular trauma serious enough to require in-patient hospitalization (see Table 1). At the more serious end of the spectrum of severity, 21%15 to 24%109 are penetrating globe injuries. Those that are less serious are more numerous. Ninety-five percent of ocular injuries do not require admission,77 suggesting that the total number of eye injuries to children under age 15 years is 3.3–5.7 million annually.

Furthermore, more than 40% of all serious ocular injuries occurring before 20 years of age are to those over age 15 years.15 If this older group is included, the estimated total number of annual ocular injuries easily exceeds 5 million. Globally there are 3.9 million people with bilateral low vision or blindness from ocular trauma and more than 18 million with unilateral visual impairment.81

One estimate is that eye injury can be prevented in up to 90% of cases,90 and though there are fewer papers focusing on ocular trauma in children, injuries in this age group are more often preventable24 and also more serious.73 Epidemiological studies have identified a range of scenarios and mechanisms by which ocular trauma commonly occurs, and this gives the possibility of effective, targeted preventative strategies.

Section snippets

Incidence

A population-based study in the United States estimated the incidence of pediatric ocular trauma requiring hospitalization to be 15.2 per 100,000 per year (95% confidence interval, 12.8–17.7).109 Although these data are now almost 20 years old, they give a measure of population risk for specific injuries, including a childhood risk of penetrating injury (3.9/100,000/year) and hyphema (8.7/100,000/year). In the United States in 200015 the risk of hospital admission from eye injury (including the

Trend by sex

All studies show more traumatic injuries among male children.37, 56, 64, 80, 103 Male preponderance expressed by male:female ratio varies according to activity, is greatest for air gun-induced injury and varies between 9:1103 and 3.8:1.64 The ratio in firework injury varies between 4:159 and 3:1,64 and an injury from desk supplies (e.g., pencils, paper clips) is 1.7:1,80 followed by injury from cleaning products at 1.4:1.80 The male preponderance is a consistent finding in studies reported

Trend by age

A US population-based study80 of pediatric ocular injury from 1997–2006 showed that the incidence of injuries caused by consumer products was lowest for children aged under 2 years. The incidence remains stable from age 2 to 12, before a rise among children over the age of 12.80 This survey80 again revealed the clear trend towards increased sports-related injury for older children shown 17 years previously,109 but also found a decrease in injury from cleaning products (Fig. 1). Injuries from

Injury environment

In South Africa during 2001–2002, penetrating injury occurred most commonly at home (55%) and away from the supervision of an adult.49 In Colombia injuries occurred most commonly at home (44%), with only 14% occurring in school.99 Studies from Israel in 1990 and the UK in 1999 confirmed this finding. The latter study showed that the proportion of childhood injury at home is greater still for the younger age groups, including preschool children. Conversely, perforating injury in children from

High-risk activities

There are particularly risky activities that merit the attention of preventative strategies. These are detailed in this section and are broadly organized by decreasing likelihood of serious injury.

Table 2 summarizes the literature regarding the rates of injury and visual prognosis from different causes. The data that inform this table are limited. There is little prospective data, case definitions vary, and the populations studied vary enormously in their demography, geography, and the risk of

Conclusions

In order to prevent the devastating consequences of potentially avoidable pediatric ocular trauma, it is necessary to understand the epidemiology and mechanisms of this diverse group of injuries. Many of these injuries have extremely poor visual outcomes, and yet evidence already exists that their prevalence can be reduced.

Based on our review, we would like to propose the following initiatives which specifically target pediatric ocular trauma. We suggest mapping the educational resources and

Methods of literature search

Comprehensive international searches were made using Medline using the terms pediatric ocular trauma, pediatric ocular trauma, ocular trauma, eye injury, sport eye injury, firework eye injury, rocket eye injury, airbag eye injury, seatbelt eye injury, inflicted injury, non-accidental head injury, compressed air gun eye, projectile injury, football eye injury, tennis eye, badminton eye. The reference list from each paper was used as a resource to identify further useful publications. We included

Disclosure

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

References (116)

  • H.T. Keenan et al.

    Increased incidence of inflicted traumatic brain in jury in children after a natural disaster

    Am J Prev Med

    (2004)
  • J.D. Kivlin et al.

    Shaken baby syndrome

    Ophthalmology

    (2000)
  • W.B. Lee et al.

    Airbags and bilateral eye injury: five case reports and a review of the literature

    J Emerg Med

    (2001)
  • K.S. Lehto et al.

    Do motor vehicle airbags increase risk of ocular injuries in adults?

    Ophthalmology

    (2003)
  • G.T. Lueder

    Air bag-associated ocular trauma in children

    Ophthalmology

    (2000)
  • R.A. Minns et al.

    Incidence and demography of non-accidental head injury in southeast Scotland from a national database

    Am J Prev Med

    (2008)
  • J. Moren Cross et al.

    Pediatric eye injuries related to consumer products in the United States, 1997–2006

    J AAPOS

    (2008)
  • J.A. Pearlman et al.

    Airbags and eye injuries: epidemiology, spectrum of injury, and analysis of risk factors

    Surv Ophthalmol

    (2001)
  • P.K. Rabiah

    Penetrating needle injury of the eye causing cataract in children

    Ophthalmology

    (2003)
  • H. Razavi et al.

    Wii eye injury: self-inflicted globe rupture and vision loss in a 7-year-old boy from a video game accident

    J AAPOS

    (2011)
  • T. Salam et al.

    Airbag injury and bilateral globe rupture

    Am J Emerg Med

    (2010)
  • S. Schloff et al.

    Retinal findings in children with intracranial hemorrhage

    Ophthalmology

    (2002)
  • J. Abbott et al.

    Prize your eyes

    BMJ

    (2011)
  • G. Adams et al.

    Update from the ophthalmology child abuse working party: Royal College ophthalmologists

    Eye

    (2004)
  • J. Aikman

    Cerebral hemorrhage in infant, aged eight month: recovery

    Arch Pediatr

    (1928)
  • I. Ashkenazi et al.

    Self-inflicted ocular mutilation in the pediatric age group

    Acta Paediatr

    (1992)
  • S.S. Baeesa et al.

    The shaken baby syndrome

    Saudi Med J

    (2000)
  • A. Barak et al.

    Incidence and severity of ocular and adnexal injuries during the Second Lebanon War among Israeli soldiers and civilians

    Graefes Arch Clin Exp Ophthalmol

    (2011)
  • K.M. Barlow

    Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy

    Pediatrics

    (2005)
  • A. Barr et al.

    Ocular sports injuries: the current picture

    Br J Sports Med

    (2000)
  • G. Barrell et al.

    Squash ball to eye ball: the likelihood of squash players incurring an eye injury

    Br Med J (Clin Res Ed)

    (1981)
  • A.L. Bella-Hiag et al.

    Ocular traumatism in children at Laquintinie Hospital, Douala (Cameroon)

    Sante

    (2000)
  • D. Bowen et al.

    Ocular injuries caused by airgun pellets: an analysis of 105 cases

    BMJ

    (1973)
  • M. Brophy et al.

    Pediatric eye injury-related hospitalizations in the United States

    Pediatrics

    (2006)
  • M.J. Burke et al.

    Soccerball-induced eye injuries

    JAMA

    (1983)
  • J. Caffey

    On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation

    Am J Dis Child

    (1972)
  • J.A. Capão Filipe et al.

    Modern sports eye injuries

    Br J Ophthalmol

    (2003)
  • S. Chattopadhyay et al.

    An unusual case of penetrating ocular trauma with a pressure cooker

    Oman J Ophthalmol

    (2010)
  • M.D. Cole et al.

    The seat belt law and after

    Br J Ophthalmol

    (1987)
  • M.D. Cole et al.

    Perforating eye injuries caused by darts

    Br J Ophthalmol

    (1988)
  • P. Corridan et al.

    Exploding microwaved eggs

    BMJ

    (1992)
  • S. Dashti et al.

    Current patterns of inflicted head injury in children

    Pediatr Neurosurg

    (2000)
  • D.B. David et al.

    Ocular protection in squash clubs: time for a change?

    Eye

    (1995)
  • P. Desai et al.

    Epidemiology and implications of ocular trauma admitted to hospital in Scotland

    J Epidemiol Community Health

    (1996)
  • P. Desai et al.

    Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome

    Br J Ophthalmol

    (1996)
  • S. Duma et al.

    Eye injuries from airbags with seamless module covers

    J Trauma

    (2000)
  • S.M. Duma et al.

    The effect of frontal air bags on eye injury patterns in automobile crashes

    Arch Ophthalmol

    (2002)
  • R.M. Eime et al.

    Have the attitudes of Australian squash players towards protective eyewear changed over the past decade?

    Br J Sports Med

    (2002)
  • R.M. Eime et al.

    Protective eyewear promotion: applying principles of behaviour change in the design of a squash injury prevention programme

    Sports Med

    (2004)
  • R. Eime et al.

    Epidemiology of squash injuries requiring hospital treatment

    Inj Control Saf Promot

    (2003)
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