Public health and the eyeThe epidemiology and etiology of pediatric ocular trauma
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)
- et al.
Bungee cord-associated ocular trauma
Ophthalmology
(2001) - et al.
Cues of paternal uncertainty and father to child physical abuse as reported by mothers in Rio de Janeiro, Brazil
Child Abuse Negl
(2011) - et al.
Annual incidence of shaken impact syndrome in young children
Lancet
(2000) - et al.
Bungee cord-associated ocular injuries
Am J Ophthalmol
(1998) - et al.
Retinal hemorrhages caused by accidental household trauma
J Pediatr
(1999) - et al.
Eye trauma in children: epidemiology, management, and prevention
J Pediatr Health Care
(1997) - et al.
Do squash players accurately report use of appropriate protective eyewear?
J Sci Med Sport
(2005) - et al.
Perinatal factors associated with infant maltreatment
Clin Med Pediatrics
(2008) - et al.
Retinal folds in the shaken baby syndrome
Am J Ophthalmol
(1988) - et al.
Traumatic retinoschisis in battered babies
Ophthalmology
(1986)
Increased incidence of inflicted traumatic brain in jury in children after a natural disaster
Am J Prev Med
Shaken baby syndrome
Ophthalmology
Airbags and bilateral eye injury: five case reports and a review of the literature
J Emerg Med
Do motor vehicle airbags increase risk of ocular injuries in adults?
Ophthalmology
Air bag-associated ocular trauma in children
Ophthalmology
Incidence and demography of non-accidental head injury in southeast Scotland from a national database
Am J Prev Med
Pediatric eye injuries related to consumer products in the United States, 1997–2006
J AAPOS
Airbags and eye injuries: epidemiology, spectrum of injury, and analysis of risk factors
Surv Ophthalmol
Penetrating needle injury of the eye causing cataract in children
Ophthalmology
Wii eye injury: self-inflicted globe rupture and vision loss in a 7-year-old boy from a video game accident
J AAPOS
Airbag injury and bilateral globe rupture
Am J Emerg Med
Retinal findings in children with intracranial hemorrhage
Ophthalmology
Prize your eyes
BMJ
Update from the ophthalmology child abuse working party: Royal College ophthalmologists
Eye
Cerebral hemorrhage in infant, aged eight month: recovery
Arch Pediatr
Self-inflicted ocular mutilation in the pediatric age group
Acta Paediatr
The shaken baby syndrome
Saudi Med J
Incidence and severity of ocular and adnexal injuries during the Second Lebanon War among Israeli soldiers and civilians
Graefes Arch Clin Exp Ophthalmol
Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy
Pediatrics
Ocular sports injuries: the current picture
Br J Sports Med
Squash ball to eye ball: the likelihood of squash players incurring an eye injury
Br Med J (Clin Res Ed)
Ocular traumatism in children at Laquintinie Hospital, Douala (Cameroon)
Sante
Ocular injuries caused by airgun pellets: an analysis of 105 cases
BMJ
Pediatric eye injury-related hospitalizations in the United States
Pediatrics
Soccerball-induced eye injuries
JAMA
On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation
Am J Dis Child
Modern sports eye injuries
Br J Ophthalmol
An unusual case of penetrating ocular trauma with a pressure cooker
Oman J Ophthalmol
The seat belt law and after
Br J Ophthalmol
Perforating eye injuries caused by darts
Br J Ophthalmol
Exploding microwaved eggs
BMJ
Current patterns of inflicted head injury in children
Pediatr Neurosurg
Ocular protection in squash clubs: time for a change?
Eye
Epidemiology and implications of ocular trauma admitted to hospital in Scotland
J Epidemiol Community Health
Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome
Br J Ophthalmol
Eye injuries from airbags with seamless module covers
J Trauma
The effect of frontal air bags on eye injury patterns in automobile crashes
Arch Ophthalmol
Have the attitudes of Australian squash players towards protective eyewear changed over the past decade?
Br J Sports Med
Protective eyewear promotion: applying principles of behaviour change in the design of a squash injury prevention programme
Sports Med
Epidemiology of squash injuries requiring hospital treatment
Inj Control Saf Promot
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UCL Partners Academic Health Science Centre, London. NIHR Biomedical research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, UK.