Background: Road traffic accidents have become a significant public health concern in the recent times. This issue has resulted in a rising rate of death and illness, largely due to changes in lifestyle and advancements in the automobile sector [1]. Trauma to eye remains a leading cause of visual morbidity and blindness, constituting approximately 75% of ocular emergencies, road traffic accidents (RTA) being one of the most common risk factors [2].
Objectives:
Material & Methods: Study Design: A prospective hospital-based cross-sectional study. Study area: Department of Ophthalmology, East Point College of Medical Sciences and Research Centre, Bengaluru, Karnataka. Study Period: 1 year. Study population: All patients with a history of ocular injuries following road traffic accidents presenting to the casualty and outpatient ophthalmology department. Sample size: The study consisted of 60 subjects.Results: The most common ocular manifestation of road traffic accidents was subconjunctival haemorrhage 32 (53.33%), followed by ecchymosis 29 (48. 33%). Majority of the ocular injuries (35%) occurred in the age group of 31- 40 years and the least number of cases (13.33%) were seen in patients over the age of 50 years. Ocular injuries were more common in males 43 (71.67%). Road traffic accidents with ocular injuries were more commonly seen with two wheelers 34 (56.67%). Conclusion: Ocular injuries resulting from road traffic accidents are among the primary contributors to eye-related health issues and loss of vision in developing nations such as India, where the number of two-wheeler vehicles is increasing and public awareness regarding eye protection gear is lacking. The most impacted demographic group consists of working-class male.
Road traffic accidents have become a significant public health concern in the recent times. This issue has resulted in a rising rate of death and illness, largely due to changes in lifestyle and advancements in the automobile sector [1]. Trauma to the eye remains a leading cause of visual morbidity and blindness constituting approximately 75% of ocular emergencies. Road traffic accidents (RTA) being one of the most common risk factors [2].
The rising number of vehicles, along with factors such as lack of knowledge and adherence to traffic regulations, inadequate traffic management, poor road conditions, a growing number of inexperienced drivers, and high-risk actions like driving under the influence of intoxicants, stunt driving, and racing, contribute to increased morbidity and mortality [3].
Often, preventive strategies related to eye injuries receive insufficient attention. Severe eye injuries can lead to vision impairment, significantly affecting the victim's daily life. Overall, ocular trauma is the primary cause of complete and partial vision loss in one eye, accounting for over 500,000 cases of blindness globally [5]. Data on head injuries indicate that 25% to 30% result in visual and ocular complications. Ocular injuries caused by road traffic accidents are the predominant source of all traumatic ocular injuries [6].
Ocular injuries resulting from road traffic accidents may present as eyelid lacerations, corneal and conjunctival abrasions, scleral tears, globe perforations, lacrimal gland injuries, orbital wall fractures and injuries to ocular muscles. [12] The traumatic ocular injuries sustained from road traffic incidents can lead to some level of visual impairment, imposing a considerable financial burden on both the individual affected and the wider community. [13] In view of public health importance, this study examines the patterns and severity of eyelid and ocular injuries linked to environmental factors, contributing to the originality of the research. The findings of this study will enhance our understanding of how ocular injuries are distributed and their severity among motorcycle accident victims, providing a foundation for relevant authorities to develop and implement preventive measures.
OBJECTIVES:
Study Design: A prospective hospital-based cross-sectional study.
Study area: Department of Ophthalmology, East Point College of Medical Sciences and Research Centre, Bengaluru, Karnataka
Study Period: 1 year.
Study population: All patients with a history of ocular injuries following road traffic accidents presenting to the casualty and outpatient ophthalmology department.
Sample size: The study consisted of 60 subjects.
Sampling method: Simple random technique.
Inclusion criteria: All patients with a history of ocular injuries following road traffic accidents presenting to the casualty and outpatient ophthalmology department, over the age of 18 years, both sexes, who were stable and co-operative, were included in the study.
Exclusion Criteria: Patients who were terminally ill, unconscious, non-co-operative patients and cases of ocular trauma due to causes other than road traffic accidents were excluded from this study.
Ethical consideration: Institutional Ethical Committee permission was obtained before the commencement of the study.
Study tools and Data collection procedure:
After obtaining written informed consent from the patient, a detailed history was taken followed by a complete ophthalmological evaluation including best corrected visual acuity using Snellen's chart, torch light examination and a detailed slit lamp examination. Intraocular pressure was recorded with a non-contact tonometer, wherever possible. A dilated fundus examination was done in all cases. B-scan ultrasonography was performed in those cases with media opacities who were suspected of having posterior segment abnormality. Computerised Tomography scan of brain and orbit was done, wherever indicated.
Depending on the presentation, patients were subjected to detailed examination by an Otorhinolaryngology surgeon, General surgeon, Maxillo-facial surgeon and General physician. Medical and surgical management was done accordingly. Patients were managed mainly at casualty and O.P.D level, with some patients admitted for further management and specialised care. Patients were followed up every week, for 6 weeks.
Statistical analysis: In the present study, descriptive statistical analysis was done. Results for categorical measurements are reported in Number (%) whereas results for continuous measurements are reported as Mean ±SD (Min-Max). At a 5% level of significance, significance is evaluated.
Table -1: Incidence of ocular injuries in road traffic accidents
Road Traffic Accidents |
Number of cases |
Percentage |
Ocular injury |
60 |
5.71 |
Non-ocular injury |
990 |
94.29 |
Road Traffic Accidents |
1050 |
100.00 |
Out of 1050 patients of road traffic accidents, who presented to the hospital, 60 had ocular injuries. The incidence of ocular injuries is 57.1/1000 RTA.
Table -2: Age-wise distribution of ocular injuries in Road Traffic Accidents
Age (years) |
Number of cases |
Percentage |
20-30 |
13 |
21.67 |
31-40 |
21 |
35.00 |
41-50 |
18 |
30.00 |
>50 |
8 |
13.33 |
Total |
60 |
100.00 |
The majority of ocular injuries (35%) occurred in the age group of 31- 40 years and the least number of cases (13.33%) were seen in patients over the age of 50 years.
Table -3: Sex distribution of ocular injuries in road traffic accidents
Sex |
Number of cases |
Percentage |
Male |
43 |
71.67 |
Female |
17 |
28.33 |
Total |
60 |
100.00 |
The prevalence of ocular injuries in road traffic accidents was more in males 43 (71.67%).
Table -4 Distribution of cases according to the types of vehicle involved
Vehicle |
Number of cases |
Percentage |
2 wheelers |
34 |
56.67 |
3 wheelers |
4 |
6.67 |
4 wheelers |
12 |
20.00 |
Pedestrians |
10 |
16.66 |
Total |
60 |
100.00 |
The prevalence of ocular injuries in Road Traffic Accidents was more in 2 wheelers 34 (56.67%).
Table -5: Distribution of cases according to eye affected.
Eye |
Number of cases |
Percentage |
Left eye |
21 |
35 |
Right eye |
33 |
55 |
Both eyes |
6 |
10 |
Total |
60 |
100.00 |
Right eye is most commonly affected, i.e., 33 (55%), and both eye involvement is least common, i.e., 6 (10%).
Table -6: Clinical manifestation of ocular injuries in Road Traffic Accidents
|
Number of cases |
Percentage |
Orbital fracture |
7 |
11.67 |
Ecchymosis |
29 |
48.33 |
Lid tear |
15 |
25 |
Sub-conjunctival haemorrhage |
32 |
53.33 |
Conjunctival tear |
4 |
6.66 |
Conjunctival foreign body |
6 |
10 |
Conjunctival chemosis |
12 |
20 |
Corneal abrasion |
2 |
3.33 |
Corneal foreign body |
3 |
5 |
Corneal tear-full thickness |
3 |
5 |
Corneal tear – partial thickness |
2 |
3.33 |
Scleral laceration |
1 |
1.67 |
Hyphaema |
2 |
3.33 |
Sphincter tear |
2 |
3.33 |
Iridodonesis |
1 |
1.67 |
Traumatic mydriasis |
3 |
5 |
Iris prolapse |
3 |
5 |
Subluxation of lens |
1 |
1.67 |
Dislocation of lens |
1 |
1.67 |
Traumatic cataract |
4 |
6.67 |
Berlin’s oedema |
1 |
1.67 |
Pre-retinal haemorrhage |
1 |
1.67 |
Vitreous haemorrhage |
1 |
1.67 |
Traumatic optic neuropathy |
1 |
1.67 |
The most common ocular manifestation of road traffic accidents was subconjunctival haemorrhage 32 (53.33%), followed by ecchymosis 29 (48.33%).
Table -7: Vision at the time of presentation
Vision |
Number of cases |
Percentage |
6/6-6/12 |
41 |
68.32 |
6/18-6/36 |
7 |
11.67 |
6/60-CF |
10 |
16.67 |
PL-PR |
1 |
1.67 |
No PL |
1 |
1.67 |
Total |
60 |
100.00 |
Majority of cases had a visual acuity in the range of 6/6 – 6/12, i.e., 41 (68.32%) and only 1 case (1.67%) had no perception of light, at presentation.
Table -8: Vision at the end of 6 weeks
Vision |
Number of cases |
Percentage |
6/6-6/12 |
56 |
93.33 |
6/18-6/36 |
3 |
5 |
6/60-CF |
0 |
0 |
PL-PR |
0 |
0 |
NO PL |
1 |
1.67 |
Total |
60 |
100 |
Visual acuity of 56 (93.33%) cases was in the range between 6/6 - 6/12 at the end of 6 weeks
This study includes a total number of 1050 road traffic accidents patients, of which 60 patients had ocular injuries. The incidence of ocular injuries in road traffic accidents in this study was found to be 57.1/1000. In this study, patients above the age of 18 years were selected. The majority of ocular injuries occurred in the age group of 31-40 years and the least number of cases of road traffic accidents were seen in patients over 50 years of age. There were a total of 43 males and 17 females. Male: female ratio was 2.5:1. A similar male predominance was found in a study from Western Maharashtra by Asok Kumar Naskar et al [14]. Out of 757 cases of road traffic accidents, males were 640 (74.7%), and females were 217 (25.3%). The highest numbers of victims were between 21-50 years of age. A similar male predominance was found in a study by Parri Muralidhar et al. [15] in South India and out of 40 patients 38 were male and 2 were female, most patients were between 41-50 years of age constituting 40%. In a Clinical Study of Anterior Segment Ocular Manifestations in Blunt Trauma by Milind Sabnis and K. Joshi [16], males were more commonly affected than females (81 males compared to 19 females). In a Study of Orbital Fractures in a Tertiary Health Care Centre by Kamath et al. [17], among the orbital fractures, the most common age group was between 20 - 40 years accounting for 13 cases (48%).
Out of 60 patients with ocular injuries, most were due to motorised two-wheelers 34 (56.67%) followed by four-wheelers 12 (20.00%), pedestrians 10 (16.66%) and three-wheelers 4 (6.67%). In the study done by Asok Kumar Naskar et al. [14], the majority of the cases (35%) were due to motorised two-wheelers followed by four-wheelers (25.9%). In a study of the Pattern of Injuries among Fatal Road Traffic Injuries done by Yadkul et al. [18], two-wheeler riders (78.15%) formed the primary group in road traffic injury. In a cross-sectional study at a rural tertiary care hospital in South India by L.Menon et al.[19], the mode of transport in the case of 143 (74.9 %) participants was a two-wheeler, while 36 (18.8%) participants travelled in four-wheelers and 12 (6.3%) used other modes of transport.
In our study, out of 60 patients, the right eye only was affected in 55% while the left eye only was affected in 35% and both eyes were involved in 10%. In a Clinical Study of Anterior Segment Ocular Manifestations in Blunt Trauma by Milind Sabnis and K. Joshi16, the right eye was affected more commonly than the left eye (right eye 64% and left eye 36%). The right eye was injured in 116 (42%) patients and the left eye in 104 (37.7%). Both eyes were affected in 28 (20.3%) of patients in a study on road traffic accidents and ocular trauma by Shtewi et al.20
A total number of 7 (11.66%) orbital fractures were seen during the period of our study. Of these 3 cases had medial wall fractures, 1 case had a breach of the orbital rim, 1 case had floor fractures, 1 case had lateral wall fractures and one patient had a pure blowout fracture. In a Study of Orbital Fractures in A Tertiary Health Care Centre by Kamath et al. [17], among orbital fractures, the infraorbital rim involvement was seen in 22 (43.13%) patients, floor in 10 (19.6%) patients, lateral wall in 4 (13.7%) patients, medial wall in 6 (11.76%) patients, pure blow out in 5 (14.28%) patients and one case had roof fracture.
Ecchymosis was the second most common clinical findings; Out of the 60 cases, 29 (49.33%) patients had ecchymosis. Twenty-eight patients with ecchymosis were associated with other clinical signs, while one patient had only ecchymosis. In a 6-month study by Muralidhar et al. [15], 40 patients who met with an ocular injury were analysed. Their research shows that ecchymosis was seen in 50% of patients.
Fifteen patients had lid tears, most of them being partial-thickness lid tears, 4 cases had both upper and lower lid tear, 6 cases had associated fracture of orbit. 3 lid tears had no associated ocular injuries, one patient had Berlin's oedema and 1 had a vitreous haemorrhage. In a study done by P. Muralidhar et al. [15], out of 40 ocular injury cases, lid tear constituted 10%.
Subconjunctival haemorrhage was the most common clinical finding in our study. 32 (53.33%) cases had a subconjunctival haemorrhage. They varied from small petechiae to large extravasations. In severe subconjunctival haemorrhage, the posterior limit could not be made out. 6 patients did not have any associated clinical findings. A conjunctival tear was seen in 4 (6.66%) patients. The conjunctival tear did not exceed more than 5 mm.
10 (16.66%) patients presented with corneal injuries, 2 (3.33%) patients had corneal abrasion, 3 (5%) patients had a full-thickness corneal tear, 2 (3.33%) patients had partial-thickness corneal damage and 3 (5%) patients had a corneal foreign body. 3 patients with full-thickness corneal tears were associated with iris prolapse, out of which 1 patient had a posterior dislocation of the lens and 1 patient had a subluxated lens. In a study of Motor Vehicle Accident Eye Injuries in Northern Israel done by M.Yulish et al. [21], corneal erosion was observed in 27%.
1.67% (1 patient) had a scleral laceration. None of them were full-thickness and were not associated with uveal prolapse. In a study done by Asok Kumar Naskar et al. [14], patients suffering from ocular injuries in one or both eyes were analysed, and the scleral injury was reported as 0.1%. In a study on road traffic accidents and ocular trauma done at Tripoli Eye Hospital, Libya by Shtewi, et al. [20], scleral perforation was observed in 23.2%.
In our study, 2 (3.33%) cases of hyphaema were presented. All the instances of hyphaema involved <1/3rd of the anterior chamber. Both instances had only a marginal increase in intraocular pressure. One patient with hyphaema had an associated fracture orbit. In a study done by P. Muralidhar et al., 15, 40 ocular injury cases were examined, and hyphema was seen in 10% of them.
The less common findings were traumatic mydriasis 3 (5%), 3 (5%) cases of Iris prolapse, followed by 2 (3.33%) patients with sphincter tear and 1 (1.67%) with iridodonesis. Our study was compared to a survey of 205 cases by Canavan and Archer [22], in which 79 cases had Iris and pupillary injuries. In a study by Dabral SM, Mukherjee AK and Saini JS [23], who analysed 82 patients hospitalised for penetrating eye injuries, the iris was involved in 36.5%.
Out of 60 patients, 4 (6.67%) patients had posterior segment involvement. 1 (1.67%) patient had a vitreous haemorrhage. 1 (1.67%) patient had traumatic optic neuropathy. 1 (1.67%) patient had Berlin's oedema. 1 (1.67%) patient had a pre-retinal haemorrhage. Most of the patients with road traffic accidents had best corrected visual acuity in the range of 6/6-6/12 41 (68.32%) at presentation and 17 (28.34%) patients had a vision in the range of 6/18 to counting fingers 1 meter. 1 (1.67%) patient had the only perception of light, and 1 (1.67%) patient had no perception of light. At the end of 6 weeks, most of the patients, i.e., 56 (93.33%), had good vision in the range of 6/6-6/12 and 1 patient, who previously had no perception of light with traumatic optic neuropathy, showed no improvement in visual outcome. Our study showed results similar to the study by Puzari BS et al., where although anterior segment injury was more common than posterior segment injury, severity of diminution of vision was seen more in posterior segment injury [2].
Ocular injuries resulting from road traffic accidents (RTA) are among the primary contributors to eye-related health issues and loss of vision in developing nations such as India, where the number of two-wheeler vehicles is increasing and public awareness regarding eye protection gear is lacking. The most impacted demographic consists of working-class males. Closed-globe injuries are more prevalent than open-globe injuries, and most cases exhibited a favourable visual prognosis. The visual acuity observed at the time of initial evaluation is directly linked to the injury's severity, how it occurred, and the involvement of essential structures along the visual pathway. Ocular injuries due to road traffic accidents represent a significant cause of preventable eye health issues, necessitating the implementation of preventive measures.