Eye injuries in motor vehicle accidents: Epidemiology, spectrum of injury and analysis of risk factors

Abstract

To study the epidemiology, clinico-radiological pattern and visual outcome in patients having ocular injuries following road traffic accident and also compare various risk factors associated with it. Materials and Methods: A prospective, hospital based, observational study was performed at a teaching hospital of North India. Various parameters including demographics, time, place and session of injury, type of road, vehicle & collision, type of injury, severity & location of injury, radiological findings and initial & final visual acuity were analysed. The association between ocular trauma and characteristics of the accident were evaluated. Results: Out of 402 patients of ocular trauma, 101 eyes of 95(23.63%) patients had injuries due to road traffic accidents. It was observed that males were affected predominantly (88.40%).The ratio between men and women was 7.6:1, age ranged from 1 year to 67 years. The most vulnerable age group was 21-30 year (25.30%) followed by 31-40 year (24.20%) and 11-20 year (21.10%).Maximum injury victims were illiterate (33.68%) or had primary education only (29.47%). The majority were married (68.42%) and belonged to rural background (42.10%). Most of the road traffic accidents occur in summer season (47.37%). Majority of the victims sustained injury in the afternoon between 12.00 -17.59 hrs (29.47%) and in evening between 18.00-23.59 hrs (27.33%). 57.89 % victims were not using any protective gear at the time of injury. Driving under influence of alcohol (42.11%) and sleepiness or drowsiness of victims (21.05%) were found to be an important risk factor in ocular injury. 43.61% of the accidents took place at highway. Two-wheeler occupants (30.53%) were more prone to ocular trauma than pedestrians (13.68%), three-wheelers occupants (5.26%) and car occupants (21.05%). However 29.47% victims were travelling in heavy vehicles like bus/ truck. The most common mode of road accident was collision with other stationary objects like a tree, pole, milepost and other vehicle (51.58%) followed by swerved / skidded vehicle (26.32%) and run in the ditch (13.68%). The commonest mode of injury was frontal impact or head-on collision (37.89%) followed by sideways impact (26.32%) and hit by projectile object (6.32%). However, in 29.47% cases the mode of injury was indeterminate. Conclusion: Road traffic accidents can cause severe ocular trauma. Victims are usually adult males of productive age group. Two wheeler occupants, driving under influence of alcohol and non-use of protective gear were found to be major risk factors. Frontal impacts posed the greatest risk of orbito-facial trauma. Open globe injury and multiple orbital wall fracture usually associated with poor prognosis. Use of helmet and seatbelt may reduce the frontal impact and hence vision threatening ocular trauma.