Gavin Journal of Ophthalmology

Volume: 2017; Issue: 4
26 May 2017

Eye Injuries in Children: About 199 Cases Collected to the Aristide Le Dantec Hospital in Dakar

Case Report

Habsa Kane1*, AS Sow, JM Ndiaye1, AM Ka2, PA Ndoye Roth1, JP Diagne2, HM Diallo, S Sow2, M Nguer1, ME De Medeiros Quenum2, EA Bâ1, PA Ndiaye2

1Department of Ophthalmology, Aristide Le Dantec Hospital, Dakar, Senegal
2Department of Ophthalmology, Abass Ndao Hospital, Dakar, Senegal

*Corresponding author: Habsa Kane, Department of Ophthalmology, Aristide Le Dantec Hospital, Dakar, Senegal, E-mail : hapikane@gmail.com

Received Date: 6, February, 2017; Accepted Date: 22 February, 2017; Published Date: 1, March, 2017

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Abstract

Introduction

References

Tables

Suggested Citation

Abstract

 

Purpose

 

Determine the demographic, clinical, and therapeutic eye injuries in Children.

 

Patients and Methods

 

A rétrospective study was conducted over a period of 4 years from 1 January 2009 to 31 December 2012. It help éd collect 119 patients Under 15 years of files received for eye trauma and / or eyelid. Excluded were patients consulting for se quels.

 

Results

 

The frequency of Child injury was 24.20%. The mean age was 7.88 years and the age group of 6 to 10 years were the most affected. Male dominance was clear, with a sex ratio of 2.9. The ave rage time of consultation was 3.6 days. Lei sure accidents were the first circum stance occurred, and 46.7% of injuries occurred in the Streets. Métal object were the main causal agents (56.8%). Visual acuity was Superior at 6/10 in 49.2% of cases. Eyelid wounds were the most frequent eye damage (35.2%) followed by corneal wounds (32.2%). The treatment was surgical in 75.4% of cases. Complications and sequelae were dominated by cataracts (48% of cases) and pillowcases (20% of cases).

 

Conclusion

 

Eye injuries in Children are serious because blindness sources especially in developing countries, where the lack of ressources and often late treatment worsens the prognosis.

 

Keywords : Children; Eye injuries

Introduction

 

Eye injuries are responsible for various and potentially serious injuries. Children are particularly vulnérable to such injuries that are responsible for almost 14% of the monocular blindness during childhood [1].

 

Eye injuries in Children are serious because blindness sources especially in developing countries, where the lack of ressources and often late treatment worsens the prognosis.

In our city, ophthalmic structures with a functional storage service are rare .This might explain the management of late, especially when the trauma occurs at night or during the weekend.

 

The aims of the study were to determine the demographic, clinical, and therapeutic aspects of eye injuries in Children.

 

Patients and Methods

 

A retrospective study over a period of 4 years (1st January 2009 to 31th December 2012), involved all Under 15 years of patient records received for eye trauma and / or eyelid. The patients consulting for se quels, or which clinical examination data were in complete were excluded.

 

On a survey sheet were specified, sex, age and geographical origin. As background, the consultation period, the circumstance of the injury, place of occurrence, the causative agent, visual acuity, type of injury, the Under taking treatment and post-treatment evolution.

 

The collection and analysis of statistical data was made using the software Epi Info 7.0 and Chi-square test

 

Results

 

We observed 199 cases of ocular trauma and / or eyelid in children from a total of 822 cases, a prevalence of 24.2%.

 

Demographic Data

 

The mean age was 7.88 ± 3.88 years, ranging from 0 to 15 years. The age group of 6 to 10 years were the most affected (43.7%).One hundred sixty-three patients were from urban areas (81.9%).

The sex ratio was 2.9. The sociodemographic characteristics are given in Table 1.

 

Clinical data

 

The clinical characteristics are shown in Table 2.

 

The average time of consultation was 3.6 days. Sixty-six patients (33.2%) had consulted between 6th and 24th hour after injury.

 

Both sexes, the circumstances of occurrence were dominated by lei sure accidents (32.2%) and brawls (20.1%).

The injuries occurred on the street in 93 cases (46.7%), at home in 75 cases (37.7%) and at School in 31 cases (15.6%).

 

The most causative agent was a métal object (56.8%), followed by a vegetable agent (14.1%). The agent was not specified in 30 cases (15.1%).

 

The initial visual acuity was ˂ at 1/10 in 56 cases (28.1%), and between 6 / 10ths and 10/10 in 98 cases (49.2%). It was not specified in 19 cases (9.6%).

 

Eyelid wounds were the most frequent (35.2% of cases), followed by isolated corneal wounds (32.2% of cases).

 

Treatment

 

The treatment was médical in 49 cases (24.6%) with eye drops and systemic drug Sand surgical in 150 cases (75.4%) including 11 eviscerations.The final visual acuity was >at 6/10 in 108 cases (54.3%). Table 3 displays the therapeutic data.

 

Complications and sequelae

 

Complications and sequelae were noted in 50 cases (25.1%). They were dominated by cataract (48%) and pillowcases (20%). Other complications and sequelae are reported in Table 4.

 

Discussion

 

Demographic Data

 

The mean age was 7.88 years, and the age range of 6 to 10 years pre dominated. Which joined Other African séries [2,3]. While for Dembélé et al [4], it is the children of more than 11 years were the most affected.

 

Male dominance was clear, with a sex ratio of 2.9. It was reported by several studies [5,6], with rates ranging from 68.5% to 85%.

 

Most patients came from urban areas (81.9% of cases). Other séries also reported that prevalence [7,8] with slightly lower rates.

 

Clinical Data

 

The delay was not specified in almost 9% of cases especially in young children. In the other cases, the majority of patients (33.2% of cases) had consulted between 6th and 24th hour. This is consistent with data from Sidi Cheikh [5] which noted a lower rate of 23.8%. For Grieshaber [9] only 25% of injured presented to the hospital with in 24h of injury.

 

The average was 3.6 days, joining with Abraham data [10] reported that with in 3 days. Some African authors [11,12] evoke diffèrent factors to explain this long delay, including the scarcity of specialized structures, and lack of Financial means. In our city, ophthalmic structures with a functional storage service are rare .This might explain the management of late.

 

Lam [3] noted that 10% of patients had consulted before the 6th time, we reported à lower rate (6%). They were dominated by leisure accidents (32.2%). Doute tien [13] confirmed this trend and reported a higher rate of 41% While Grieshaber [9] in South African noted a two time higher rate of 66%. Brawls were the second circumstance with 20.1% of cases. This rate was lower for Luff [14] (8%) where they occupied the 4th place. Falls are the 3rd circumstance with 18.1% of the cases.

 

For Yaya [15], the beatings were the first circumstance with 25.9% of cases. This rate was only 8.5% in our séries, but still may be underestimated because physical abuse are not exceptional in our country. They are not always recognized and they could appear in un specified circumstances. The injuries occurred at home in 37.7% of cases, While Grieshaber [9] reported a higher rate of 55%.For him, most injuries (85%) occurred in the absence of a care givre.

 

The causative agent was not specified in 30 cases (15.1%). In other cases, métal objects pre dominated, with 56.8% of agents, like other séries [16,17]. For some authors [6,8], it is the vegetable nature of agents who dominated While in our série it is the second most causative agent (14.1%). The beatings were reported in 8.5% of cases, Dembélé [4] almost found a two times higher rate (15.4%). Initial visual acuity was not specified in 19 cases (9.6%), due to the lack of children’s cooperation.

 

Visual acuity was >at 6/10 in 98 cases (49.2%). There were cases of eye injury with intact eyeball. Eyelid lesions pre dominated with 35.2% of cases, followed by corneal wounds (32.2% of cases). Other authors [3,4] note the process prevalence of corneal wounds.

 

The hyphe ma represented 12.1% of the cases, this rate was two times higher in Bella data [18].In our séries, this rate may be underestimated because parents do not consulat systematically before contusive lesions that may be over looked or minimized.

 

Treatment

 

The treatment was surgical in 75.4% of cases. Several authors report the frequent need for surgical treatment [14,19]. The extent of damage and the delay in the consultation often lead to mutilating surgery [20]. Thus according Rigal-sas tourne [21], one third of patients suffer an evisceration. In our série, it was a lower rate of 5.5% which were the results of endophthalmitis which did not respond well to treatment, mainly due to delayed management.

Most of half of our patients regained a visual acuity of 6/10 or better, While for Grieshaber [9] 51% of patients regained 20/40 or better.

 

Post-Treatment Complications and Sequelae

 

Cataract was the main complication (48% of cases). Which joined the literature data [22,23] with most of the major risk of amblyopie in children. All cases of cataract have been successfully operated, some have been implanted immediately, others in a second time.

 

Among the recovered sequelae, corneal scarring ranked first (20%), followed by eye phtyses (12%).

These results confirm the serious ness of eye injuries in children with functional and anatomical significant impact. Even if the conditions for keratoplasty are possible it is not carried out because of a problem of législation.

 

Conclusion

 

Eye injuries in children are very serious, particularly because they may go unnoticed, and be responsible for amblyopia. The implémentation of parental awareness campaigns and the increase in human and material ressources would improve prognosis.

References

 

  1. Khalki H (2010) Les traumatismes oculaires (A propos de 408 cas). Thèse Med Fès.
  2. Sanou J (2003) Complications et séquelles des traumatismes oculaires à l’IOTA chez le sujet jeune de 0 à 30 ans. Mem CES Ophtalmol Bamako 30.
  3. Lam A, Ndiaye MR (1992) Traumatismes oculaires au Sénégal – Bilan épidémiologique et statistique de 1872 cas. Med Afr Noire 39 : 810-815.
  4. Dembélé J (2011) Les traumatismes oculaires à l’Hôpital Nianakoro Fomba de Ségou. Etude rétrospective à propos de 666 cas. Thes Med Bamako 109.
  5. Sidi Cheikh S, Ducouso F, Traore L, Momo G, Schemann JF (2000) Etude rétrospective des traumatismes oculaires perforants traits à l’IOTA Bamako : A propos de 180 cas. Med Afr Noire 47 : 285-289.
  6. Rahmatou N (1987) Traumatisme du globe et de ses annexes à l’Hôpital National de Niamey : aspects épidémiologiques et étude détaillée des lésions. Thes Med Niamey 70.
  7. Sylla F (2003) Les urgences traumatiques de l’enfant de 0 à 18 ans à l’IOTA. Mem CES Ophtalmol Bamako.
  8. Moussa AG (1989) Traumatismes oculaires au centre de Yeelen de Sikasso : étude de 50 dossiers cliniques. Rev Int Trach 163-171.
  9. Grieshaber MC, Stegmann R (2006) Penetrating eye injuries in South African children : aetiology and visuel outcome. Eye Lond 20: 789-795.
  10. Abraham D, Vitale S, West S, Isseme I (1999) Epidemiology of eye injuries in rural Tanzania. Ophthalmol Epidemiol 6: 85- 94.
  11. Mensah A, Fany A, Adjorlolo C, Toure ML, Gbe MK, et al. (2004) Epidémiologie des traumatismes oculaires de l’enfant à Abidjan CHU de Treichville. Cah Sant 14: 239 -243.
  12. Kaimbo WK, Spileers W, Missotten L (2002) Ocular emergencies in Kinshasa DRC. Bull Soc Belg Ophtalmol 284: 49- 53.
  13. Doutetien C, Oussa G, Noukiatchop-Noumi M, Deguenon J, Tchabi S, et al. (2000) Les traumatismes oculaires de l’enfant au CNHU de Cotonou. Benin Med 14: 66 -71.
  14. Luff AJ, Hodgkins PR, Baxter RJ, Morrell AJ, Calder I (1993) Etiology of perforating eye injury. Arch Dis Child 68: 682-683.
  15. Yaya G, Boboss G, Serengbe, Gandeuille A (2005) Traumatismes oculaires chez les enfants âgés de 0 à 15 ans : aspects épidémiologiques et cliniques au CNHU de Bangui. J Fr Ophtalmol 28 : 708-712.
  16. Skiker H, Laghmari M, Boutimzine N, Ibrahimy W, Benharbit M, et al. (2007) Les plaies du globe oculaire de l’enfant : étude rétrospective de 62 cas. Bull Soc Belg Ophtalmol 306: 57- 61.
  17. Soylu M, Demircan N, Yalaz M, Isiguzel I (1998) Etiology of pediatric perforating eye injuries in Southern Turkey. Ophthalmol Epidemiol 5: 7-12.
  18. Bella HI Al, Ebana MC (2000) Traumatologie oculo-orbitaire infantile à l’Hôpital de Douala. Cah Sant 10: 173-176.
  19. Rigal-Sastourne JC, Hamard H (1995) Rea Soin Intens. Med Urg 11: 98-100.
  20. Soliman MM, Macky TA (2008) Pattern of ocular trauma in Egypt. Graef Arch Clin Exp Ophthalmol 246: 205-212.
  21. Losseny O (2012) Les traumatismes oculaires de l’enfant au CHU Yalgado Ouedraogo : aspects épidémiologiques, cliniques et thérapeutiques : à propos de 267 cas. Thes Med Burkina Faso N°
  22. Kharbouch H, Benchrifa F, Mellal Z, Loudghiri MA, Berraho A (2009) La cataracte traumatique de l’enfant. J Fr Ophtalmol 32: 118-119.
  23. Poon AS, Ng JS, Lam DS, Fan DS, Leung AT (1999) Epidemiology of severe childhood eye injuries that required hospitalization. Hong Kong Med 4: 371-374.
Tables

 

  n %
Age (yrs)    
0-5   6231.20%
 6 – 10 87 43.70%
15-Nov 50 25.10%
Gander    
Female  148 74.40%
Male  51 25.60%
Geographic origin    
Urban areas  163 81.90%
Rural areas  28 14.10%
Neighboring countries 8 4.00%
Total (N=199)

 

Table 1 : Sociodemographic Characteristics.

  n %
Consultation deadline    
0 – 6 h 12 6.00%
6 – 24h 66 33.20%
24 – 48h 20 10.10%
2d – 7d 34 17.10%
>  7d 50 25.10%
Not specified 17 8.50%
Circumstances of occurrence    
Brawls 40 20.10%
Falls 36 18.10%
Leisure accidents 64 32.20%
Beatings 17 8.50%
Domestic accidents 28 14.10%
Not specified 14 7.00%
Type of eye damage    
Corneolimbic wounds 9 4.50%
Corneoscleral wounds 15 7.50%
Eyelid wounds   70 35.20%
Corneal wounds 64 32.20%
Hyphe ma 24 12.10%
Endophthalmitis 17 8.50%
Nature of the causative agent    
Métal object 113 56.80%
Blunt 23 11.50%
Vegetable 28 14.10%
Chemical 5 2.50%
Not specified 30 15.10%
Initial visual acuity    
<at 1/10 56 28.10%
1/10 – 5/10 26 13.10%
6/10 – 10/10 98 49.20%
Not specified 19 9.60%
Total (N=199)

 

Table 2 : Clinical Characteristics.

  n %
Type of treatment    
Surgical 150 75.40%
Médical 49 24.60%
Final visual acuity    
<at 1/10 50 25.10%
1/10 – 5/10 22 11.00%
>at 6/10 108 54.30%
Not specified 19 9.60%
Total (N=199)

 

Table 3 : Treatment.

  n %
Complications    
Cataract 24 48%
Cellulites 5 10
Ocular hypertension 4 8
Sequelae    
Leucome 1 2
Pillowcases 10 20
Phtyse 6 12
Total (N= 50)

 

Table 4 : Complications and sequelae.

Suggested Citation

 

Citation: Kane H, Sow AS, Nadiaye JM, Ka AM, Ndoye Roth PA, et al. (2017) Eye Injuries in Children: About 199 Cases Collected to the Aristide Le Dantec Hospital in Dakar. Ophthalmol Res Rep 2017: J119.

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