Niger J Paed 2014; 41 (3):215 –217  
Bodunde OT  
Alabi AD  
Ayeni OA  
Eye injuries in children the  
Sagamu experience  
Accepted: 19th February 2014  
Abstract: Objective: To describe  
version 16.  
the pattern of eye injuries in chil-  
dren at Olabisi Onabanjo Univer-  
sity Teaching Hospital (OOUTH),  
Sagamu, Nigeria.  
Results: A total of 131 case notes  
were available for analysis. The  
age range of affected children was  
9months to16 years: mean (SD) -  
8.56years(4.18).The male female  
ratio was 2:1. The majority of  
affected children were age 6- 10  
years. The right eye was involved  
in 55.7% of cases. The most com-  
mon agent of injury was stick  
(22.1%), followed by slap.  
Conclusion: Intensifying health  
education to the children, parents  
and teachers will go a long way in  
reducing ocular injuries and vision  
loss in children.  
Bodunde OT  
Ayeni OA  
Department of Ophthalmology,  
Methods: The records of all chil-  
dren 16years and below presenting  
with eye injuries to the Eye clinic  
between January 2007 and Decem-  
ber 2011 were reviewed retrospec-  
tively. Demographic data, cause of  
injury, time of presentation, the  
injured eye, visual acuity at presen-  
tation, diagnosis, intraocular pres-  
sure, treatment given, post treat-  
ment visual acuities at one week,  
one month and three months were  
obtained and analyzed using SPSS  
Alabi AD  
Department of Community Medicine &  
Primary Care  
Olabisi Onabanjo University Teaching  
P.M.B.2001, Sagamu.  
Ogun state, Nigeria.  
Email: bbodunde@yahoo.com,  
Subjects and methods  
Eye/ocular injuries are a common cause of uniocular  
blindness in children. Ocular trauma is said to be a lead-  
ing cause of visual impairment and blindness in young  
adults and children resulting in ophthalmic morbidity  
This is a descriptive, cross-sectional study of patients  
presenting at OOUTH, one of the two tertiary centres in  
the state. It is located within a semi urban city with  
agrarian orientation.  
and monocular blindness all over the world . According  
The case notes of all children aged 16years and below  
who presented with eye injuries to OOUTH between  
January 2007 and December 2011 were retrieved from  
the Information Management department of the hospital.  
Demographic data, cause of injury, time of presentation,  
the injured eye, visual acuity at presentation, diagnosis,  
intraocular pressure, treatment given, post treatment  
visual acuities at one week, one month and three months  
were recorded. Visual acuity was not checked in prever-  
bal children while in verbal children vision was checked  
with Snellen’s chart and E chart in those who could not  
read the letters of the alphabet. Ocular examinations  
were done with pen torches and Haagstreight Slit lamp  
where the child could co-operate. Intraocular pressures  
were checked with Goldman’s applanation tonometer.  
Cases were defined according to the International classi-  
fications of Diseases (ICD) published by the WHO. Vis-  
ual acuity was classified as category 1 (>20/200 =6/60),  
category 2 (< 20/200 to light perception) or category 3  
(no light perception).  
to the WHO, about 1.6 million patients become blind  
out of 55 million ocular injuries occurring yearly world  
wide The burden /impact of this is more and significant  
when one considers the number of blind years a child  
has to live compared to adults. Ocular injuries represent  
approximately 4-20% of all eye injuries and is a signifi-  
cant cause of corneal scarring which is the most com-  
mon cause of childhood blindness in developing coun-  
tries. Prompt diagnosis and treatment of ocular injuries  
in children can help reduce morbidity however most  
cases have been found to report late to the hospitals  
. Also even after treatment, visual acuity may not  
improve in affected children because of amblyopia. This  
study was carried out to determine the pattern of eye  
injuries among children presenting at Olabisi Onabanjo  
University Teaching Hospital (OOUTH) a semi urban  
city. Findings in this study will assist heath planners in  
Ogun state plan appropriate prevention/healthcare for  
children in the state.  
According to the ocular trauma classification system  
OTS), mechanical injuries of the globe were divided  
into “Open globe” or “Closed globe” injuries. An open  
globe injury was defined as a full thickness wound of  
Table 3: Visual acuity at presentation of 33 subjects at the  
-month follow-up  
the eyeball. A closed globe injury was defined as a con-  
tusion (defined as no corneal or scleral wound), a lamel-  
lar laceration (a partial thickness) or superficial foreign  
Visual acuity  
Number (%)  
20/200 (6/60)  
20/200 to LP  
No LP  
10 (31.6)  
10 (31.6)  
13 (36.8)  
33 (100.0)  
Data was analyzed with SPSS statistical package version  
6.0.Variables were calculated and inferential statistics  
LP = light perception  
Fig 1: Causes of injury  
A total of 142 cases of eye injury were seen during the  
study period but only 131 (92.3%) case notes were seen  
for review. The age range of affected children was  
months to 16 years with a mean of 8.56years+  
.18years .There were 88(67.2%) males and 43(32.8%)  
females with a ratio of 2:1. The majority of affected  
children were aged 6-10 years (Table 1). The right eye  
was involved in 73(55.7%) of cases while left eye was  
involved in 58(44.3%). Open globe injuries constituted  
2(40%) of cases while closed globe injuries was much  
more common constituting 79(60%) of cases. The most  
common cause of injury was stick (22.1%), followed by  
slap (8.6%), accidental hitting of face against the door  
Table 4: Comparison of visual acuity at presentation and at 3-  
months follow-up  
8.6%), broomstick (5.3%) pencil (4.6%) (Fig 1). Others  
include finger, scissors, cutlass, antenna fall etc. The  
earliest time of presentation was 30minutes. Mean pres-  
entation time was 37.5days +9.41days: 34(26%) pre-  
sented within twenty four hours of injury. Blunt trauma  
was the most common mechanism of injury, accounting  
for 70(53.4%) while penetrating trauma occurred in 58  
At presentation  
At 3 months  
Category 1  
Category 2  
Category 3  
Category 1: n = 07  
Category 2: n = 16  
Category 3: n = 10  
All: n = 33  
44.3%); chemical injury was 3(2.3%).  
The most common visual acuity group at presentation  
was category 1(37.4%) - (Table 2). Visual acuity was  
not done in preverbal children. Many of the patients  
defaulted before the three months follow up hence at this  
time only 33 visual acuities were available for analysis  
Eye injuries in children though very common are usually  
accidental and can affect any age. In this study the mean  
age was 8.56 + 4.18years and this is similar to the find-  
Table 3). These are category 1- 10(30.3%), category 2-  
0(30.3%) and category 3- 13(39.4%). Of these 33,7  
21.2%) were initially in category 1,16 (48.5%) were in  
ings of Hamid et al in Iran whose mean was 7.6 +  
3.6years. Also in this study, there was a male prepon3,d7,e8,r9-  
category 2 and 10(30.3%) were in category 3. There was  
thus a 9.1% (3) improvement in visual acuity and 9.1%  
ance of ratio 2:1 similar to the findings of others  
This has been related to the greater degree of freedom  
and stimulus to aggressiveness given to boys in all so-  
3) had worsened visual acuity (Table 4).  
cieties . Ocular trauma was more common among the 6-  
Table 1: Age group distribution of study subjects  
other countries .According to Glynn the estimated  
0years age gro8u,1p0,1a1nd this is also similar to findings in  
Age group years  
Number (%)  
to 5  
to 10  
1 to 16  
36 (27.5)  
48 (36.6)  
47 (35.9)  
131 (100.0)  
risk of sustaining ocular trauma increases by 80% when  
comparing older persons to those who are 10years or  
younger .  
In our study the right eye was involved in 55.4% of  
cas3es which was similar to the findings of Thompson et  
Table 2: Visual acuity of 107 eligible children at presentation  
al but in contrast to the findings of Dasgupta et al and  
Visual acuity  
Number (%)  
Kov,1a4l who found that the left eye was more affect-  
20/200 (6/60)  
20/200 to LP  
No LP  
49 (45.8)  
42 (39.3)  
16 (15.0)  
107 (100.0)  
ed . The difference may be related to the socioeco-  
nomic conditions and the larger sample size in our  
study. Closed globe injuries were found to be commoner  
than open injuries in this study, as previously reported  
by Ching who found close globe injuries in 78.1% of his  
LP = light perception  
Like in o8t,h10e,r16studies, stick was the most common cause  
of injury . Many of these occurred while the chil-  
dren are being reprimanded for erring either at home or  
dren, teachers and parents will go along way in helping  
to correct this.  
in schools . Hence teachers, parents and caregivers  
should be taught to be extremely careful to avoid the  
face or hands held close to the face in beating erring  
children. If anything, corporal punishment should be  
administered on the buttocks and legs. Of note is that  
bomb blast, bows and arrows, and toys reported by some  
authors are not found in this study, . Also broomstick  
injury is much more dangerous because majority of  
cases presenting with this actually developed  
endophthalmitis before presentation. This is not unex-  
pected since the broom has been used to sweep dirt’s  
making it contaminated in most cases. Unlike developed  
countries, only 24% presented within twenty –four hours  
of injury, a factor tha1t0has been found to affect prognosis  
and visual outcome . Health education of school chil-  
A high default rate was noted in this study, hence oph-  
thalmologists and other eye care workers need to edu-  
cate the masses on the danger of this and increase  
awareness on problems associated with ocular trauma  
among children. We therefore conclude that intensifying  
health education to the children and their teachers and  
intensive parental education will go a long way in reduc-  
ing ocular injuries and vision loss in children.  
Authors’ contribution  
BOT: Conception and design of study  
AAD: Data analysis  
AOA: Data collection  
Conflict of interest: None  
Funding: None  
Rooper Hall MJ. Prevention of  
blindness from trauma. Trans  
Ophthalmol 1978; 314-8.  
Programme for the Prevention of  
Blindness and Deafness, World  
Health Organization (WHO).  
7. Hamid H, Masoumeh M, Fatemeh  
12. Glynn R, Seddon J, Berlin B. The  
incidence of eye injuries in New  
England adults. Arch Ophthalmol  
1988; 106:785-9  
13. Thompson C, Kumar N, Bilson  
FA, Martin F. The aetiology of  
penetrating ocular injury in chil-  
dren. Br J Ophthalmol  
K, Reza MR, Ramin S,  
Mohammad HN.Clinical and Epi-  
demiologic Characteristic of se-  
vere Childhood ocular injuries in  
Southern Iran. Middle East Afr J  
Ophthalmol 2011;18(2): 136–140.  
8. Dasgupta S, Mukherjee R, Ladi  
DS, Gandhi VH, Ladi BS. Pediat-  
ric ocular trauma--a clinical pres-  
entation. J Postgrad Med  
(Online) 2010 (Cited 2005 May)  
Available from URL:http://www  
Tariq FB, Sanaullah J, Loreena G,  
Muhammad T, Muhammad YK,et  
al. Pattern of paediatric Ocular  
trauma in Hayatabad Medical  
Complex, Peshawar. Pak J Res  
14. Koval R, Teller J, Belkin M,  
Romem M,Yanko L, Savir H et al.  
The Israeli ocular injuries study. A  
nationwide collaborative study.  
Arch Ophthalmol 1988;106:776-  
15. Ching-Hsing L, Wan-Ya S, Lan  
L,Meng-Ling Y. Paediatric Ocular  
Trauma in Taiwan. Gung Med J  
9. Juan CS, Patricia C, Juan DA.  
Epidemiology of Childhood Ocu-  
lar trauma in Northeastern Colom-  
bia region. Arch Ophthalmol  
10. Sameen AJ, Munawar A, Mehtab  
A. Endophthalmitis in paediatric  
penetrating ocular injuries in Hy-  
derabad. JPMA 2010; 60:532  
11. Onakpoya OH, Adeoye  
AO.Childhood eye diseases in  
Southwest Nigeria: a tertiary hos-  
pital study. Clinics 2009;64  
006;45(1): 6-9  
Umeh RE, Umeh OC. Causes and  
visual outcome of childhood eye  
injuries in Nigeria. Eye  
Sadia B, Mahar PS, Umair Q,  
Israv AB, Abdul SM. Ocular  
trauma in children. Pak J Ophthal-  
mol 2011; 27(4):208-213  
MacEwen CJ, Braines PS, Desai  
P.Eye injuries in children: The  
current picture. Br J Ophthalmol  
16. AdegbehingbeBO, Ajite F. Corpo-  
ral punishment-related ocular inju-  
ries in Nigerian Children. J Indian  
Assoc Pediatr Surg 2007;12:76-9