Abstract
AIM
To complete the data of ocular trauma in central China, as a well-known tertiary referral center for ocular trauma, we documented the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in this region.
METHODS
A retrospective study of patients hospitalized for ocular trauma in central China from 2006 to 2011 was performed.
RESULTS
This study included 5964 eyes of 5799 patients. The average age was 35.5±21.8y with a male-to-female ratio of 2.8:1. The most common age was 45-59y age group. Most patients were farmers and workers (51.9%). The most common injuries were firework related (24.5%), road traffic related (24.2%), and work related (15.0%). Among the most common causative agents were firecrackers (24.5%), followed by metal/knife/scissors (21.4%). Most injuries occurred in January (14.2%), February (27.0%), and August (10.0%). There were 8.5% patients with ocular injuries combined with other injuries. The incidence of open ocular injuries (4585 eyes, 76.9%) was higher than closed ocular injuries (939 eyes, 15.7%). The incidences of chemical and thermal ocular injuries were 1.2% and 0.6%. Ocular trauma score (OTS) predicted final visual acuity at non light perception (NLP), 20/200-20/50 and 20/40 with a sensitivity of 100%, and light perception (LP)/hand motion (HM) and 1/200-19/200 with a specificity of 100%.
CONCLUSIONS
This study provides recent epidemiological data of patients hospitalized for ocular trauma in central China. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.
Keywords: ocular trauma score, ocular trauma, visual acuity
INTRODUCTION
Ocular trauma is a common cause of visual morbidity. It causes extreme psychological and emotional stress to victims, as well as an economic burden to society. Worldwide, every year there are approximately 1.6 million people blinded from ocular injuries, and approximately 2.3 million people with bilateral low vision resulting from eye injuries [1]. In the United States, there are approximately 2.5 million cases of eye trauma every year, resulting in approximately 50 000 people that lose partial or full vision [2]. In addition, the rates at which eye injuries require hospitalization are in the range of 4.9-89 per 10 million in developing countries[3]–[7].
Although ocular trauma data have been reported for the United States [8], Ireland [4], Greece [9], Singapore[10], and Korea[11], complete ocular trauma data for China have still not been obtained. China is the world's most populous country, so it is difficult to obtain complete data, although some regions have already reported results. Wang et al[12] listed the characteristics of ocular traumas in northern China, and Cao et al[13] reported the epidemiology of ocular injuries in southern China. Our hospital in central China is a well-known tertiary referral center for ocular trauma, so ocular trauma patients are transferred to our hospital, making our data representative of ocular trauma in our region.
SUBJECTS AND METHODS
Subjects
All reported cases were from the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, from January 2006 to December 2011. Our department is a well-known ocular trauma center in China that offers specialized care for patients of all ages with specific and complicated ocular or orbital diseases and conditions. It houses a 24h ophthalmic emergency department to treat minor and major ocular injuries. When trauma patients in central China are hospitalized for further treatment, they are usually transferred to our center. This provides the opportunity to obtain comprehensive data on the characteristics and visual outcomes of patients hospitalized for ocular trauma in central China.
Our study adhered to the tenets of the Declaration of Helsinki. All medical records were anonymous, and all information was used only for research purposes. Informed written or oral consent was given by the patients and the next of kin. Informed written or oral consent was also given by caregivers or guardians on behalf of minors who were involved in the study. The procedures were approved by the Ethics Committee of the Medical College, the First Affiliated Hospital of Zhengzhou University.
Methods
Ocular trauma was defined as any injury affecting the eye or adnexa that required hospital admission and had a principal or secondary discharge diagnosis from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Records of all patients were classified by the standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology, BETT)[14], which divided ocular injuries into those involving blunt force, resulting in contusion (closed globe injury) or rupture (open globe injury), and those involving sharp force, resulting in lamellar laceration (closed globe injury) or penetrating, perforating, and intraocular foreign body laceration (open globe injury). Wound location was defined by the Ocular Trauma Classification Group. Zone I injuries were confined to the cornea, zone II injuries confined to the anterior 5 mm of the sclera and zone III injuries involved more posterior than 5 mm from the limbus[15].
Patients' data included age, gender, occupational categories, place of residence, date and cause of injury, initial and final best corrected visual acuity, anatomical site, location and nature of injury, clinical diagnosis, and primary and secondary treatment and follow-up. The patients were classified into five age groups (0-14, 15-29, 30-44, 45-59, and 60 plus years) based on the criteria used in the China Injury Surveillance System and the National Statistical Yearbook. The data were classified into 10 groups based on the places where eye injuries occurred: work-related injuries, home-related injuries, school-related injuries, sport-related injuries, road traffic-related injuries, violence-related injuries, animal-related injuries, chemical injuries, firework-related injuries, and other various injuries. The initial visual acuity was the best corrected Snellen visual acuity in the affected eye at the time of presentation. The final visual acuity was measured at the last follow-up (the least duration of follow-up was 1 year).
The OTS was developed by Kuhn et al[16] in 2002 which was based on the eye injury registry databases of the United States and Hungary. The OTS is a simplified categorical system for standardized assessment and visual prognosis associated with ocular injuries. Certain numerical values classified as OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, and afferent pupillary defect) at presentation were summarized and classified as OTS categories (Table 1). The likelihood of final visual acuities (NLP, LP/HM, 1/200-19/200, 20/200-20/50, and ≥20/40) in the OTS categories (1 to 5) was calculated. The sensitivity and specificity of OTS were then calculated.
Table 1. Ocular trauma score.
| Variables | Raw points |
| Initial vision | |
| NLP | 60 |
| LP/HM | 70 |
| 1/200-19/200 | 80 |
| 20/200-20/50 | 90 |
| <20/40 | 100 |
| Rupture | -23 |
| Endophthalmitis | -17 |
| Perforating or penetrating injury | -14 |
| Retinal detachment | -11 |
| Afferent pupillary defect | -10 |
NLP: Non light perception; LP: Light perception; HM: Hand motion.
Statistical Analysis
Data were analyzed with SPSS software, version 18.0 (SPSS, Inc., Chicago, IL, USA). Frequency distributions were calculated for injury types and causes. Statistical analyses of the quantitative data, including descriptive statistics and parametric and nonparametric comparisons were performed for all variables. Frequency analyses were performed using the Pearson's Chi-square test. A one-way analysis of variance (ANOVA) was used to evaluate differences in parametric variables. Categorical evaluations were performed for the numeric scores representing the likelihood of the final visual acuity in the OTS study. Correlation analyses were performed using the Spearman's test. All P values in our study were two-sided, and a value of less than 0.05 was considered statistically significant.
RESULTS
This study occurred from January 2006 to December 2011, and included 5964 eyes of 5799 patients who were admitted to our hospital with eye trauma (958 cases in 2006, 925 cases in 2007, 941 cases in 2008, 975 cases in 2009, 1003 cases in 2010, and 997 cases in 2011). Patients' ages ranged from 2mo to 86y with a mean age and standard deviation of 35.5±21.8y. Within this patient population, 4285 were male (73.9%) and 1514 were female (26.1%) (P=0.01, Pearson's Chi-square test). The ratio of male to female was 2.8:1. The mean ages were 31.4±12.7y for male patients and 37.2±9.3y for female patients (P=0.02, t test). The most common ages of patients were 45-59y (26.2%), 30-44y (23.7%), and 0-14y (20.2%). The common ages for male patients were 30-59y (52.9%) and 0-14y (27.6%) for female patients. Patients under 2y of age involved 317 eyes (5.3%). Right eye injuries involved 2894 cases, left eye injuries involved 2740 cases, and bilateral eye injuries involved 165 cases. There was no significant difference between the frequencies of with respect to laterality. Most patients in our study were farmers and workers (51.9%), while students accounted for 18.3%.
Urban residents accounted for 28.6%, and rural residents accounted for 71.4% of the patient population. The total hospitalization time, including other departments such as surgical neurology, orthopedics, and neurology, was in the range of 1-193d. The average hospitalization time in the Ophthalmology Department was 10.8d (1-27d).
The most frequent injuries among all cases were firework related (24.5%), road traffic related (24.2%), and work related (15.0%). For male patients, the most common injuries were firework related (24.6%), road traffic related (24.4%), work related (14.8%), and sport related (10.2%). For female patients, the common injuries were firework related (24.4%), road traffic related (23.7%), work related (15.3%), and home related (10.1%). The results were similar with respect to injury type between genders (P=0.001; Pearson's Chi-square test).
The most common injury types for male and female patients in different age groups were shown in Figure 1.
Figure 1. Frequency of types of eye injuries by age and gender.
Injuries caused by electric bicycles accounted for 15.1% of all cases. Injuries caused by animals accounted for 2.9% of cases.
There were numerous types of causative agents (Table 2). The most common causative agent was the firecracker (24.5%), followed by metal/knife/scissors (21.4%). Most of the chemical trauma were caused by alkalis (44 eyes, 63.8%), lime (10 eyes, 14.5%), acids (9 eyes, 13.0%) and others (6 eyes, 8.7%).
Table 2. Types of causative agents.
| Types of causative agents | Male | Female | Total | Percentage (%) |
| Fire cracker | 1053 | 369 | 1422 | 24.5 |
| Metal/knife/scissor | 984 | 256 | 1240 | 21.4 |
| Electric bicycle | 682 | 195 | 877 | 15.1 |
| Steel/iron | 356 | 277 | 633 | 10.9 |
| Motor | 364 | 164 | 528 | 9.1 |
| Stick | 304 | 57 | 361 | 6.2 |
| Fist | 154 | 35 | 189 | 3.3 |
| Stone | 129 | 56 | 185 | 3.2 |
| Animal | 144 | 26 | 170 | 2.9 |
| Chemical injury | 49 | 20 | 69 | 1.2 |
| Thermal injury | 9 | 25 | 34 | 0.6 |
| Gun bullet | 12 | 14 | 26 | 0.4 |
| Others | 45 | 20 | 65 | 1.1 |
The time interval between injury and visit to the clinic was 6h (20.9%), 6-12h (42.4%), 12-24h (20.3%), and greater than 1d (16.4%; Table 3). There was a significant difference in the final visual acuity between patients who arrived in the hospital within 24h and those who arrived over 24h after an injury (P<0.01; Pearson's Chi-square test).
Table 3. Time interval between the injuries to the visit to the clinics.
| Time interval | Cases | Percentage (%) |
| <6h | 1213 | 20.9 |
| 6-12h | 2458 | 42.4 |
| 12-24h | 1177 | 20.3 |
| >1d | 951 | 16.4 |
Most of the injuries occurred in January (14.2%), February (27.0%), and August (10.0%). The common injury types occurring in January were road traffic related (44.1%), work related (14.9%), and home related (12.5%). The most common injury types occurring in February were firework related (77.8%). The firework-related injuries in February accounted for 12.5% of all firework-related injuries.
There were 91.5% patients with a single ocular injury, and 8.5% patients with combined injuries involving injuries outside the eye. The injuries outside the eye included head and facial trauma (84.3%; brain damage, skull fractures, and nasal injuries), limb injuries (18.7%; bone fractures and soft tissue damage), abdominal injuries (8.3%), and chest injuries (6.3%). The sum was over 100%, because some patients had compound injuries. For patients with injuries outside the eye, the most common injuries were caused by car accidents (82.9%), violence (11.3%), and fireworks (2.2%).
The incidence of open ocular injuries (4585 eyes, 76.9%) was higher than closed ocular injuries (939 eyes, 15.7%; Table 4). There were 1477 cases complicated with accessory injuries (11.5%). The clinical manifestation in open ocular injuries included traumatic cataract (25.0%), endophthalmitis (16.8%), intraocular foreign bodies (16.6%), retinal detachment (15.0%), vitreous hemorrhage (8.0%), lens luxation (7.7%), and secondary glaucoma (6.0%; Table 5). Hyphema was noticed in 50 eyes in closed injury. Of these cases, the most common complication were iridodialysis (124 eyes, 13.2%), cataract (92 eyes, 9.9%) and glaucoma (48 eyes, 5.2%).
Table 4. Clinical manifestation of hospitalized for ocular trauma (1st January, 2006- 31st December, 2011).
| Clinical manifestation | Eyes | Percentage (%) |
| Open ocular injury | ||
| Penetrating injury / perforating injury | 2368 | 39.7 |
| Rupture | 1458 | 24.4 |
| Intraocular foreign body | 759 | 12.7 |
| Closed ocular injury | ||
| Lamellar laceration | 45 | 0.8 |
| Contusion | 894 | 15.0 |
| Chemical injury | 69 | 1.2 |
| Thermal injury | 34 | 0.6 |
| Accessory injury | ||
| Orbital fracture | 315 | 5.3 |
| Lacrimal laceration | 478 | 8.0 |
| Eyelid laceration | 684 | 11.5 |
| Others | 35 | 0.6 |
Table 5. The clinical manifestation of open ocular injuries.
| Clinical manifestation | Eyes | Percentage (%) |
| Traumatic cataract | 1145 | 25.0 |
| Lens luxation | 354 | 7.7 |
| Secondary glaucoma | 275 | 6.0 |
| Endophthalmitis | 768 | 16.8 |
| Vitreous hemorrhage | 365 | 8.0 |
| Retinal detachment | 687 | 15.0 |
| Intraocular foreign body | 759 | 16.6 |
| Others | 584 | 12.7 |
Due to a patient will have a variety of clinical manifestations, the percentage of the total number will exceed 100%.
The results of wound location involved zone I injuries (3556 eyes, 77.6%), zone II injuries (984 eyes, 21.5%), and zone III injuries (45 eyes, 1.0%). In zone III open globe injuries, there was a worse visual prognosis than that of injuries in zone I and zone II (P<0.01, ANOVA test).
There were 946 cases (15.9%) treated by conservative medical treatment. Surgeries were performed on 5018 eyes. The most common surgeries were debridement and suture (4556 eyes, 76.4%), posterior vitrectomy (1957 eyes, 33.1%), and lens extraction (1523 eyes, 25.5%). The percentage of enucleation was 4.1% (Table 6). The surgical intervention for chemical trauma was performed in 60 eyes (87.0%) in the form of amniotic membrane (46 eyes, 76.7%), symblepharon release (11 eyes, 18.3%), lamellar keratoplasty (7 eyes, 11.7%).
Table 6. Management reports from initial presentation to final follow up in eye injury cases.
| Treatment | Cases | Percentage (%) |
| Medical conservative treatment | 946 | 15.9 |
| Debridement and suture | 4556 | 76.4 |
| Lens extraction | 1523 | 25.5 |
| Posterior vitrectomy | 1975 | 33.1 |
| Anterior irrigation | 125 | 2.1 |
| Enucleation | 246 | 4.1 |
| Antiglaucoma surgery | 358 | 6.0 |
| Lacrimal apparatus repair | 564 | 9.5 |
| Orbital fracture repair | 24 | 0.4 |
| Others | 648 | 10.9 |
Due to a variety of patients have combined surgery, there will be two or more surgical treatment options. Percentage is more than 100%.
Initial visual acuities were ≥20/40 in 214 eyes (3.6%), 20/200-20/50 in 456 eyes (7.6%), and NLP in 786 eyes (13.2%). Final visual acuities were ≥20/40 in 421 eyes (7.1%), 20/200-20/50 in 548 eyes (9.2%), and NLP in 510 eyes (8.6%) (Table 7). In cases with hyphema, the visual acuity was 0.62±0.37 (range, NLP to 20/20). The initial visual acuity was correlated with final visual acuity (Spearman's correlation coefficient = 0.68, P<0.001).
Table 7. The initial and final visual acuity.
| Visual acuity | Initial visual acuity |
Final visual acuity (last follow-up) |
||
| Frequencies | Percentage (%) | Frequencies | Percentage (%) | |
| NLP | 786 | 13.2 | 510 | 8.6 |
| LP/HM | 2368 | 39.7 | 1803 | 30.2 |
| 1/200-19/200 | 1689 | 28.3 | 1998 | 33.5 |
| 20/200-20/50 | 456 | 7.6 | 548 | 9.2 |
| ≥20/40 | 214 | 3.6 | 421 | 7.1 |
| Others1 | 451 | 7.6 | 684 | 11.5 |
1Others: No vision because the vision can not be tested due to the young age.
Open globe injuries and closed ocular injuries had different prognoses (P <0.001, Pearson's Chi-square test). In the last follow-up, visual acuity at NLP was 8.0% in open globe injuries and 0.3% in closed ocular injuries. The final visual acuity at LP/HM was 24.5% in open globe injuries and 5.3% in closed ocular injuries. The final visual acuity at ≥20/40 was 5.7% in open globe injuries and 0.5% in closed ocular injuries. The closed ocular injuries had better final vision than Open globe injuries.
OTS was correlated with final visual acuity as shown in Table 8. The patients with higher scores in higher grades had better vision. Predictive vision was shown in Table 9, showing that OTS predicts NLP, 20/200-20/50 and ≥20/40 with a sensitivity of 100%, and predicts LP/HM and 1/200-19/200 at a specificity of 100%.
Table 8. Correlation of the final visual acuity category with the OTS in 5280 eyes.
| OTS | Final visual acuity category |
||||
| NLP | LP/HM | 1/200-19/200 | 20/200-20/50 | ≥20/40 | |
| 0-44 | 256 | 172 | 34 | 14 | 5 |
| 45-65 | 220 | 1245 | 510 | 230 | 55 |
| 66-80 | 31 | 357 | 1025 | 224 | 145 |
| 81-91 | 3 | 15 | 415 | 78 | 182 |
| 92-100 | 0 | 14 | 14 | 2 | 34 |
OTS: Ocular trauma score; Spearman's correlation coefficient= 0.67, P<0.01.
Table 9. Comparison of predictive vision based on OTS and corrected vision at the last follow up.
| Grade of vision | Corrected vision at the last follow up (eyes) | Predictive vision based on OTS ( eyes) | Sensitivity (%) | Specificity (%) |
| NLP | 510 | 1009 | 100 | 89.5 |
| LP/HM | 1803 | 870 | 48.3 | 100 |
| 1/200 to 19/200 | 1998 | 729 | 36.5 | 100 |
| 20/200 to 20/50 | 548 | 1061 | 100 | 89.2 |
| ≥20/40 | 421 | 1640 | 100 | 74.9 |
OTS: Ocular trauma score; NLP: Non light perception; LP: Light perception; HM: Hand motion.
DISCUSSION
Our study involved a large sampling that included the medical records of approximately 6000 cases of ocular trauma from 2006 to 2011. In each age group, there were more male patients than female patients. The most common patients were male patients aged 30-59y, who were usually the worker in the family, thus, ocular trauma could cause significant economic and psychological burdens.
Patients aged younger than 2y comprised 317 eyes (5.3%). Although this is not a high number, ocular trauma in children could compromise their visual acuity, character development, and career choices, which could affect their remaining lives. To avoid pediatric ocular trauma, more attention should be addressed to the following: 1) when children light or watch fireworks, parents or guardians should protect them from danger, and large fireworks should never be lit by children; 2) schools should try to avoid potential injuries from stationery (pen, pencil, knife, or scissors), school tables, or desks, and from extracurricular activities such as physical exercise, and 3) because pediatric ocular trauma resulting from traffic accidents was frequent, greater precautions including the use of child safety seats should be practiced to avoid ocular harm involving vehicles.
Our data show that firework-related injuries are serious health and social problems as well as other reports[17]–[19]. Some ocular traumas are partially seasonal, with ocular trauma in January and February accounting for 14.2% and 27.0% of all injuries, respectively, which was higher than other months. There are many celebrations in January and February, such as the Solar New Year and the Lunar New Year, and 77.8% of ocular traumas in February involved fireworks, while firework-related injuries in February accounted for 97.5% of all firework-related injuries. Consistent with another report[16], fireworks are therefore the most common cause of ocular traumas. The Chinese government has regulated the place and time of lighting fireworks, but the rate of ocular injuries caused by fireworks is still high for the following possible reasons. First, in China, there are regulations that allow children under 14y of age to light firecrackers without guardians. Many kids are hurt by fireworks because they do not know how to protect themselves. Second, sometimes the eyes of elderly people were injured because they could not see the lighter clearly or they could not leave quickly after lighting a firecracker. Third, although the maximal firecracker weight is limited to 50 g, similar restrictions on the type of pneumatic tool or detonator are not made. Finally, some patients were injured by homemade firecrackers, which are usually loaded with powerful explosives.
The other most prevalent cause of ocular trauma was vehicle-related injury, almost a quarter of eye injuries. In our region, there are 9 national highways and more than 20 regional local highways and total mileage of expressways ranks first in China. Most of the road traffic-related injuries occurred in January and August. The main reason for the high rate of road traffic-related injuries was bad weather (e.g. rain, snow, and frost). There are poor traffic conditions during this month, and people more frequently also go outside to celebrate. The high rate in August was associated with high temperatures when many people are outside.
Compared with mechanical eye injuries, road traffic-related injuries are more serious[20]–[22]. Our data suggest that when treating ocular trauma patients, it is important to examine the patients carefully to identify other possible injuries outside the eye. When questioning the patient, it is therefore important to inquire about conscious conditions, head problems, and chest pain or limb movement. When patients have other serious injuries that endanger their life, the most dangerous conditions such as stroke, cerebral injuries, or airway problems should be treated first.
The incidence of open globe injuries in our area is higher than in other areas [5],[13]. This result differed from the reports from Nigeria[23] and New Zealand [24] Compared with other reports, the rates of serious lens, endophthalmitis and retinal problems were higher in this region. It is possible that some of the more serious patients were transferred to our hospital.
Hyphema also was an important issue which caused visual decrease. The association of hyphema with the final vision was not noticed in our study as other reference[25]. The lack of detailed medical records in hyphema was the main reason which should be improved in the future study.
The chemical injury is emergenct. Most of the cases accepted more than one surgery. So the sum of percentage of operation is beyond 100%. This was different form other reports[26],[27].
OTS was used to evaluate final visual outcome. OTS has good predictive ability in predicting the visual outcome of pediatric penetrating injuries, open globe injuries, and weapons-related injuries [28]–[32]. Our data showed that the sensitivity of OTS predicting vision at NLP, 20/200-20/50, and ≥ 20/40 was 100%. The specificity of OTS in predicting vision at LP/HM, 1/200-19/200 was 100%.
Based upon our data, five factors are important in the prognosis of visual outcomes: 1) there was a significant difference in the final visual acuity between the patients who arrived in the hospital within 24h and those who arrived 24h after the injury; 2) zone III open globe injuries had a worse visual prognosis than zone I and zone II injuries; 3) initial visual acuity correlated with final visual acuity; 4) open globe injuries and closed ocular injuries had different prognoses; and 5) patients with a higher score and higher grade in OTS had better vision.
There were several limitations of our study. A long-term follow-up system and a national eye injury surveillance system were not yet established. In addition, the prevalence or incidence of ocular trauma could not be calculated.
Despite these limitations, this study remains one of the large sample size studies to reveal the clinical characteristics of patients hospitalized for ocular trauma. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.
Acknowledgments
The authors thank the Medical Records Center and the Computer Center of the First Affiliated Hospital of Zhengzhou University for providing the medical records of the hospitalized patients.
Foundations: Supported by National Key Basic Research Program of China (973 Program, No.2013CB967001); National Natural Science Foundation of China (No.31271400); Medical Science and Technology Research Project of Henan Province, China (No.201203021); 2014 Annual Science and Technology Key Project of Education Department of Henan Province (No.14A320085); the Team Construction and Innovative Research of the First Affiliated Hospital of Zhengzhou University of 2011; Youth Innovation Foundation of the First Affiliated Hospital of Zhengzhou University of 2011.
Conflicts of Interest: Qi Y, None; Zhang FY, None; Peng GH, None; Zhu Y, None; Wan GM, None; Wang WZ, None; Ma J, None; Ren SJ, None.
REFERENCES
- 1.Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol. 1998;5(3):143–169. doi: 10.1076/opep.5.3.143.8364. [DOI] [PubMed] [Google Scholar]
- 2.May DR, Kuhn FP, Morris RE, Witherspoon CD, Danis RP, Matthews GP, Mann L. The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp Ophthalmol. 2000;238(2):153–157. doi: 10.1007/pl00007884. [DOI] [PubMed] [Google Scholar]
- 3.Raymond S, Jenkins M, Favilla I, Rajeswaran D. Hospital-admitted eye injury in Victoria, Australia. Clin Experiment Ophthalmol. 2010;38(6):566–571. doi: 10.1111/j.1442-9071.2010.02296.x. [DOI] [PubMed] [Google Scholar]
- 4.Saeed A, Khan I, Dunne O, Stack J, Beatty S. Ocular injury requiring hospitalisation in the south east of Ireland: 2001-2007. Injury. 2010;41(1):86–91. doi: 10.1016/j.injury.2009.01.118. [DOI] [PubMed] [Google Scholar]
- 5.Cillino S, Casuccio A, Di Pace F, Pillitteri F, Cillino G. A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area. BMC Ophthalmol. 2008;8:6. doi: 10.1186/1471-2415-8-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Bhogal G, Tomlins PJ, Murray PI. Penetrating ocular injuries in the home. J Public Health (Oxf) 2007;29(1):72–74. doi: 10.1093/pubmed/fdl074. [DOI] [PubMed] [Google Scholar]
- 7.Smith AR, O'Hagan SB, Gole GA. Epidemiology of open- and closed-globe trauma presenting to Cairns Base Hospital, Queensland. Clin Experiment Ophthalmol. 2006;34(3):252–259. doi: 10.1111/j.1442-9071.2006.01200.x. [DOI] [PubMed] [Google Scholar]
- 8.McGwin G, Jr, Hall TA, Xie A, Owsley C. Trends in eye injury in the United States, 1992-2001. Invest Ophthalmol Vis Sci. 2006;47(2):521–527. doi: 10.1167/iovs.05-0909. [DOI] [PubMed] [Google Scholar]
- 9.Mela EK, Dvorak GJ, Mantzouranis GA, Giakoumis AP, Blatsios G, Andrikopoulos GK, Gartaganis SP. Ocular trauma in a Greek population: review of 899 cases resulting in hospitalization. Ophthalmic Epidemiol. 2005;12(3):185–190. doi: 10.1080/09286580590964801. [DOI] [PubMed] [Google Scholar]
- 10.Loon SC, Tay WT, Saw SM, Wang JJ, Wong TY. Prevalence and risk factors of ocular trauma in an urban south-east Asian population: the Singapore Malay Eye Study. Clin Experiment Ophthalmol. 2009;37(4):362–367. doi: 10.1111/j.1442-9071.2009.02035.x. [DOI] [PubMed] [Google Scholar]
- 11.Han SB, Yu HG. Visual outcome after open globe injury and its predictive factors in Korea. J Trauma. 2010;69(5):E66–72. doi: 10.1097/TA.0b013e3181cc8461. [DOI] [PubMed] [Google Scholar]
- 12.Wang JD, Xu L, Wang YX, You QS, Zhang JS, Jonas JB. Prevalence and incidence of ocular trauma in North China: the Beijing Eye Study. Acta Ophthalmol. 2012;90(1):e61–67. doi: 10.1111/j.1755-3768.2011.02230.x. [DOI] [PubMed] [Google Scholar]
- 13.Cao H, Li L, Zhang M. Epidemiology of patients hospitalized for ocular trauma in the chaoshan region of China, 2001-2010. PLoS One. 2012;7(10):e48377. doi: 10.1371/journal.pone.0048377. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham Eye Trauma Terminology system (BETT) J Fr Ophtalmol. 2004;27(2):206–210. doi: 10.1016/s0181-5512(04)96122-0. [DOI] [PubMed] [Google Scholar]
- 15.Pieramici DJ, Sternberg P, Jr, Aaberg TM, Sr, Bridges WZ, Jr, Capone A, Jr, Cardillo JA, de Juan E, Jr, Kuhn F, Meredith TA, Mieler WF, Olsen TW, Rubsamen P, Stout T. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group. Am J Ophthalmol. 1997;123(6):820–831. doi: 10.1016/s0002-9394(14)71132-8. [DOI] [PubMed] [Google Scholar]
- 16.Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The Ocular Trauma Score (OTS) Ophthalmol Clin North Am. 2002;15163(2):165, vi. doi: 10.1016/s0896-1549(02)00007-x. [DOI] [PubMed] [Google Scholar]
- 17.Malik A, Bhala S, Arya SK, Sood S, Narang S. Five-year study of ocular injuries due to fireworks in India. Int Ophthalmol. 2013;33(4):381–385. doi: 10.1007/s10792-013-9714-x. [DOI] [PubMed] [Google Scholar]
- 18.Rashid RA, Heidary F, Hussein A, Hitam WH, Rashid RA, Ghani ZA, Omar NA, Mustari Z, Shatriah I. Ocular burns and related injuries due to fireworks during the Aidil Fitri celebration on the East Coast of the Peninsular Malaysia. Burns. 2011;37(1):170–173. doi: 10.1016/j.burns.2010.05.019. [DOI] [PubMed] [Google Scholar]
- 19.Wisse RP, Bijlsma WR, Stilma JS. Ocular firework trauma: a systematic review on incidence, severity, outcome and prevention. Br J Ophthalmol. 2009;94(12):1586–1591. doi: 10.1136/bjo.2009.168419. [DOI] [PubMed] [Google Scholar]
- 20.Parkinson F, Kent SJ, Aldous C, Oosthuizen G, Clarke D. The hospital cost of road traffic accidents at a South African regional trauma centre: A micro-costing study. Injury. 2014;45(1):342–345. doi: 10.1016/j.injury.2013.04.007. [DOI] [PubMed] [Google Scholar]
- 21.Haghparast-Bidgoli H, Saadat S, Bogg L, Yarmohammadian MH, Hasselberg M. Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran. BMC Health Serv Res. 2013;13:281. doi: 10.1186/1472-6963-13-281. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Chen H, Du W, Li N, Chen G, Zheng X. The socioeconomic inequality in traffic-related disability among Chinese adults: the application of concentration index. Accid Anal Prev. 2013;55:101–106. doi: 10.1016/j.aap.2013.02.025. [DOI] [PubMed] [Google Scholar]
- 23.Ojabo CO, Adeniyi OS, Ogli SA. Farm-related ocular trauma in Makurdi, Nigeria. Niger J Med. 2011;20(1):114–119. [PubMed] [Google Scholar]
- 24.Pandita A, Merriman M. Ocular trauma epidemiology: 10-year retrospective study. N Z Med J. 2012;125(1348):61–69. [PubMed] [Google Scholar]
- 25.Türkcü FM, Yüksel H, Sahin A, Cingü K, Arı S, Cınar Y, Sahin M, Yıldırım A, Caça I. Demographic and etiologic characteristics of children with traumatic serious hyphema. Ulus Travma Acil Cerrahi Derg. 2013;19(4):357–362. doi: 10.5505/tjtes.2013.99810. [DOI] [PubMed] [Google Scholar]
- 26.Vajpayee RB, Shekhar H, Sharma N, Jhanji V. Demographic and clinical profile of ocular chemical injuries in the pediatric age group. Ophthalmology. 2014;121(1):377–380. doi: 10.1016/j.ophtha.2013.06.044. [DOI] [PubMed] [Google Scholar]
- 27.Radosavljević A, Kalezić T, Golubović S. The frequency of chemical injuries of the eye in a tertiary referral centre. Srp Arh Celok Lek. 2013;141(9-10):592–596. doi: 10.2298/sarh1310592r. [DOI] [PubMed] [Google Scholar]
- 28.Schörkhuber MM, Wackernagel W, Riedl R, Schneider MR, Wedrich A. Ocular trauma scores in paediatric open globe injuries. Br J Ophthalmol. 2013;98(5):664–668. doi: 10.1136/bjophthalmol-2013-304469. [DOI] [PubMed] [Google Scholar]
- 29.Agrawal R, Wei HS, Teoh S. Prognostic factors for open globe injuries and correlation of ocular trauma score at a tertiary referral eye care centre in Singapore. Indian J Ophthalmol. 2013;61(9):502–506. doi: 10.4103/0301-4738.119436. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Acar U, Tok OY, Acar DE, Burcu A, Ornek F. A new ocular trauma score in pediatric penetrating eye injuries. Eye (Lond) 25(3):370–374. doi: 10.1038/eye.2010.211. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Unver YB, Kapran Z, Acar N, Altan T. Ocular trauma score in open-globe injuries. J Trauma. 2009;66(4):1030–1032. doi: 10.1097/TA.0b013e3181883d83. [DOI] [PubMed] [Google Scholar]
- 32.Sobaci G, Akin T, Erdem U, Uysal Y, Karagül S. Ocular trauma score in deadly weapon-related open-globe injuries. Am J Ophthalmol. 2006;141(1):760–761. doi: 10.1016/j.ajo.2005.11.002. [DOI] [PubMed] [Google Scholar]