Abstract
Background:
Ocular injuries, especially corneal foreign bodies (CFBs), are common among blue-collar professionals in India due to the insufficient use of protective eye equipment. This study aimed to the investigate the incidence and causes of suboptimal Eye Protective Device (EPD) usage.
Methods:
A cross-sectional study was conducted at a tertiary hospital from January to June 2024, including 102 patients with occupational CFBs. A structured questionnaire assessed demographics, occupational exposure, EPD usage, and awareness levels.
Results:
The mean age was 37.97 years. Welding (38.23%) and metal grinding (31.37%) were the leading causes of injury. Only 27.45% regularly used EPDs, 17.64% used them occasionally, and 54.90% never used them. Reasons for non-usage included lack of regulations (60.78%), unawareness (17.64%), and financial constraints (15.68%). Notably, 35.29% had previously attempted foreign body removal themselves. Despite 80.39% being aware of EPDs, usage remained low.
Conclusion:
There is a significant gap between awareness and practice regarding EPD usage. Enforcement of workplace safety laws and provision of affordable EPDs are essential to prevent CFBs and related complications.
KEYWORDS: Corneal foreign body, eye protective devices, occupational injury, blue-collar workers, ocular trauma
INTRODUCTION
Corneal foreign bodies (CFBs) represent one of the most common ocular emergencies in India, especially among labor-intensive workers. These injuries, if neglected, can lead to irreversible corneal scarring, vision loss, or severe infections like keratitis and endophthalmitis.[1,2] Despite being preventable using eye protective devices (EPDs), a significant number of blue-collar workers continue to operate in hazardous environments without adequate eye protection.[3]
The incidence of work-related eye injuries remains underreported, with limited emphasis on safety training, regulation, and enforcement among informal labor sectors. While various global initiatives advocate for occupational safety, India still faces substantial challenges in implementation and compliance, particularly among low-income and low-literacy groups.[4,5]
MATERIALS AND METHODS
This hospital-based cross-sectional study was conducted over a 6-month period from January to June 2024 at a tertiary care center. A total of 102 patients presenting with CFBs due to occupational exposure were enrolled based on the specific inclusion and exclusion criteria. Patients aged over 18 years, of either sex, who sustained CFB injuries and were able to comprehend and respond to a structured questionnaire were included. Those with non-occupational corneal injuries or cognitive impairments were excluded. Data were collected using a pre-validated structured questionnaire that captured demographic details such as age, gender, occupation, educational status, and living conditions, along with information on the type of activity being performed at the time of injury, frequency of EPD use, and reasons for non-usage. Each patient underwent a thorough ophthalmic examination using slit-lamp biomicroscope to assess the type, location, and depth of the foreign body, and to document associated complications such as rust rings, epithelial defects, or stromal scars. Removal of foreign bodies was performed under topical anesthesia using a sterile 26-gauge needle, followed by prescription of topical antibiotics for infection prophylaxis.
RESULTS
Distribution by activity at time of injury
Most of the corneal foreign body (CFB) cases were associated with high-risk manual tasks. Welding emerged as the leading activity during which injuries occurred, accounting for 38.23% of cases (39 patients). This was followed closely by metal grinding, involved in 31.37% of injuries (32 patients). Cement-related work accounted for 17.64% (18 patients), and wood cutting was the cause in 12.74% (13 patients) [Graph 1].
Graph 1.
Distribution by activity at time of injury
Distribution by business sector
When stratified by business sector, the construction industry had the highest representation, with 35.29% (36 patients). This was followed by metalwork at 30.39% (31 patients), electricians at 23.52% (24 patients), and carpenters at 10.78% (11 patients) [Graph 2].
Graph 2.
Distribution by business sector
Usage of Eye Protective Devices (EPDs)
Despite the availability of eye protective devices, regular usage was reported by only 27.45% (28 patients), while 17.64% (18 patients) admitted to using them occasionally. Alarmingly, more than half the study population—54.90% (56 patients)—reported never using EPDs at work [Graph 3 and Figure 1].
Graph 3.
Usage of Eye Protective Devices (EPDs)
Figure 1.
Clinical and imaging photographs
Injury recurrence and awareness
First-time CFB cases were reported in 56.86% (58 patients). Recurrent injuries were significant, with 26.47% (27 patients) presenting with a second episode, and 14.70% (15 patients) having a third episode. Despite 80.39% (82 patients) being aware of eye protection devices, the repeated injuries indicate poor enforcement or adoption of safety practices. Notably, 35.29% (36 patients) attempted self-removal of foreign bodies, further exacerbating the risk of complications [Graph 4].
Graph 4.
Injury recurrence and awareness
DISCUSSION
While 80.39% of participants acknowledged awareness of EPDs, only 27.45% used them regularly. This gap highlights a disturbing trend—knowledge does not necessarily translate to compliance. This discrepancy may be due to the lack of enforcement or inadequate workplace culture of safety, as echoed by Ramakrishnan et al.,[4] who noted that absence of strict supervision leads to negligence. Similar observations were made in previous studies.[6,7,8]
Financial constraints, unavailability, and discomfort with using protective gear were also cited, like reports from Ajayi et al.[8] in Nigeria, reflecting that this is a global issue in resource-poor labor sectors.
Repeated injuries, reported in over 40% of the subjects, point to a failure in both preventive counseling and occupational safety enforcement. Alarmingly, over one-third of patients attempted self-removal of foreign bodies, risking infection or corneal damage. As Ozkurt et al.[6] described, self-removal often leads to incomplete debris extraction and scarring.
The data further expose systemic issues such as lack of free or subsidized EPD provision (47.05%) and poor regulation compliance (60.78%), necessitating policy reforms. Governmental and NGO-driven workplace safety education and provision of EPDs may help bridge this gap.
CONCLUSION
Reinforcing occupational safety laws, ensuring accessibility of EPDs, and continuous education campaigns are essential steps to reduce the burden of CFBs. Proactive governmental involvement and industry accountability will be key in preventing avoidable ocular injuries among the vulnerable labor force.
Ethical clearance
Ethical approval was obtained.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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