A Retrospective Study of the Epidemiological and Clinical Patterns of Workplace Ocular Injuries among Southern Railway Employees

Abstract

Background:

Workplace-related ocular injuries (WROI) are a major public health concern, particularly in developing countries where occupational safety measures are often insufficient. This study investigates the epidemiological and clinical characteristics of WROI among Southern Railways employees in India, aiming to improve preventive strategies and workplace safety.

Methodology:

This retrospective study was conducted at a tertiary care hospital in South India over a one-year period (January to December 2024). Medical records of 159 railway employees who sustained WROI were reviewed. Data included demographic details, type and cause of injury, visual acuity, use of protective eyewear, time of presentation, and treatment modalities.

Results:

The study population was predominantly male (95%), with the highest incidence in the age group of 21–40 years (99%). Mechanical injuries (primarily corneal foreign bodies) were more common than nonmechanical injuries (notably radiation-related photokeratitis from welding. Adnexal injuries were observed in 15.2% of cases. Occupations involving welding and grinding accounted for 59.75% of injuries, followed by construction work. Most injuries were unilateral (84.2%), and 81% of patients sought treatment within 24 h. Despite availability, only 16.9% of patients reported using protective eyewear at the time of injury; discomfort and poor visibility were cited as key reasons for noncompliance. At presentation, 89.9% had visual acuity of 6/60 or better. Medical management sufficed in over 95% of cases.

Conclusion:

Mechanical injuries are the most prevalent, often associated with inadequate use of protective equipment. Improved safety training, better-designed protective gear, and stricter enforcement of safety protocols could significantly reduce the incidence of WROI.

INTRODUCTION

Workplace-related ocular injuries (WROI) remain a significant public health concern globally, contributing to substantial visual morbidity and economic losses. These injuries account for a considerable proportion of preventable visual impairments, particularly in developing nations, where workplace safety and occupational health protocols are often inadequately implemented.[1,2] The Birmingham Eye Trauma Terminology (BETT) classification system is widely used for categorizing ocular injuries and provides a standardized framework for their clinical assessment.[3] The Ocular Trauma Scoring system, devised later, enhanced the prediction of the final visual outcome.[4] Unlike isolated ocular trauma, ophthalmic trauma includes damage to both the eyes and their surrounding structures, such as the eyelids, periocular tissues, lacrimal apparatus, orbit, and orbito-facial region. Injuries involving the orbit and related facial fractures also pose a significant challenge.[5]

The prevalence of occupational ocular injuries underscores their socioeconomic impact. They not only reduce productivity through loss of working days but also affect the overall quality of life of workers by diminishing their ability to perform routine tasks.[6] India faces a unique challenge in managing workplace ocular injuries due to the prevalence of unorganized labor sectors.[7] Workers in these settings often lack access to basic protective equipment and safety protocols.[8] Studies conducted in industrial and rural settings in southern India have revealed that most occupational eye injuries could be prevented through targeted interventions such as mandatory safety training, the provision of high-quality protective gear, and the establishment of workplace safety cultures.[9]

This study aims to analyze the epidemiological and clinical patterns of WROI among employees of Southern Railways, a high-risk occupational group. By identifying the demographic and clinical characteristics of these injuries, this research seeks to inform effective preventive strategies and highlight the importance of early intervention in mitigating permanent visual impairment. Understanding these patterns will provide a basis for evidence-based policies to enhance workplace safety and reduce the burden of preventable ocular injuries in India.

METHODOLOGY

This retrospective, hospital record-based observational study was conducted at the Tertiary care center in South India from January 2024 to December 2024. The study focused on WROI among railway employees. This study adhered to the principles of the Declaration of Helsinki and obtained the approval of the Institutional Ethical Committee. Patient confidentiality was maintained, and no identifiable information was disclosed. As the study was retrospective, informed consent was waived. Data were extracted from hospital records, including demographic details such as age, gender, and occupation, clinical characteristics of injuries, and information on protective gear usage. Injuries were classified using the BETT system into mechanical and nonmechanical types. Patients with incomplete medical records or pre-existing ocular conditions unrelated to workplace injuries were excluded.

The primary outcomes analyzed included the types and patterns of injuries, visual acuity at presentation, the use of protective eye gear, and the time of presentation. Treatment details, including medical and surgical interventions, were documented. Statistical analyses were conducted using Statistical Package for Social Sciences (SPSS) version 21.0 (SPSS Inc, Chicago, IL, USA). Continuous variables were presented as means with corresponding standard deviations, whereas categorical variables were expressed as frequencies (n) and percentages.

RESULTS

Out of 159 patients from WROI cases among Southern Railway employees included in this study, the majority were male (95%). The injuries were common among the age group of 31–40 years, accounting for 57.86% of cases, followed by the age group of 21–30 years (41.52%). The type of WROI encountered in this study is summarized in Figure 1. In our study, 2.52% of cases account for associational injuries involving the face such as periocular contusions, facial lacerations, and soft tissue trauma alongside primary ocular injuries [Figure 2a]. Mechanical injuries were observed more frequently than nonmechanical injuries. In mechanical injuries, corneal foreign body (67.47%) was most observed, followed by contusions and lamellar lacerations [Table 1 and Figure 2b]. Only one case of penetrating injury was noted during the study period [Figure 2c]. In nonmechanical injuries, radiation-related injuries (58.93%) were commonly seen, followed by thermal and chemical. Radiation-related injuries include photokeratitis induced by welding work [Figure 2d]. Adnexal injuries account for 15.2% of cases, which include lid edema, ecchymosis, and lacerations. The leading causes of injuries include occupations that deal with metal grinding and welding activities (59.75%), followed by construction-related activities (18.86%) and chemical exposure (6.93%) [Table 2].

Figure 1.

Type of workplace-related ocular injuries (n = number of patients)

Figure 2.

(a) Lower lid laceration with facial injury, (b) corneal metallic foreign body with surrounding stromal edema with Descemet folds, (c) penetrating metal wire through the center of cornea and lens, and (d) photokeratitis (multiple punctate epithelial lesions stained with fluorescein)

Table 1.

Classification of globe injuries observed in our study

	n (%)
Globe injuries (n=84)
Closed globe	83 (98.81)
Open globe	1 (1.19)
Closed globe (n=83)
Contusion	12 (14.46)
Abrasion and lamellar laceration	15 (18.07)
Corneal foreign body	56 (67.47)

Table 2.

Occupation of patients during the time of injury

Occupation	n (%)
Welding	58 (36.48)
Grinding	37 (23.27)
Construction	30 (18.86)
Painting	6 (3.78)
Cleaning (chemicals)	5 (3.15)
Others	23 (14.46)

Most of the cases were unilateral (n = 134, 84.2%). Bilateral cases were primarily due to radiation and chemical injuries. Most patients (81%) presented to the hospital within 24 h of injury, while the remaining 19% experienced delays ranging from 2 to 7 days [Figure 3]. Only 18% of injured workers reported using protective eyewear at the time of injury [Figure 4]. The reason for nonusage of protective eyewear during work, even when provided, was poor visibility. At the time of presentation, 89.9% of patients had a visual acuity of 6/60 or better [Figure 5]. Medical management was the primary mode of treatment, accounting for more than 95% of cases. This included the removal of foreign bodies, management of abrasions, and medical therapy for inflammation and infection. Surgical intervention was required in a case of penetrating injury.

Figure 3.

Injury-to-presentation time

Figure 4.

Use of protective eyewear during work time (n = number of patients)

Figure 5.

Best corrected visual acuity at the time of presentation (n = number of patients)

DISCUSSION

Our findings reveal that young male workers in physically demanding and high-risk occupations, such as welding and metal grinding, are especially vulnerable to ocular trauma. This aligns with trends observed in both national and international literature, where similar occupational roles carry a higher burden of eye injuries.[10,11,12] Additionally, younger workers may lack experience and awareness of workplace hazards, increasing their susceptibility to injuries.[13]

The predominant types of injuries observed were mechanical, including foreign body impacts and blunt trauma, followed by chemical burns. Similar patterns have been reported in previous studies in India, which emphasize the high-risk nature of activities such as grinding and construction works.[14,15,16] Photokeratitis was the second most observed injury. Globally, many studies agree with this pattern of injuries being the most common among workers involved in welding.[13,17,18,19] In total, 84.2% cases were unilateral eye involvement, and blunt trauma was the major cause, which was consistent with similar studies.[20] Bilateral cases were primarily due to chemical and radiation injury.[21]

The use of protective eye gear was found to be alarmingly low, with many workers citing discomfort and poor visibility as barriers to compliance. This finding aligns with earlier research suggesting that ill-fitting or poorly designed protective gear undermines its utility and adoption.[22,23,24] These findings underscore the critical need for preventive strategies, including the enforcement of workplace safety protocols, improved design and accessibility of protective eye gear, and targeted safety training programs. Studies have demonstrated that effective preventive measures can reduce the incidence of work-related eye injuries by up to 60%.[8] Our study highlights the importance of early intervention and compliance with safety measures to mitigate the burden of workplace ocular injuries and improve overall outcomes.

CONCLUSION

WROI is a significant yet preventable cause of visual morbidity, particularly among young male workers engaged in high-risk occupations such as metal grinding and welding. Despite the availability of protective eyewear, noncompliance due to discomfort and poor visibility remains a critical barrier. Targeted measures such as mandatory safety training, improved design and accessibility of protective gear, and stricter workplace safety protocols can significantly reduce the burden of these injuries. By addressing these gaps, we can minimize the socioeconomic impact of workplace-related ocular trauma and improve the quality of life for affected workers.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.