|Year : 2014 | Volume
| Issue : 1 | Page : 35-38
Bilateral blindness from ocular injury: A 15 year review
Adepoju Feyi Grace1, KF Monsudi2, BJ Adekoya3
1 Department of Ophthalmology, University of Ilorin, Kwara State, Nigeria
2 Federal Medical Center, PMB 1126, Birnin Kebbi, Nigeria
3 Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
|Date of Web Publication||26-Aug-2014|
K F Monsudi
Department of Ophthalmology, Federal Medical Center, PMB 1126, Birnin Kebbi
Source of Support: None, Conflict of Interest: None
Background: Ocular injury remains a significant cause of monocular visual impairment and blindness worldwide; impact on bilateral blindness needs further elucidation.
Aims: The aim of this study is to review cases of bilateral blindness from ocular injury: The etiology, risk factors, psychosocial effect as well as suggest preventive measures.
Materials and Methods: A 15 year retrospective review of bilateral blindness from ocular injury at the eye clinic of the University of Ilorin Teaching Hospital (UITH) From January 1997 through December 2012 was carried out.
Results: Sixteen cases of traumatic bilateral blindness were recorded, compared to 2155 total number of bilateral blindness recorded during the study period, giving a proportion of 0.8%. This consisting of 12 males and 6 females. The modal age group was 17-33 years. Blindness resulting from chemical assault was (37.5%), gunshot injury (12.5%), and assault for presumed ritual purposes made up 25%. The major risk factors identified are male sex, younger age group, students, and artisan. Psychosocial burden in the immediate period of loss of vision include anxiety, fear of loss of occupation or basic skills, denial and hope for visual restoration, aggression, poor appetite, and excessive crying. Three patients developed depression and required medical management.
Conclusion: Bilateral blindness in our environment is mainly assault-related from chemicals, gunshot, and rituals. Public enlightenment on far reaching consequences of sudden traumatic blindness, health education on preventive measures, legislation and adequate punitive measures are important tools required to reduce this menace. Adequate psychotherapy by behavioral scientist, rehabilitation, and societal reintegration is mandatory to effectively treat cases.
Keywords: Bilateral blindness, chemical injury, Nigeria, psychological effect, trauma
|How to cite this article:|
Grace AF, Monsudi K F, Adekoya B J. Bilateral blindness from ocular injury: A 15 year review. Afr J Trauma 2014;3:35-8
| Introduction|| |
Ocular trauma remains a significant cause of monocular visual impairment and blindness worldwide, accounting for 20-50%, out of which bilateral blindness is 3.2-5% (approximately 1.6 million blindness worldwide). , However, 5% of bilateral blindness in developing countries is due to trauma.  Despite the small size of the eye (accounts for 4% of face and 0.27% of total body surfaces), it ranks 3 rd to hands and feet as most common site of injury.  The impacts of binocular blindness on individual and the society are far worse than monocular blindness in all ramification.  However, 90% of all cases of ocular trauma are preventable, hence the emphasis on prevention.  There are few studies on the etiology of bilateral traumatic blindness in developing countries , despite the great implication on the wellbeing and quality of life of affected individual. Hence, this study was conducted to know the etiology of bilateral traumatic blindness and ways of preventing it in a referral tertiary hospital in central geological zone of Nigeria.
| Materials and Methods|| |
A cross-sectional case series over 15 years period of all patients who presented in the accident and emergency section and at the eye clinic of the University of Ilorin teaching hospital (UITH), from January 1997 through December 2012 with bilateral blindness resulting from injury was done.
The UITH is a tertiary eye center in Kwara State, Nigeria, serving a population of around 2.4 million.  It also acts as a referral center for the surrounding states (Oyo, Osun, Ekiti, and Niger) and neighboring country (Benin republic). All patients' data were entered into the study proforma. The demographic factor, including age, sex, occupation, and level of education were recorded. The cause of injury and events surrounding the injury were also entered. Bilateral blindness was defined as best corrected visual acuity in the better eye less than 3/60. All the patients had their visual acuity checked with Snellen visual acuity chart and pen touch. The eyes examinations were done with Haagstreit slit lamp biomicroscope and Keller ophthalmoscope (direct and indirect). Any patient with unilateral traumatic ocular blindness and those whose visual acuity improved more than 3/60 following medical and surgical treatment by 6 months after intervention were excluded. All the patients were co-management with behavioral scientist. The data was recorded and analyzed using a scientific calculator.
| Results|| |
Of all the 16 bilateral traumatic blind Patients who presented at our hospital during the study period, 12 were males and 4 were females with an age range of 1 to 50 years.
[Table 1] shows the 'Age and sex distributions of the patients.' The prevalence of the bilateral traumatic blindness was greatest in 17-33 year old group (37.5% of all cases), with most of the cases occurring in students (31.3%). [Table 2] showed the occupation of the patients. Chemical injury (car battery water) assault accounted for the highest number of bilateral blindness (37.5% of all cases). [Figure 1] and [Figure 2] patients with bilateral blindness due to chemical injuries, [Figure 3] bilateral blindness due to snake bite. [Table 3] shows the causes of bilateral blindness. The majority (14) of the people affected with this blindness were Yorubas (87.5%).
|Figure 1: A 25 - year - old lady with bilateral blindness following battery water acid assault|
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|Figure 2: A 22 - year - old boy with bilateral blindness following acid assault|
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|Figure 3: A 9 - year - old boy with bilateral blindness following snake bite|
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All patients had interaction with behavioural scientist; three of the patients in the study refused to interact with members of their family and withdrew to themselves and hence underwent psychological evaluation and were confirmed to have developed depression. The remaining had anxiety and fear of loss of job, spouse, and independence.
| Discussion|| |
Only 16 cases of bilateral traumatic blindness were treated at our hospital during 15 years study period; these small number agreed with other previous studies which reported lower cases of bilateral traumatic blindness. ,,,
The trauma is more in young male patients due to their occupation and outdoor activities which is consistent with other studies. ,,,,,, Students and artisan accounted for majority of cases in this report in contrast to report from Cambodia  and Afghan  where higher prevalence of bilateral landmine blindness were found in soldiers and civilians. A chemical injury from car battery water assault was responsible for highest number of the blindness in our study. This is different from finding of previous studies. , The difference may be due to easy access to car battery acid in our environment because of the unrestricted control on its sale.
There were 2 cases of bilateral removal of eyes presumably for rituals in 6 and 10 year old children at farms. The practice of ritual eye removal for money making or other spiritual purposes has been earlier reported by Popoola et al. 
Cases of assault tend to be bilateral and severe, resulting in bilateral blindness as opposed to accidental injuries. The prevalence of bilateral traumatic blindness was common among the Yorubas because the study was done in a predominantly Yoruba-speaking area of Nigeria.
A sudden bilateral blindness in a person has far reaching psychological effect. In the young student, it is a calamity to both the parent and the country in term of blind years. The major psychological effects were denials, depression, and aggression in some individuals. Sudden loss of economic and career prospect may lead to suicidal tendency, which were noted and managed in 3 of our cases. The effect of trauma to the eye should be incorporated in to the Nigeria education curriculum, and also there should be a regulation and legislature on the availability and accessibility to car water battery in our environment. Its regulation will significantly reduce the incidence of chemical bilateral eye blindness in our environment. There should be a regular health education campaign on the various possible risk factors and causes of eye injury and blindness.
Government should review the rehabilitation of blind policy so that this group of people will be able to cater for themselves and contribute to the development of the country.
| Conclusion|| |
Chemical injury accounts for most cases of bilateral blindness in our environment, and because of the devastating effect on the affected individual and the society, the importance of prevention in terms of education and legislature is underscored.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]