Ocular injuries in children

Abstract

Objectives: To describe the epidemiology, referral system and visual outcomes of eye injuries in children.

Design: Retrospective case series.

Setting: Kenyatta National Hospital (KNH) Nairobi, Kenya.

Subjects: Children aged up to 15 years with eye injuries hospitalised between January 1st, 2000 and December 31st, 2004.

Results: There were 182 cases. Male: female ratio was 2: 1. Median age was sevenyears (IQR 4-10) with bimodal peaks at four and seven years. The most common cause (35%) was sticks. One hundred and twenty seven cases (70%) were open- globe injuries. One hundred and fourty one (77%) presented with visual acuity worse than 6/60 seven eyes were badly damaged and were removed (evisceration enucleation). Ninety five children (52%) were referred from Central and Eastern provinces while 87 (48%) were from Nairobi province. Most [26 (31%)] cases in Nairobi were from Kibera, Dandora and Kariobangi. Median duration between injury and arrival at first medical facility was one day but three days from injury to KNH after referral. Only 29% got tetanus toxoid, antibiotics, analgesics or eyepads at the referring facility. Median hospitalisation was seven days with a median bill of KSh 5,275/= (US$ 70.00). Fourty four children (24%) had their bills waived for inability to pay. At the last recorded follow-up 81 (57%) children had better visual acuity, 16.9% had light perception (PL). Corneal scar was the most common complication. Conclusions: Eye injuries in KNH are severe, mostly affecting pre-school children from low-income settings. There is delay in arriving at KNH and inadequate care at the referring centres. Outcomes were poor although better than on admission. This may affect education, careers and quality-of-life. Injury-prevention programmes are recommended.