A review of eye injuries in adults hospitalised at Kenyatta National Hospital (KNH) Eye Ward
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Objective: To describe the epidemiology, types and causes of ocular injuries, the referral pattern of '';.ctims, interventions provided visual outcome and complications of the injuries. The study also examined the duration and cost of hospitalisation of affected patients. Justification: Ocular trauma is one of the commonest causes of monocular blindness. This not only affects the patient but the family especially where the victim is the breadwinner. The study aimed to look at the patterns of ocular injuries in adults and provide epidemiological data on the burden of this problem. It may also promote clinical audit by reviewing the care and management of patients with ocular trauma. Design: Retrospective case series. Setting: Kenyatta National Hospital (KNH). Subjects: All adult patients admitted for ocular trauma at KNH eye ward between January 2005 and December 2009. Outcome measures: Post treatment visual acuity, complications, time from injury to presentation and surgery, duration of hospitalisation, cost of hospitalization. Data analysis: Data was collected using questionnaires and analysed using SPSS. A confidence level of 95% was used. Ethical approval was obtained from.the KNH Ethics, Research and Standards Committee prior to commencement of the study. Results: A total of 265 files were reviewed. Most patients (87.9%) were males and majority of them (46%) were in the 21-30 age group. 25.3% of the patients were self employed and 24.2% were casual workers. In 55.9% of cases, the left eye was injured. The commonest cause of injury (36.9%) was metal and 90.6% of the injuries were open globe injuries. 54.3% of the injuries were sustained in accidental circumstances while 45.7% were due to assaults. 78.9% of patients presented to a health facility within 72 hours. Of the total patients seen, 40.8% were referred to KNH from another health facility. 124 of the 265 patients received some treatment before coming to KNH. The commonest injuries involved the cornea (64.~Io) and sclera (45.3%). 90.6% patients needed surgical intervention, 54.2% of them waited one day before theatre was available. Most injured eyes (81.5%) were blind at admission and 63.8% were blind at discharge. The commonest complications seen during follow up were corneal opacities (45.6%) and phthisis of the injured eye (24.9%). The average cost of care was Ksh 9552.50 (approximately US$120). There was a statistically significant difference in the visual acuity at admission and at discharge. Conclusion: Management of eye injuries still continues to pose a challenge. Most of the injuries admitted are severe open globe injuries and the productive age groups are the most affected. Despite advances in diagnostic and therapeutic methods, ocular trauma remains a significant cause of visual loss. Most of the injuries were due to accidents but rising levels of assaults leading to ocular trauma are noted. Initial visual acuity correlated well with the visual acuity at discharge with more severely injured eyes having worse visual acuity and vice versa. Majority of the eyes were blind on admission and discharge.