Indonesia Journal of Opthalmologi

(IJO)
Vol. 7. No. 3 Juni 2010

The Relation of Onset of Trauma and Visual Acuity on Traumatic

Patient
Abstract
The aim of this study is to evaluate the relation between onset of trauma and visual acuity
in patient suffering from injury in Sanglah Hospital Emergency Room on the period of 2006
2008. This is a retrospective analytic study. All data were reviewed from medical records.
During 20062008 we found higher incidence of ocular injury on male (78.4%). The peak of
incidence was between 1540 years old (61.2%). Ocular injury mostly happened on right eye
(55,7%) and visual acuity was > 6/18 (64.4%). Sixty three percent of ocular injuries
occurred at home. Blunt trauma was the most common mode of ocular injuries (26.2%). Most
complications happened in cornea (59.2%). There was a relationship between the onset of
trauma and visual acuity in patients suffering from injury in Sanglah Hospital.
Key words: ocular injury, visual acuity, onset
Correspondence: AAA Sukartini Djelantik, Department of Ophthalmology Faculty of
Medicine Udayana University, Bali. (Tel. +62-361-244364. Fax. +62-361-244364. Email.
sukartinidjelantik@gmail.com)

Trauma oculi is one of the major

causes of visual impairment and blindness
in one eye that can prevented. 1-4 Trauma
oculi can be divided into sharp trauma,
blunt trauma , chemical trauma, thermal
trauma, physical trauma, extraocular
foreign body, and penetrating trauma by
mechanism oculi trauma.1-3 Trauma can
occur in various places , at home, at work,
or on the highway. Nirmalan2 and Vats5 get
oculi greatest incidence of trauma occurred
in the home .
The prevalence of trauma oculi in
the United States at 2.4 million per year
and at least half a million of which cause
blindness . In the world , there are
approximately1.6 million people who are

blind, 2.3 million bilateral decreased visual

function , and 19 million of unilateral
decreased visual function due to trauma
okuli.1.4 Based on gender, some studies
using the data base hospital and population
data , show that men have a higher
prevalence.
Wong1 get trauma incidence rate in
men was 20 per 100, 000 compared to 5
per 100, 000 in women. Most oculi trauma
occurs at a young age, where Vats5 get a
mean age of incidence of trauma is 24.2
years ( 13.5). Based on the Standards of
Medical Services (MSS) section Eye
Health Sciences General Hospital Center
(Dr) Sanglah, 6 trauma oculi divided into
sharp

trauma, blunt trauma, chemical trauma,

physical trauma, thermal trauma, extraocular foreign body (EOFB) and intraocular foreign body (IOFB). Oculi trauma
classification is similar to the study
conducted by Wong,1,3 Nirmalan2 and Vats5
that divides trauma oculi be blunt trauma,
sharp trauma, physical trauma, thermal
trauma, foreign body, sharp and
penetrating trauma.

This study is a retrospective

analytic study. Data were obtained from
medical records of patients who come to
the IRD Sanglah Hospital during the
period January 1, 2006 through December
31, 2008. Patient data is then inserted into
the parent table includes name, age, sex,
visual acuity arrival, onset arrival, the
scene, the eye is involved, the type of
trauma and complications.

Complications caused by trauma to

the eye can encompass all parts of the eye,
which is a complication of the eyelids,
eyeball surface, the camera oculi anterior
vitreous, and retina. The types of trauma
involving the orbit or intra structure oculi
can be caused by sharp objects, blunt
objects, physical trauma, or chemical
trauma. The type and extent of damage
caused by trauma to the eye depends on
the mechanism and strong trauma
occurred. A penetrating trauma intraokuli
both large objects or small objects will
result in greater damage than the trauma of
benturan.7-10

Subjects in this study were all

trauma patients who come to the IRD oculi
Sanglah Hospital during the period
January 1, 2006 until December 31, 2008.
In this study, a sample of 926 patients with
973 eyes.

Early treatment of trauma oculi

properly can help prevent blindness and
visual
impairment.
Trauma
oculi
comprehensively in less than 6 hours can
produce better results. But unfortunately,
the eye health services are scarce and
incomplete often the cause of delays in the
handling of trauma oculi, in addition to
lack of knowledge and financial
problems.11

RESULT

Data were collected by medical

records of trauma patients who come to the
IRD oculi Sanglah, include name, age, sex,
visual acuity arrival, the eyes are involved,
the type of trauma, complications, and
location of trauma. Data were analyzed
descriptively and analytically. Data on the
characteristics of the subject and the eyes
were analyzed descriptively. Data on the
relationship between the variables and the
onset of the arrival of visual acuity when
first examined, and the relationship
between types of trauma with sex, age, and
location of traumatic events were analyzed
with chi-square test. This research
significance level at p <0.05. Process and
data analysis conducted programs SPSS
for Windows 13.0 application.

During the 2006-2008 period, a

total of 926 trauma patients oculi come to
Sanglah IRD service unit. Of all patients
counted 973 eyes were included as a

subject of research by the medical records

of trauma patients oculi.Characteristics of
the patients in this study are described in
Table 1

Table 1. Characteristics of patients who experienced trauma oculi (N = 926 patients)

patient characteristics
Sex
Male
Female
Age
14 years
15 40 years
41 years
Involved eye
Right
Left
both

Amount

percentage

726
200

78,4
21,6

180
567
179

19,5
61,2
19,3

516
363
47

55,7
39,2
5,1

Table 1 shows the characteristics

oculi trauma patients who come to the
Emergency service unit General Hospital
Center ( Dr IRD ) Sanglah that includes
gender, age and the eyes are involved.
From the data collected, it appears that
more males ( 78.4 % ) compared to
traumatized women ( 21.6 % ). Age range
most traumatized that comes to IRD
Sanglah are mature age, ie 15-40 years by
61.2 %. The right eye ( 55.7 % )
experienced more trauma than the left eye
( 39.2 % ), whereas patients who
experienced trauma oculi in both eyes as
much as 5.1 % .

Table 2 shows the characteristics of

the data that comes into the trauma oculi
IRD Sanglah services unit that includes
visual acuity moment came the first time,
after the onset of the arrival of trauma,
trauma scene, the type of trauma and
complications. Visual acuity when he first
came to be evaluated at 90.5 % , other 9.5
% can not be evaluated, because the 9.1 %
eye with an age range of 0-6 years
uncooperative during the examination, and
0.4 % did not Eye can be evaluated
because of decreased consciousness.

Table 2. Characteristics of eye trauma oculi (n = 973 eyes)

Characteristics trauma
>6/18
6/186/60
5/603/60
<3/60
FO+, FL+
Cant be evaluated

Total
Visual acuity first visit
627
109
25
119
89
4
Onset arrival

Percentase (%)
64,4
11,2
2,6
12,2
9,1
0,4

<7 hour
724 hour
>24 hour
Home
workplace
highway
Sharp trauma
Blunt trauma
Chemical trauma
Physical trauma
Thermal trauma
Extra ocular foreign body
(EOFB)
Intra ocular foreign body
(IOFB)
complications on the lid
Complication on the
conjunctiva
Complication on the cornea
Complication on the sclera
Complication on the iris
Complication on the anterior
chamber
Complication on the
posterior segmen
Complication on the bone
and adnexa
The others complication

664
217
92
The scene of trauma
616
207
150
Type of trauma
233
255
152
35
49
249
2

68,2
22,3
9,5
63,3
21,3
15,4
23,9
26,2
15,6
3,6
5,0
25,6
0,2

Type of complication
243
221

25,1
22,7

576
17
50
77

59,2
7,3
5,1
7,5

13

1,3

11

1,1

27

2,6

Patients
visual
acuity
was
measured using Snellen charts and count
fingers from a distance of 6 meters at the
first time examined. Visual acuity of
patients who could be evaluated showed
627 eyes (64.4%) with a vision that is still
good, 109 eyes (11.2%) with borderline
visual acuity, 25 eyes (2.6%) had poor
visual acuity, and 119 eyes (12.2%)
classified as blind. The house was the
scene of the most widely in the amount of
63.3%, trauma in the workplace occurs at
21.3%, and on highways of 15.4%. Blunt

trauma is the most type of trauma that

comes to IRD Sanglah is equal to 255 eyes
(26.2%), followed by EOFB many as 249
eyes (25.6%), and trauma sharply by 233
eyes (23.9%). Trauma oculi most cause
complications in the cornea that is equal to
59.2%, followed by complications in the
lid of 25.1%, 22.7% and conjunctiva.
Based on the study (Table 3)
showed that of the 973 eyes, 664 eyes are
coming <7 hours with good eyesight of
41.6%, borderline 7.6%, 2.1% poor, blind
8.6%, and 0, 4% could not be evaluated. In

the group of patients with the onset of the

arrival of 7-24 hours, 16.3% obtained with
good visual acuity, 2.5% borderline, poor
0.3%, and 2.2% blind. Patients with onset
of the arrival of> 24 hours, 6.5% is

obtained with good visual acuity, 1.1%

borderline, poor 0.2%, and 1.4% blind.
There is a relationship between the onset
of the arrival of the visual acuity. (X2 =
23, df = 10, p = 0.008).

Table 3. The relationship between the onset of the arrival of the visual acuity (n = 973 eyes)
onset

< 7 hours
7 24
hours
>24
hou
rs
total

Visual acuity
>6/18
6/18
6/60
n
%
n
%
40 41, 74 7,6
5
6
15 16, 24 2,5
9
3
63 6,5 11 1,1

62 64, 10 11,
7
4
9
2
X2 = 2 23, df = 10 p = 0.008

total
5/60
3/60
n
%
2
2,
0
1
3
0,
3
2
0,
2
2
5

2,
6

<3/60
n
84

%
8,6

21

2,2

14

1,4

11
9

12,
2

FT+,
FC+#
n
%
7
7,
7
9
1
1,
0
0
2
0,
2
8
9

9,
1

Tde*
n
4
0
0

%
0,
4
0,
0
0,
0

n
66
4
21
7
92

%
68,2

0,
4

97
3

100,
0

22,3
9,5

*: Tde = not evaluated

#: FO, FL = following objects, following light

From Table 4 it was found that of

926 pasient traumatized oculi, 78.4% were
male and 21.6% female. Most types of
trauma in men is EOFB for 24.0%,
followed by 19.8% blunt trauma, and
trauma sharply by 19.5%. In women this

type of trauma is the most common of

7.8% blunt trauma, sharp trauma followed
by 5.2% and 4.0% chemical trauma. There
is a relationship between the sexes with
this type of trauma oculi. (X2 = 28, df = 6,
p = 0.000).

Table 4. Sex relationship with the type of trauma (n = 926 patients)

Sex

Male
Fema
le
total

Sharp
trauma

Blunt
trauma

Chemic
al
trauma

n
18
1
48

%
19,
5
5,2

n
18
3
72

%
19,
8
7,8

n
92

%
9,9

37

4,0

22
9

24,
7

25
5

27,
5

12
9

13,
9

Type of trauma
Physic Therm
al
al
traum traum
a
a
n % n %
1 2, 2 2,
9 1
7
9
6 0, 1 1,
6
0
1
2 2, 3 4,
5 7
7
0

EOFB#

n
22
2
27

%
24,
0
2,9

24
9

26,
9

Sharp
trau
ma +
IOFB*
n %
2 0,
2
0 0,
0
2 0,
2

Total

n
72
6
20
0
92
6

%
78,
4
21,
6
10
0

X2= 28 df = 6 p = 0,000
#: EOFB = extra ocular foreign body
*: IOFB = i ntra ocular foreign body

In this study, 19.5% of patients

who experienced trauma oculi aged 0-14
years, 61.2% aged 15-40 years, and 19.3%
aged> 40 years. In the age group 4 years
found that most types of trauma is blunt
trauma by 8.3%, followed by sharp trauma
of 7.1%. In the age group 15-40 years
obtained most types of trauma is EOFB of

21.3%, followed by blunt trauma of

14.0%. In the age group> 40 years found
that most types of trauma is trauma sharply
by 5.8%, followed by blunt trauma by
5.2%. There is a relationship between the
type of trauma with age. (X2 = 106, df =
12,
p
=
0.000).
(Table
5)

Table 5. The relationship of age to the type of trauma (n = 926 patients)

Sharp
trauma

Blunt
trauma

Chemic
al
trauma

14

n
66

%
7,1

n
77

%
8,3

n
11

%
1,2

1440
>40

10
9
54

11,
8
5,8

13
0
48

14,
0
5,2

86

9,3

32

3,5

Total

22
9

24,
7

25
5

27,
5

12
9

13,
9

Sex

Type of trauma
Physic Therm
al
al
traum traum
a
a
n % n %
2 0, 1 1,
2
2
3
2 2, 2 2,
2 4
2
4
1 0, 3 0,
1
3
2 2, 3 4,
5 7
7
0

EOFB#

n
12

%
1,3

19
7
40

21,
3
4,3

24
9

26,
9

Sharp
trau
ma +
IOFB*
N %
0 0,
0
1 0,
1
1 0,
1
2 0,
2

Total

n
18
0
56
7
17
9
92
6

%
19,5
61,2
19,3
100,
0

X2= 106 df = 12 p = 0,000

#: EOFB = extra ocular foreign body
*: IOFB = ntra ocular foreign body

Table 6. Relationship with the type of trauma scene (n = 926)

Locati
on
Ruma
h
Tempa
r kerja
Jalan
raya
Total

Sharp
trauma

Blunt
trauma

Chemic
al
trauma

n
14
5
20

%
15,
7
2,2

n
19
7
25

%
21,
3
2,7

n
11
7
12

%
12,
6
1,3

64

6,9

33

3,6

0,0

22

24,

25

27,

12

13,

Type of trauma
Physic Therm
al
al
traum traum
a
a
n % n %
9 1, 3 3,
0
1
3
1 1, 6 06
6 7
0 0, 0 0,
0
0
2 2, 3 4,

EOFB#

n
86

%
9,3

11
1
52

12,
0
5,6

24

26,

Sharp
trau
ma +
IOFB*
N %
1 0,
1
1 0,
1
0 0,
0
2 0,

Total

n
58
6
19
1
14
9
92

%
63,3
20,6
16.1
100,

Based on research conducted found

that of 926 patients, 63.3% experienced
trauma oculi at home, 20.6% at work, and
16.1% on the highway. Trauma types most
common in the home is blunt trauma of
21.3% followed by trauma sharply by
15.7%, and chemical trauma of 12.6% of
the total incidence of trauma. Most types
of trauma occurring in the workplace is
EOFB trauma by 12% followed by 2.7%

of blunt trauma, sharp trauma and 2.2% of

the total incidence of trauma.
Type of trauma most common on
the highway is sharp trauma by 6.9%,
followed by EOFB of 5.6%, and 3.6% of
blunt trauma of the total incidence of
trauma. There is a relationship between the
type of trauma with the trauma scene. (X2
= 248, df = 12, p = 0.000). (Table 6)

DISCUSSION
Trauma is the leading cause of
blindness oculi in the world that can be
prevented, but only a little information
about the characteristics and epidemiology
of trauma oculi. Some research on trauma
oculi detailed report on the cause, severity
and consequences, but very little is
reported on the prevalence and incidence
of trauma okuli.2,3,4 Cumulative prevalence
rate of blindness due to trauma have been
reported in Baltimore and Australia with
some methods , which is based on data
from the hospital, the patient data in the
emergency ward, and population-based
interview.12,13
This study shows that trauma is the
leading cause of blindness unilateral oculi
very important. By gender, it was found
that the male (78.4%) experienced more
trauma than women (21.6%). This fact is
consistent with other studies in Australia,
Madison, and Baltimore which states that
men experience more traumatic than
woman.12,13 In another study, 61.6%
Nirmalan2 also get oculi trauma occurs in
males. Wong3 get oculi trauma occurred in
20.0 per 100.000pada of men and 5.1 per

100.000 that women. Vats5 get 55.6% oculi

trauma occurs in males. Badrinath14 get
oculi trauma comparison between men and
women is 5,4:1. Vasu15 in India stated that
95% of trauma oculi occur in men.
Possible cause is because men do more
physical activity than women, it is
associated with a picture of male workers
more than female. Moreover men
generally do activities / work at greater
risk than women exposed to trauma.
In this study it was found that
younger age ( 15-40 years ) is that many
traumatized group ( 61.2 % ) . This fact is
in accordance with several studies Wong 1
in Madison and Katz12 in Baltimore ,
found that age is under 40 years of age
who have a high risk of trauma. While the
research in Singapore, Wong3 get that age
are susceptible to trauma is aged between
20 30 years old . Vats5 get 44.2 % of
patients who experienced 16-39 years
Tauma oculi . Badrinath14 get that 2/3 of
the total trauma oculi occurred at age < 30
years. Vasu15 in India stated that 79 % of
trauma oculi occurs between the ages of
16-45 years. Nash16 on research in the U.S.

found that trauma oculi is greatest in the

age of 15-44 years is equal to 64.6 % .
Krisnaiah17 in India gained 35.9 % oculi
trauma occurs in 15 - 40 years of age .
This might be due to that age is still a
productive age in physical activity.1,2
Trauma oculi generally about the
involvement of one eye but both eyes may
also occur . This gain the right eye ( 55.7
% ) more than the left eye ( 39.2 % ) or
both eyes ( 5.1 % ) . 72.2 % reported
trauma Wong1 oculi of the right eye . This
may be caused by most people use the
right hand to perform activity.
In this study, the majority of eye
trauma oculi had visual acuity > 6/18 is
64.4 % , and 12.2 % eyes had visual acuity
< 3/60 . Vats5 get 82.9 % of patients with
trauma oculi have visual acuity with
correction > 20/60dan 9.5 % < 10/200 .
Nirmalan2 reported that 27.2 % of the
traumatized eye oculi had visual acuity >
6/18 , and 15.2 % eyes had visual acuity <
3/60 , and the remaining 57.6 % had a
visual acuity 6/18-3/60 . Krisnaiah17 get
9.3 % oculi trauma patients had visual
acuity < 3/60 when he first came to the
emergency room. To date , no study has
discussed the relationship between the
onset of the arrival of the visual acuity.
In this study it was found that the
type of trauma most oculi come to Sanglah
IRD is blunt trauma by 26.2 % , followed
by 25.6 % EOFB , and sharp trauma 23.9
% . This fact is consistent with studies
conducted Nirmalan2 and Badrinath14 in
research in India states that this type of
trauma is the most common blunt trauma
respectively by 54 % and 46.94 % . This is
in contrast to research conducted by Vats5
who do research in Rural South Indian
oculi get that trauma is the most frequent

EOFB of 37.5 %, followed by 29.2 % of

blunt trauma, sharp trauma and thermal
trauma each until respectively, 5 %. Nash16
get oculi trauma is the most frequent
EOFB of 16.2 % , followed by trauma
sharply by 14.8 % , and 13.1% of blunt
trauma . Wong1 get that oculi traumatic
incident caused a lot of trauma most
sharply by 65.2 % .
In this study it was found that the
location where the most trauma is at home
( 63.3 % ), followed by the workplace
( 21.3 % ) , and on the highway ( 15.4 % ).
This result is consistent with research
conducted by Nash16 and Vats5. Vatz5 and
33.1 % earn oculi traumatic events
occurred at home, and 21.7 % occurred in
the workplace . Nash16 get 34.7 % oculi
trauma occurred at home. While the study
conducted by Nirmalan2 and Krisnaiah17
said most trauma occurred in the
workplace oculi respectively 41.7 % and
55.9 %. In this study it was found that
trauma oculi most often occurs in the
home is the blunt trauma of 21.3 %,
followed by trauma sharply by 15.7 % ,
oculi type of trauma most often occurs in
the workplace is EOFB by 12 %, followed
by blunt trauma of 2.7 %. While this type
of trauma oculi most frequent trauma on
the highway is sharp at 6.9 % , followed
by 5.6% EOFB . Nash16 oculi get that
trauma most often occurs in the home is
EOFB of 30.9 %, followed by trauma
sharply by 25.7 %, oculi trauma most often
occurs in the workplace is EOFB at 66.8 %
followed by sharp trauma of 6.8 %, while
oculi trauma most often occurs on the road
is 27.3 % blunt trauma, sharp trauma
followed by 14.6%. Yu18 also get that most
trauma oculi in Hong Kong occurred in the
workplace, due to low levels of worker
safety in industrial areas and low labor

discipline in the use of safety glasses while

working. Housing has long been known as
the site of trauma is most often the cause
of which is unknown . While the absence
of effective prevention information in
working practices can reduce the incidence
of trauma in the workplace oculi.15,16
Type of trauma has a close
connection with the kinds of complications
that occur. Sharp trauma can cause more
complications than other trauma and can
affect multiple organ, while blunt trauma
can lead to more severe complications,
such as vitreous hemorrhage, retrobulbar
hemorrhage, orbital fractures, to blow out
fracture.13,16 This is consistent with the
study where complications caused by
sharp and blunt trauma injury to the multi
organ. Katz12 and McCarty13 get that
chemical trauma and physical trauma
cause more complications in the cornea
and conjunctiva. This fact is in accordance
with the data obtained in this study ,
namely that the complications caused by
chemical and physical trauma occurs more
frequently in the cornea. Chemical trauma
CONCLUSION
There is a relationship between the onset
of the arrival of the visual acuity when he

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