Types and Causes of Occupational Eye Injuries
Summary of the articles
Ngo, C. & Leo, S. (2008). “Industrial accident-related ocular emergencies in a tertiary hospital in Singapore.” Singapore Medical Journal, 49(4), 280-286
Ngo & Leo (2008) wanted to find out the nature and causes of industrial eye-related injuries in Singapore. It was achieved through a retrospective study carried out in Tan Tock hospital, Singapore. Birmingham eye terminology was the standard used in classifying the cases. Lamellar injuries (foreign bodies, chemicals) accounted for 92% of the cases; contusions (blunt trauma) were responsible for 4.3% of the cases while penetrating lacerations caused 2.7% of the injuries. Only 66% of the cases had protective eyewear and about 44.7% did not comply with workplace directives on eye protection. Reasons for not doing so included: habit, sweatiness, discomfort, and poor vision when using the devices. It was suggested that poor supervision and weak legislation should be corrected. On the organizational level, employers can improve the visibility, ergonomics, resistance, and comfort of the protective eye devices.
Thompson, G. & Mollan, S. (2009). “Occupational eye injuries: a continuing problem”. Occupational medicine, 59:123-125
This was a study done in Scotland and aimed at finding the prevalence of eye protection devices and reasons for non-use. Thompson and Mollan (2009) collected information from the hospital database through the code word eye. They found that approximately 33% were work related. Also, half the group did not wear eye protection devices. Improper use, poor design and wrong use contributed to accidents for those who complied. Grinding, blunt trauma, and welding led to the injuries with recorded incidences of 22%, 10%, and 10% respectively. Only 20% of the subjects had undergone safety training while 44% were injured regardless of wearing protection. It was suggested that the right gear should be worn to minimize these injuries.
Chen, S., Fong, P., Lin, S., Chang, C. & Chan, C. (2009). “A case crossover study on transient risk factors of work related eye injuries”. Occupational Environ Med, 66, 517-522
The authors wanted to look at how modifiable factors affected workplace related eye injuries. Seven centres around Taiwan were identified for this analysis. A case crossover study was utilised where conditions unique to the accident were compared to daily activities of the respondents. Modifiable factors were characterised into three domains. The first was work practice and this included unskilled tool operation, performance of unfamiliar tasks and weak eye protection devices. The second category comprised of all employee related factors such as fatigue, distraction or rushing. Thirdly, were the environmental factors such as noisiness, excessive heat, humidity and visual lighting. It was found that worker related and employee related factors tremendously affected occurrence of eye injuries. Use of eye protection minimised risk by 60%.
Wolkoff, P., Nojgaard, J., Troiano, P. & Picolli, B. (2005). “Eye complaints in the office environment: precorneal tear film integrity influenced by eye blinking efficiency.” Occupational Environ Med, 62, 4-12.
The research focused on unravelling the pathogenesis of eye complaints at the workplace. Data was collected through literature on eye irritations and eye symptoms. Workers with immense visual display work were prone to Precorneal eye tear film thinning and hence dehydration. Also, upward gazes at work led to excess evaporation of moisture from eyes. High periocular air velocity was found to increase evaporations from the ocular surface and so did high/ low temperature. Room humidity also impacted eye injuries negatively. Fatigue caused slower blinking frequency and led to uneven pre corneal tear film distribution thus leading to eye complaints. Contact lens wearers were vulnerable when suffering from dry eye conditions. It was suggested that downward gazes be practiced for affected workers. Also, fast blinking exercises help.
Connelll, P., Saddak, T., Harrison, I., Kelly, S., Bobart, A., McGettrick, L. & Collum, L. (2007). “Construction related eye injuries in Irish nationals and non national: attitudes and strategies for prevention.” Ir. J Med Sci, 176, 11-14
The authors wanted to find out the prevalence of ocular protection devices, the attitudinal differences between Irish and non Irish nationals towards the use of these devices and to determine the nature of those eye injuries in the construction sector. Corneal foreign bodes of metallic nature led to 71.5% of the injuries, 14.5% of the accidents were caused by corneal abrasions while penetrating injuries of the eye accounted for 4.9% of the injuries. 22% of the subjects with serious eye injuries had gone to safety training courses. None of them had put on safety devices. Those who did not comply with protection cited lack of awareness (30%) and lack of the equipment (22%). 43% of the injured persons were Lithuanian while 41.2% were Irish and the rest were Romanian. 70% of non nationals attended safety courses while 90% of Irish nationals did. Lack of translation and poor understanding of English led to poor results among non nationals.
Occupational eye injuries have tremendous effects on the work environment as they cause social and economic losses to employers and the injured. They may result in complicated cases that could hamper future employability of the victims. It is therefore crucial to understand how workplace injuries occur, their epidemiology and how they affect workers. This will provide insights into possible prevention strategies in the future.
Types and causes of occupational eye injuries
The Birmingham Eye Trauma terminology (BETT) System is by far one of the most reliable methods of analysing the types of occupational eye injuries. The BETT can best be understood as a dichotomous tree that starts with two large categories of occupational eye injuries and then subdivides them into smaller groups. Here, an eye injury can either be open globe or closed globe (Kuhn, et. al., 2004). Open globe injuries cover all full thickness wounds found on the eyewall. It should be noted that the eyewall in this case refers to the combination of the sclera and the cornea. On the other hand, the closed globe type of injury refers to all those cases that do not involve full thickness wounds. Under the closed globe class, contusions and lamellar lacerations can be found here. Contusions are all those injuries that are brought on by objects that exert energy upon the eye but no wound exists (Kuhn, et. al., 2004). Conversely, lamellar lacerations are partial wounds found in the sclera or the cornea. An example includes an infected corneal abrasion. When solid particles get in prolonged contact with the eye then one may suffer from this type of injury. Therefore, this category (Closed globe) is normally associated with falling objects because no wounds or partial wounds exist. Eye injuries may also be classified as open globe; ruptures and lacerations can be found in this category (Kuhn, et. al., 2004). Ruptures occur because the eye contains incompressible liquids. When a blunt object exerts pressure on the eyewall, it may dehisce at another point other than where the impact occurred. The wound therefore gets produced from the inside and is seen through the external part. Sharp objects lead to wounds known as lacerations. In such scenarios, the wound will arise exactly where the impact is. All lacerations can either be: penetrating, perforating or IOFB. Penetrating lacerations are those entrance wounds that have been brought on by different agents. Examples here include corneo sclerotic wounds. IOFBs denote foreign objects being retained in the eye. An example includes Traumatic cataract which occurs when particles such as steel get into the eye. Perforating lacerations are wounds that have both an entrance and exist and have been caused by the same agent (Kuhn, et. al., 2004). Not all eye injuries can be classified neatly as open globe or closed globe since some agents can cause wounds thus making them appear as open globe but the wound may not be a rupture or laceration. Common examples include injuries caused by chemicals or ultraviolet radiations. Conjunctivitis and Keratitis are two such examples of workplace injuries. Conjunctivis occurs less frequently than the earlier mentioned injury. It is caused by exposure to certain chemicals such as lime. Keratitis also occurs because of the use of chemicals like ammonia. Usually, Keratitis is caused by a biological condition called herpes but it can also arise when chemicals get into contact with the eye. Most of the time, these are alkaline chemicals and can be found in several chemically based industries. Those who manufacture such chemicals can often be exposed to them and need to cover up. Chemicals may also be used in metallic industries for adjoining purposes. If workers do not cover their eyes then they will be vulnerable to Keratitis. Ultraviolet radiation can also cause keratitis in what is known as the welder’s arc eye. This must be intense in order to cause a substantial effect and is often classified as photokeratitis. Conjunctivitis on the other hand occurs when the conjunctiva gets inflamed and maybe due to allergic reactions caused from acidic or alkaline chemicals. Alkaline chemicals cause more severe conjunctivitis and they burn the eye. These chemicals include sodium hydroxide
Generally speaking, eye injuries at the workplace can be caused by a variety of sources. These can be brought on by conditions in the work environment such as dust; machines such as drilling, grinding and welding machines; hand tools like hammers – that can lead to blunt object injuries; chemical use; constructions that involve leading and stacking and other miscellaneous causes like office jobs (Maceween, 1989), (Saari and Parvi, 1984).
Sometimes small particles can enter into the eye. And these may include metallic objects, wood, cement and dust. Usually, those objects may be blown by the wind or may get into the eye by falling from a higher space (Garrow, 1923). Larger objects can also hurt workers’ eyes and thus lead to blunt trauma. In the industrial sector, workers may splash liquid chemicals onto their eyes or may get the powdered version to enter their eyes. In the engineering sector, many workers are often vulnerable to thermal burns or maybe affected by ultraviolet radiation. These can cause immense damage to worker’s eyes and thus lead to economic and physical challenges.
The extent and incidence of occupational eye injuries
Most analyses carried out on incidences of occupational eye injuries normally focus on case studies. Sometimes researchers may focus on a particular hospital, town or country so it may be difficult to come up with a figure concerning the global prevalence rate. Nonetheless, a number of studies still give crucial indicators on trends about workplace eye injuries. In the UK for example, workplace eye injuries were at their peak in the 1920s (Garrow 1923). At that time, protective eye devices had not been propagated so workers were quite vulnerable. In fact seven out of ten eye injuries recorded in the UK at that time were workplace related. But as more standards were introduced into the industrial sector then occupational eye incidences started declining with traffic accidents and sports related activities being the leading cause of eye injuries. Workplace eye injuries still occur today although their prevalence is much lower than other occupational injuries.
In the United States for example, a survey carried out by Wong et. al. (2001) revealed that males were more susceptible than women to ocular trauma and this can be linked to their occupational eye activities (Wong et. al, 2001). It was also found that the cause of the eye injuries were mostly sharp objects which are found in several work professions such as construction workers who may get exposed to bits of stone, industry workers in glass manufacture, miners and furniture makers. Also, prevalent rates were more significant in the younger populations than the older ones as the participants started from age 43 to 86. These findings indicate that prevalence rates are sometimes determined by factors which cannot be controlled. One such uncontrollable factor is age. (Wong et. al., 2000).
Chen et. al. (2009) explains that most injury-causing activities occur in manufacturing – about 34.6% of all Taiwanese workers in 2007 obtained work related eye injuries from this sector. Consequently, it can be said that incidences of workplace injuries are highest in factories. Construction contributed approximately 24.7% of reported cases of eye injuries. In the same country, agriculture, steel and service sectors followed each other in close succession with each contributing about 15.7%. 11.3% and 8.5% respectively to the total number of occupational eye injuries reported in that country. Clearly, the type of profession or occupation one engaged in contributed towards one’s susceptibility to injuries.
Strategies for prevention of workplace eye injuries
Lipscomb (2000) classifies prevention strategies in two categories; they can either be environmental controls or behavioural controls. Behavioural controls can be done in various ways. They can be initiated through educational strategies (Mancini et. al., 2005). Here, workers may be given materials that include brochures or pamphlets that talk about technical aspects of work that could lead to eye injuries. Also, since occurrence of injuries amongst workers who had suffered from eye injuries is quite high then these brochures can be distributed in hospital ophthalmic departments around the country. Furthermore, even mass media approaches such as radio and tv interviews may sensitise the public about the risks and ways of preventing workplace eye injuries (Smith et al (1978). House to house distribution can be done around neighbourhoods located near manufacturing or construction zones as these are high risk occupations for eye injuries. Educational prevention can also occur through provision of safety training as described by Ngo and Leo (2008). Safety training should occur prior to new job postings so that workers may know what is expected of them in the job. On the other hand since the manufacturing and construction sectors tend to attract high representations of foreign workers then language barriers need to be considered. Training courses should have adequate translators and material should be written in a variety of languages so as to cope with these problems. Behavioural changes can also occur through work policies. Companies need to be strict about compliance with safety environments. Supervisors should be strict about their employees and should keep checking on these environments from time to time (Connell et. al (2007). Lawmakers also need to make legislations that punish employers for laxity and noncompliance with workplace eye injury prevention. This would spearhead a change in workplace culture. It has also been shown that other modifiable factors like fatigue, suitability of workers for certain jobs, and level of concentration cause eye injuries (Chen et. al, 2009). Employees need to be informed about the importance of concentrating on each task so as to minimize distractions. Supervisors need to be stricter prior to departure from work because employees are likely to be rushing. Also, employers should only touch certain tools when they are sure about them. Poor familiarity with tools is an important determinant of occupational eye injuries.
The other component revolves around the workplace environment. This is actually the most important aspect of prevention strategies. All workplaces need to have adequate eye protection devices (EPD). Employers need to make sure that they match work tasks and EPD sizes with employee needs. This will ensure that the eye protection devices are comfortable and would also increase compliance. The kinds of lenses used should be workable and in line with visual conditions of occupational tasks. Work environment changes also involve noise minimisation, heat control and reduction of fogginess. That would ensure that eye protection devices work well. Lastly, assessment of eye protection device use should be done so as to keep a score on compliance levels in the most relevant occupations.
Workplace injuries are still highly prevalent; with the greatest proportion emanating from the construction sector. Some eye injuries occur at the workplace due to employee related factors such as unfamiliarity with tasks or nervousness over time pressure. Employers are failing employees by providing them with the wrong eye protection devices or not offering them at all. Others have weak enforcement mechanisms or unfavourable work environments for use of the devices. Some employees lack proper language skills needed to attend training and others just have not been sensitised about the importance of preventing workplace eye injuries. If these matters are given greater attention then chances are that fewer workplace eye injuries will be reported.
Chen, S., Fong, P., Lin, S., Chang, C. & Chan, C. A case crossover study on transient risk factors of work related eye injuries. Occupational Environ Med 2008; 66: 517-522
Connelll, P., Saddak, T., Harrison, I., Kelly, S., Bobart, A., McGettrick, L. & Collum, L. Construction related eye injuries in Irish nationals and non national: attitudes and strategies for prevention. Ir. J Med Sci 2008; 176:11-14
Garrow, A. A statistical enquiry into 1000 cases of eye injuries. British journal of ophthalmology 1923; 7(2): 65-80
Kuhn, F., Morris, R., Mester, V. & Witherspoon, C. The Birmingham Eye trauma terminology system (BETT). Fr Ophtalmol J 2004; 27(4): 206-210
Macewen, C. Eye injuries: a prospective survey of 5671 cases. British journal of ophthalmology 1989; 72: 888-894
Mancini, G., Baldasseroni, A., Laffi, G., Mattioli, S. & Violante, F. Prevention of work related eye injuries: long term assessment of the effectiveness of multi component interventional among metal workers. Occupational Environ Med 2005; 62(12): 830-835
(This research was carried out in Italy where metal industry workers in Imola district were first informed about eye protection and then inspected after four years to find if the interventions had worked. The interventions were multipronged and extensive as they involved dispersion of educational material through newspapers, brochures and television or radio. In the results, data for workplace eye injuries was collected after the intervention. The paper illustrates that these extensive interventions do work. In the analysis, occupational eye injury rates prior to the interventions were noted. Then after the intervention, surprise visits were conducted by the researchers shortly after to analyse the incidences of eye injuries and these were also recorded. They were followed by late interventions and recordings of instances of eye injuries. These interventions involved a reemphasis of the main messages in the first intervention. Another third measure of eye injuries was done. A plot of injury rates against time (in years) revealed that there was significant reduction in workplace eye injuries. The injuries reduced by 23.4%, 37.4% & 42.4% for all the three measures taken.
Ngo, C. & Leo, S. Industrial accident-related ocular emergencies in a tertiary hospital in Singapore. Singapore Medical Journal 2008; 49(4), 280-286
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Smith, M., Angger, W. & Uslan, S. Behavioural modification applied to occupational safety. J safety Res 1978; 10(3): 87-88
Thompson, G. & Mollan, S. (2009). Occupational eye injuries: a continuing problem. Occupational medicine 2009; 59:123-125
Wolkoff, P., Nojgaard, J., Troiano, P. & Picolli, B. Eye complaints in the office environment: precorneal tear film integrity influenced by eye blinking efficiency. Occupational Environ Med 2005; 62: 4-12.
Wong, T., Klein, B. & Klein, R. The prevalence and 5 year incidence of ocular trauma. Opthalmology journal 2000; 107(12): 2196-2202