Ocular Trauma Trends in Indonesia: Poor Initial Uncorrected Visual Acuity Associated with Mechanism of Injury


  • Sauli Ari Widjaja Department of Ophthalmology, Graduate School of Medicine, Juntendo University, Tokyo, Japan; Department of Ophthalmology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-7033-524X
  • Yoshimune Hiratsuka Department of Ophthalmology, Graduate School of Medicine, Juntendo University, Tokyo, Japan https://orcid.org/0000-0001-8934-9396
  • Koichi Ono Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
  • Ima Yustiarini Department of Ophthalmology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia https://orcid.org/0000-0001-9361-7824
  • Nurwasis Nurwasis Department of Ophthalmology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
  • Akira Murakami Department of Ophthalmology, Graduate School of Medicine, Juntendo University, Tokyo, Japan https://orcid.org/0000-0002-0022-2514




Ocular trauma, Eye injuries trend, Mechanism of injury, Initial visual acuity, Ocular trauma epidemiology, Traffic accident


Objectives: To identify ocular trauma trends and to analyze how initial uncorrected visual acuity (VA) is associated with mechanism of injury (MOI) in a referral hospital in Indonesia.

Methods: A five-year medical chart review at the Ophthalmology Emergency Department (OED) Dr. Soetomo General Academic Hospital (DSGAH). The information retrieved included sex, age, laterality involvement, initial uncorrected VA, MOI and management. Sex- and age- adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the relationship between poor initial uncorrected VA and MOI, using multivariate logistic regression analysis.

Results: A total of 953 patients consisted of 80.3% males and 19.9% females. Ocular trauma predominantly occurred in 21–30 years age group (20.9%). May and November were found to have the highest average number of monthly patients. Closed globe injuries (80.3%) were more prevalent than open globe injuries (17.7%). The most frequent MOIs were sharp objects (311; 32.6%), followed by blunt objects (236; 24.8%). Most cases (89.2%) displayed unilateral involvement and 54.3% cases showed an initial uncorrected VA of better than 6/18. Compared to road dust, blunt object, sharp object and traffic accident were significantly associated with poor initial VA, with adjusted ORs (95% CIs) of 5.24 (2.27-12.10), 4.03 (1.76-9.25) and 8.17 (3.31-20.15), respectively.

Conclusions: Initial uncorrected VA and MOI provide earlier information regarding the prognosis. Traffic accident showed a greater tendency to cause a poor initial uncorrected VA. Most ocular trauma is preventable by educating people at risk to avoid common MOIs and to use protection.


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Dhillon PK, Jeemon P, Arora NK, Mathur P, Maskey M, Sukirna RD, et al. Status of epidemiology in the WHO South- East Asia region: Burden of disease, determinants of health and epidemiological research, workforce and training capacity. Int J Epidemiol. 2012;41(3):847-60. https://doi.org/10.1093/ije/dys046 PMid:22617689

Négrel A, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol. 1998;5(3):143-69. https://doi.org/10.1076/opep. PMid:9805347

Lin KY, Ngai P, Echegoyen JC, Tao JP. Imaging in orbital trauma. Saudi J Ophthalmol. 2012;26(4):427-32. PMid:23961028

Chua D, Wong W, Lamoureux EL, Aung T, Saw SM, Wong TY. The prevalence and risk factors of ocular trauma: The Singapore Indian eye study. Ophthalmic Epidemiol. 2011;18(6):281-7. https://doi.org/10.3109/09286586.2011.628775 PMid:22053838

Kementerian Kesehatan RI. Laporan Riskesdas 2018. Lap Nas Riskesdas. Vol. 53. Indonesia: Kementerian Kesehatan RI; 2018. p. 181-222. Available from: http://www.yankes.kemkes.go.id/assets/downloads/pmkno.57tahun2013tentangptrm.pdf. [Last accessed on 2021 Jan 25].

Zhang X, Liu Y, Ji X, Zou Y. A retrospective study on clinical features and visual outcome of patients hospitalized for ocular trauma in Cangzhou, China. J Ophthalmol. 2017;2017:7694913. https://doi.org/10.1155/2017/7694913 PMid:28386477

Mallika PS, Tan AK, Asok T, Faisal HA, Aziz S, Intan G. Pattern of ocular trauma in Kuching, Malaysia. Malays Fam Physician. 2008;3(3):140-5. PMid:25606139

Wang W, Zhou Y, Zeng J, Shi M, Chen B. Epidemiology and clinical characteristics of patients hospitalized for ocular trauma in South-Central China. Acta Ophthalmol. 2017;95(6):e503-10. https://doi.org/10.1111/aos.13438 PMid:28371405

Meng Y, Yan H. Prognostic factors for open globe injuries and correlation of ocular trauma score in Tianjin, China. J Ophthalmol. 2015;2015:345764. https://doi.org/10.1155/2015/345764 PMid:26491549

Kuhn F, Morris R, Mester V, Witherspoon CD. Terminology of mechanical injuries: The Birmingham eye trauma terminology (BETT). In: Ocular Traumatology. Berlin, Germany: Springer; 2008. p. 3-11. https://doi.org/10.1007/978-3-540-33825-3_1

Puzari BS, Das RK, Pegu I. A study on ocular injuries following road traffic accidents. Int J Res Med Sci. 2017;5(2):627. https://doi.org/10.18203/2320-6012.ijrms20170164

Cao H, Li L, Zhang M. Epidemiology of patients hospitalized for ocular trauma in the Chaoshan region of China, 2001-2010. PLoS One. 2012;7(10):e48377. https://doi.org/10.1371/journal. pone.0048377 PMid:23118997

Ramirez DA, Porco TC, Lietman TM, Keenan JD. Ocular injury in United States emergency departments: Seasonality and annual trends estimated from a nationally representative dataset. Am J Ophthalmol. 2018;191(1):149-55. https://doi.org/10.1016/j.ajo.2018.04.020 PMid:29750945

Kwon JW, Choi MY, Bae JM. Incidence and seasonality of major ocular trauma: A nationwide population-based study. Sci Rep. 2020;10(1):10020. https://doi.org/10.1038/s41598-020-67315-9 PMid:32572124

Movahedinejad T, Adib-Hajbaghery M, Zahedi MR. A study on hospital admissions for eye trauma in Kashan, Iran. Trauma Mon. 2016;21(2):e28073. https://doi.org/10.5812/traumamon.28073 PMid:27626013

Toride A, Toshida H, Matsui A, Matsuzaki Y, Honda R, Ohta T, et al. Visual outcome after emergency surgery for open globe eye injury in Japan. Clin Ophthalmol. 2016;10:1731-6. https://doi.org/10.2147/opth.s103704 PMid:27660410

Patil S, Biala A, Khanna A, Meena A. Prevalence of ocular trauma in KLES hospital: A 1-year cross-sectional study. Indian J Health Sci. 2016;9(2):175-8. Available from: https://www.ijournalhs.org/text.asp?2016/9/2/175/191262. [Last accessed on 2019 Jun 15]. https://doi.org/10.4103/2349-5006.191262

Li L, Lu H, Ma K, Li YY, Wang HY, Liu NP. Etiologic causes and epidemiological characteristics of patients with intraocular foreign bodies: Retrospective analysis of 1340 cases over ten years. J Ophthalmol. 2018;2018:6309638. PMid:29651344

Agrawal R, Wei HS, Teoh S. Prognostic factors for open globe injuries and correlation of ocular trauma score at a tertiary referral eye care Centre in Singapore. Indian J Ophthalmol. 2013;61(9):502-6. https://doi.org/10.4103/0301-4738.119436 PMid:24104709

Lubis RR, Limanto V, Putri R, Lubis AN, Arrasyid NK. Epidemiological characteristics of work-related ocular trauma among the carpenters in Medan, Indonesia. Open Access Maced J Med Sci. 2018;6(11):2119-22. https://doi.org/10.3889/oamjms.2018.441 PMid:30559872

Pandita A, Merriman M. Ocular trauma epidemiology: 10-year retrospective study. N Z Med J. 2012;125(1348):61-9. PMid:22282278

Voon LW, See J, Wong TY. The epidemiology of ocular trauma in Singapore: Perspective from the emergency service of a large tertiary hospital. Eye (Lond). 2001;15(1):75-81. https://doi.org/10.1038/eye.2001.18 PMid:11318302

Makhrash MA, Gosadi IM. Open globe eye injury characteristics and prognostic factors in Jazan, Saudi Arabia. Saudi Med J. 2016;37(12):1328-33. https://doi.org/10.15537/smj.2016.12.15545 PMid:27874147

Oum BS, Lee JS, Han YS. Clinical features of ocular trauma in emergency department. Korean J Ophthalmol. 2004;18(1):70-8. https://doi.org/10.3341/kjo.2004.18.1.70 PMid:15255241

Qi Y, Zhang FY, Peng GH, Zhu Y, Wan GM, Wang WZ, et al. Characteristics and visual outcomes of patients hospitalized for ocular trauma in Central China: 2006-2011. Int J Ophthalmol. 2015;8(1):162-8. PMid:25709927

Mishra A, Parihar J, Verma A, Aggarwal S, Baranwal V, Bhargava N. The pattern and visual outcomes of ocular trauma in a large zonal hospital in a non-operational role: A 36 months retrospective analysis. J Clin Ophthalmol Res. 2014;2(3):141-4. Available from: https://www.jcor.in/text.asp?2014/2/3/141/138856. [Last accessed on 2019 Jun 15]. https://doi.org/10.4103/2320-3897.138856

Pai SG, Kamath SJ, D’Souza S, Dudeja L. A clinical study of blunt ocular trauma in a tertiary care centre. Online J Health Allied Sci. 2013;12(2):2-5.

Monsudi K, Adekoya B, Grace A. Bilateral blindness from ocular injury: A 15 year review. Afr J Trauma. 2014;3(1):35-8. Available from: https://www.afrjtrauma.com/text.asp?2014/3/1/35/139467. [Last accessed on 2019 Jun 15]. https://doi.org/10.4103/1597-1112.139467

Okeigbemen V, Osaguona V. Seasonal variation in ocular injury in a tertiary health center in Benin city. Sahel Med J. 2013;16(1):10-4. Available from: https://www.smjonline.org/text.asp?2013/16/1/10/112055. [Last accessed on 2019 Jun 15]. https://doi.org/10.4103/1118-8561.112055

Dryden SC, Jensen JD, Fleming JC, Fowler BT. Ocular trauma: Trends and considerations for resident education. J Acad Ophthalmol. 2020;12(1):e46-51. https://doi.org/10.1055/s-0040-1709177

Mahendradhata Y, Trisnantoro L, Listyadewi S, Soewondo P, Marthias T, Harimurti P, et al. The Republic of Indonesia Health System Review. WHO Regional Office for South-East Asia. Vol. 7. Geneva: World Health Organization; 2017. Available from: https://www.apps.who.int/iris/handle/10665/254716. [Last accessed on 2021 Mar 30].

Cai X, Lu JJ, Xing Y, Jiang C, Lu W. Analyzing driving risks of roadway traffic under adverse weather conditions: In case of rain day. Procedia Soc Behav Sci. 2013;96:2563-71. https://doi.org/10.1016/j.sbspro.2013.08.287

Chakrabarty N, Gupta K. Analysis of driver behaviour and crash characteristics during adverse weather conditions. Procedia Soc Behav Sci. 2013;104:1048-57. https://doi.org/10.1016/j.sbspro.2013.11.200

Siregar ML, Jachrizal Sumabrata R, Kusuma A, Samosir OB, Rudrokasworo SN. Analyzing driving environment factors in pedestrian crashes injury levels in Jakarta and the surrounding cities. J Appl Eng Sci. 2019;17(4):482-9. https://doi.org/10.5937/jaes17-22121

Ismaili AF. The influence of weather on the behavior of motorcycle riders in the special area of Yogyakarta. Semesta Tek. 2017;20(2):132-8.

McGwin G, Hall TA, Xie A, Owsley C. Trends in eye injury in the United States, 1992-2001. Invest Ophthalmol Vis Sci. 2006;47(2):521-7. https://doi.org/10.1167/iovs.05-0909 PMid:16431945

Iqbal Y, Khan QA, Zia S, Malik A. Frequency and characteristics of ocular trauma in Gilgit, Pakistan. J Islam Int Med Coll. 2016;11(4):157-62.

Wong TY, Tielsch JM. A population-based study on the incidence of severe ocular trauma in Singapore. Am J Ophthalmol. 1999;128(3):345-51. https://doi.org/10.1016/s0002-9394(99)00167-1 PMid:10511030

Alem KD, Arega DD, Weldegiorgis ST, Agaje BG, Tigneh EG. Profile of ocular trauma in patients presenting to the department of ophthalmology at Hawassa University: Retrospective study. PLoS One. 2019;14(3):e0213893. https://doi.org/10.1371/journal.pone.0213893 PMid:30921358




How to Cite

Widjaja SA, Hiratsuka Y, Ono K, Yustiarini I, Nurwasis N, Murakami A. Ocular Trauma Trends in Indonesia: Poor Initial Uncorrected Visual Acuity Associated with Mechanism of Injury. Open Access Maced J Med Sci [Internet]. 2021 Aug. 29 [cited 2022 May 21];9(B):903-8. Available from: https://oamjms.eu/index.php/mjms/article/view/6862