Characteristics of eye trauma in children and adolescents in China (China Eye Trauma Study 2023)_Chinese Journal of Ocular Fundus Diseases

Authors：

 Liao Mengyu ¹ , Han Han ¹ , Yao Xuyang ¹ , Nan Jiaying ¹ , Chen YongJie ² , Yan Hua ¹

1. Department of Ophthalmology, Tianjin Medical University General Hospital, International Joint Laboratory of Ocular Diseases (Ministry of Education), Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin 30052, China;
2. Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China;

Corresponding author：

Liao Mengyu, Email: lmy@tmu.edu.cn

Keywords：

Pediatric ocular trauma; Injury pattern; Visual acuity; Prognosis

DOI：

10.3760/cma.j.cn511434-20241014-00382

Video：

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Objective To analyze the epidemiological characteristics and injury patterns of eye trauma in children and adolescents in China. Methods A multicenter cross-sectional, retrospective, observational study. Based on the Chinese Eye Trauma Registry database, 189 patients (189 eyes) aged 0-18 years (13.4%, 189/1 412) of 1 412 patients (1 435 eyes) with eye trauma who were hospitalized from January to December 2023 were included in the study. Patients were recruited from 23 tertiary general hospitals or ophthalmology specialty hospitals located in 17 provincial-level administrative regions across six major geographical areas in China (North China, East China, South China, Central China, Northwest China, and Southwest China). The analysis focused on population characteristics, epidemiological features, injury patterns, and visual outcomes of children from different geographical regions and age groups. Among the 189 eyes, 95 eyes underwent secondary surgery. A total of 23 eyes were excluded due to non-cooperation during examination, no light perception, or only light perception. Ultimately, 72 eyes were included in the statistical analysis. Of these, 36 eyes had follow-up data and were used to observe postoperative visual outcomes. Results Among 189 patients, 143 were males (75.7%, 143/189) and 46 were females (24.3%, 46/189). Age 8.73 (1-18) years old. The gender composition of all age groups was mainly male. The geographical distribution showed that East China had the largest number of cases, 55 (29.1%, 55/189). There were 70 cases (37.0%, 70/189) in 7-10 years old. The type analysis of eye trauma showed that in 189 eyes, mechanical ocular trauma accounted for 130 eyes, of which 105 (80.8%, 105/130) eyes had open globe injuries and 25 (19.2%, 25/130) eyes had closed globe injuries. 122 eyes received emergency surgery within 24 h after injury (accounts for 83.6% of emergency surgical cases, 122/146). In 36 eyes with complete follow-up data, the initial visual acuity distribution was: blind 23 eyes (63.9%), low visual acuity 6 eyes (16.7%), visual acuity ≥0.3 in 7 eyes (19.4%). At the last follow-up, visual acuity improved in 12 eyes (33.3%), 8 eyes (22.2%) with low visual acuity, and 16 eyes (44.4%) with visual acuity ≥0.3. The final visual outcome showed that the disability rate was 22.2% (8/36) and the blindness rate was 33.3% (12/36). Conclusions Children and adolescents account for 13.4% of the hospitalized patients with eye trauma in the same period, and there is a significant gender difference (male accounted for 75.7%). There are obvious age-specific distribution rules in the causes, locations and clinical features of eye trauma in children and adolescents of different ages.

1.	Jandeck C, Kellner U, Bornfeld N, et al. Open globe injuries in children[J]. Graefe's Arch Clin Exp Ophthalmol, 2000, 238(5): 420-426. DOI: 10.1007/s004170050373.
2.	王甜, 颜华. 儿童眼外伤特点及治疗进展[J]. 中华眼外伤职业眼病杂志, 2016, 38(11): 877-880. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.022.Wang T, Yan H. The characteristics and treatment progress in pediatric ocular trauma[J]. Chin J Ocul Traum Occupat Eye Dis, 2016, 38(11): 877-880. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.022.
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4.	Jovanović N, Peek-Asa C, Ling Z, et al. Association between paediatric eye injuries, later academic success and social performance[J/OL]. Med Glas (Zenica), 2024, 21(2): E1(2024-10-14) [2024-01-09]. https://pubmed.ncbi.nlm.nih.gov/38852574/. DOI: 10.17392/1703-21-02.[published online ahead of print].
5.	Hashemi H, Pakzad R, Khabazkhoob M, et al. Prevalence of ocular trauma in 6-12-year-old children living in Shahroud, Iran[J/OL]. BMC Ophthalmol, 2022, 22(1): 320[2022-07-26]. https://pubmed.ncbi.nlm.nih.gov/35883120/. DOI: 10.1186/s12886-022-02541-5.
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7.	Kuhn F, Morris R, Witherspoon CD, et al. A standardized classification of ocular trauma[J]. Ophthalmology, 1996, 103(2): 240-243. DOI: 10.1016/s0161-6420(96)30710-0.
8.	Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries[J]. Ophthalmol Clin North Am, 2002, 15(2): 139-143. DOI: 10.1016/s0896-1549(02)00004-4.
9.	Pieramici DJ, Sternberg P, Aaberg TM, et al. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group[J]. Am J Ophthalmol, 1997, 123(6): 820-831. DOI: 10.1016/s0002-9394(14)71132-8.
10.	Feghhi M, Khataminia G, Ziaei H, et al. Prevalence and causes of blindness and low vision in khuzestan province, iran[J]. J Ophthalmic Vis Res, 2009, 4(1): 29-34.
11.	卢海, 刘敬花. 正确认识儿童开放性眼外伤诊疗的复杂性, 不断提高其诊疗效果[J]. 中华眼底病杂志, 2021, 37(5): 333-337. DOI: 10.3760/cma.j.cn511434-20210512-00250.Lu H, Liu JH. Correctly understanding the complexity of diagnosis and treatment of children's open ocular trauma to improve its diagnosis and treatment effect[J]. Chin J Ocul Fundus Dis, 2021, 37(5): 333-337. DOI: 10.3760/cma.j.cn511434-20210512-00250.
12.	封康, 靳瑛, 胡运韬, 等. 中国眼外伤登记网在多中心队列研究中的应用[J]. 中华眼科杂志, 2014, 50(12): 918-921. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.010.Feng K, Jin Y, Hu YT, et al. Application of Chinese Eye Injury Registry Network in multicenter cohort study[J]. Chin J Ophthalmol, 2014, 50(12): 918-921. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.010.
13.	Israeli A, Wald M, Safuri S, et al. Characteristics of pediatric ocular trauma in a tertiary hospital in Israel 2011-2020-how can public prevention policy be improved?[J]. Eur J Ophthalmol, 2024, 34(3): 852-858. DOI: 10.1177/11206721231199862.
14.	Alabdulkader B, Alsiwat Y, Almatar H, et al. Prevalence, characteristics, and management of pediatric ocular trauma in Riyadh, Saudi Arabia: a retrospective analysis[J/OL]. Healthcare (Basel), 2024, 12(16): 1673[2024-08-22]. https://pubmed.ncbi.nlm.nih.gov/39201231/. DOI: 10.3390/healthcare12161673.
15.	Ashby GB, Claxton MR, Kim EJ, et al. Incidence and clinical features of pediatric ocular trauma in a population-based cohort[J/OL]. J AAPOS, 2023, 27(2): e1-e6[2023-02-20]. https://pubmed.ncbi.nlm.nih.gov/36813127/. DOI: 10.1016/j.jaapos.2023.01.009.
16.	Kinoshita M, Ihara T, Mori T. Characteristics of pediatric ocular trauma in a pediatric emergency department in Japan[J]. Am J Emerg Med, 2023, 70: 75-80. DOI: 10.1016/j.ajem.2023.05.012.
17.	Cariello AJ, Moraes NS, Mitne S, et al. Epidemiological findings of ocular trauma in childhood[J]. Arq Bras Oftalmol, 2007, 70(2): 271-275. DOI: 10.1590/s0004-27492007000200015.
18.	Rachapudi S, Kaleem M. Pediatric toy-related ocular injuries in the United States: a national electronic injury surveillance system study[J]. Semin Ophthalmol, 2024, 40(2): 128-131. DOI: 10.1080/08820538.2024.2388622.
19.	Dentel A, Boulanger E, Chapron T, et al. Incidence and outcomes of eye trauma associated with recreative use of nonpowder toy guns: a 12-year retrospective study[J]. Am J Ophthalmol, 2024, 265: 73-79. DOI: 10.1016/j.ajo.2024.02.009.
20.	Uppuluri S, Uppuluri A, Zarbin MA, et al. Epidemiology of non-motorized pedal cycle-related ocular injuries in children ages 5 to 17[J]. Am J Emerg Med, 2023, 70: 185-186. DOI: 10.1016/j.ajem.2023.06.049.
21.	Boret C, Brehin C, Cortey C, et al. Pediatric ocular trauma: characteristics and outcomes among a French cohort (2007-2016)[J]. Arch Pediatr, 2020, 27(3): 128-134. DOI: 10.1016/j.arcped.2020.01.002.
22.	Ugalahi MO, Adebusoye SO, Olusanya BA, et al. Ocular injuries in a paediatric population at a child eye health tertiary facility, Ibadan, Nigeria[J]. Injury, 2023, 54(3): 917-923. DOI: 10.1016/j.injury.2023.01.014.
23.	Zhang J, Zhu X, Sun Z, et al. Epidemiology of sports-related eye injuries among athletes in Tianjin, China[J/OL]. Front Med (Lausanne), 2021, 8: 690528[2021-09-16]. https://pubmed.ncbi.nlm.nih.gov/34604250/. DOI: 10.3389/fmed.2021.690528.
24.	Zheng L, Tan J, Liu R, et al. The impact of primary treatment on post-traumatic endophthalmitis in children with open globe injuries: a study in China[J/OL]. Int J Environ Res Public Health, 2019, 16(16): 2956[2019-08-16]. https://pubmed.ncbi.nlm.nih.gov/31426389/. DOI: 10.3390/ijerph16162956.
25.	Feng K, Hu Y, Wang C, et al. Risk factors, anatomical, and visual outcomes of injured eyes with proliferative vitreoretinopathy: eye injury vitrectomy study[J]. Retina, 2013, 33(8): 1512-1518. DOI: 10.1097/IAE.0b013e3182852469.
26.	Puodžiuvienė E, Jokūbauskienė G, Vieversytė M, et al. A five-year retrospective study of the epidemiological characteristics and visual outcomes of pediatric ocular trauma[J/OL]. BMC Ophthalmol, 2018, 18(1): 10[2018-01-18]. https://pubmed.ncbi.nlm.nih.gov/29347941/. DOI: 10.1186/s12886-018-0676-7.
27.	Serrano JC, Chalela P, Arias JD. Epidemiology of childhood ocular trauma in a Northeastern Colombian region[J]. Arch Ophthalmol, 2003, 121(10): 1439-1445. DOI: 10.1001/archopht.121.10.1439.
28.	Sharifi M, Sedaghat M, Vaseie M. Ocular injuries sustained at home in five metropolitan cities: a review of 5008 cases[J]. Med Hypothesis Discov Innov Ophthalmol, 2024, 12(4): 194-202. DOI: 10.51329/mehdiophthal1486.
29.	Yardley AE, Hoskin AK, Hanman K, et al. Paediatric ocular and adnexal injuries requiring hospitalisation in Western Australia[J]. Clin Exp Optom, 2017, 100(3): 227-233. DOI: 10.1111/cxo.12486.
30.	Armstrong GW, Kim JG, Linakis JG, et al. Pediatric eye injuries presenting to United States emergency departments: 2001–2007[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(3): 629-636. DOI: 10.1007/s00417-011-1917-0.
31.	Andoh JE, Miguez S, Andoh SE, et al. Epidemiologic trends of domestic violence-related ocular injuries among pediatric patients: data from the Nationwide Emergency Department Sample 2008-2017[J]. J AAPOS, 2023, 27(6): 335-335. DOI: 10.1016/j.jaapos.2023.09.008.

1. Jandeck C, Kellner U, Bornfeld N, et al. Open globe injuries in children[J]. Graefe's Arch Clin Exp Ophthalmol, 2000, 238(5): 420-426. DOI: 10.1007/s004170050373.
2. 王甜, 颜华. 儿童眼外伤特点及治疗进展[J]. 中华眼外伤职业眼病杂志, 2016, 38(11): 877-880. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.022.Wang T, Yan H. The characteristics and treatment progress in pediatric ocular trauma[J]. Chin J Ocul Traum Occupat Eye Dis, 2016, 38(11): 877-880. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.022.
3. Ibukun FA, Ugalahi MO, Bekibele CO. Unilateral visual impairment and blindness in school children - prevalence and aetiology in Saki-East LGA of Oyo State, Nigeria[J]. Eye (Lond), 2024, 38(11): 2117-2123. DOI: 10.1038/s41433-024-02960-2.
4. Jovanović N, Peek-Asa C, Ling Z, et al. Association between paediatric eye injuries, later academic success and social performance[J/OL]. Med Glas (Zenica), 2024, 21(2): E1(2024-10-14) [2024-01-09]. https://pubmed.ncbi.nlm.nih.gov/38852574/. DOI: 10.17392/1703-21-02.[published online ahead of print].
5. Hashemi H, Pakzad R, Khabazkhoob M, et al. Prevalence of ocular trauma in 6-12-year-old children living in Shahroud, Iran[J/OL]. BMC Ophthalmol, 2022, 22(1): 320[2022-07-26]. https://pubmed.ncbi.nlm.nih.gov/35883120/. DOI: 10.1186/s12886-022-02541-5.
6. Dube M, Gupta S, Sarkar D, et al. Prevalence and pattern of ocular diseases among children aged 7-14 years visiting a tertiary care teaching hospital in central India[J/OL]. Cureus, 2024, 16(8): e66383[2024-08-07]. https://pubmed.ncbi.nlm.nih.gov/39246963/. DOI: 10.7759/cureus.66383.
7. Kuhn F, Morris R, Witherspoon CD, et al. A standardized classification of ocular trauma[J]. Ophthalmology, 1996, 103(2): 240-243. DOI: 10.1016/s0161-6420(96)30710-0.
8. Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries[J]. Ophthalmol Clin North Am, 2002, 15(2): 139-143. DOI: 10.1016/s0896-1549(02)00004-4.
9. Pieramici DJ, Sternberg P, Aaberg TM, et al. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group[J]. Am J Ophthalmol, 1997, 123(6): 820-831. DOI: 10.1016/s0002-9394(14)71132-8.
10. Feghhi M, Khataminia G, Ziaei H, et al. Prevalence and causes of blindness and low vision in khuzestan province, iran[J]. J Ophthalmic Vis Res, 2009, 4(1): 29-34.
11. 卢海, 刘敬花. 正确认识儿童开放性眼外伤诊疗的复杂性, 不断提高其诊疗效果[J]. 中华眼底病杂志, 2021, 37(5): 333-337. DOI: 10.3760/cma.j.cn511434-20210512-00250.Lu H, Liu JH. Correctly understanding the complexity of diagnosis and treatment of children's open ocular trauma to improve its diagnosis and treatment effect[J]. Chin J Ocul Fundus Dis, 2021, 37(5): 333-337. DOI: 10.3760/cma.j.cn511434-20210512-00250.
12. 封康, 靳瑛, 胡运韬, 等. 中国眼外伤登记网在多中心队列研究中的应用[J]. 中华眼科杂志, 2014, 50(12): 918-921. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.010.Feng K, Jin Y, Hu YT, et al. Application of Chinese Eye Injury Registry Network in multicenter cohort study[J]. Chin J Ophthalmol, 2014, 50(12): 918-921. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.010.
13. Israeli A, Wald M, Safuri S, et al. Characteristics of pediatric ocular trauma in a tertiary hospital in Israel 2011-2020-how can public prevention policy be improved?[J]. Eur J Ophthalmol, 2024, 34(3): 852-858. DOI: 10.1177/11206721231199862.
14. Alabdulkader B, Alsiwat Y, Almatar H, et al. Prevalence, characteristics, and management of pediatric ocular trauma in Riyadh, Saudi Arabia: a retrospective analysis[J/OL]. Healthcare (Basel), 2024, 12(16): 1673[2024-08-22]. https://pubmed.ncbi.nlm.nih.gov/39201231/. DOI: 10.3390/healthcare12161673.
15. Ashby GB, Claxton MR, Kim EJ, et al. Incidence and clinical features of pediatric ocular trauma in a population-based cohort[J/OL]. J AAPOS, 2023, 27(2): e1-e6[2023-02-20]. https://pubmed.ncbi.nlm.nih.gov/36813127/. DOI: 10.1016/j.jaapos.2023.01.009.
16. Kinoshita M, Ihara T, Mori T. Characteristics of pediatric ocular trauma in a pediatric emergency department in Japan[J]. Am J Emerg Med, 2023, 70: 75-80. DOI: 10.1016/j.ajem.2023.05.012.
17. Cariello AJ, Moraes NS, Mitne S, et al. Epidemiological findings of ocular trauma in childhood[J]. Arq Bras Oftalmol, 2007, 70(2): 271-275. DOI: 10.1590/s0004-27492007000200015.
18. Rachapudi S, Kaleem M. Pediatric toy-related ocular injuries in the United States: a national electronic injury surveillance system study[J]. Semin Ophthalmol, 2024, 40(2): 128-131. DOI: 10.1080/08820538.2024.2388622.
19. Dentel A, Boulanger E, Chapron T, et al. Incidence and outcomes of eye trauma associated with recreative use of nonpowder toy guns: a 12-year retrospective study[J]. Am J Ophthalmol, 2024, 265: 73-79. DOI: 10.1016/j.ajo.2024.02.009.
20. Uppuluri S, Uppuluri A, Zarbin MA, et al. Epidemiology of non-motorized pedal cycle-related ocular injuries in children ages 5 to 17[J]. Am J Emerg Med, 2023, 70: 185-186. DOI: 10.1016/j.ajem.2023.06.049.
21. Boret C, Brehin C, Cortey C, et al. Pediatric ocular trauma: characteristics and outcomes among a French cohort (2007-2016)[J]. Arch Pediatr, 2020, 27(3): 128-134. DOI: 10.1016/j.arcped.2020.01.002.
22. Ugalahi MO, Adebusoye SO, Olusanya BA, et al. Ocular injuries in a paediatric population at a child eye health tertiary facility, Ibadan, Nigeria[J]. Injury, 2023, 54(3): 917-923. DOI: 10.1016/j.injury.2023.01.014.
23. Zhang J, Zhu X, Sun Z, et al. Epidemiology of sports-related eye injuries among athletes in Tianjin, China[J/OL]. Front Med (Lausanne), 2021, 8: 690528[2021-09-16]. https://pubmed.ncbi.nlm.nih.gov/34604250/. DOI: 10.3389/fmed.2021.690528.
24. Zheng L, Tan J, Liu R, et al. The impact of primary treatment on post-traumatic endophthalmitis in children with open globe injuries: a study in China[J/OL]. Int J Environ Res Public Health, 2019, 16(16): 2956[2019-08-16]. https://pubmed.ncbi.nlm.nih.gov/31426389/. DOI: 10.3390/ijerph16162956.
25. Feng K, Hu Y, Wang C, et al. Risk factors, anatomical, and visual outcomes of injured eyes with proliferative vitreoretinopathy: eye injury vitrectomy study[J]. Retina, 2013, 33(8): 1512-1518. DOI: 10.1097/IAE.0b013e3182852469.
26. Puodžiuvienė E, Jokūbauskienė G, Vieversytė M, et al. A five-year retrospective study of the epidemiological characteristics and visual outcomes of pediatric ocular trauma[J/OL]. BMC Ophthalmol, 2018, 18(1): 10[2018-01-18]. https://pubmed.ncbi.nlm.nih.gov/29347941/. DOI: 10.1186/s12886-018-0676-7.
27. Serrano JC, Chalela P, Arias JD. Epidemiology of childhood ocular trauma in a Northeastern Colombian region[J]. Arch Ophthalmol, 2003, 121(10): 1439-1445. DOI: 10.1001/archopht.121.10.1439.
28. Sharifi M, Sedaghat M, Vaseie M. Ocular injuries sustained at home in five metropolitan cities: a review of 5008 cases[J]. Med Hypothesis Discov Innov Ophthalmol, 2024, 12(4): 194-202. DOI: 10.51329/mehdiophthal1486.
29. Yardley AE, Hoskin AK, Hanman K, et al. Paediatric ocular and adnexal injuries requiring hospitalisation in Western Australia[J]. Clin Exp Optom, 2017, 100(3): 227-233. DOI: 10.1111/cxo.12486.
30. Armstrong GW, Kim JG, Linakis JG, et al. Pediatric eye injuries presenting to United States emergency departments: 2001–2007[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(3): 629-636. DOI: 10.1007/s00417-011-1917-0.
31. Andoh JE, Miguez S, Andoh SE, et al. Epidemiologic trends of domestic violence-related ocular injuries among pediatric patients: data from the Nationwide Emergency Department Sample 2008-2017[J]. J AAPOS, 2023, 27(6): 335-335. DOI: 10.1016/j.jaapos.2023.09.008.

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