Unintentional adult eye injuries in Victoria

Monash University Accident Research Centre - Report #137 - 1998

Authors: A. Imberger, A. Altmann & W. Watson

Full report in .pdf format [413KB]

Abstract:

Eye trauma is the leading cause of blindness worldwide. It is estimated that 116,000 Australians, and nearly 30,000 Victorians, present to hospitals, emergency departments and general practitioners every year with ocular injuries. These figures are probably conservative estimates, as they do not include those managed at work by on-site medical and nursing staff.

The aims of this study were to examine:

  • the epidemiology of adult eye injuries occurring in Victoria across three severity levels: inpatients from Victorian public hospitals, and cases presenting to emergency departments and general practitioners;
  • two products commonly associated with eye injuries: welders and workshop power grinders;
  • the main causes of welding and grinding eye injuries;
  • the use of safety eyewear whilst welding and grinding in the home and work environments;
  • the type of eyewear worn and the reasons for eyewear failure.

Data was obtained from three databases which provide information on admissions to hospitals, and presentations to emergency departments and the general practitioner. The study involved analysis of coded data fields and the examination of one line "narrative" texts. A critical review of the literature was also undertaken to compare findings and to investigate potential interventions and the issues surrounding their implementation. For the purposes of this study, adults were defined as any person 15 years of age or older.

Nearly one in ten adults presenting to emergency departments with an unintentional injury had sustained an injury to the eye. Welding and grinding were responsible for 29% of all eye injuries. Approximately one half (49%) of those injured through welding-related activities, and one-third (33%) of those injured through grinding-related activities, did not report wearing any form of eye protection at the time of injury. However, the reported use of eye protection was significantly greater among workers than home handy persons. For those that were grinding, objects commonly flicked underneath or through the sides of the safety eyewear (particularly safety glasses). For welders, injuries commonly occurred because the protective equipment was not worn throughout the entire welding process. In many cases (25% of welding and 6% of grinding cases), those not wearing protective equipment, were injured whilst walking past or assisting others who were performing these activities.

Two main issues arising from this study need to be addressed. First, large numbers of individuals are not wearing eye protection whilst performing, or in the vicinity of, activities that present dangers to the eyes. Second, injuries are still occurring despite the use of protective eyewear. Numerous strategies are proposed to increase the use of appropriate protective equipment, particularly for home handy persons. Improved designs that are already available and have the potential to prevent many of the problems observed, are also discussed.

Executive Summary

Introduction

Eye trauma is the leading cause of blindness worldwide. It is estimated that 116,000 Australians, and nearly 30,000 Victorians, present to hospitals, emergency departments and general practitioners every year with ocular injuries. A Victorian study estimated that eye injuries cost the state community $39 million each year, with nationwide estimates of $155 million (Fong, 1995). These figures are probably conservative estimates, as they do not include those managed at work by on-site medical and nursing staff.

Aims

The aims of this study were to examine:

  • the epidemiology of adult eye injuries occurring in Victoria across three severity levels: inpatients from Victorian public hospitals, and cases presenting to emergency departments and general practitioners;
  • two products commonly associated with eye injuries: welders, and workshop power grinders;
  • the main causes of welding and grinding eye injuries;
  • the use of safety eyewear whilst welding and grinding in the home and work environments;
  • the type of eyewear worn, and the reasons for eyewear failure.

Methodology

Data was obtained from three databases which provide information on admissions to hospitals, and presentations to emergency departments and the general practitioner. The study involved analysis of coded data fields and the examination of one line "narrative" texts. A critical review of the literature was also undertaken to compare findings and to investigate potential interventions and the issues surrounding their implementation. For the purposes of this study, adults were defined as any person 15 years of age or older.

Results

Nearly one in ten adults presenting to emergency departments with an unintentional injury had sustained an injury to the eye. The majority of patients were men (86 percent of presentations), most of whom were aged between 20 and 44 years (73 percent). While 94 percent of those presenting to emergency departments received some form of treatment for their injury, only 3.7 percent were admitted to hospital. Half the eye injuries recorded by emergency departments were due to foreign bodies (50.5 percent). Superficial abrasions (13.3 percent), inflammation/swelling (11.4 percent), partial thickness burns (9.3 percent) and cuts and lacerations (7.1 percent) were the other major types of eye injuries sustained.

For patients presenting to emergency departments, the most common place for injury to occur was at home (37.8 percent) mainly outside in the garden, yard or garage. This was followed by areas of production (29.1 percent) such as industrial settings, factories, warehouses and construction sites.

Occupational activities accounted for 38 percent of eye injuries presenting to emergency departments, followed by maintenance activities outside the workplace (31.4 percent), then leisure or recreational activities (15.5 percent). Welding and grinding were responsible for 29 percent of all eye injuries

Grinding-related activities caused about 17 percent of all eye injuries recorded in the databases. Of these, 49 percent occurred in the workplace and 51 percent were the result of "Do-It-Yourself" activities in the home. The main cause of injury was foreign bodies entering the eyes (83 percent of cases). Approximately one-third (33 percent) of those injured through grinding-related activities did not report wearing any form of eye protection at the time of injury. However, the use of eye protection was significantly greater among workers (81 percent) than home handy persons (51 percent). Safety glasses were the most common form of safety eyewear worn (64 percent) either on their own (53 percent of all wearers) or with a visor, shield or mask (10 percent). For those injured whilst wearing some form of eye protection, objects commonly flicked underneath or through the sides of the safety eyewear (particularly safety glasses). In about 10 percent of cases, the protective eyewear was not worn at all times during the grinding process.

Welding activities caused almost 12 percent of all eye injuries recorded in the database. About half (49 percent) occurred in the workplace, with the balance (51 percent) occurring as the result of "Do-It-Yourself" activities around the home. The main causes of eye injury associated with welding were flash burns (54 percent) and foreign bodies entering the eye (32 percent). Only about half of those injured claimed to be wearing some form of protective eyewear. As with grinding injuries protective eyewear was more common in the workplace than at home (60 percent compared to 49 percent). Sixty percent of those using protective eyewear were wearing a welding helmet/mask, shield or visor. However, the main factor, in the case of welding, appeared to be that the injured were not wearing protective eyewear at all times (62 percent of cases) during the welding process. Welders either activated the welder before the protective eyewear was in place, or removed the eyewear due to poor visibility.

In many cases (25 percent of welding and 6 percent of grinding cases), those not wearing protective eyewear, were injured whilst walking past or assisting others who were performing these activities.

Discussion

The main finding from this study is that, despite the availability of appropriate protective eyewear, eye injuries remain common. Nearly one in ten adults presenting to emergency departments, with an unintentional injury in Victoria, have sustained an eye injury. Most eye injuries occur in either the residential setting (particularly the garage and the garden) or in the workplace (particularly industrial areas, factories, warehouses and construction sites). The two activities most frequently associated with eye injuries are welding and grinding. Together these accounted for nearly one third of all eye injury cases presenting to emergency departments and general practitioners.

The findings also highlight the need for bystanders to wear protective eyewear when in the vicinity of welding and grinding activities. This is particularly important if watching or assisting in welding and/or grinding operations, but also if passing through a workshop area (eg. visitors, management and other workers) in which these activities are taking place. In terms of those engaged in these activities, the literature suggests that the main reasons people do not wear protective eyewear relate to issues such as comfort, style, restricted vision, and safety equipment not provided by employers. Other authors suggest that these reasons are less relevant than the fact that individuals feel that eye protection is unnecessary.

The study also showed that workers are more likely to wear protective eyewear than home handymen. Indeed, other studies have shown that eye injuries at work, while still a large proportion of all eye injuries, have decreased (Jones & Griffith, 1992; Bell, 1994) while domestic injuries have increased (Schrader, 1993). This is not surprising, given that, unlike the workplace, there are major difficulties in targeting the home handy person since there is little control over safety education and no regulation or enforcement in the use of protective equipment.

A recent study (Routley & Ozanne-Smith, 1995) suggested a multi-faceted approach to reduce injuries in the "Do-It-Yourself" area since individual strategies, such as warning labels, are unlikely to succeed alone (Petré, 1996). They suggested a coordinated approach with four main locations for intervention : the workplace; retail outlets; manufacturers; and the media.

The results of this present study suggest that, when protective eyewear is worn, it is often the wrong type. In the case of grinding-related eye injuries, in particular, over half the cases injured whilst wearing protective eyewear were wearing safety glasses as opposed to wide-vision goggles, face-shields or visors. It has been shown that the relative risk of injury whilst wearing safety glasses is 4.3 times greater than when wearing goggles (Henderson, 1991). Since safety glasses provide only frontal protection many injuries are caused by objects impacting from the side or from below.

For welding-related eye injuries, this and other studies suggest that flash burns often occur when welders strike the arc before lowering the eye shield. Auto-darkening filters are becoming increasingly available and, while more costly than fixed filters, allow the welder to perform the entire welding process without raising the protective shield. This improves the quality, quantity and consistency of welding, as well as reducing the risk of injury.

Conclusion

Two main issues arising from this study need to be addressed. First, large numbers of individuals are not wearing eye protection whilst performing, or in the vicinity of, activities that present dangers to the eyes. Second, injuries are still occurring despite the use of protective eyewear. In general, it seems that those injured often wear inappropriate safety or ill-fitting eyewear for the task being undertaken, or do not wear protective eyewear at all times while undertaking the task. The finding that safety glasses may not provide adequate protection against small, off-centre particles, needs to be addressed, and the use of goggles promoted.

While this study highlights several important issues, further research investigating the details of these issues is necessary. In particular, research is required to determine why home handy persons, in particular, do not wear eye protection, and what factors influence the likelihood of their wearing protection. Until these issues are addressed, and prevention strategies implemented, eye injuries will remain a common cause of emergency department and general practitioner presentations.

Sponsoring Organisation: Victorian Health Promotion Foundation.