The impact of coronavirus disease on ocular trauma: a review of 5065 cases from Kuwait
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 4 (2024),
2 March 2025
,
Page 145-151
https://doi.org/10.51329/mehdioptometry209
Abstract
Background: Early reports during the lockdown associated with the coronavirus disease 2019 (COVID-19) pandemic indicated a shift in the trends of ocular injuries. This study examined the demographics and clinical characteristics of patients who presented with ocular trauma during the lockdown period in 2020, and compared them to those seen during the same months in the next year, after the lockdown had been lifted, at Farwaniya Hospital in Kuwait.Methods: This retrospective hospital-based chart review was a comparative observational study that examined individuals who presented to the Ophthalmology Department's emergency room during two distinct periods: from March 22, 2020, the day quarantine measures were announced, until August 30, 2020, when the quarantine ended, and the same time frame in the following year. Demographic characteristics, diagnoses, mechanisms of ocular trauma, and the locations where the eye injuries had occurred were recorded. Local injuries were classified as either mechanical or non-mechanical. Mechanical injuries were further subdivided by their cause. Non-mechanical injuries encompassed those caused by burns or corrosive substances.
Results: The incidence of ocular trauma increased from 18.9% (1470 out of 7763 cases) during the lockdown to 21.5% (3595 out of 16 748 cases) in the post-lockdown period. The mean age of the study population was slightly lower during the lockdown compared to the post-lockdown period, although this difference did not reach statistical significance (P > 0.05). Ocular trauma among children < 18 years was significantly higher during the lockdown period, accounting for 39.1% (575 of 1470 cases), compared to 36.0% (1293 of 3595 cases) in the post-lockdown period (P < 0.05). During both periods, injuries predominantly occurred at home, but the percentage of injuries decreased significantly during the post-lockdown period (P < 0.05). Workers were the most affected group, representing nearly 50% of cases during both periods. During the lockdown, 29.9% (439 cases) of ocular trauma cases involved work-related injuries, but this percentage increased significantly to 33.7% (1213 cases) post-lockdown (P < 0.05). Mechanical injuries constituted the majority of cases in both periods, accounting for almost 95% of the incidents, with a significant difference between the two periods (P < 0.05). Non-mechanical eye injuries did not differ between the two periods (P > 0.05). Most ocular trauma cases involved the anterior segment of the eye, with superficial corneal and conjunctival injuries being predominant, accounting for > 50% of cases during both periods.
Conclusions: The COVID-19 pandemic significantly impacted the trends in cases visiting ophthalmic emergency departments. After the lockdown, the incidence of ocular trauma increased. Ocular trauma among children was significantly higher during the lockdown period. The frequency of home-related ocular injuries was greater during the lockdown than in the post-lockdown phase. Work-related injuries showed a marked increase after the lockdown. Long-term, retrospective multicenter epidemiological studies in Kuwait could shed light on changes in the use of eye emergency department services during pre- and post-pandemic periods.
Keywords:
- trauma
- injury
- wounds
- eye injury
- coronavirus disease 2019 virus
- quarantines
- children
References
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16. Shah M, Shah S, Agrawal R, Patel K. Validation of a modified Birmingham eye trauma terminology classification for mechanical eye injuries. Trauma. 2018 Jul;20(3):217-20. doi: 10.1177/1460408617715488.
17. Pellegrini M, Roda M, Di Geronimo N, Lupardi E, Giannaccare G, Schiavi C. Changing trends of ocular trauma in the time of COVID-19 pandemic. Eye (Lond). 2020 Jul;34(7):1248-1250. doi: 10.1038/s41433-020-0933-x. Epub 2020 May 6. PMID: 32376977; PMCID: PMC7202459.
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20. Pande R, Mohod SS, V P, Shanbhag S, Kumar NS. Impact of the COVID-19-induced lockdown on the incidence of ocular trauma presenting to a tertiary care hospital. BMJ Open Ophthalmol. 2022 Mar 18;7(1):e000861. doi: 10.1136/bmjophth-2021-000861. PMID: 35342820; PMCID: PMC8935004.
21. Halawa OA, Friedman DS, Roldan AM, Zebardast N. Changing trends in ocular trauma during the COVID-19 pandemic in the USA. Br J Ophthalmol. 2023 Feb;107(2):295-298. doi: 10.1136/bjophthalmol-2021-319627. Epub 2021 Aug 20. PMID: 34417186.
22. Hattenbach LO, Heinz P, Feltgen N, Hoerauf H, Kohnen T, Priglinger S, Bachmann W, Rieks J, Eter N, Reinhard T. Impact of the SARS-CoV-2 pandemic on ophthalmic care in Germany. Ophthalmologe. 2021 Jul;118(Suppl 2):166-175. doi: 10.1007/s00347-021-01411-7. Epub 2021 Jun 4. PMID: 34086070; PMCID: PMC8176275.
23. Whang WJ, Kwon JW. Yearly trends in the incidence of ocular traumas and the effects of COVID-19 pandemic: a nationwide population-based study of Korean data. Ann Transl Med. 2023 Mar 31;11(6):241. doi: 10.21037/atm-22-2458. Epub 2023 Mar 6. PMID: 37082683; PMCID: PMC10113071.
24. Liew TK, Yong GY, Zainal Abidin Z, Asnir ZZ. Ocular Trauma Trends during COVID-19 Pandemic. Malays J Med Sci. 2023 Jun;30(3):135-142. doi: 10.21315/mjms2023.30.3.12. Epub 2023 Jun 27. PMID: 37425384; PMCID: PMC10325137.
25. Wu C, Patel SN, Jenkins TL, Obeid A, Ho AC, Yonekawa Y. Ocular trauma during COVID-19 stay-at-home orders: a comparative cohort study. Curr Opin Ophthalmol. 2020 Sep;31(5):423-426. doi: 10.1097/ICU.0000000000000687. PMID: 32740065.
26. Agrawal D, Parchand S, Agrawal D, Chatterjee S, Gangwe A, Mishra M, Sahu A. Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute. Indian J Ophthalmol. 2021 Mar;69(3):709-713. doi: 10.4103/ijo.IJO_3200_20. PMID: 33595506; PMCID: PMC7942066.
27. Chauhan MZ, Ali AA, Healy J, Elhusseiny AM, Phillips PH, Sallam AB, Uwaydat SH. The impact of the COVID-19 pandemic on ocular trauma in American infants and toddlers. J AAPOS. 2024 Apr;28(2):103864. doi: 10.1016/j.jaapos.2024.103864. Epub 2024 Mar 6. PMID: 38458597.
28. Martin GC, Boulanger E, Maalej R, Partouche S, Dentel A, Grosselin M, Ettayeb R, Chapron T, Caputo G, Vignal-Clermont C. Specificities of pediatric ocular emergencies before and during the COVID-19 era: A retrospective comparative study in an eye-related emergency department in Paris. Arch Pediatr. 2023 Aug;30(6):396-400. doi: 10.1016/j.arcped.2023.06.002. Epub 2023 Jun 12. PMID: 37394362; PMCID: PMC10258578.
29. Cavuoto KM, Vanner EA, Osigian CJ. Trends in pediatric ocular trauma presenting to an ophthalmology-specific emergency department during the COVID-19 pandemic. J AAPOS. 2021 Jun;25(3):170-172. doi: 10.1016/j.jaapos.2021.01.004. Epub 2021 Apr 29. PMID: 33932568.
30. Xu YM, Du LP, Huo YD, An GQ, Jin XM, Zhou PY. COVID-19 pandemic impact on ocular trauma in a tertiary hospital. Int J Ophthalmol. 2023 Jan 18;16(1):16-21. doi: 10.18240/ijo.2023.01.03. PMID: 36659937; PMCID: PMC9815970.
31. Schulz M, Thomas PJ, Legocki AT, Bonnell A, Chee Y, Feng S, Chen P, Bojikian KD. Impact of socioeconomic status on open globe injuries during the COVID-19 pandemic. Int Ophthalmol. 2024 Aug 12;44(1):346. doi: 10.1007/s10792-024-03257-9. PMID: 39134831.
32. Zhang YX, Feng K, Liao MY, Yan H. Comparison of ocular trauma between normalized and the COVID-19 epidemic periods in China: a multi-center cross-sectional study. Int J Ophthalmol. 2023 Jan 18;16(1):10-15. doi: 10.18240/ijo.2023.01.02. PMID: 36659951; PMCID: PMC9815975.
2. Wilder-Smith A, Chiew CJ, Lee VJ. Can we contain the COVID-19 outbreak with the same measures as for SARS? Lancet Infect Dis. 2020 May;20(5):e102-e107. doi: 10.1016/S1473-3099(20)30129-8. Epub 2020 Mar 5. PMID: 32145768; PMCID: PMC7102636.
3. Tyshenko MG, Oraby T, Longenecker J, Vainio H, Gasana J, Alali WQ, AlSeaidan M, ElSaadany S, Al-Zoughool M. Analysis of intervention effectiveness using early outbreak transmission dynamics to guide future pandemic management and decision-making in Kuwait. Infect Dis Model. 2021;6:693-705. doi: 10.1016/j.idm.2021.04.003. Epub 2021 Apr 19. PMID: 33898885; PMCID: PMC8054527.
4. Aldhyani THH, Alkahtani H. A Bidirectional Long Short-Term Memory Model Algorithm for Predicting COVID-19 in Gulf Countries. Life (Basel). 2021 Oct 21;11(11):1118. doi: 10.3390/life11111118. PMID: 34832994; PMCID: PMC8625101.
5. Low L, Hodson J, Morris D, Desai P, MacEwen C. Socioeconomic deprivation and serious ocular trauma in Scotland: a national prospective study. Br J Ophthalmol. 2017 Oct;101(10):1395-1398. doi: 10.1136/bjophthalmol-2016-309875. Epub 2017 Mar 8. PMID: 28274942; PMCID: PMC5629949.
6. 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 Jul;191:149-155. doi: 10.1016/j.ajo.2018.04.020. Epub 2018 May 9. PMID: 29750945; PMCID: PMC6014923.
7. Matsa E, Shi J, Wheeler KK, McCarthy T, McGregor ML, Leonard JC. Trends in US Emergency Department Visits for Pediatric Acute Ocular Injury. JAMA Ophthalmol. 2018 Aug 1;136(8):895-903. doi: 10.1001/jamaophthalmol.2018.2062. Erratum in: JAMA Ophthalmol. 2018 Aug 1;136(8):959. doi: 10.1001/jamaophthalmol.2018.2944. PMID: 29879287; PMCID: PMC6142941.
8. Kanoff JM, Turalba AV, Andreoli MT, Andreoli CM. Characteristics and outcomes of work-related open globe injuries. Am J Ophthalmol. 2010 Aug;150(2):265-269.e2. doi: 10.1016/j.ajo.2010.02.015. Epub 2010 Jun 3. PMID: 20522411.
9. Chang A, Schnall AH, Law R, Bronstein AC, Marraffa JM, Spiller HA, Hays HL, Funk AR, Mercurio-Zappala M, Calello DP, Aleguas A, Borys DJ, Boehmer T, Svendsen E. Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 - National Poison Data System, United States, January 1, 2020-March 31, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 24;69(16):496-498. doi: 10.15585/mmwr.mm6916e1. PMID: 32324720; PMCID: PMC7188411.
10. Le Roux G, Sinno-Tellier S, Puskarczyk E, Labadie M, von Fabeck K, Pélissier F, Nisse P, Paret N; French PCC Research Group; Descatha A, Vodovar D. Poisoning during the COVID-19 outbreak and lockdown: retrospective analysis of exposures reported to French poison control centres. Clin Toxicol (Phila). 2021 Sep;59(9):832-839. doi: 10.1080/15563650.2021.1874402. Epub 2021 Feb 12. PMID: 33576261.
11. Raffee L, Daradkeh HM, Alawneh K, Al-Fwadleh AI, Darweesh M, Hammad NH, Almasarweh SA. Impact of COVID-19 lockdown on the incidence and patterns of toxic exposures and poisoning in Jordan: a retrospective descriptive study. BMJ Open. 2021 Dec 9;11(12):e053028. doi: 10.1136/bmjopen-2021-053028. PMID: 34887279; PMCID: PMC8662587.
12. Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol. 2004 Feb;27(2):206-10. doi: 10.1016/s0181-5512(04)96122-0. PMID: 15029055.
13. Kuhn F, Morris R. A quarter of a century of the Birmingham Eye Trauma Terminology (BETT) system. Graefes Arch Clin Exp Ophthalmol. 2021 Oct;259(10):2867-2868. doi: 10.1007/s00417-021-05407-6. Epub 2021 Sep 6. PMID: 34487225.
14. Shukla B, Agrawal R, Shukla D, Seen S. Systematic analysis of ocular trauma by a new proposed ocular trauma classification. Indian J Ophthalmol. 2017 Aug;65(8):719-722. doi: 10.4103/ijo.IJO_241_17. PMID: 28820158; PMCID: PMC5598183.
15. Xiao JH, Zhang MN, Li SY, Jiang CH, Jiang H, Zhang Y, Qiu HY. A new classification for epidemiological study of mechanical eye injuries. Chin J Traumatol. 2014;17(1):35-7. PMID: 24506921.
16. Shah M, Shah S, Agrawal R, Patel K. Validation of a modified Birmingham eye trauma terminology classification for mechanical eye injuries. Trauma. 2018 Jul;20(3):217-20. doi: 10.1177/1460408617715488.
17. Pellegrini M, Roda M, Di Geronimo N, Lupardi E, Giannaccare G, Schiavi C. Changing trends of ocular trauma in the time of COVID-19 pandemic. Eye (Lond). 2020 Jul;34(7):1248-1250. doi: 10.1038/s41433-020-0933-x. Epub 2020 May 6. PMID: 32376977; PMCID: PMC7202459.
18. Congdon NG, Friedman DS, Lietman T. Important causes of visual impairment in the world today. JAMA. 2003 Oct 15;290(15):2057-60. doi: 10.1001/jama.290.15.2057. PMID: 14559961.
19. Liang H, Zhang M, Chen M, Lin TPH, Lai M, Chen H. Ocular Trauma During COVID-19 Pandemic: A Systematic Review and Meta-analysis. Asia Pac J Ophthalmol (Phila). 2022 Sep 1;11(5):481-487. doi: 10.1097/APO.0000000000000539. PMID: 36094376.
20. Pande R, Mohod SS, V P, Shanbhag S, Kumar NS. Impact of the COVID-19-induced lockdown on the incidence of ocular trauma presenting to a tertiary care hospital. BMJ Open Ophthalmol. 2022 Mar 18;7(1):e000861. doi: 10.1136/bmjophth-2021-000861. PMID: 35342820; PMCID: PMC8935004.
21. Halawa OA, Friedman DS, Roldan AM, Zebardast N. Changing trends in ocular trauma during the COVID-19 pandemic in the USA. Br J Ophthalmol. 2023 Feb;107(2):295-298. doi: 10.1136/bjophthalmol-2021-319627. Epub 2021 Aug 20. PMID: 34417186.
22. Hattenbach LO, Heinz P, Feltgen N, Hoerauf H, Kohnen T, Priglinger S, Bachmann W, Rieks J, Eter N, Reinhard T. Impact of the SARS-CoV-2 pandemic on ophthalmic care in Germany. Ophthalmologe. 2021 Jul;118(Suppl 2):166-175. doi: 10.1007/s00347-021-01411-7. Epub 2021 Jun 4. PMID: 34086070; PMCID: PMC8176275.
23. Whang WJ, Kwon JW. Yearly trends in the incidence of ocular traumas and the effects of COVID-19 pandemic: a nationwide population-based study of Korean data. Ann Transl Med. 2023 Mar 31;11(6):241. doi: 10.21037/atm-22-2458. Epub 2023 Mar 6. PMID: 37082683; PMCID: PMC10113071.
24. Liew TK, Yong GY, Zainal Abidin Z, Asnir ZZ. Ocular Trauma Trends during COVID-19 Pandemic. Malays J Med Sci. 2023 Jun;30(3):135-142. doi: 10.21315/mjms2023.30.3.12. Epub 2023 Jun 27. PMID: 37425384; PMCID: PMC10325137.
25. Wu C, Patel SN, Jenkins TL, Obeid A, Ho AC, Yonekawa Y. Ocular trauma during COVID-19 stay-at-home orders: a comparative cohort study. Curr Opin Ophthalmol. 2020 Sep;31(5):423-426. doi: 10.1097/ICU.0000000000000687. PMID: 32740065.
26. Agrawal D, Parchand S, Agrawal D, Chatterjee S, Gangwe A, Mishra M, Sahu A. Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute. Indian J Ophthalmol. 2021 Mar;69(3):709-713. doi: 10.4103/ijo.IJO_3200_20. PMID: 33595506; PMCID: PMC7942066.
27. Chauhan MZ, Ali AA, Healy J, Elhusseiny AM, Phillips PH, Sallam AB, Uwaydat SH. The impact of the COVID-19 pandemic on ocular trauma in American infants and toddlers. J AAPOS. 2024 Apr;28(2):103864. doi: 10.1016/j.jaapos.2024.103864. Epub 2024 Mar 6. PMID: 38458597.
28. Martin GC, Boulanger E, Maalej R, Partouche S, Dentel A, Grosselin M, Ettayeb R, Chapron T, Caputo G, Vignal-Clermont C. Specificities of pediatric ocular emergencies before and during the COVID-19 era: A retrospective comparative study in an eye-related emergency department in Paris. Arch Pediatr. 2023 Aug;30(6):396-400. doi: 10.1016/j.arcped.2023.06.002. Epub 2023 Jun 12. PMID: 37394362; PMCID: PMC10258578.
29. Cavuoto KM, Vanner EA, Osigian CJ. Trends in pediatric ocular trauma presenting to an ophthalmology-specific emergency department during the COVID-19 pandemic. J AAPOS. 2021 Jun;25(3):170-172. doi: 10.1016/j.jaapos.2021.01.004. Epub 2021 Apr 29. PMID: 33932568.
30. Xu YM, Du LP, Huo YD, An GQ, Jin XM, Zhou PY. COVID-19 pandemic impact on ocular trauma in a tertiary hospital. Int J Ophthalmol. 2023 Jan 18;16(1):16-21. doi: 10.18240/ijo.2023.01.03. PMID: 36659937; PMCID: PMC9815970.
31. Schulz M, Thomas PJ, Legocki AT, Bonnell A, Chee Y, Feng S, Chen P, Bojikian KD. Impact of socioeconomic status on open globe injuries during the COVID-19 pandemic. Int Ophthalmol. 2024 Aug 12;44(1):346. doi: 10.1007/s10792-024-03257-9. PMID: 39134831.
32. Zhang YX, Feng K, Liao MY, Yan H. Comparison of ocular trauma between normalized and the COVID-19 epidemic periods in China: a multi-center cross-sectional study. Int J Ophthalmol. 2023 Jan 18;16(1):10-15. doi: 10.18240/ijo.2023.01.02. PMID: 36659951; PMCID: PMC9815975.
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