Pediatric Eye Trauma: Epidemiological, Clinical and Therapeutic Aspects at CADESSO in Donka, Guinea

Introduction: Eye trauma represents all morbid lesions on the eyeball due to external violence. In children, they are an important cause of morbidity and the leading cause of monocular blindness. The aim of this study was to determine the sociodemographic, clinical and therapeutic characteristics of eye trauma in children aged 0 to 16 at the Application Centre for the Diploma of Specialized Higher Studies in Ophthalmology (CADESSO) in Donka, Guinea. Patients and Method: This was a prospective longitudinal study with descriptive purposes from January 1 to December 31, 2019 involving 205 children victims of eye trauma. Variables related to sociodemographic, clinical and therapeutic characteristics were studied. Informed consent from patients and/or their parents was sought and obtained. The confidentiality of the files was guaranteed. The data entry was done on EPI-Info version 7 and the analysis using the Stata software. The tables were made in Excel 2010. Pearson’s Chi2 test was used for the comparison of proportions. Results: Pediatric eye trauma accounted for 9.


Introduction
Eye trauma can be defined as the set of morbid lesions on the eyeball due to external violence. Worldwide, approximately 55 million cases of eye trauma requiring a shutdown of more than 24 hours occur each year. Nineteen million cases of monocular blindness are thought to be linked to sequelae of eye trauma [1]. In children, eye trauma is an important cause of morbidity and the leading cause of non-congenital monocular blindness [2]. Some features complicate management and prognosis. These particularities are related both to the circumstances of the occurrence and to the frequent delay in diagnosis, due to the difficulties of verbalization or the reluctance of the child or the parents to confess the details of the accident [3]. The difficulties of the eye examination in young children sometimes require the use of exploration under general anesthesia for a more precise assessment, which contributes to the complexity of the management [3].
In the United States of America, about two million four hundred thousand cases of eye trauma occur each year and 35% of these traumas involve children [4]. In Africa, hospital-based studies have shown that children account for a significant proportion of eye trauma cases. In a study by Gaboune et al. in 2007 at the University Hospital Center (CHU) of Marrakech, 33.4% of admissions for eye trauma concerned the age group of 4 to 16 years [5]. At the Kasr El Aini Hospital in Cairo, Mahmoud et al. reported in 2008, that a proportion of 49.7% of children among admitted to ophthalmology for eye trauma [6]. At Treichville University Hospital in Côte d'Ivoire, Mensah et al. [7] in 2004 found a proportion of 29% of children aged 0 to 15 years among cases of eye trauma. Eballe et al. [8] in 2009 in Yaoundé found that eye trauma was the main cause of monocular blindness in children aged 6 to 15 years. Studies have been carried out on eye trauma in Guinea, but no publication has been found on this entity. The high frequency of eye trauma in daily practice, concerning children who constitute a generally innocent vulnerable layer and the complexity of its care motivated this study. The aim of this study was to determine the socio-demographic, clinical and therapeutic aspects of eye trauma in children aged 0 to 16 at the Application Centre for the Diploma of Specialized Higher Studies in Ophthalmology (CADESSO) in

Patients and Method
This was a prospective, longitudinal study with descriptive purposes over a period of one year from January 1 to December 31, 2019. The study focused on children aged 0 -16 who consulted at CADESSO during the study period. All children aged 0 to 16 years who were consulted for eye trauma during the study period were included in this study. People over 16 years of age and those under 16 years of age with pathologies other than trauma were not included. Data were collected on a pre-established survey sheet and sampling was extensive. We studied sociodemographic variables (age, gender, and occupation), consultation time, circumstances and mechanism of trauma, and data from the initial clinical and paraclinical examination. The treatment was medical and/or surgical. Although the measurement of visual acuity is an essential step in the clinical examination, we found it difficult to find quantified assessments of visual acuity in some of our patients, which led to a lack of information on this variable in the smallest and large non-cooperative children. We used the Birmingham Eye Trauma Terminology (BETT) classification to classify the lesions. Informed consent from patients and/or parents was sought and obtained. The confidentiality of the files was guaranteed.
The data entry was done on EPI-Info version 7 and the analysis using the Stata software. The tables were made in Excel 2010. Pearson's Chi 2 test was used for the comparison of proportions.

Results
During our study, we recorded 663 cases of eye trauma out of all 4467 patients consulted; an overall rate of 14.84%. Of the patients consulted, 2200 were children aged 0 to 16 years including 205 cases of eye trauma, a pediatric eye trauma rate of 9.31%. The proportion of pediatric eye trauma to all eye trauma cases received was 30.92% ( Figure 1). We had regained a male predominance of 126 (61%) against 79 (39%) with a sex ratio of 1.59 ( Figure 2). The average age of our patients was 7.87 years with extremes ranging from 1 to 16 years. The age group between 13 and 16 years was the least affected ( Table 1). The admission time was 49% for the first 24 hours, 35% between 24 and 48 hours and 16% beyond 48 hours. The average time was 3.47 days with extremes of 1 to 32 days.
Prior to admission to CADESSO, 101 children or 49.3% had received treatment by a non-general practitioner and 3 or 1.5% had received traditional therapy.
Accidents involving games and sports as well as domestic accidents accounted for 33.2% and 16.6% respectively, followed by physical abuse by parents and school teachers for 8.2%, Road Accidents (AVP) for 2.9% and 2.4% for accidents at work (  (Table 4). After treatment and depending on the type of trauma, we found VA ≥ 5/10 th in 67% of cases and 6% of AV < 2/10 th in closed-globe trauma compared to 5% of cases with VA ≥ 5/10 th and 11% OF AV < 2/10 in open-globe trauma (Table 5)

Discussions
Although we had difficulty finding a quantified assessment of visual acuity in many children resulting in a loss of information on visual acuity in the smallest  [16]. This indicates that the frequency of eye trauma to the child comes from their unconsciousness, clumsiness, the lack of supervision of parents and even the extreme violence of parents and school teachers in the correction of children. The average consultation time in our series was 3.47 days. This delay in the consultation period is noted by Lam et al. [15] who note that only 10% of their traumatized had consulted within the first 6 hours. The proportion of patients examined on the day of trauma was 49.3%. In general, studies carried out in developing countries consistently report a delay in care [7] [15] [17]. However, in terms of ocular traumatology, inadequate and delayed care aggravates the functional or even anatomical prognosis of the traumatized eye. In the series of Mensah et al. [7] in Abidjan, 66% of the children had had a first non-specialized medical care or by a traditional practitioner. There is a resemblance to our results where 101 or 49.3% had done self-medication and 3 or 1.5% had done traditional therapy. The late use of the specialized care service would be due to several reasons among which we have the lack of universal health coverage in our country leaving all the health burdens to parents and their families who often have a low economic income; the child's too young age to speak or the child's concealment of the accident because he is afraid of his parents. Sometimes it is the parents who underestimate the trauma when there is no important functional sign. The study did not include the socio-economic standard of living of the family; further studies would be needed to clarify the impact of the socio-economic aspects of eye trauma in the child. The circumstances of children's eye injuries are very varied, in our series 56 cases or 27.3% were due to gambling accidents, followed by domestic accidents 16.6%. Our data corroborate those of Saadallaoui et al. [18] in Morocco and Lam et al. [15] who found respectively 67.4% and 29.5% related to games and those of Limaiem et al. [19] in Tunisia who noted 79.6% of their trauma at the child's home. In 32.2% of cases the circumstances of the trauma were imprecise; this indicates the absence of adults during the traumas. These data are confirmed by Mensah et al. [7] who in their study at the University Hospital in  [15] in Senegal found that physical abuse was incriminated in 8.8% and 3.73% respectively. Abuse is regularly described in African series and is the conse-

Conclusion
Eye trauma in children is common in Guinea and represents 9. Hence the need to make the prevention of childhood eye injuries a health priority that will involve state officials and communities.