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HEALTH PROMOTION

Preventing blindness from eye injuries through health education

Eye injuries occur without any warning. One moment a person can have perfectly normal eyes, and the next moment he or she may be blind or at least in severe pain. Therefore we should be eternally vigilant and aware of situations that could lead to injury. Eye injuries may be trivial or serious. All precautions should be taken to avoid injury. Repair of a grave injury is almost impossible, and prevention is most certainly better than cure. The role of health education is to promote awareness amongst the public about how to protect their eyes, and what to do in the case of injury.

Educational opportunities for creating ‘safe eyes’ awareness

1. Educate all children starting from pre-school age about objects, events and actions that can cause eye injuries.

2. Educate the mother - the first health provider in the home.

3. Create awareness regarding eye injuries at the interpersonal level, for example in one-to-one situations, never missing an opportunity to teach people about potential dangers to the eyes and what to do in case of an injury.

4. Create awareness regarding eye injuries at the group level, for example, amongst groups sharing a common occupation or activity such as welders, football players, cyclists and industrial workers. At group level one might channel messages through community health workers, teachers, sports coaches, volunteers and journalists, who themselves will need to be educated.

5. Create awareness regarding eye injuries amongst the general public through appropriate mass media such as print (e.g. newspapers), electronic media (e.g. radio and TV) and non-electronic media (e.g. street theatre, puppet shows).

6. Advocate amongst leaders and policy makers to introduce and enforce policies which will help prevent blindness from injuries, for example, legislation for health and safety at work, the wearing of car seat belts, the banning of explosive fire crackers, etc.

7. Advocate on a global level on issues such as banning anti-personnel mines. From the educational point of view, we analyse the types of human situations or activities that put people at risk of blindness from eye injury. The list can be extensive and will vary from place to place. As a first step, it is useful to think through risks of different types of injuries in your own context.

Foreign bodies

Risk situations

Foreign body flying at high speed, for example:

• harvesting

• processing grain

• particles from a high speed grinder.

Particles splintering off, for example:

• when using a hammer on a cold chisel.

Travelling at high speed in an open vehicle, for example:

• motor cycle

• push cycle

• speed boat.

Multiple foreign bodies

Risk situations

• festive seasons which are often celebrated by lighting explosive firecrackers

• blasting of rock with explosives or associated with acts of terrorism

• shootings resulting in multiple shrapnel injuries.

Penetrating injuries

Risk situations

Hazards in the home and the garden, for example:

• playing with sharp objects, sticks, sharp pencils, pens, toys, scissors, metal dividers and compasses

• playing with kittens close to the face

• playing with small injured birds can lead to a serious bird peck injury with iris prolapse

• leaving an infant supine on a mat in the front yard or garden exposes the baby to the risk of being pecked by the household fowl. The bright cornea attracts the bird

• playing with bow and arrows, for example, when imitating television heroes.

Travel

• road traffic accidents.

Assault

• sharp weapons

• gunshot wounds

• violent explosion.

Work place and agricultural accidents

• plucking fruits using a knife tied to a long pole/stick

• injuries from industrial machinery.

Burns or scalds

Risk situations

Hot substances left within reach of children, for example:

• hot soups

• boiling water

• irons.

Chemical burns

These often burn both eyes and parts of the face. Burnt eyelid skin scars, contracts and leads to severe exposure keratitis and loss of the eye.

Risk situations

Dangerous substances left within reach of children, for example:

• many household cleaning substances containing acids and alkalis, fungicides, weed killers and pesticides.

Accidents caused by careless use of dangerous substances

• alkali burns caused by a spray of calcium oxide/hydroxide (lime)

• acid burns occur while tampering with wet cell batteries (car batteries)

• using acids in factories.

Violent assault

• acid thrown at a face by an assailant.

Ultra violet light burns

High-risk situations

Severe burn of the cornea and face can occur with prolonged exposure to ultra violet light. Ultra violet light being at the shorter end of the spectrum cannot penetrate the cornea. Maximum damage is to the corneal epithelium. The epithelium peels off causing severe pain but re-epithelializes. For example:

• welding arc burn

• long term skiing

• gazing at UV light sources.

Solar eclipse macular burns

A self-induced cause of blindness is an eclipse burn.

Blunt trauma

Risk situations

Situations where an object can hit the eye, for example:

• sports of any nature but especially boxing and squash

• removing a champagne cork without adequate care

• assault.

Lid lacerations and tears

Risk situations

Sharp nails at eye level

• longish nails and hooks fixed to doorposts

• lamp hooks hung from a rafter would tear off the entire upper lid when children in a group run around the house.

Attacks by animals

• avulsion or lacerations of the eyelids occur when children are mauled by cats or dogs

• adults suffer similar injuries when mauled by a bear or are gored by a bull.

Key message for preventing lid lacerations and tears

• Adults should take adequate care to see that no hooks and nails are left fixed at a low level.

• Supervise children when they are playing with animals.

Don’t lose the sight of our children!

Eye injuries are largely preventable and occur mostly in the younger age groups. The key intervention for preventing blindness from injuries is through health promotion. Eye care workers need to collaborate with teachers, media professionals and health educators to inform the public. They also need to influence policy makers and leaders to minimise the public’s exposure to risks: potentially dangerous household and industrial products should be appropriately packaged and labelled; the wearing of protective eyewear should be promoted in hazardous situations and legally enforced if necessary; and children’s toys and environments should be scrutinised for potential dangers to their eyes. Since accidents will happen, education should include the message that eye injuries should be treated as a medical emergency and patients should seek help immediately. First aid at home should only be attempted if chemicals have splashed in the eye, but in all other cases, health education should warn people of the dangers of trying to treat eye injuries themselves.

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CASE STUDY

Reducing eye injuries in Sri Lanka

The Sri Lanka Eye Foundation has been working to prevent ocular injuries since 1982. At this time, over 400 ocular injuries were seen around the festival times of Sinhala and Tamil New Year (mid April) and Christmas. All were due to firecracker injuries. To address this problem, an eight-minute drama was produced and aired on primetime national radio. A slot on post-primetime national TV used the format of a panel discussion between two members of our organisation and the interviewer, based on a screening of slides of injuries from the previous year. Additionally, cartoon posters were painted on aluminium sheets 4ft by 2ft and riveted on the back and side of long distance intercity coaches. The same posters are still being printed on paper in print runs of 1,000 each year. The set of seven posters are distributed free to schools, displayed in public places, and issued to every primary health care worker trained (Sri Lanka has approximately 6,000 PHC workers), trainee volunteers, journalists, factory workers and teachers. Sri Lanka Eye FoundationAnother target for health promotion was to prevent eye injuries from lime burns. In Sri Lanka, a mixture of calcium oxide and hydroxide (slaked lime) is packaged in a small polythene bag. The package is about two inches by one inch. Children play with these packets, blowing into them and causing the lime to enter the eye. The eye appears almost normal just after the accident but progressively blood vessels invade the cornea. Health promotion interventions to win the battle against calcium burns included advising the public not to purchase the lime pack or, if they did purchase it, to cut open one entire side and squeeze the lime onto a container such as a saucer or betel leaf. Attempts to address the problem at source were less successful: dealers did not follow advice to avoid packing the mixture in polythene bags, and a request to the Department of Small Industries to ban the small packet was not supported. However, thanks to sustained health education efforts, we hardly see children with lime burns nowadays.

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CASE STUDY

Involving children in understanding eye injuries and developing teaching materials

The Healthy Eyes Activity Book (see useful resources page 116) was based on research conducted with rural school children in three African countries using the Draw and Write technique, whereby children’s views and experiences are solicited. Many of the children cited accidents as a cause of eye problems and a selection of the illustrated stories were used to develop this health education book. The idea was to make an activity book which would tell stories in the children’s own words, and then encourage the readers to think about the potential dangers which may occur in their own activities and environments. Each story is followed by information on what to do about different types of eye injuries.

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