Challenges of agriculture-related eye injuries in Nigeria
Agriculture, which includes crop farming, livestock rearing and fishing, provides work for up to 70% of the labour force in Nigeria.1 The agricultural sector contributes up to 20% of the gross domestic product (GDP) of Nigeria, with an average real growth rate of 3.5% from 2014 to 2015.2
People involved in agriculture and farm-related activities are at greater risk of eye injuries. Unpublished data from the Nigeria National Blindness and Visual Impairment Survey showed that, of the participants who had a history of eye injury, over half (53%) were farmers. Of those without a history of eye injury, only 39% were farmers. A 5-year hospital review of people with eye injuries showed that more than two-thirds of all eye injuries were sustained on a farm. Although non-penetrating eye injuries were more common, 15% of people were already blind in the injured eye at presentation.3 In a multi-centre retrospective review of ocular trauma among older people, eye injury most commonly occurred on the farm (37.2%).4
Some of the main causes of agriculture-related eye injuries include:
- Accidental direct trauma with farm implements (e.g. cutlass, hoe, fishing hook, etc.)
- Vegetable/plant/organic material hitting the eye, or spillage into the eye (cocoa pod, cornstalks, sticks/twigs, palm tree stalks, thorn, leaf, kernel, etc.)
- Sand spillage into eye
- Other foreign body (FB) in the eye
- Animal attack injury (e.g. cow horn injury, spitting cobra, insect sting)
- Assault injuries during communal conflicts involving crop farmers and cattle herdsmen.
A hospital series reported vegetative/plant material as a cause of 42% of eye injuries.5 Cow horn injury is an important cause of monocular blindness as it often results in severe open globe injuries with corneoscleral lacerations.6,7 Life-threatening poisonous arrow injuries to the eye sustained during communal conflicts between farmers have also been reported.8
The effects of injury to the eye include:
- Embedded foreign body in the eye
- Corneal abrasion
- Traumatic cataract
- Penetrating laceration resulting in lens injury, vitreous haemorrhage, or retinal tear/detachment
- Microbial keratitis – fungal or bacterial
- Panophthalmitis/endophthalmitis, or sympathetic ophthalmitis – often requiring enucleation/evisceration
Four decades ago, a hospital case series in Nigeria reported that 15 out of 21 patients with mycotic keratitis (71%) had a history of eye injury, 10 (66.7%) of which involved vegetative matter.9 One recent retrospective review of corneal ulcers/suppurative keratitis showed that the most common predisposing factor was trauma (seen in 51.3%); of these, 36/117 (30.8%) were from plant/vegetable matter.10
Poor prognostic factors for agriculture-related eye injuries are:
- Nature of injury: worse prognosis if due to vegetative material and exacerbated by inappropriate use of traditional eye medication or steroid eye drops.
- Severity of injury: worse if it is a penetrating injury or an injury to multiple ocular structures
- Late presentation at a health care facility
- Evidence of infection at the time of presentation
- Difficulty in management and inadequate treatment options for eye injuries in health care facilities, e.g. lack of required products such as bandage contact lens, visco-elastic and fine nylon sutures; and the lack of support services for therapeutic keratoplasty, corneal repair within 24 hours and vitreo-retinal surgical facilities.
Prevention and management
A large sector of the population is at risk of monocular blindness from agriculturerelated eye injuries, so there is a need for prevention. However, there is very little evidence (from research in this area) to guide and develop appropriate messages or policy. Some possible measures include:
- Raising public awareness and health education through television or radio programmes on eye safety or by giving health education talks in hospital/clinic waiting rooms.
- Encouraging the use of protective eyewear by those at risk and making such eyewear available and affordable.
- Establishing a national or state-based ocular injuries register to record incidence by type, cause and pattern of injury. This could be used to inform appropriate public policy and legislation on eye safety.
- Working with hospitals to develop policies that will allow management of eye injuries on an emergency basis. Departments can collaborate and work out a payment schedule so that treatment/surgery can be initiated without having to wait for payment of fees by patients.
- Lobbying government, or insurance companies directly, for health insurance to cover the treatment of eye injuries.
- Demarcating dedicated ranches or areas of free-grazing for livestock/ cattle-rearing which are separate from areas of crop farming. This will help to prevent communal clashes between farmers. This is being implemented in some communities at present.
1 CIA. Central Intelligence Agency (US). Accessed 21 September 2015. 2014.
2 NBS. National Bureau of Statistics of the Federal Republic of Nigeria. Accessed 14 September 2015. 2015.
3 Ojabo CO, Adeniyi OS, Ogli SA. Farm-related ocular trauma in Makurdi, Nigeria. Niger J Med. 2011:20(1);114-9.
4 Onakpoya OH, Adeoye A, Adeoti CO, Ajite K. Epidemiology of ocular trauma among the elderly in a developing country. Ophthalmic Epidemiol. 2010:17(5);315-20.
5 Omolase CO, Omolade EO, Ogunleye OT, Omolase BO, Ihemedu CO, Adeosun OA. Pattern of ocular injuries in owo, Nigeria. J Ophthalmic Vis Res. 2011:6(2);114-8.
6 Ibrahim O, Olusanya B. Occupational cow horn eye injuries in ibadan, Nigeria. Ann Med Health Sci Res. 2014:4(6);959-61.
7 Onyekwe LO, Ohaegbulam SC. Penetrating orbitocranial and ocular cow-horn injuries. Nig J Clin Pract. 2007:10(2);177-9.
8 Lawan A, Danjuma SA. Arrow injuries to the eye. Ann Afr Med. 2012:11(2);116-8.
9 Gugnani HC, Talwar RS, Njoku-Obi AN, Kodilinye HC. Mycotic keratitis in Nigeria. A study of 21 cases. Br J Ophthalmol. 1976:60(9);607-13.
10 Oladigbolu K, Rafindadi A, Abah E, Samaila E. Corneal ulcers in a tertiary hospital in Northern Nigeria. Ann Afr Med. 2013:12(3);165-70.