Childhood blindness due to landmines

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Most data on the causes of blindness in children who live in developing countries come from examining children in schools for the blind as it is difficult to obtain population-based information. Data have been collected using a standard method from 23 countries in 4 regions of the world, and over 4,100 children with severe visual impairment and blindness have been examined. These studies suggest that severe visual impairment and blindness (i.e., visual loss in both eyes) due to trauma is an unusual cause of blindness in children. For example, only 1.1% of 1,318 children examined in India were blind from ocular trauma, and a further 0.5% were blind following head injuries.

There are, however, two exceptions; Albania and Eritrea. Until the death of the communist leader, Hoxha, in 1991, Albania was an isolated, totalitarian state. It had extensive military and civil defence systems, which took the form of a network of small heavily fortified ‘pill box’ buildings, and landmines along the boundaries. Until recent years Eritrea was involved in a long armed struggle for independence.

There is only one school for the blind in Albania, in Tirana, the capital city. In 1992 there were 70 pupils in the school, 50 of whom were available for examination. Although some were aged over 16 years, all had lost vision before the age of 16 years. Thirty-seven pupils (74%) had a corrected visual acuity in the better eye of less than 6/60. Overall 11 children had lost vision during childhood (30%), and 9 of these were boys who had been playing with landmines (24%). Trauma due to landmines was the single most common cause of blindness in children in the school. The added tragedy is that 3 of these blind boys had lost a hand (see photo), and one boy had lost both hands.

In 1995, 61 children with severe visual impairment or blindness were examined in the school for the blind in Asmara, Eritrea. The most common cause of visual loss was corneal scarring due to vitamin A and measles infection (36%). Landmine injury was the second most common cause, accounting for blindness in 10 children (16%). As in Albania all the children blind from landmine injuries were boys.

The findings from these two countries show that although an unusual cause of blindness in children, trauma is an important cause. In several cases the boys had found the landmines which had exploded as they were holding them, causing loss of fingers and hands. To be blind and to have lost tactile contact (sense of touch) with the world as well is a disability that is hard to imagine.