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Risk factors for corneal abrasions in Nepal: a community-based study

Eye volume 38, pages 945–950 (2024)Cite this article

Subjects

Abstract

Background

South Asia is experiencing rapid urbanization, which may be changing the risk factor profile for ocular trauma. The objective of this study was to compare risk factors for traumatic corneal abrasions in rural versus urban Nepal, and to assess if any risk factors were associated with a poor outcome.

Methods

In a prospective, cross-sectional, community-based study performed as part of a cluster-randomized trial, community health workers from Nepal were trained to diagnose and treat traumatic corneal abrasions. Participants with an abrasion were invited to complete a risk factor survey. The main exposure variable was the object of eye injury, stratified by rural-urban residence. The main outcome measure was a lack of corneal healing after a three-day course of antimicrobials.

Results

Of 3657 participants diagnosed with a corneal abrasion, 2265 completed a survey. Eye trauma occurred most frequently during agricultural activities. The most common object of injury was vegetative matter, accounting for approximately 40% of injuries in rural, peri-urban, and urban communities. Wood injuries were more common in rural communities (24%) compared with urban or peri-urban communities (13%). Eye injury from an animal was more likely to result in a non-healing corneal abrasion after 3 days of treatment compared with other types of trauma (prevalence ratio 2.59, 95%CI 1.16–5.76).

Conclusions

Health promotion activities for prevention of corneal ulcers in Nepal should focus on agricultural trauma in both rural and urban areas. Community members experiencing eye trauma from an animal may benefit from early referral to an eye clinic.

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Fig. 1: Self-reported activities at the time of corneal abrasion and objects of injury, stratified by urban/rural status.
Fig. 2: Association between rural/urban status and causes of eye trauma.
Fig. 3: Self-reported activities at the time of corneal abrasion and objects of injury, stratified by whether abrasions had healed by day 4.
Fig. 4: Risk factors for lack of healing of corneal abrasion after 3 days of antimicrobials.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, JDK.

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Funding

This study was supported by the National Eye Institute (U10EY022880), the Peierls Foundation, the ALTA Foundation, the All May See Foundation, and Research to Prevent Blindness.

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Author notes

  1. These authors contributed equally: Sylvia R. Brekke, Puspa Giri.

Authors and Affiliations

  1. Francis I Proctor Foundation, University of California, San Francisco, CA, USA

    Sylvia R. Brekke, John A. Gonzales, John P. Whitcher, Kieran S. O’Brien, Thomas M. Lietman & Jeremy D. Keenan

  2. Bharatpur Eye Hospital, Bharatpur, Nepal

    Puspa Giri, Raghunandan Byanju, Sangita Pradhan, Gopal Bhandari, Sadhan Bhandari & Bimal Poudyal

  3. Seva Foundation, Berkeley, CA, USA

    Ram Prasad Kandel

  4. Department of Ophthalmology, University of California, San Francisco, CA, USA

    John A. Gonzales, John P. Whitcher, Kieran S. O’Brien, Thomas M. Lietman & Jeremy D. Keenan

  5. Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India

    Muthiah Srinivasan

  6. BP Eye Foundation, Children’s Hospital for Eye, Ear, and Rehabilitation Services (CHEERS), Kathmandu, Nepal

    Madan Upadhyay

  7. Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA

    Kieran S. O’Brien & Thomas M. Lietman

  8. Institute for Global Health Sciences, University of California, San Francisco, CA, USA

    Thomas M. Lietman

Authors
  1. Sylvia R. Brekke
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  2. Puspa Giri
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  3. Raghunandan Byanju
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  4. Sangita Pradhan
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  5. Gopal Bhandari
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  6. Sadhan Bhandari
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  7. Ram Prasad Kandel
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  8. Bimal Poudyal
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  9. John A. Gonzales
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  10. Muthiah Srinivasan
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  11. Madan Upadhyay
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  12. John P. Whitcher
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  13. Kieran S. O’Brien
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  14. Thomas M. Lietman
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  15. Jeremy D. Keenan
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Consortia

VIEW Trial Study Group

Contributions

Concept and design: SRB, RPK, MS, MU, JPW, KSO, TML, JDK. Acquisition, analysis, or interpretation of data: SRB, PG, RB, GB, SB, RPK, BP, JAG, KSO, TML, JDK. Drafting of the manuscript: SRB and JDK. Critical revision of the manuscript for important intellectual content: All authors. Administrative, technical, or material support: PG, SB, SP. Supervision: PG, RB, SP, GB, SB, RPK, BP, MS, MU, JPW, KSO, TML, JDK.

Corresponding author

Correspondence to Jeremy D. Keenan.

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Brekke, S.R., Giri, P., Byanju, R. et al. Risk factors for corneal abrasions in Nepal: a community-based study. Eye 38, 945–950 (2024). https://doi.org/10.1038/s41433-023-02809-0

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