Olive-harvesting eye injuries.

PURPOSE: To document the types of ocular trauma that occurs during the olive-harvesting season in a region of the Middle East.
MATERIALS AND METHODS: Ophthalmic assessments of all patients were performed by one ophthalmologist. Examinations included visual acuity, slit-lamp evaluation of the anterior segment, intraocular pressure measurement and posterior segment assessment after pupil dilatation.
RESULTS: The study cohort comprised 119 patients who presented for ocular injury due to olive harvesting. Seven patients (5.9%) had severe ocular trauma. Two of these patients presented with corneal perforation, and five with retinal edema. Six patients with severe ocular injury were male.
CONCLUSIONS: Ocular injuries are common when olives were harvested manually or with sticks. A preventive program to reduce injury should consider environmental and cultural factors.

INTRODUCTION

More than 65,000 work-related eye injuries and illnesses are reported in the United States annually.1 Ocular injuries can cause severe complications and disabilities that can be partial or permanent. In agricultural operations, trauma to the eyes is commmon.23

Olea europaea, the European olive is a fruit tree that has was first cultivated prior to the Bronze Age. The Bible describes the olive as one of the seven species that bless the Holy Land. It is believed that the variety was initially introduced to northern Africa and Greece by the Semitic inhabitants of the Middle East and Syria. From there it spread to southern Europe and to other geographical areas (America, Australia, South Africa). Olive oil and olives are used for cosmetics, food, ancient and modern customs and ceremonies. Olive trees reach a height of 3-7 meters. Adjacent to the trunk, they develop many stems that serve as seedlings. Olives are harvested by hand, with the aid of sticks and also by more modern equipment. Harvesting by primitive methods such as hand picking or with sticks can result in injury to farmers. We report the incidence of ocular trauma during the olive-harvesting season in the Tira-Taibe-Kalansua Triangle. In this region of Israel, populated by Arabs, there is a long tradition of olive growing and olive oil production.

MATERIALS AND METHODS

In this prospective case series, data were collected from all patients presenting with ocular trauma due to olive harvesting between October 2009 and December 2009 at the primary community eye clinics. Patient interviews and eye examinations were conducted by a single senior ophthalmologist.

The eye examination consisted of visual acuity measurement, slit-lamp examination of the anterior segment, applanation tonometery and dilated posterior segment examination.

Clinical features of the injury were recorded and classified as “severe” or “mild.” Severe injuries were penetrating eye injuries, intraocular foreign body, corneal perforation, iridodialysis, iris prolapse, dislocated lens, choroidal rupture and macular/retinal damage. Mild injuries consisted of lid laceration, corneal erosion, corneal and fornix foreign body, conjunctival tear, subconjunctival hemorrhage and hyphema.

RESULTS

Between October 2009 and December 2009, 1,956 patients visited the community primary eye clinics in the Tira-Taibe-Kalansua Triangle region. One hundred and nineteen patients (6.08%), one hundred and twenty-four eyes, presented with ocular trauma due to olive harvesting. Five of patients presented with bilateral eyelid lacerations. Of the patients presenting with olive-harvesting-related trauma, most had mild ocular trauma. Seven patients (5.9%) presented with severe ocular trauma. The common cause of ocular trauma was injury due to sharp or blunt olive tree branches. In three cases, the ocular injury was the part of complex trauma due to a fall from the tree. Severe ocular trauma included two cases of corneal perforation, one with lens dislocation, iridodialysis and retinal edema; and another five patients with retinal edema [Table 1]. Mild ocular trauma included corneal erosions, corneal and fornix foreign bodies, eyelid lacerations, hyphema and conjunctival lacerations [Table 1]. More than two-thirds (83/119) of the patients were men. Six of the seven (86%) cases of severe ocular injury occurred in males. Both cases of corneal perforation were referred to the tertiary medical center, sutured and treated by local and systemic intravenous antibiotics. No cases of endophthalmitis occurred during the course of this study.

Table 1

Distribution of patients according to ocular injury during olive harvesting

Final visual acuities in patients with mild ocular trauma ranged from 20/40 to 20/20 in the injured eye [Table 2]. Final visual acuity, of a patient with paracentral corneal perforation and peripheral retinal edema was 20/40 due to a corneal scar 1 year after trauma. The outcome of the patient with paracentral corneal perforation, lens dislocation, Iridodialysis and peripheral retinal edema was 20/70 16 months after trauma. This patient underwent successful primary corneal wound suturing and, 4 months later, cataract extraction with anterior chamber intraocular lens implantation [Table 2].

Table 2

Final visual acuity based on ocular injury during olive harvesting

DISCUSSION

This study documents the different types of ocular injuries resulting from olive harvesting by with hands and sticks. Among Arab communities in the Middle East, olive harvesting is a family business. Usually, men climb the olive trees and shake the branches and women gather olives near the trunk of the tree. This division of labor explains the greater number of men reporting ocular injuries, particularly severe injuries.

A common mode of ocular trauma was injury by sharp or blunt olive tree branches. Two corneal perforation cases were caused due to injury by sharp branches. Injury due to sharp branches was more serious resulting in a less favorable visual outcome.

There is a higher risk of endophthalmitis in ocular injury caused by vegetable matter. The cause of endophthalmitis developing in rural trauma is associated with soil contamination.45 In this study, there were no cases of endophthalmitis cases, likely, due to a small number of corneal perforations (only two cases), prompt hospitalization, suturing, and administration of local and systemic intravenous antibiotics.

A comprehensive literature review and field study of migrant farm workers found vegetation was the most common source of eye injuries. The hazards from pruning and harvesting of orchard crops were similar to those documented in the current study; workers’ eyes were at a constant risk of being poked by a branch or leaf.6

Work-related eye trauma is the major cause of eye injury and most often occurs as a result of the lack of proper eye protection.78 One study estimated that 90% of work-related eye injuries are preventable with adequate eye protection.1 In a study of patients with work-related eye injuries in Hong Kong reported 85.4% reported not wearing protective devices at the time of injury.9

The majority of patients in the current study presented with mild ocular trauma.

Nevertheless, this study highlights the importance of improving conditions and awareness of ocular trauma in the agricultural workplace. We expect that protective glasses would reduce the risk of ocular injury during olive harvesting. Since the olive trees in the Tira-Taibe-Kalansua Triangle region are under family ownership, the owners, who are also the harvesters, need be educated regarding the risks of eye injuries and implementation of preventative safety measures. Specifically, farm workers should be encouraged to wear protective glasses and to be more cautious during the harvesting process. From interviews during examination we learned that more careful pruning may reduce injuries to eyes, and also preserve the trees. However, there is resistance to change due to the desire to save time and the lack of awareness. The role of men in harvesting should receive particular attention. A preventive and educational strategy that considers the work environment, as well as cultural factors and restraints, may reduce the occurrence of ocular trauma during olive-harvesting season.