Commentary: Tackling the corneal foreign body.

Corneal foreign body (CFB) is the most common form of ocular injury encountered globally with studies reporting the magnitude to be as high as 35 to 58% of ocular trauma, and it is vastly preventable.[1] The deterioration of vision by corneal scarring to secondary infections, ranging from keratitis to endophthalmitis, can result from CFB.[2] Further, they incur substantial costs, imposing an additional burden on the national economy. India has over 340 million workforces in the unorganized sector of which about 50% are in the construction and metal industry, which accounts for the majority of CFB, demanding concerned addressal and prompt remedial measures in huge magnitude.[3] The article in the current issue of the Indian Journal of Ophthalmology titled, “Etiological Causes and Epidemiological Characteristics of Patients with Occupational Corneal Foreign Bodies: A Prospective Study in Hospital Based Setting in India” highlights the aspects to be focused upon in this regard, prompting this commentary.[4]

The findings of the aforementioned study revealed that 96% of the CFB patients were in the age bracket of 14 to 44 years, all males. Also, of the 53% of the patients that were provided with protective glasses, only 27% of the patients were wearing it.[4] This is a very important finding in terms of its implication on formulating strategies for the prevention of occupational CFB. Studies have shown that although the use of safety goggles in the workplace reduces eye injuries by about two-thirds, employees tend to not use them, citing ergonomic reasons.[5] Legislation to this effect would be a welcome measure. Just as the road traffic deaths reduced by more than one-third after helmets and seatbelts were made compulsory in many countries, a similar mandatory rule of using safety goggles in workplaces with strict compliance on the part of employer and employee can infallibly bring down the visual morbidity that occupational CFB entails.[6]

The study demonstrated that although 49% of the patients that presented had received education on occupational hazards, they do not understand the seriousness of such injuries, elucidating that patient's understanding of the threat to vision that CFB poses is infinitesimal.[4] Mandatory safety education with periodic awareness sessions and workshops can help the vulnerable working population understand the grave consequences CFB can pose to ocular health.

A study by Ramakrishnan et al. (2012) comprehensively concluded that the propensity for development of corneal scar and rust ring is directly related to the delay in seeking treatment from an ophthalmologist and the attempt of removing the FB with traumatic materials.[7] This prompts an urgent referral to the ophthalmologist and strictly discouraging the practice of self-removal of CFB.

It has also been reported that even after using some form of eye protection a substantial proportion of workers sustain eye injury. In this context, improvised designs should be sanctioned, and workplace standards and ergonomics should be optimized to increase the protective capabilities of goggles.

As we stand at the culmination of VISION 2020, addressing the issue of prevention and treatment of CFBs is very pertinent to substantially decrease the proportion of avoidable blindness. Increasing awareness regarding the visual impact of occupational CFBs, enforcement of using safety goggles at the workplace, improvising the safety design of goggles, and prompt referral to an ophthalmologist for retrieval of CFB are strongly advocated to overcome the ocular morbidity attributed to CFB.