Impact of COVID-19 pandemic on the spectrum of ocular trauma during Diwali at a tertiary eye care center of Western India.

Dear Editor,

The coronavirus disease 2019 (COVID-19) pandemic has been an unprecedented challenge to the healthcare services, with a great impact on the management of ocular emergencies, especially during Diwali, an annual Indian festival traditionally celebrated by lighting lamps, bursting firecrackers (FC), and socializing.[12] During the pandemic, people were expected to have muted festive celebrations with social distancing due to the fear of getting infected by the virus and various restrictions on travel and use of FC imposed by the Indian Government.[3]

This study evaluated the impact of the COVID-19 pandemic on the demographic and clinical spectrum of ocular trauma presenting during the festival of Diwali at a tertiary eye care center in western India. The retrospective comparative study included patients with a history of noninfectious ocular trauma presenting during the five consecutive days of Diwali in the COVID-19 pandemic period (D-CP) (November 12–16, 2020). Results were compared with the available records of the five consecutive days of Diwali during the pre-COVID-19 period (D-PC) (October 25–29, 2019). In total, 163 eyes of 138 patients (D-PC: 103 eyes of 88 patients; D-CP: 60 eyes of 50 patients) with ocular injuries were reviewed. The demography and clinical data of patients presenting during both D-PC and D-CP are presented in Table 1.

Table 1

Demography and clinical profile of the patients with ocular trauma during Diwali of pre-COVID (D-PC) and COVID-19 period (D-CP) (Numbers in brackets indicate percentage)

	Parameters	D-PC (n=88)	D-CP (n=50)	P
Mean age (years)		30.27±18.9 (Range: 2-76)	24.06±13.9 (Range: 1-69)	0.04
Age groups (years)	0-14	24 (27.27)	14 (28.0)	0.01
	15-50	48 (54.55)	35 (70.0)
	>50	16 (18.18)	01 (2.0)
Gender	Males	58 (65.91)	46 (92.0)	0.006
	Females	30 (34.09)	04 (8.0)
Residence	Rural	45 (51.14)	28 (56.0)	0.58
	Urban	43 (48.86)	22 (44.0)
Visit	Primary	32 (36.36)	11 (22.0)	0.07
	Referral	56 (63.64)	39 (78.0)
Laterality	Right eye	45 (51.14)	15 (30.0)	0.04
	Left eye	28 (31.82)	25 (50.0)
	Bilateral	15 (17.04)	10 (20.0)
Place of injury	Work place	19 (21.6)	02 (4.0)	0.007
	Home	12 (13.63)	04 (8.0)
	Outdoor	57 (64.77)	44 (88.0)
Mean duration of presentation post trauma (h)		5.24±8.06 (Range: 0.5-72 h)	7.26±14.52 (Range: 1-72 h)	0.29
Type of injury (BETTS) Cause of trauma	OGI	18 (20.45)	04 (8.0)	0.054
	CGI	70 (79.55)	46 (92.0)
	FC	33 (37.5)	27 (54.0)	0.008
	RTA	31 (35.22)	21 (42.0)
	HHW related	05 (5.68)	01 (2.0)
	Occupational work related	19 (21.6)	01 (2.0)

OGI - Open globe injuries, CGI - closed globe injuries, HHW - household work

A 26.38% decline in the number of emergency ocular trauma cases presenting during the D-CP was noted, similar to that found by Pellergini et al.[4] Ocular surface burns and vitreous hemorrhage were the most common anterior and posterior segment manifestations, respectively, during both periods. The management of the injuries during D-PC and D-CP was done as shown in Table 2. The decline noted in the need for surgical intervention was similar to that noted by Agrawal et al.[5] During the D-CP, none of the 15 patients requiring emergency surgical intervention were diagnosed as being positive for COVID-19 on the preoperative RT-PCR test, with the report available within a mean duration of 7.63 ± 1.21 h of taking the swab from the patient. The waiting time of RT-PCR report delayed the surgical intervention in 10 patients with a mean waiting time/delay of 6.1 ± 1.28 h than the expected time of scheduling of surgery. The mean duration of surgical intervention in D-CP was found to be more than that in D-PC (P = 0.2). The decline in workplace injuries might have been due to a majority of population staying at or working from home during the pandemic. Preponderance of road traffic accidents indicated that despite the risk of a second wave of the pandemic, people ventured out for travel.

Table 2

Comparison of management of patients of ocular trauma in Diwali of COVID-19 and pre-COVID-19 era. (Numbers in brackets indicate percentage)

Management	Number of eyes (n=103 eyes) in D-PC	Number of eyes (n=60) in D-CP
A. Conservative	57 (55.33)	45 (75)
B. Surgical	46 (44.66)	15 (25)
1. Lid tear repair	15 (32.6)	06 (40.0)
2. Conjunctival tear repair	05 (10.87)	01 (6.67)
3. Corneal foreign body removal	08 (17.4)	02 (13.33)
4. Corneal tear repair	07 (15.21)	01 (6.67)
5. Globe rupture repair	04 (8.7)	02 (13.33)
6. Scleral tear repair	02 (4.35)	-
7. Debridement of foreign bodies with amniotic membrane graft	02 (4.35)	-
8. Pars plana lensectomy and vitrectomy	03 (6.52)	02 (13.33)
9. Keratoplasty	-	01 (6.67)
C. Mean duration of surgical intervention (hours)	5.23±11.05	10.21±21.65

With a minimal decline in the ocular trauma cases during the Diwali in the pandemic and the mandatory RT-PCR testing leading to a delay in the surgical intervention, it will be advisable to strictly enforce the existing legislation related to road safety, firework use, and control of COVID-19 infection during Diwali in the pandemic era. This may help in reducing the incidence of ocular trauma and improving the overall outcome of debilitating injuries during this resource-constrained period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.