Loss of vision following severe ocular injury resulting from corporal punishment: a case report

C. O. Omolase FWACS, FMCOph, (1) M. Y. Majekodunmi MBBS (1) A. K. Akinwalere MBBS (1) B. O. Omolase MBBS (2) 1) Department of Ophthalmology, Federal Medical Centre, Owo, Ondo State, Nigeria. 2) Department of Radiology, Federal Medical Centre, Owo, Ondo State, Nigeria. Correspondence: Dr Omolase Charles Oluwole Federal Medical Centre, PMB 1053,Owo,Ondo State, Nigeria Email:omolash2000@yahoo.com

ABSTRACT The report is that of Nigerian child who lost vision in his left eye following traumatic hyphema. The patient who had enjoyed good vision in both eyes prior to the incident sustained blunt trauma to his left eye in the course of corporal punishment by a school teacher. The patient was placed on conservative management and the hyphema resolved completely however the vision was nil perception of light in the affected eye due to secondary glaucoma. The need to exercise caution and restraint in the course of corporal punishment cannot be overemphasized so as to prevent avoidable injuries. Key words: Blunt trauma, hyphema, corporal punishment, Nigeria

INTRODUCTION

Corporal punishment is often practiced to discipline erring children.(1,2,3) However corporal punishment could inadvertently result in severe ocular injuries.(2,3) It is a major cause of morbidity and mortality in USA and some other countries.(4) In the course of corporal punishment, different instruments are used indiscriminately to discipline erring children.(5) No part of the body is spared during corporal punishment and this could result in loss of vision arising from ocular injury. Corporal punishment is a major cause of injuries in children world wide.(1,4) There have been previous reports of ocular injuries resulting from assault inflicted during administration of corporal punishment in schools and at home.(2,6)
Eye injury is one of the common causes of monocular blindness world wide.(7) Ocular injuries occur frequently in children and these often require prompt attention.(5) Traumatic hyphema resulting in loss of vision in children due to ocular trauma has been reported in children in the U.S.A. (6) It often results from unnecessary injuries that are largely preventable.(7) The eyes rank as the third most common organ affected by injuries, next to the hands and feet.(8)
In view of injuries to school children due to corporal punishment, we decided to report this case of loss of vision following severe ocular injury inflicted on the child in the course of corporal punishment by a school teacher, so as to draw the attention of the populace to the dangers inherent in the practice.

CASE HISTORY
A 15 year old Nigerian male child presented to the eye clinic of Federal Medical Centre, Owo, Ondo State, Nigeria in February, 2010 on account of a six day history of left ocular pain, loss of vision and lacrimation following the blunt trauma the patient sustained in the affected left eye. There was associated redness of the left eye, discharge, photophobia and headache. The patient was inadvertently hit on the affected left eye by one of his school teachers for not doing his assignment. The patient had enjoyed good vision in both eyes prior to this incident. The patient presented at a General Hospital prior to presentation to us. He received first aid treatment at the hospital.

On examination at presentation, the visual acuity on the right eye was 6/5 while that of the left was nil perception of light. The anterior and posterior segments of the right eye were essentially normal. The conjunctiva of the left eye was hyperaemic; the cornea had microcystic oedema and there was hyphema of about 30%.The pupil was mid-dilated. There was poor view of the posterior segment. The intraocular pressure was 12mmHg on the right and 44mmHg on the left. The patient was commenced on conservative management and this included bed rest at home. He was placed on Tabs acetazolamide, gutt chloraphenicol, gutt tropicamide and gutt Dexamethazone. The affected left eye was also padded. The hyphema resolved completely within two weeks of conservative management and the intraocular pressure reduced to 14mmHg. However fundoscopy done following resolution of the hyphema, revealed a pale cupped disc with cup:disc ratio of 1.0. In view of the loss of vision in the left eye, the need for the patient to protect the right eye (only eye) was impressed on him.

DISCUSSION
It is quite unfortunate that the patient who presented had lost vision in the affected eye prior to presentation. This brings to the fore the need for patients to present early following ocular injuries so that appropriate measures can be instituted to limit the damage to the eyes. Apparently the school teacher who inflicted injury on the child did so inadvertently as she was trying to correct the patient for failing to carry out his assignment. The raised intraocular pressure which was uncontrolled could have contributed to the permanent loss of vision in the affected eye as the patient probably suffered the damage to the optic nerve as a result of the high intraocular pressure. There has been previous reports of loss of vision arising from corporal punishment. Calzada et al stated that ocular injury to a child can result from trauma inflicted with a belt by a parent or care taker, during corporal punishment and this may result in permanent loss of vision.(6) A study done in South- Eastern Nigeria revealed that corporal punishment was responsible for a significant proportion of ocular injuries.(2) Another Nigerian study revealed that corporal punishment was responsible for 10% of eye injury cases in children.(3) The impact of ocular injury on ocular morbidity is quite enormous. Thus the need to evolve preventive measures for ocular injuries cannot be overemphasized. School authorities should make school environments safe for pupils and students. Teachers should be enlightened on the need to exercise extreme caution while correcting erring school children so as to prevent unnecessary harm to the students.

Acknowledgement
The contribution of other heath workers involved in the management of this patient is hereby acknowledged.

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