Review of Ocular Injuries in Malaysia

Background and Purpose

Ocular trauma remains a significant cause of preventable visual impairment worldwide. In Malaysia, eye injuries pose a persistent public health concern due to the country’s industrial, agricultural, and domestic settings where hazardous exposures are common. This comprehensive review, published in the Malaysian Journal of Public Health Medicine, synthesised findings from 28 studies conducted in Malaysian hospitals between 1991 and 2016 to characterise the patterns, causes, and outcomes of ocular injuries nationwide.

The authors conducted literature searches using PubMed, Google Scholar, and Science Direct databases to identify the most common injury mechanisms, demographic profiles of affected individuals, types of ocular trauma encountered, and factors predicting visual outcomes. Studies were drawn from multiple states including Melaka, Kuala Lumpur, Johor Bahru, and Sarawak, providing a national perspective.

Demographic Patterns

A striking and consistent finding across the reviewed studies was the overwhelming predominance of male patients, comprising 83% to over 90% of all ocular injury cases. Young working-age males — with an average age of approximately 35 years — were most affected, reflecting the high-risk nature of industrial and construction work where men are disproportionately represented in Malaysia’s workforce.

The age distribution demonstrated a bimodal pattern. Among adults, injuries peaked in the 20–40 year age group, corresponding to the most economically productive years. In paediatric populations, ocular trauma was most frequent among preschool and primary school-aged children, with the majority of injuries occurring at home rather than in occupational or school settings.

Mechanisms and Causes of Injury

The review identified several dominant mechanisms. Occupational injuries constituted the largest category at 35–44% of all cases, followed by motor vehicle accidents at 23–29%, and domestic accidents at approximately 23%. Common modes of injury included sharp objects penetrating the eye, high-velocity projectiles from power tools, chemical splash injuries, and blunt force trauma.

Chemical injuries in industrial settings involved alkalis in 52% of cases and acids in approximately 29%. Factory-related settings accounted for 42.7% of workplace eye injuries, followed by construction sites at 22.7%. Notably, only 2.5% of workers who sustained injuries reported wearing eye protective devices at the time of the incident — a critical gap in occupational safety compliance.

The review also documented uniquely regional causes of ocular trauma. Firecracker injuries during festive celebrations were a recurring source of severe eye damage. Perhaps most distinctive to the Southeast Asian context, the authors noted cases of globe rupture caused by falling durian fruit — a heavy, spiky fruit harvested from tall trees — with at least four documented cases in the literature involving patients aged 12 to 54 years.

Types of Injuries and Clinical Presentation

Injuries were categorised according to the Birmingham Eye Trauma Terminology system. Both open globe injuries (penetrating and perforating wounds) and closed globe injuries (contusions and lacerations) were well represented across the reviewed literature. Hyphaema — bleeding into the anterior chamber — was the most frequent clinical finding, particularly in cases of blunt trauma.

Visual Outcomes and Prognostic Factors

Visual outcomes varied substantially depending on the type and severity of injury. At initial presentation, up to 64% of injured eyes had vision of 3/60 or worse, and approximately 55% were classified as legally blind. Open globe injuries carried a significantly worse prognosis: 84.6% presented with impaired visual acuity compared with 18.1% for closed globe injuries, yielding an odds ratio of 25.0 (95% CI: 5.3–118.4).

Delay in seeking treatment was another critical determinant of outcome. Patients presenting seven or more days after trauma had significantly worse results: 76.9% showed no improvement or worsened at three months, compared with 27.7% of those presenting within the first week. Key prognostic factors included initial visual acuity, wound length, and the presence of associated findings such as hyphaema, intraocular foreign body, or vitreous prolapse.

Paediatric Ocular Injuries

Children presented a distinct injury profile. A study from Kuching, Sarawak, documented 117 paediatric patients over three years (2006–2008). The mean age was 6.1 ± 3.0 years, with preschool children accounting for 58.2% of cases. Boys comprised 65.8% of patients. Most injuries occurred at home when children were unsupervised, with sharp objects as the leading cause (38.1%). Critically, 87.3% of cases were considered preventable. Visual outcomes were generally poor, with only 28.8% of eyes showing no visual impairment at follow-up.

Sports-Related Eye Injuries

Badminton emerged as a notable cause of ocular trauma in Malaysia, reflecting the sport’s widespread popularity across Southeast Asia. A clinical audit from Hospital Universiti Sains Malaysia documented badminton-related injuries over a 15-year period, finding that 96% of injured players wore no protective eyewear. Angle recession — a known precursor to secondary glaucoma — was detected as early as one week after initial presentation, underscoring the importance of long-term ophthalmological follow-up.

Public Health Implications

This review highlights several critical public health priorities. The extremely low rate of protective eyewear usage in occupational settings suggests that existing occupational safety regulations under the Occupational Safety and Health Act 1994 are inadequately enforced. The authors advocate for mandatory eye protective device usage in high-risk workplaces, enhanced public awareness campaigns about injury preventability, improved first-aid training for general practitioners who serve as the initial point of contact, and standardised referral protocols to ophthalmologists for timely intervention.

For paediatric injuries, prevention through education — particularly targeting parents about the risks of sharp objects and the importance of supervision at home — is emphasised as the most effective strategy. The establishment of a national long-term database of all ocular injuries in Malaysia is recommended to facilitate research and the development of targeted prevention programmes.

Limitations

As a literature review, this study is limited by the heterogeneity of included studies, which varied in design, sample size, and outcome measurement. Most reviewed studies were retrospective and hospital-based, meaning that less severe injuries managed at primary care level may be underrepresented. The absence of a centralised national trauma registry for ocular injuries makes it difficult to accurately estimate the true incidence and economic burden of eye injuries in Malaysia. Additionally, studies from rural and East Malaysian settings were underrepresented compared with urban centres in Peninsular Malaysia.

← Back to MJPHM Homepage