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Occupational ocular problems
- 1. Occupational Ocular Problemsin Sports, Driving, Agriculture & Industries Sabina Poudel B. Optometry Institute of Medicine
- 2. PRESENTATION LAYOUT Introduction Environmental and occupational optometry Classification of occupational ocular hazards and their effects Occupational ocular problems in sports Occupational ocular problems in driving Occupational ocular problems in agriculture Occupational ocular problems in industries
- 3. Introduction Occupational eye disordersrepresent a complex group of Traumatic injuries Harmful exposures Uncorrected and undiagnosed ocular diseases Eyestrain and fatigue Miscellaneous ocular complaints Goldsmith et.al. 2007
- 4. • Almost alladults spend a significant portion of their lives working in a variety of occupational settings • Exposure to hazards in the workplace can cause or exacerbate ocular illness • It is crucial to know The environments of the patients The type of work they do How it may affect their eyes, vision and health
- 5. Environmental and Occupational Optometry:Introduction Environmental Optometry- An Essential Part of Primary Care Branch of optometry that broadly considers the relationship of people’s eyes and vision to all aspects of their environments, including home, school, work, recreation, transportation, underwater and outerspace
- 6. Occupational Optometry Branch ofenvironmental optometry that considers all aspects of the relationship between work and vision, visual performance, eye safety and health Worker’s eyes and visual system Worker and workplace environments
- 7. • Prevention ofwork related eye diseases, injuries & vision disorders • Enhanced performance of workers on the job Major Priorities
- 8. Occupational ocular hazardscan be broadly classified as Type of hazards Causative agents Mechanical Flying objects Contact with fixed objects Dusts , powders Hot solids Chemical Dusts , powders Liquids , droplets , splashes Vapours , fumes , gases Radiation Glare from visible light Short circuit electric arc Ultraviolet rays Infrared Laser sources Combinations of the above
- 9. Mechanical Hazards Comprises about70 – 80 % of all work related eye injuries Large range of severity- wide range of missile size, mass and speed that is involved Large slow moving missiles: Contusive or concussive injuries to eye and adnexa Contusion results from direct blow to the eye Concussion arises from conduction of energy from a remote site to target tissue
- 10. Missile with roughsurface or sharp edges: Lacerations and abrasions Foreign bodies in the eye: May be superficial, imbedded or intraocular, depending on size, shape and speed of the body Ferrous foreign body should be removed as quickly as possible to remove siderosis (formation of rust in ocular tissues as a result of oxidation of iron contained in foreign body)
- 11. Particles less than0.5 mm diameter Too small to cause penetrating ocular injuries May become embedded in the ocular surface if at high speed Cause foreign body sensation upon contact with the eye
- 12. Chemical Hazards commoncauses of chemical injury: Alkali Common sources Ammonia Fertilizers , refrigerants Lye Drain cleaners Lime Plaster , mortar, cement Magnesium hydroxide Sparklers Potassium hydroxide Caustic potash
- 13. Acid Common sources Sulphuricacid Industrial cleaners,battery acid Hydrofluoric acid Glass polishing,glass frosting,gasoline alkylation Acetic acid vinegar Sulphurous acid Fruit and vegetable preservative, bleach
- 14. • Alkaline solutionspenetrate the eye rapidly by saponification of cell membranes and cause more severe injuries than acids of same concentration • Acids cause coagulation of proteins of ocular tissue which acts as a barrier for further penetration
- 15. Electrical Hazards Electrocutionmay result in damage to the central nervous system In rare cases , an electric cataract can be observed
- 16. Optical Radiation Hazards Opticalradiation ranges from 200 nm to 1 mm in the electromagnetic spectrum UV C (FAR) 200 t0 290 nm UV B (MIDDLE) 290 to 320 nm UV A (NEAR) 320 to 380 nm VISIBLE LIGHT 380 to 760 nm IR A (NEAR) 760 to 1400 nm IR B (MIDDLE) 1400 to 3000 nm IR C (FAR) 3000 nm to 1 mm
- 17. Transmission of Radiationby the Ocular Media UV (nm) VISBLE (nm) IR (nm) Tear layer 290 - 380 380 - 760 760 - 3000 Cornea 290 – 380* 380 - 760 760 – 3000* Aqueous 290 – 380* 380 - 760 760 – 3000* Lens (child) 310 – 380* 380 - 760 760 – 2500* Lens (older adult) 375 – 380* 380 – 760* 760 – 2500* Vitreous 290 – 380* 380 - 760 760 – 1600* * Partial transmission
- 18. Effects of UltravioletRadiation 1) Photophthalmia Aka photokeratitis or photoconjunctivitis Photochemical damage to the corneal epithelium Results from absorption of UV of 300 nm and below 2) Pterygia , Pingueculae & Band Shaped Keratopathy Result from repeated, long continued exposure to UV radiation
- 19. 3) Cataract Cumulativeeffect of UV radiation UV B (290-320 nm) is main causative factor Photo-oxidation of lens crystallins Photo-oxidation of lens membrane lipids Damage to lens epithelial DNA 4) Retinal lesions cataract
- 20. Effects of InfraredRadiation Ocular Structure Damage Cornea Opacification , haze , debris, exfoliation Aqueous humor Flare , cells , pigment Iris Miosis , hyperemia , swelling , necrosis Lens Cataract Vitreous humor Haze or flare Retina Depigmentation , edema , frank burn
- 21. Effects of VisibleRadiation Normal levels of visible light not hazardous Unusually high levels of visible radiation cause both photochemical and thermal injury to retina Short wavelength – photochemical damage Longer wavelength – both photochemical and thermal damage
- 22. Occupational ocular problemsdepend on Nature of the work Working environment 90 % of the occupational ocular hazards are preventable
- 23. Occupational ocular problemsin sports Sports – physical activity carried out under an agreed set of rules, with a recreational purpose: for competition or a self enjoyment or a combination of these
- 24. American Medical Associationclassifies sports as Collision Football Hockey Rugby Contact baseball Basketball Wrestling Boxing Non contact Running Tennis Swimming Others Bowling Golf Archery
- 25. On the basisof potential for eye injuries Low risk sports • No use of ball, puck, bat, stick, racquet, no body contact • Running, swimming, cycling, gymnastics High risk sports • Use of ball, puck, bat, stick, racquet, body contact • Baseball, hockey, football, basketball, racquet sports, tennis, golf Very high risk sports • Boxing, wrestling, contact martial arts • Eye protectors typically not worn
- 26. Common mechanism ofeye injuries in sports Blunt trauma Penetrating injuries Radiation injuries
- 27. Blunt Trauma Accountsfor most sports related eye injuries Extent of ocular damage depend on size, hardness and velocity of blunt object Caused by ball, bat, stick, racquet used for playing Eye hand collision in games like wrestling, boxing, so on
- 28. Penetrating Injuries Relativelyuncommon but may occur even with large projectiles Range from mild abrasions to serious lacerations Radiation Injuries Occur as a result of exposure to ultraviolet rays In snow skiing, water skiing and other water sports
- 29. Use ofprotective eyewear , filters and performance sun eyewear help in the prevention of these hazards Nature of athletic activity (contact or non contact) , weather and atmospheric conditions that may be encountered by athlete should be considered while prescribing protective eyewear and filters
- 30. Purpose of sportseyewear • Protect eye from ocular injury and UV radiation • Provide proper vision so that wearers can continue to perform with least discomfort while getting the right level of protection
- 31. Protective eyewear insports • Use of polycarbonate, Trivex , NXT lens materials can provide superior impact resistance over glass and CR 39 lens materials • However the frame construction does not withstand the forces encountered in many sports • Use of protective eyewear required to ensure adequate protection
- 32. Two basic typesof protective eyewear designs available Goggle style Shield style protection attached to a helmet
- 33. Lightweight framebut resistant to strong impact Fitted with an elasticated sports band Made of impact resistant plastics, preferably polycarbonate Glass lenses should be avoided
- 34. • Face-form (wrap)design sun eyewear offers improved coverage of the ocular surface tissues and a wider field of view than traditional designs • The improved coverage increases UV protection by preventing light leakage around the frame and protects the eye from the harmful effects of wind and dust.
- 35. Protection eyewear usedin some sports 1) Racquet Sports Includes badminton, handball, tennis, etc Ball or shuttlecock is hit with tremendous force and can travel at speed of upto 90 mph The eyewear must protect the eye and orbit from several angles including the sides
- 36. 2) Hockey Full faceshield Half face shield
- 37. 3) Swimming andwater sport • Most swimmers and divers use a goggle or face mask so that no adjustment is necessary to the habitual prescription to compensate for the difference in the index of refraction of the water medium. • Some goggle designs have ventilation holes to reduce lens fogging in highly active water sports such as water skiing, surfing, windsurfing, and endurance swimming.
- 38. 4) Snow skiing Snow skier encounters a 15 % increase in UVR for each km (3000 ft) of altitude above sea level May lead to photokeratitis that might ultimately lead to snowblindness Eyewear with UV filters should be used
- 39. Filters and performancesun eyewear • Higher level of solar radiation in outdoor sports saturate the photoreceptors and reduce finer level of contrast sensitivity • Properly selected filters reduce glare and improve contrast • This enhance the ability to discern the crucial details and judge depth • Protection from UV exposure
- 40. • Protection fromlight radiation is directly related to filter lens density • Transmittance of filter defined in shade number (higher the shade no. lower the transmittance of filter) • Select the darkest shade that allows the task performance
- 41. 1) Neutral GrayTints • Absorbs all wavelength of visible spectrum almost equally, natural appearance of colors is preserved • Preferred by athletes who are sensitive to color information in their sport and who do not appreciate even subtle alteration of the natural environment
- 42. • Often favoredby those participating in golf, skiing, and mountaineering activities • Athletes must make critical performance decisions based on subtle terrain details in these sports, and distortion of natural contour cues can lead to poor decisions
- 43. 2) Yellow –Brown Range Tints • Filter visible spectrum through the attenuation of the transmittance of the shorter wavelength colors • Decreases the chromatic aberration between the longer red wavelengths and the transmitted mid- range greens
- 44. • Leads toimproved image clarity, and the selective transmission of yellow wavelength light concentrates the visible information at the most sensitive portion of the visible light spectrum • Filter the glare produced by short wavelength light • Preferred in shooting, snow sports, tennis, baseball
- 45. 3) Green RangeTints • Green portion is selectively transmitted • Preferred in golf, tennis, woodland shooting 4) Red Tints • Provides better color perception in low light condition • Helps in contrasting object against blue and green background • Ideal for night sports
- 46. 4) Polarized Filters •Reduce the reflected glare off the horizontal surfaces, water, snow, pavement, sand • Useful in fishing, water sports, snow sports, cycling, driving
- 47. 5) Photochromic lens •Plastic photochromic lens suitable for some non contact sports like running, cycling • Glass photochromic lenses not used
- 48. Contact lenses insports Choice of refractive correction in highly dynamic sports Dynamic sports – baseball, basketball, football, racquet sports, skiing sports, volleyball, gymnastics,etc Field of view aberrations Visual field restrictions Optical distortion Frame discomfort Frame instability Surface reflections Lens fogging Largely avoided by moving optics on cornea
- 49. In aimingsports like shooting and archery, spectacles preferred over contact lens Undesirable visual fluctuation on prolonged gaze due to lens movement on eye Peripheral vision do not affect the performance Contact lens movement decrease contrast sensitivity
- 50. • Soft lenswith UV absorbing tints protect only the ocular tissues covered by contact lens • Best protection when used in combination with quality sun eyewear
- 51. Occupational ocular problemsin driving Driving can be defined as the ability to operate, control and direct the course of vehicles Normal visual functioning is an essential requirement for driving- drivers need to be able to judge the distance - read road signs and traffic lights - assists driver to respond to changes in environment quickly and efficiently
- 52. • Good visualacuity in addition to normal visual field, good stereopsis, normal color vision, eye co- ordination, good retinal adaptation are essential to avoid RTAs (Nwosu 1989) • As driving is an outdoor activity, drivers are exposed to high level of radiations, dusty and windy environments
- 53. Common ocular problems: Pterygium Pingueculae Allergicconjunctivitis Cataract Presbyopia Glaucoma (pattern of eye diseases among commercial intercity vehicle drivers in Nigeria Bola J Adekoya et.al Nigerian J of Opth 2008)
- 54. Protective eyewear indriving For day time driving Sunglass lens that transmits less than 67 % of the incident light can be used Excellent absorption in 200 to 300 nm portion of UV region Inadequate absorption in 300 to 400 nm portion of UV region Less than 15 % transmittance in range of 700 to 15oo nm
- 55. Maintain optimumretinal adaptation for night vision in night driving Yellow, green and brownish lenses impair color vision significantly due to selective shift in the spectral transmittance of the lenses so not recommended as sunglass lenses for drivers
- 56. Lenses withanti reflection coating Polarizing lenses- reduce reflection from wet road and snow
- 57. For night driving Only the lightest of the tints should be used Poor illumination at night, and use of tint can further reduce illumination which is unsafe for driving Antireflection coating on the lens with lightest tint maximize the transmission of absorptive lens Increase in transmission caused by coating sufficient to offset the loss from absorption by the tint
- 58. Occupational ocular problemsin agriculture Agriculture includes crop farming, livestock rearing and fishing Most of the agricultural works involves use of agricultural tools, fertilizers, insecticides and pesticides Most of them are outdoor works
- 59. Main causes ofagriculture related ocular problems : direct trauma with agriculture tools vegetable/plant/organic materials hitting the eye chemical injuries by pesticides and insecticides animal attack injury ( e.g cow horn injury , insect sting)
- 60. soil spillageinto the eye other foreign bodies in the eye constant exposure to wind, dust and allergens constant exposure to UV light ( challenges of agriculture related eye injuries in Nigeria, Community Eye Health Journal 2015)
- 61. Short termeffects of UV exposure- photokeretitis , irritation Long term effects- pterygia, pingueculae, cataract and retinal damage Allergic conjunctivitis
- 62. Protection eyewear inagriculture 1) Sunglasses 2) Safety glasses- wrap around lenses 3) Goggles – protection from front and side impact 4) Full face shield
- 63. Occupational ocular problemsin industries Potential eye hazards are found in almost every industries Common ocular hazards 1) Mechanical injury - By flying fragments, objects, large chips, sand, dirt - Common in chipping, grinding, machining , sanding tasks 2) Heat injury - By hot sparks, splash from molten metals, high temp exposure - Common in furnace operations, casting, gas cutting, welding tasks
- 64. 3) Chemical injury -Common in acid and chemicals handling tasks 4) Radiation injury - Common in welding electric arc, welding gas, cutting, brazing, soldering
- 65. Ocular protection devicesfor industries These devices must protect the workers from 1) Potential mechanical and chemical injury 2) Possible radiant energy damage Available in the form of 1) Spectacles 2) Goggles 3) Face shields 4) Helmets
- 66. 1) Safety Spectacles -Manufactured in both metal and plastic materials - Provided with or without sideshields which protect eye against objects flying from the side - May be supplied with plano lenses or worker’s RX
- 67. 2) Chipping goggle -Aka impact cup goggle - Useful in tasks involving chipping and grinding where foreign body may strike the eye from any direction
- 68. 3) Impact ordust goggles - Made from a soft, flexible plastic material that is molded in a single front - Lenses inserted into the frame of eye cup to provide rigidity to goggle
- 69. - Designed tobe worn over a pair of spectacles - Perforated holes on the side of goggles extending from mask to facial area allow ventilation that prevent lenses from fogging
- 70. 4) Chemical goggles -Constructed the same as impact goggles except for ventilation system - Consists of a series of plastic louvers designed to provide indirect ventilation while preventing chemical splashes - May also be worn over spectacle lenses
- 71. 5) Welding goggles -Protect welder’s eye from impact as well as harmful radiation - Welding helmet provides the required protection for the head, neck and eyes during electric arc welding operations
- 72. - There isa window through which the welder can view the welding process - Window hold a series of filter for protection against UVR, IR and visible radiation generated by welding arc
- 73. 6) Face shield -Protect the head, neck, face and eyes from flying particles and chemical and molten metal splash
- 74. Eye and FaceProtection Selection Chart Source Assessment of Hazard Protection IMPACT - Chipping, grinding, machining, drilling, chiseling, riveting, sanding, etc. Flying fragments, objects, large chips, particles, sand, dirt, etc. Spectacles with side protection, goggles, face shields. For severe exposure, use face shield over primary eye protection. HEAT - Furnace operations, pouring, casting, hot dipping, and welding. Hot sparks Splash from molten metals High temperature exposure Face shields, goggles, spectacles with side protection. For severe exposure use face shield. Face shields, reflective face shields. Screen face shields, reflective face shields. CHEMICALS - Acid and chemicals handling Splash Irritating mists Goggles, eyecup and cover types. For severe exposure, use face shield over primary eye protection Special-purpose goggles
- 75. DUST - Woodworking,buffing, general dusty conditions Nuisance dust Goggles, eyecup and cover types. LIGHT and/or RADIATION Welding - electric arc Welding - gas Cutting, torch brazing, torch soldering Glare Optical radiation Optical radiation Optical radiation Poor vision Welding helmets or welding shields. Typical shades: 10-14 Welding goggles or welding face shield. Typical shades: gas welding 4-8, cutting 3-6, brazing 3-4 Spectacles or welding face shield. Typical shades: 1.5-3 Spectacles with shaded or special-purpose lenses, as suitable.
- 76. CONCLUSION…. • Majority ofthe occupational ocular hazards are preventable • All protective eyewear have certain limitations • Proper selection of protective eyewear depending on the nature of work and working environment helps in the prevention of potential eye hazards
- 77. REFERENCES Environmental Vision,Interactions of the Eye, Vision, and the Environment-Donald G. Pitts Sports Vision – Erickson Occupational and Environmental Vision- The Role of the Optometrist in Occupational Safety and Health, Ralph G Chou Internet sources Borish’s Clinical Refraction- William J Benjamin Clinical Optics- Theodore Grosvenor Solutions for Living: Personal Protective Equipment for Agriculture- Randolph Weigel
Editor's Notes
- #10 Concussion- mild traumatic brain injury Contusion- vessels damaged by trauma allowing blood to seep and collect in interstitial tissue
- #11 Laceration deep cut of tissues
- #13 Lye highly alkaline soln of sodium or pot hydroxide used for cleansing
- #21 Anterior sub capsular opacity is common in almost all type of radiation induced cataract
- #42 photo
- #44 photo
- #58 Other protective eyewear for drivers
- #65 Brazing- metal joining process
- #66 photo
- #67 photo