EYE INJURY IN ROAD TRAFFIC ACCIDENTS

S . J . Ashton , G . M . Mackay , P . F . G loyns and J . L . G .Hardy Department of Transportation and Environmen tal P lanning , Univers ity of Bi rmingham, U . K .

ABSTRACT

German and French authors have reported that eye inj uries are a serious problem in road accidents whi lst previous Brit ish work has not ident i fied a prob lem. An analy s i s of accidents in which there was occupant eye inj ury has been undertaken from the cases invest igated by the Accident Research Uni t . Details o f the accidents and inj uries are reported. A s tudy was made to determine the incidence of eye injury in the City of Birmingham.

PREVIOUS WORK

The occurrence of eye inj uries resul t ing from shattered toughened glass windscreens in road traffic accidents was firs t reported in the mid s ixties by Holland (1-3) . The problem has been further investi gated by Hol l and (4) and by others in Germany (5-12 ) . A number of reports on eye inj uries have been pub lished in the last few years in France ( 13-16 ) . Salient features of these French and German reports have been that the windscreen was the maj or cause of the eye inj uries , that the front seat passenger was more like ly to sus tain an eye inj ury than the driver and that the eye injuries generally occurred in low speed accidents , indirect evidence for this being the frequent lack of other severe inj uries to the injured occupan t .

I n the United Kingdom, however , there has been l i t t le pub l ished work on the problem of eye inj uries sus tained in road accidents . Gissane and Bull ( 1 7 ) noted, in a s tudy of one year ' s admi s s i ons to the B irmingham Accident Hos p i tal , that there were 4 cases of permanent disab i li ty . resulting from eye inj uries out of 79 vehi c le occupants permanently d i s ab led.

The TRRL , in a repor t on inj uries from toughened glass windscreens pub lished in 1969 ( 1 8) , sugge s ted that " inj ury to the eye , of a severity sufficient to cause imp ai rmen t of vis ua l function, would appear to b e uncommon" . A later report ( 19 ) s ugge s ted that the incidence o f eye injury in seriously injured vehicle o ccupants was less than 1% - 9 cases of eye inj ury having been s een in a s ample of 1423 vehicle occupants .

Mackay e t al ( 20) , in a s tudy o f inj uries from toughened and laminated g lass windscreens , noted 4 cases of eye injury in a s ample of 1 7 7 front seat occupants .

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EYE INJURY ACCIDENTS

Introduction

S ince 1969 the Accident Research Vni t o f the Depar tment of Transportation and Environmental P lanning at B irmingham University has been engaged upon a retrospe c t ive s tudy of serious occupant inj ury accidents involving current production models less than three years old . By the end of February 1973 some 700 vehicles had been s t udied and in 2 8 of these vehicles there was one occupant with an eye inj ury whi ls t in one case both front seat occupants received eye inj urie s . I t is these 30 occupants with eye inj uries and the vehicles in whi ch they were t rave l l ing that are reported here . I t mus t b e s tressed that the s ample o f accidents from which these eye injury cases were t aken was not s tructured to be representative of United Kingdom accidents and therefore this s amp le of eye inj uries may not be a represent­ative s amp le . The methodology of accident inve s tigati on at B irmingham has been des cribed e lsewhere ( 2 1) .

The Vehicles

Twenty-four ( 82 . 8%) of the twenty-nine vehicles s us tained an impact to the front of the vehicle and in eighteen ( 7 5 . 0%) of these frontal impacts the direction of principal force was 12 o ' clock. Tab le 1 shows the s ample by imp ac t direction and impact locat ion - the impact condi tions being described using the SAE Collis ion Deformation Clas s i f ication (22) . There were s li gh t ly more accidents in urban areas than rural areas - thir teen of the veh i c les being involved in rural accidents and s ix teen in urban accident s . The mos t frequent obj ects struck were other car s , accounting for 4 1 . 4% of a l l obj ects s truck whi l s t the second most frequent obj ects s t ruck were poles , accounting for a further 2 4 . 1% of the obj ects s truck . The severity of the accident was ass es sed using the concept of Equivalent Tes t Speed. This is a method whereby the damage sustained by the case vehicle is related to the damage sus tained by a vehi cle of the s ame type which i s crashed under known condit ions . I t is neces s ari ly an approximate method due to the limited data availab le from experimental tes t s ; the errors in asses sment increasing as the case vehicle damage moves further away from the experimental test vehicle damage . However , even with these errors i t is considered t o be the bes t method currently available for assess ing accident severity . Tab le 2 gives an analys is of the cases by Equivalent Test Speed and shows that the maj ority ( 72 . 4%) of the cases occurred in the 20 to 40 Km/hr Equivalent Tes t Speed range .

The Occupants

The twenty-nine vehi cles contained 62 occupants of whom 30 sustained eye inJ urie s . E ight of the vehicles contained only a drive r ; s ixteen vehicles had two occupan ts , two had •three occupants and four had four occupants . Sixteen ( 53 . 3%) of those s us taining eye inj uries were driver s , twelve ( 40 . 0% ) were fron t seat passengers and two were rear s eat occupants . Both the rear seat occupants and one of the front seat occupants sustaining eye inj uries were chi ldren. Half the drivers with eye inj uries were in the age group 25-34 years , whi l s t only 16 . 7% of the front seat occupants were in that age group - the mos t common age group for front s eat occupants was 35-44 years .

The Inj uries

The definition of an eye inj ury used in this s tudy was b ased on the c las s i f ications used in the International C las s ification of Injuries (23) and includes inj uries t o the eye lids as we l l as to the eyes . Four of the thirty nine cases of eye inj ury noted involved only inj ury to the eye l ids . In the remaining twenty s ix cases of inj ury t o the eye itself there were twenty three cases of injury to one eye and three cases ( 1 1 . 5%) of inj ury to both eye s . I f inj uries to the eye lids are inc l uded then there were inj uries to both eyes in 20 . 0% of the cases . Tab le 3 detai ls the nature of the inj uries in the s amp le . There was impairment to the sight in 40 . 0% of the cases and in three ( 10 . 0%) of the cases both eyes were affecte d .

The eye inj uries were normally associated with lacerations to the face in the region of the eyes . There was only one case of eye injury without ass ociated facial laceration and this was an injury due to s triking the corner of the rear view mirror with no winds creen breakage . In twenty ( 66 . 6%) of the cas e s extens ive facial lacerations were sustained whi l s t in five cases ( 1 6 . 7%) there were facial fractures . Tab le 4 gives detai ls of the associated head and face inj uries .

The inj uries occurring in association with eye inj uries were ana lysed. The head was the mos t frequently inj ured and the mose severely inj ured body area. Twenty nine of the thirty injured had head inj ur ie s , fourteen of which were moderate (AIS 02) injuries and one a severe (AIS 03) inj ury -clas s i f ied on the Abbreviated Injury S cale (24) . Two o f the injured had minor (AIS 01) ehes t inj uries ; one a severe (AIS 03) abdominal inj ury ;

four had upper l imb inj uries - two minor (AIS 0 1 ) and two moderate (AIS 02) and twe lve had lower l imb inj uries - nine minor (AIS 01) , two moderate (AIS 02) and one severe (AIS 03) .

Inj ury Causation

Tab le 5 gives details of the s ources of eye inj ury . In three cases the rear view mirror was the cause of inj ury and in two of these cases the windscreen was unbroken . S ixteen of the eye inj uries were caused by toughened glass windscreens whi ls t in a further four cases it could not be abs olutely determined that the windscreen was the cause of inj ury as the rear view mirror had been impacted as wel l . l t is considered that three o f these four ' eye ' inj uries were probably caused by the winds creen . In this sample the windscreen was the cause of inj ury for j us t over two thirds ( 67 . 8%) of the inj uries for which the cause was known .

In two cases , both be lted occupants of the s ame vehicle, the eye inj uries were associated with severe head and facial injuries caused by a motor cycle pas s ing through the plane of the winds creen .

In one case the b e l ted front seat pas senger of a car involved in a severe head-on collis ion with another car s us tained severe lacerations to the eyel ids .

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Representativeness of s ample

Comparison of thi s s ample of accidents w ith the total incidence s tudy detailed in the next section showed that the s ample was a representative s ample of eye inj ury accidents .

INCIDENCE OF EYE INJURIES

Introduction

As the s ample of accidents col lected by the Accident Research Uni t was not s tructured to be representative of accidents occurring in England , a t o ta l population s tudy was undertaken to estab lish the incidence of eye inj uries in the C i ty of B irmingham. Thi s s tudy enab led the representat ive­ness of the cases collected by the Accident Resear ch Uni t to be determine d .

Methodology

Details of a l l injured persons who were recorded as sus taining an eye inj ury as a result of a road traffic accident in 1 9 7 1 and who were treated as inpatients at hosp i tals in , and next to, the City of Birmingham were obtained from the computer records of the B irmingham Regional Hospi t a l Boar d . A s e arch was then made through the police records to identify which of the inpat ients received their inj ury as a result of an accident in which they were a vehicle occupant in the study area . Examination of the p o l i ce accident booklets gave information on the type of accident , number of occupants and occupant s eating pos i t ions . A total of 2 7 vehicles in which an occupant sus tained an eye inj ury were identified in this way .

The Vehicles

Twenty one ( 7 7 . 8%) of the vehicles were involved in accidents which involved damage to the front of the veh icle and in which the main impact forces were j udged , from the recorded details of the accident circums t ance s , t o b e along the longitudinal axis o f the vehicle . A further two cases involved damage t o the front corner of the vehicle which resulted from intersect ion collisions .

Twelve ( 44 . 4%) of the vehicles were involved in co llis ions with other vehicles and seven ( 2 5 . 9% ) were in collis ions with po les .

Comparison of these results with a representative s ample of a l l B irmingham accidents (25) indicates that eye inj uries are a phenomena that generally occur in frontal impacts - frontal impacts accounted for 7 7 . 8% o f the eye injury accidents although only 32 . 2% of all urban accidents are frontal impacts .

The Occupants

The twenty seven veh icles contained 53 occupants of whom 27 sus tained eye inJ uries . Five of the vehi c les contained only a driver , twenty had two occupants and two vehi c les each had four occupants . All the occupants with

eye inj uries were front seat occupants . Five were unaccompanied drivers . In the twenty two vehicles with both a driver and a front seat passenger there were fourteen cases ( 6 3 . 6%) of passenger eye inj ury and eight cases ( 36 . 4%) of driver eye inj ury . Eight ( 6 1 .5%) of the drivers were under 25 years old .

The Inj uries

The mos t commonly occurring inJury was ' open wound of eye and orb i t ' accounting for 85 . 2% of the eye inj uries . O ther injuries recorded were ' superficial inj ury to face , neck and s calp , ' includes abrasion of eye and eyelid - one cas e , ' con tus ion of eye and orb i t , ' - two cases , and ' foreign body in eye and adnexa , ' - one cas e .

Incidence o f eye inj uries

In 1 9 7 1 in the B irmingham City Police area 2 , 1 1 7 people sustained s light inj uries , 660 sus t ained serious inj uries and 35 people were kil led whi l s t vehicle occupants . Thi s s tudy shows that 2 7 o f the 660 ser iously injured occupants sus tained eye inj uries . Tab le 6 gives details of the severity of inj uries sus tained by vehicle occupants in 19 7 1 .

Thirteen o f the 330 s erious ly injured drivers sustained an eye inj ury , giving an incidence figure of 4% .

The fourteen pas sengers who s us t ained eye inj ury were all front s eat occupants whi l s t the 330 serious ly injured passengers noted in T ab le 6 include rear seat occupants . Data from the Birmingham Accident Hos p i t al ( 17) indi cates that the ratio of front to rear s eat passengers s us taining serious inj ury is 5 : 2 which suggests that the 14 front seat pas s engers were drawn from a p opulation of about 2 35 whi ch gives an incidence f igure of 6% .

CONCLUSIONS

Eye inj uries are an ident i fiab le injury in road traffic accidents .

They commonly occur in frontal impacts and are caused mos t frequen t ly by glass from toughened glass windscreens . Just over two thirds ( 67 . 8%) of the eye inj uries in thi s s tudy resul ted from toughened g lass windscreens .

The front s eat pas s enger is more l ikely to sus tain an eye injury than the drive r . Four per cent ( 4%) of s erious ly injured drivers sus tain eye inj uries and 6% of s er iously injured passengers sus tain eye inj uries .

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TABLE 1 IMPACT DIRECTION AND LOCATION

Impact Locati on Impact Direction 1 10 1 1 1 1 1 2 1 0 1 1 02 1 Total

Front D 1 8 9 L 2 2 c 2 5 7 R 1 1 2 y 1 1 z 1 1 1 3

Left Side F 1 1 2 p 1 1 z 1 1

Right S ide p 1 1 1 1 1 1 1 1

TABLE 2 EQUIVALENT TEST SPEED

Equivalent Tes t Speed kph 1 Unc las s 1 0-10 1 1 1-20 1 2 1-30 1 31-40 1 41-50 1 5 1-60 1 6 1- 7 0 1 Total

Front 2 1 1 7 10 2 Le ft 1 2 1 Right 1

TABLE 3 NATURE OF EYE INJURY

Eyelid inj ury - one eyelid 3

1 L 4 - b o th eye l ids ������������- ) Eye inj ury - one eye - no s igh t impairment

-����-1

04 L 1 4 - b o th eyes - no s i ght impairment )

Impairment of s i gh t in one eye 6 Loss of s i ght in one eye 3 Impairment of s i ght in both eyes 1 Loss of s i ght in one eye + impairment t o

s ight o f o ther eye ��������������������- 1 Los s o f s ight in b o th eyes 1

1 2 4 4 1

TABLE 4 ASSOCIATED HEAD AND FACE INJURIES

No concuss ion or fracture Concuss ion

No other inj ury 1 Lacerat ion in area

of eyes 7 Laceration in area

of eyes + other facial lacerations 8

TABLE 5 SOURCE OF EYE INJURIES

Winds creen Windscreen or rear view mirror Rear view mirror Spectacles Intruding Obj e c t Not Known

1

7

TABLE 6 INJURIES 1 9 7 1 BIRMINGHAM ACCIDENTS

s l ight serious fatal

Driver 9 35 330 19

Other Vehicle Occupants 1 , 182 330 1 6

A l l 2 , 1 1 7 660 35

Fracture

1

4

N o . 1 6

4 3 3 2 2

Concus s ion + fracture

% 5 3 . 3 1 3 . 3 10 . 0 10 . 0

6 . 7 6 . 7

1

30 100. 0

eye eye inj ury % serious

1 3 3 . 9 4

1 4 4 . 2 4

2 7 4 . 09

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Ass ises

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