Prevalence and factors associated with ocular burns among patients with burns in the Burns Unit at Kiruddu National Referral Hospital

Abstract

Introduction: Ocular burns are a significant cause of morbidity and visual impairment with potentially devastating long-term consequences in the burn patient. Mulago National Referral Hospital Eye Clinic frequently receives referrals for ocular burns after discharge from the burns unit at Kiruddu National Refer Hospital. There are no documented studies investigating the burden of ocular burns among patients receiving care at the burns unit which is their first point of contact for emergency care in Uganda. Aim: To determine the prevalence and factors associated with ocular burns among the patients seeking care in the Burns Unit at Kiruddu National Referral Hospital. Methods: This was a hospital-based cross-sectional study. Two hundred and six burns patients aged 6 months to 86 years (mean age 18 years SD± 17.9 years) seeking care in the inpatient and the outpatient burns unit at Kiruddu National Referral Hospital from 1st September 2022 to 31st April 2023 were recruited consecutively. All consented and assented patients underwent a detailed history and medical evaluation where data on relevant socio-demographic characteristics, burn aetiology, burn severity, clinical management, and associated factors were collected. This was followed by a detailed ophthalmological evaluation to determine the presence of ocular burns. Ocular burns were defined as burns to the eyelids, conjunctiva, cornea, and deeper intraocular tissues. Appropriate treatment was given to all patients. Data was collected using a semi-structured questionnaire, entered into REDCAP, and exported to STATA 17/MP for analysis at univariate, bivariate, and multivariate levels. Adjusted odds ratios from a multi-variable binary logistic regression model were used to determine the factors associated with ocular burns and those with a p-value of less than 0.05 were considered significant. Results: A total of 20 patients were identified with ocular burns, accounting for (9.7%) of all burn patients attending the burns unit during the study period. The majority of burns were caused by thermal agents (92.3%) followed by chemical agents (4.4%). Concomitant injuries included facial burns (33.5%), upper limb burns (78%) lower limb burns (64.7%), head and neck burns (42%), and burns to the trunk (39.6%). Eyelid changes were the most frequent clinical finding and were found in all patients(n=20), followed by decreased vision (n=20) and dry eye syndrome (n=17). Fifteen percent (15%) of the patients had severe visual impairment while 15% were blind. The factor associated with ocular burns was ages 21-30 years aOR:95% CI:8.29(2.03-33.80) with significant p-value 0.003 as well as ages 31-40 aOR:95%CI:9.26(2.11-40.10) with significant P value 0.003. Conclusion: Ocular burns affected a notable proportion of patients attending the burns unit at Kiruddu Hospital. Dry thermal agents and acidic chemicals were the most frequent cause of ocular burns. Age between 21 and 40 years was the significant risk factor for ocular burns. Recommendations: Targeted ophthalmological evaluations to identify the presence of ocular burns, provision of appropriate management, and public health awareness campaigns about prevention and first aid for ocular burns should be integrated into the routine care of patients with burns.