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Etiology of Ophthalmic Medicolegal Cases Presenting to Tertiary Care Hospital

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Etiology of Ophthalmic Medicolegal Cases Presenting to Tertiary Care Hospital ETIOLOGY OF OPHTHALMIC MEDICOLEGAL The Professional Medical Journal www.theprofesional.com ORIGINAL PROF-0-2631 DOI: 10.29309/TPMJ/2019.26.07.2631 ETIOLOGY OF OPHTHALMIC MEDICOLEGAL CASES PRESENTING TO TERTIARY CARE HOSPITAL. Arooj Amjad1, Muhammad Shaheer2, Zubair Saleem3 1. FCPS (Ophthalmology) Senior Registrar ABSTRACT… To study the etiology and visual acuity profile of ophthalmic medicolegal cases Department of Ophthalmology presenting to a tertiary care hospital. Study Design: Retrospective study. Setting: Lahore General Lahore General Hospital, Lahore. Hospital, Lahore. Period: 1-3-2017 to 30-10-2018. Materials and Methods: This retrospective 2. FCPS, MRCSEd, FVRO Senior Registrar study was conducted after taking ethical approval from the institutional review board. Record of Department of Ophthalmology medicolegal cases presenting during the study period were studied and assessed. In this study, Lahore General Hospital, Lahore. etiology of trauma inflicted to eye and visual acuity at presentation were analyzed in addition 3. FCPS (Ophthalmology) to the age, gender and eye distribution. Age and visual acuity were categorized into subsets Associate Professor Department of Ophthalmology for assessment. Results: The authors reviewed the data of 40 ophthalmic medicolegal cases Lahore General Hospital, Lahore. presenting to the department. The medicolegal cases were common in patients aging between 21-30 years (32.5%) which predominantly involved males (65%). Right eye was involved in 40% Correspondence Address: Dr. Muhammad Shaheer of patients and 35% of patients had normal (6/6) visual acuity. Most common trauma inflicted to 48-B, TECH Town, Satiana Road, eye was by fist or blow from hand in 75% of cases. Conclusion: Trauma to eye in medicolegal Faisalabad, Punjab, Pakistan. cases is common and is frequently inflicted by fist or hand. [email protected] Article received on: Key words: Corneal Abrasions, Etiology, Globe injury, Medicolegal, Ocular Trauma. 18/12/2018 Accepted for publication: 14/03/2019 Article Citation: Amjad A, Shaheer M, Saleem Z. Etiology of ophthalmic medicolegal cases Received after proof reading: 25/06/2019 presenting to tertiary care hospital. Professional Med J 2019; 26(7):1192- 1196. DOI: 10.29309/TPMJ/2019.26.07.2631 INTRODUCTION the medicolegal report has to be made timely, A case of trauma where the attending emergency meticulously and in an unbiased manner.4,5 doctor after obtaining pertinent history and necessary examination declares that investigation Medicolegal cases may present at varying according to local law in order to declare the time intervals after the trauma is inflicted. responsibility of trauma is mandatory, is called a Sometimes the patient arrives days or weeks medicolegal case.1 Such cases are then referred after the given history of trauma, in which case to the causality medical officer who takes the a careful history and thorough examination is relevant history and does the examination necessary to ascertain the actual and realistic with the help of specialists and then gives his estimation of injuries.6 This is done to rule out report to the court of law.2 Ocular involvement the fact that in some cases, patients may try to if medicolegal cases is very common and they feign injuries which may mislead the doctor to routinely run into the ophthalmic practice.3 In a wrong conclusion.7 Therefore, besides history our country, Government designated doctors are examination, evaluation of all the laboratory reports responsible for the examination and treatment of including X rays and previous medical record of medicolegal cases. In the case of tertiary care the patient is mandatory.8 Various methods and hospitals, senior registrar is designated to deal systems have been postulated for the formulation with the medicolegal cases and give his report to of a system to identify and note the injuries in a the court of law which helps in ascertaining the medicolegal cases. Recently, a Hill Criteria has responsibility of trauma according to the law of been purposed which primarily consists of three land. The doctor who prepares the medicolegal interlinked steps.9 In the first step, Plausibility is report is like an expert witness which is helping thought of which takes into account the biological the court of law in the given criminal case so possibility and sequence of events leading to Professional Med J 2019;26(7):1192-1196. www.theprofesional.com 1192 ETIOLOGY OF OPHTHALMIC MEDICOLEGAL 2 the presenting condition of the patient. Next is of inflicting agent was recorded besides the temporality in which the timing of trauma and demographic data of the patients. The data onset of signs and symptoms is weighed in order was entered and analyzed using the Statistical to establish a connection between the two and Package for Social Sciences (SPSS). lastly the possible alternate differential diagnosis is ruled out one by one thereby confirming the RESULTS medicolegal cause of injury.9,10,11 Majority of the patients were male (65%) while only 35% cases were female patients. Right eye METHODS was involved in 40% of cases and left eye in 17.5% Ethical approval of this retrospective study patients while 42.5% patients had involvement of was obtained from Institutional Review Board both eyes. The age of patients was segregated of hospital. The record of all medicolegal with respect to decades between 30 and 50 years cases (n=40) presenting to the department of of age. 20% patients were aged less than 20 ophthalmology during the study period were years of age while 7.5% patients were ages above analyzed and findings noted. The first two 50 years of age. Medicolegal cases were most authors have been working as Senior Registrar common between 21-30 years of age comprising for the last two years, the post which also has of 32.5% cases. 22.5% cases were between 31- the responsibility of medicolegal consultant to 40 years of age and 17.5% patients were between the court of law. The medicolegal cases were 41-50 years of age. Table-I. referred to the Ophthalmology department by causality medical officer after necessary The visual acuity was measured on Snellen acuity history and documentation. The victims were chart. Majority of patients had no deterioration of accompanied by police officer to the eye clinic visual acuity i.e. 6/6 in 35% cases. 25% patients where the necessary history and examination had visual acuity of 6/60 or worse. Rest of the was undertaken and report was issued which cases had visual acuity ranging from 6/9 to 6/36. was received by accompanying police officer. Table-II. After receiving the patient and checking all required documents, a thorough history and Blow by fist or hand was the most common agent comprehensive eye examination was conducted inflicting trauma to eye (75% cases). This was by the authors before the report was issued to the followed by brick (10%), firearm (5%), iron stick/ casualty medical officer. The medicolegal report rod (7.5%) and knife (2.5%). Table-III. was written in a systematic manner to facilitate the casualty medical officer and court of law. Parameter N=40 Percentage Gender First part of report contained the demographic Male 26 65% information of patient such as name, age, gender, Female 14 35% national identity card number, medicolegal case Laterality number and hospital admission number if any. Next part of report contained the complaints Right Eye 16 40% of patients which also included the nature and Left Eye 7 17.5% cause of ocular injury and last part of the report Both Eyes 17 42.5% contained the ocular examination findings Age including the visual acuity of the patient. The < 20 Years 8 20% report was received by accompanying policeman 21-30 Years 13 32.5% with his signature and police station name. 1-40 Years 9 22.5% 41-50 Years 7 17.5% All case files were kept in order with time and >50 Years 3 7.5% were studied for collection of data. During data Table-I. Age, gender and laterality of patients search, Visual acuity at presentation and Nature Professional Med J 2019;26(7):1192-1196. www.theprofesional.com 1193 ETIOLOGY OF OPHTHALMIC MEDICOLEGAL 3 Visual Acuity N=40 Percentage=100 common cause of trauma to eye. Improvised 6/6 14 35% explosive device caused more open globe injuries 6/9 5 12.5% as compared to closed globe Injuries and were 6/12 3 7.5% associated with worse visual prognosis.14 6/18 3 7.5% 6/24 3 7.5% Chang IT et al studied the causes of ocular 6/36 2 5% trauma as a result of firearm injuries presenting to 6/60 or Worse 10 25% a trauma center. They retrospectively studied the Table-II. Visual acuity at presentation data of three hundred and twenty seven patients over a period of ten years. In their study, they Parameter N=40 Percentage=100 concluded that most common cause of firearm Fist/Physical abuse 30 75% ocular trauma was by mortors (22%) followed by Brick 4 10% rocket (22%). The most common injury inflicted to Firearm 2 5% eye was corneal abrasion and those having open Iron Stick 3 7.5% globe injury had the worst visual prognosis.15 Knife 1 2.5% Table-III. Nature of inflicting object Pandita A and Merriman M studied the profile and incidence of ocular trauma in a certain region of DISCUSSION New Zealand. During their study period, a total The authors present the retrospective data of 821 patients with ocular trauma were reported of medicolegal cases presenting to the of which males were predominant (74%). The ophthalmology department during a twenty highest number of ocular trauma was seen in 15- month period. 20 years age group and the most frequent cause of trauma in both genders was outdoor sctivities.16 Pieramici DJ and colleagues published the conclusions on behalf of “The ocular trauma Soylu M and associates studied the profile of classification group’’.
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