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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 4  |  Issue : 1  |  Page : 56

Scare air gun-induced ocular trauma in an agriculture farm in India


1 Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
2 Department of Cornea, Narayana Nethralaya, Bengaluru, Karnataka, India

Date of Submission28-Sep-2022
Date of Decision21-Oct-2022
Date of Acceptance01-Nov-2022
Date of Web Publication22-Nov-2022

Correspondence Address:
Srinivasan Sanjay
Narayana Nethralaya, Chord Road, Rajaji Nagar, Bengaluru - 560 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/pajo.pajo_54_22

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  Abstract 


Purpose: The purpose was to highlight the potential dangers of the air gun loaded with carbide commonly used by the farmers, causing injury to the eye. Scare airguns are used to prevent the birds from destroying the crops in their fields.
Method: This was an observational study.
Results: A 44-year-old Indian male presented to us with redness, diminution of vision, and mucopurulent discharge in his right eye (RE). On evaluation, it showed lid edema, excoriations, conjunctival congestion, corneal epithelial defect, anterior chamber inflammation, and hyphema in his RE. On his last follow-up a month later, hyphema and anterior chamber inflammation had resolved in his RE with an improved visual acuity. He was also educated about the dangers of using illegal air guns.
Conclusion: Eye protection should be used when using devices that are inflammable. Ocular air gun injuries can range from some causing minor corneal abrasions to potentially serious ones. Due to the timely evaluation and treatment of our patient, the patient did not suffer significant visual morbidity.

Keywords: Air gun, anterior chamber inflammation, birds, blunt trauma, calcium carbide, hyphema


How to cite this article:
Sanjay S, Gupta A, Uday S. Scare air gun-induced ocular trauma in an agriculture farm in India. Pan Am J Ophthalmol 2022;4:56

How to cite this URL:
Sanjay S, Gupta A, Uday S. Scare air gun-induced ocular trauma in an agriculture farm in India. Pan Am J Ophthalmol [serial online] 2022 [cited 2022 Nov 29];4:56. Available from: https://www.thepajo.org/text.asp?2022/4/1/56/361718




  Introduction Top


Worldwide, agriculture ranks among the most hazardous occupations alongside mining, manufacturing, and construction in the prevalence of work-related eye injuries.[1] In developed countries where most farming practices are mechanized, eye injuries are mostly machine-related, either open- or closed-globe injuries. In the developing countries with a lesser degree of mechanization, corneal ulceration is a more common manifestation. In Southeast Asia, where paddy cultivation is predominant, injury from the paddy leaf during harvesting causes corneal abrasion, which gets secondarily infected from lack of care or the use of traditional eye medicines. The resultant corneal ulcer (harvest ulcer or rice-harvesting keratitis) is a significant cause of ocular morbidity and visual impairment. Work-related injuries in agriculture result in huge economic losses, placing an enormous burden on the agrarian community worldwide.[1]

There can be other causes of serious ocular trauma among the farmers, like those who tend to use air guns to scare away the birds in their fields. A similar low-cost carbide gun is used in warding off crop-raiding animals or birds.

We are reporting a unique case of a scare air gun-associated ocular injury for the first time in the medical literature.


  Case Report Top


A 44-year-old Asian Indian male farmer was in his agricultural farm trying to scare the birds with an air gun using the chemical compound calcium carbide [Figure 1]a and [Figure 1]b. In his attempt to fire the air gun, the faulty gun backfired, leading to blunt trauma of the right eye (RE). The patient sought treatment elsewhere and was given a thorough eye irrigation for 15 min and explored for any particles as mentioned by the patient and prescribed a combination of betamethasone 0.1% and neomycin 0.5% eyedrops. On presentation at our tertiary eye hospital, he presented with redness, diminution of vision, and mucopurulent discharge in his RE. Unaided visual acuity was 20/250 in the RE and 20/20 in the left eye (LE). The RE showed lid edema and excoriations with conjunctival congestion and subconjunctival hemorrhage, mucopurulent discharge with stromal corneal edema, central epithelial defect (1 mm × 1 mm), hyphema of 4 mm, and iris pattern not clearly made out with a mydriatic pupil and phacodonesis [Figure 2]a. The intraocular pressure (IOP) was 5 mm of Hg in the RE, most likely due to temporary ciliary body shutdown, while the LE was 17 mm of Hg. Gonioscopy showed recession of the nasal angle. The fundus was not visible. There was no evidence of choroidal/retinal detachment, as confirmed by ultrasound B scan. The RE was thoroughly irrigated to wash out the calcium carbide particles. He was started on drop amikacin 1% × 4 times/day), fortified vancomycin eye drops (6 times/day), lubricants, and tobramycin 0.3% eye ointment pending culture report. Conjunctival swabs did not yield the growth of any organism. Subsequently, he was started on topical prednisolone acetate 1% six times/day (tapered over a month) with homatropine 2% eye drops two times/day (for 2 weeks).
Figure 1: (a) An innovative carbide scare air gun. (b) The calcium carbide compound used in the gun

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Figure 2: (a) Color photograph of the right eye in diffuse illumination showing subconjunctival hemorrhage (yellow arrow) and hyphema (blue arrow). (b) Color photograph of the right eye in diffuse illumination showing resolution of subconjunctival hemorrhage, ciliary congestion, and hyphema. The pupil has been dilated for posterior segment evaluation

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At his last follow-up a month later, his best-corrected visual acuity in the RE had improved to 20/20, and IOP was 10 mmHg. The subconjunctival hemorrhage, corneal epithelial defect, and hyphema had resolved [Figure 2]b. Mild phacodonesis was present, and posterior segment examination was normal.

To the best of knowledge, this is the first time in the literature we are reporting such a case of blunt trauma associated with a calcium carbide-loaded bird scare air gun.


  Discussion Top


Ocular trauma has recently been highlighted as a major cause of visual morbidity. Worldwide, there are approximately 1.6 million people blind from eye injuries, 2.3 million having bilateral visual impairment, and 19 million with unilateral visual impairment.[2] In an Indian study, the most common place of injury was at home (33.8%), followed by street or road (28.6%), workplace (17.4%), playground (9.2%), and school (9.0%), and the most common type of injury was nonoccupational (82.3%), while (17.2%) had occupational injury. The most common nonoccupational injury was recreational or sports-related injury (23.9%), followed by road traffic accident (23.6%), assault-related (17.2%), and domestic accidents (15.2%).[3]

In a large-scale hospital-based epidemiological study of ocular trauma in northern India, the extent of ocular trauma was 3.93% (95% confidence interval: 3.23–4.63). As observed in this study (male: female – 2.7:1), several workers have reported male predominance in case of ocular trauma.[4],[5],[6],[7] Male preponderance is true for all age groups except for infants and elderly people. Higher preponderance of ocular trauma in males can be explained by their increased outdoor activities, including occupations like farming.[3]

Calcium carbide is a chemical agent which is popular among farmers as it is commonly used for ripening of fruits artificially. Although it is banned in many countries across the world, it is freely available and is used in the Indian subcontinent.

Due to its easy availability, the farmers have come up with the idea of a carbide gun. It uses a mixture of calcium carbide and water to make a loud bang. It is basically two PVC pipes [Figure 1]a of varying diameters joint together and has a triggering apparatus made from gas stove lighters. A piece of calcium carbide [Figure 1]b dipped in water is dropped down the muzzle. The acetylene gas produced in the reaction is ignited using a triggering mechanism connected to the device to produce a loud bang. It is very cost-effective for the farmers as well costing a mere rupees 85/kg (1.51 CAD/1.15 USD), enough to make 400 explosions. Calcium carbide with a pH of 12.4 causes skin irritation and rashes. Its reaction is more severe due to its highly alkaline nature; if it comes in contact with moisture, caustic lime is formed, which can lead to ulceration and scarring.

Ocular air gun injuries can range from some causing minor corneal abrasions to potentially serious ones. Due to the timely evaluation and treatment of our patient, the patient did not suffer significant visual morbidity. We also educated our patient regarding these dangerous contraptions and advised eye protection when using explosives. The evaluation and treatment of air gun injuries should be similar to that currently used for powder-weapon injuries.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chatterjee S, Agrawal D. Primary prevention of ocular injury in agricultural workers with safety eyewear. Indian J Ophthalmol 2017;65:859-64.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143-69.  Back to cited text no. 2
    
3.
Maurya RP, Srivastav T, Singh VP, Mishra CP, Al-Mujaini A. The epidemiology of ocular trauma in Northern India: A teaching hospital study. Oman J Ophthalmol 2019;12:78-83.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Pandita A, Merriman M. Ocular trauma epidemiology: 10-year retrospective study. N Z Med J 2012;125:61-9.  Back to cited text no. 4
    
5.
Tielsch JM, Parver L, Shankar B. Time trends in the incidence of hospitalized ocular trauma. Arch Ophthalmol 1989;107:519-23.  Back to cited text no. 5
    
6.
Desai P, MacEwen CJ, Baines P, Minassian DC. Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome. Br J Ophthalmol 1996;80:592-6.  Back to cited text no. 6
    
7.
El-Sebaity DM, Soliman W, Soliman AM, Fathalla AM. Pediatric eye injuries in upper Egypt. Clin Ophthalmol 2011;5:1417-23.  Back to cited text no. 7
    


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