Dr. Simon George, G11538
TitleDo construction workers in Kerala protect their eyes from trauma during work ?
Worksite injuries to the eyes are common. The trauma can cause damage to the eyes affecting vision and their livelihood. Many of these patients work in the construction field. Do these workers use any measure to protect their eyes against trauma?
Aim of study
To determine the use of protective eye glasses by construction workers during work in Kerala .
Materials and Methods
Cross-sectional , six months descriptive study of 600 construction workers. A pretested questionnaire was used after getting informed consent. The obtained data was statistically analysed using SPSS version 11.5 software .
96% were males. 96.45% had past history of injury to either eye during work. 24.67 % had injury to eye at least once a week. 40 % self treated the injury without seeking hospital treatment. 21.6 % needed inpatient treatment following eye injury in the past. 34.6 % complained of defective vision following the ocular trauma. 82.66% were aware about need for using protective eye glasses during work. Only 14% had protective glasses of which only 4% were using the glasses always during work. Lack of compulsion, cost, limited field of vision and discomfort during wear were some reasons for not using glasses during work. 99.4 % workers were willing to use protective eye glasses if the use of protective eye glasses during work was made compulsory by law or employer .
Workers are aware about the need to use protective eye glasses. However only a few workers are using protective glasses during work. Ocular trauma is common among construction workers. Steps should be adopted to minimise ocular trauma by ensuring the use of protective eye glasses during work.
Do construction workers in Kerala protect their eyes from trauma during work?
Ocular trauma is considered as the commonest cause for unilateral blindness 1. 19 million people have become blind and every year 5,00,000 more people become blind worldwide following ocular trauma 2 . Based on the US Bureau of Labour Statistics , the American Academy of Ophthalmology found that 40 % of the workplace eye injuries occurred in the construction, manufacturing and mining industries .The estimated yearly cost of occupational eye injuries in medical treatment, workers compensation and loss of productivity was found to be roughly $ 400 million. 90 % of the workplace eye injuries could have been prevented by protective eye wear. In India, most of the workers in the manufacturing and construction sectors do not have protective eye wear 3.
Why was this study done ?
In Kerala, industrialisation and increased demand for housing has lead to a spurt in the construction industry. I noticed that many construction workers were coming daily to the hospital casualty following eye injury during work. Most of the workers were young and had past history of ocular trauma. Clinical examination yielded findings ranging from corneal foreign bodies to open globe injuries .
The quality of life, vision, financial and social status of the workers were affected following ocular trauma. These problems could have been prevented by the use of protective eye wear during work. I did a review of available scientific literature regarding use of protective eye wear during work. However I did not find any published study on this topic from Kerala. So I decided to do this study to obtain insights regarding construction work related ocular trauma in Kerala and measures to reduce the incidence of vision threatening eye injuries
AIM OF THE STUDY
To determine the awareness and use of protective eye glasses by construction workers during work in Kerala.
MATERIALS AND METHODS
- Cross-sectional, descriptive, field study conducted during June – November 2015 .
- Thiruvananthapuram city was selected for the study as it is the capital city of Kerala with many construction projects.
- The written permission of the Thiruvananthapuram Corporation Health Officer and the Institutional Ethical Committee was obtained prior to the conduct of the study.
- Calculated sample size – 596 ( rounded to 600 ).
- 600 construction workers in 20 different construction project sites were selected by random sampling technique .
- After obtaining consent, a single interviewer interviewed the worker using a pretested questionnaire to obtain the data.
- The collected data was analysed using SPSS version 11.5 software.
- Questionnaire used for the study is given below
Sl.no. Gender 1. Male 2.Female Address 1. From Kerala 2. Outside Kerala
Age 1. 20 – < 30 yrs 2. 30 – < 40 yrs 3. 40 – <50 yrs 4. 50y – < 60 yrs 5. > 60 yrs
Education 1. Illiterate 2.Primary School 3.Middle School 4.High School 5.Plus two 6.Graduate 7. Postgraduate
Occupation 1. Unskilled worker 2. Mason 3. Electrician 4. Carpenter 5. Plumber 6.Welder 7. Painter 8. Granite work 9. Others
Monthly income (rupees) 1. > 29,766 2. 14,883 – 29,766 3. 11,162 -14,882 7,442 – 11,161 5. 4,465 -7,441 6. 1,503 – 4,464 7. < 1,502
Socioeconomic Class 1. Upper 2. Middle 3. Lower
Vision Left eye Right eye
A . How long have you been working in the construction field ?
Less than 1 year 1 – < 5 yrs 3. 5 – < 10 yrs 4. More than 10 yrs
B.Have you had any injury to either eye during work ?
1.Yes 2. No
If yes ( Questions C – H )
C.Details of the injury ?
1.One eye injury 2. Both eyes injury
D.Frequency of injury ?
1.Daily 2. Once in a week 3. Once in a month 4. Once in a year
E.How was the injury treated ?
1.As outpatient 2. As inpatient with medicines
3.As inpatient with surgery 4. Treated only by self
F.Has the injury affected your vision ?
1.Yes 2. No
G.Has the injury affected your ability to work ?
1.Not able to work at all 2. Partly affected 3. No effect
H.Are there any retained foreign bodies in the eye following the injury ?
1 . Yes, in both eyes 2. Yes, in one eye 3. No
IAre you aware about the need for using protective eye glasses during work ?
1.Yes 2. No
J.Do you have protective eye glasses at your work place ?
1.Yes, bought by self 2. Yes, provided by employer 3. No
K . Do you use protective eye glasses during work ?
1Yes, rarely (0-24 %) 2.Yes, occasionally ( 25-49 %) 3. Yes, often (50-74%)
4.Yes, most of the time (75- 99 %) 5. Yes, always ( 100 %) 6. No
L . If yes , what are your concerns while working with protective glasses ?
1.Limited field of vision while working 2. Discomfort during wear 3. Social stigma to use
4.Costly price 5. Lack of full protection to eyes 5. Low substandard quality of glasses
M.If no, why do you not use protective eye glasses during work ?
1difficult /inconvenient to work with glasses 2. I don’t feel the need for glasses
3.Cant afford buying glasses 4. Others will make fun of me
5.Others are not using glasses 6.Employer has not provided me glasses.
7.Glasses not available in market for buying
N.If you are provided protective eye glasses by your employer , would you wear them ?
1.Yes 2. No
O.If your employer / law makes use of protective eye glasses compulsory during work, will you wear protective glasses during work ?
1.Yes 2. No
1) 71.66 % of the workers interviewed were in the age group 20 – < 40 years of age.
2) 96 % were males .
Figure 1. Gender ratio ( Males : Females – 96 : 4 )
3) 100 % were from the lower socio economic class.
4) 39.66 % were working for more than 10 years.
5) 96.45 % had history of injury to either eye during work. Among these workers with past history of eye injury during work, 79.66 % had injury to both eyes.
Figure 2 . History of injury to either eye during work
6) 24.67 % had history of injury to the eye during work atleast once every week.
7) 40 % treated their eye injury by themselves without meeting a doctor for treatment.
8) 21.6 % were admitted as inpatients for treatment following eye injury .
9) 34.6 % complained of defective vision following ocular trauma.
10) 82.66 % were aware about the need for protective eye glasses during work
Figure 3. Awareness regarding need for using protective eye glasses during work.
11) 14 % workers had protective eye glasses , of which only 4 % were using these glasses full time during their work.
Figure 4. Percentage of workers having protective eye glasses .
12) Lack of compulsion, other workers not using glasses , restricted field of vision, cost factor and discomfort during wear were some of the reasons mentioned for not using their protective eye glasses.
13) There was no history of eye injury among the workers who were using protective eye glasses full time during work.
14) Only 7.33% workers were provided protective glasses by their employer.
15) 98 % were willing to use protective eye glasses during work if the glasses were provided free of cost to them by their employer.Figure 5. Willingness to use protective eye glasses if provided by the employer.
16) 99.4 % workers were willing to use protective eye glasses if the use of protective eye glasses during work is made compulsory by law or by employer .
82.66 % of the workers were aware about the need to use protective glasses during work. However only 14 % had protective glasses, of which just 4 % were using the glasses full time during work. In the study done by Ajayi I A et al 4 in Nigeria, 90.6 % welders were aware about the need for protective glasses during work . 45.9 % had protective eye glasses of which only 9.6 % used the glasses always during work. In the study done by Omolase C O et al 5, all the workers were aware about the need for protective eye glasses but only 17.5 % workers were constantly using these glasses during work. In an Indian study done by Vasu U et al 6, 76.74% of the open globe patients did not use any form of eye protection while working.
The low use of protective glasses during work is responsible for the high prevalence ( 96.45 % ) of injuries to either eye during work.
The high prevalence of bilateral eye injuries (79.66 % ) and relatively high prevalence of self treatment of eye injuries ( 40 % ) can cause long term visual and social disabilities to these young workers (71.66 % were in age group 20-< 40 yrs).
34.6 % had defective vision after ocular trauma .
No eye injury was reported among the workers who were using their protective eye glasses throughout their work.
98 % were willing to wear protective eye glasses during work if their employer provided them with these glasses free of cost . However only 7.33 % workers were provided protective glasses by their employers for use during the work.
99.4 % were willing to use protective glasses during work if the employer/ law makes it compulsory . Similar need for legislative enforcement of safety measures at work have been reported in the studies done by Boniface et al 7 and Shaikh MA 8 .
What was learnt from this study ?
The awareness regarding protective eye glasses among the construction workers in Kerala is high. However only few workers are using protective eye glasses full time during work. These workers have no history of ocular trauma while at work. However there is a high prevalence of ocular injuries among those who do not use protective glasses at work. To reduce ocular injuries and visual disability , it is necessary that preventive occupational eye health educational measures are taken to address the workers’ concerns regarding the use of protective glasses during work. Use of protective glasses by workers will be facilitated if their employers provide them free of cost to all construction workers. Legislative measures should be taken to enforce compulsory use of these glasses throughout their work.
How has this study modified my approach to workers with ocular trauma ?
• I realized that ocular trauma management is not limited to only prescribing medicines and doing surgery. Unless preventive measures are adopted by the worker, he/she will come back with repeated injuries and complications including visual disability. So I started spending more time with the patients to discuss about their occupation and the need for using protective eye glasses throughout work. I noticed that the workers who obtained information regarding prevention of occupational eye injuries were less likely to return back in the hospital casualty with repeat ocular trauma.
• I now ask all my work related ocular trauma patients to buy a protective eye glass before discharge from the hospital. The cost of protective glasses is cheaper than cost of medicines/surgery needed for any future ocular trauma treatment .Voluntary organizations help those workers who cannot afford the cost of protective glasses.
• I read an article published by Mancini G et al 9, in which it was found that distribution of specific educational posters and conducting talks lead to a sustained reduction in eye injury risk among workers. Based on this article and inputs from my study, I conducted classes and stuck posters in different areas in the construction sites reminding the workers about the importance of using protective eye glasses throughout their work.
Poster stuck at different construction sites to
remind workers to wear protective glasses
• Regular follow up of the workers in their construction site is required to ensure that they are using the protective glasses throughout their work. In the paper published by Forst L et al 10, Community Health Workers were found to be effective for training workers in the use of personal protective equipment in eye health and safety. So I contacted the Health Workers in the local Primary Health Centre and asked them to visit the construction sites in their area to ensure proper eye protection by the workers.
- I requested the 20 construction site managers to provide protective glasses free of cost to all their workers and to make it compulsory to wear the protective glasses throughout the work duration. Eight construction companies agreed and have now provided free protective glasses to all their workers.
- The Government order to make helmet compulsory for two wheelers has helped reduce head injury. In the same way, legislation can enforce eye safety measures in workplaces. Accordingly, I sent a letter on April 23, 2016 to the Ministry of Labour and Employment, Government of India requesting for legislative measures to ensure that all construction companies should provide protective glasses to their workers and the use of these glasses should be compulsorily enforced throughout the work time. The license permit of those companies which do not compile with the legislation should be cancelled. I have not yet got a reply to my letter from the Ministry of Labour and Employment.
- I realised the important role that All India Ophthalmological Society and the Ocular Trauma Society of India could contribute to the realisation of educational and legislative measures for the prevention of work related ocular trauma.
Construction workers are aware about the need for using protective eye glasses during work.However only few workers are actually using these glasses. This is the reason for the high prevalence of eye injuries among workers .Use of protective glasses during work can prevent eye injury. Health education classes, provision of free protective glasses by employers and legislation can help enforce the use of protective glasses among construction workers. Prevention is better than cure. In addition to treating eye injury patients, Ophthalmologists can also help in the prevention of work related ocular trauma.
- Somashekar P. Biradar and Arvind H.S., Industrial eye injuries, Journal of Clinical and Diagnostic Research. 2011 October, Vol-5(5): 1076-1081
- Macewen CJ. Ocular injuries. Jr. R .Coll Surg 1999;44:317-23.
- Jha KN.Ocular trauma has fallen on our blind spot.J Clin Ophthalmol Res 2016 : 4:65-9
- 4 . Ajayi IA, Adeoye AO, Bekibele CO, Onakpoya OH, Omotoye OJ. Awareness and utilization of protective eye device among welders in a southwestern Nigeria community. Ann Afr Med 2011;10:294-299
- Omolase C. O , Mahmoud A. O. The Welders protective Goggles: An evaluation of its Appreciation. Nigerian Journal of Surgical Sciences 2007; 17(1); 54-58
- 6. Vasu U, Vasnaik A, Battu R R, Kurian M, George S. Occupational open globe injuries. Indian J Ophthalmol 2001; 49:43-7
- 7. Boniface I. Eze ,Obiekwe Okoye , Emmanuel N. Aguwa . Awareness and Utilization of Welders’ Personal Protective Eye Devices and Associated Factors Findings and Lessons From a Nigerian Population. Workplace Health April 2015 vol. 63 no. 4 170-178.
- 8. Shaikh MA . Hazard perception and occupational injuries in the welders and lathe machine operators of Rawalpindi and Islamabad. J Pak Med Assoc. 2001 Feb; 51 (2): 71-4 .
- Mancini G, Baldasseroni A, Laffi G, Curti S, Mattioli S, Violante F. Prevention of work related eye injuries: long term assessment of the effectiveness of a multicomponent intervention among metal workers.Occupational and Environmental Medicine. 2005;62(12):830-835. doi:10.1136/oem.2004.019570.
- Forst L, Lacey S ,Chen HY, Jimenez R . Effectiveness of community health workers for promoting use of safety eyewear by Latino farm workers. Am J Ind Med 2004 Dec : 46(6):607-13
Source of financial support: None
Conflict of interest: None