ocular complaints and disorders among wood …...presbyopia 21.6%, refractive errors 19.7% pterygium...

$: Ocular complaints and disorders among wood …...presbyopia 21.6%, refractive errors 19.7% pterygium 15.2% and pinguecula 7.1%. Twenty-two (4.8%) workers had visual impairment. Conclusion:$
Etim B et al Ocular complaints in wood market workers

1 Cross River Journal of Medicine Vol.2 No.1 January -March, 2018

Available online at www.crjmed.com

Original article

Ocular complaints and disorders among wood market workers in

Calabar, Nigeria.

1Bassey A. Etim,

1Dennis G. Nkanga,

1Uduak A. Asana,

2John A. Okwejie

1. Department of Ophthalmology, University of Calabar and University of Calabar Teaching

Hospital, Calabar, Nigeria.

2. Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria.

Corresponding Author: Bassey A. Etim. Department of Ophthalmology, University of Calabar,

Nigeria. E-mail: [email protected]

Phone: +234-8035521827

ABSTRACT

Background/Objectives: A significant proportion of ocular disorders occur in

the workplace, and is a major cause of socioeconomic loss, morbidity, and

disability. Ocular disorders are a result of exposure to occupational hazards.

The present study set out to outline ocular complaints and disorders among

wood market workers in Calabar, their causes and pattern of occurrence with

a view to comparing them to other population of industrial workers and the

general population.

Methods: It is a cross sectional descriptive study of wood market workers

carried out over a 2-month period. Study group was made up of technical and

non-technical workers. A pretested structured interviewer administered

questionnaire was used to collect information on demographics. Examination

findings of visual acuity with Snellen’s chart, eye adnexae, anterior segment

and posterior segments with use of pen torch and ophthalmoscope were

recorded in eye examination proforma form. Data were collated and analyzed

using the statistical package for social sciences version 24.0 (SPSS Inc., IBM

Corp, NY, USA). Cross tabulation was made, and statistical significance set at

p≤ 0.05. Ethical approval was obtained from the Ethical Committee of the

University of Calabar Teaching Hospital, Calabar.

Results: There were 405 (88.6%) males and 52 (11.4%) females. The mean

age in his study was 40.1 years with a range of 18-71 years. Inability to read

fine prints and ocular itching were the commonest ocular complaints in this

study. The prevalence of ocular disorder was 82.7%. The commonest eye disorders seen were

presbyopia 21.6%, refractive errors 19.7% pterygium 15.2% and pinguecula 7.1%. Twenty-two

(4.8%) workers had visual impairment.

Conclusion: Although the ocular disorders and complaints of wood market workers are not

significantly different from that of the general population in Nigerian, they are still at greater risk and

need eye health education and accessible quality eye care services

KEY WORDS:

Cornea thickness

Altitude

Obudu

Cattle Ranch

mailto:[email protected]




INTRODUCTION Ocular complaints are part of systemic

myriad of complaints among wood

workers because of being exposed and

unprotected while at work. Wood work is

not only vision demanding but also labour

intensive with workers being at increased

risk of ocular injury because of their

occupation. The human eye is naturally

endowed with anatomical and protective

mechanisms against injury. However, in

industrial environment these natural

mechanisms fail to protect the eyes

adequately, hence wearing of protective

devices become imperative.

A significant proportion of ocular

disorders occur in the workplace, and they

are a major cause of socioeconomic loss,

morbidity, and disability.1 Ocular

disorders are a result of exposure to

occupational hazards. Hazards are work

conditions of a job which make workers

prone to accidents or injury. Hazards are

also risk factors for eye disorders and

injury, and work place design should be

tailored to minimize hazards.2

A study in Nigeria has implicated airborne

wood dust as the prevalent occupational

exposure hazard in wood industry.3

Air

borne wood dust concentration was

compared in sawmill air against non-

sawmill air and showed that wood dust

particles in sawmill air was 1.39mg/m3

compared to non-sawmill air 0.52mg/m3.

A similar study in Calabar yielded wood

dust concentration of 31.75mg/m3 sawdust

particles in sawmill environment thus

implicating saw dust particles as a major

aetiological agent for most woodwork

industry ocular complaints, constituting

31.15%.4 Other aetiological agents are:

blow/trauma to the eyes 32.79%, cuts or

penetrating injuries 9.84%, chemical burns

26.23 %.

Wood market workers are known to

present with a myriad of ocular disorders

as documented in a study in Ghana.5The

study revealed that foreign bodies in eyes

76.6%, allergic conjunctivitis 80%,

infections 33.3%, pterygia 47.33%,

pinguecula 25.33% and less than 2% with

chemical injuries were the common ocular

disorders noted.5

Ocular complaints and disorders are not

only peculiar to wood market workers as

same disorders may also be found in the

general population presenting to the

hospitals for treatment. Findings on a

5year hospital study in Singapore revealed

the following ocular complaints:

Superficial foreign body in eye 58.2%,

corneal foreign body 24.9%, blunt trauma

12.6%, open globe injury 2%.6

Apart from the wood dust and particle

associated eye disorders or complaints in

wood market workers, many woods

contain chemicals that irritate the eyes

with added effects of molds growing on

the wood.7 These mold spores become

airborne when wood chips are moved,

lumber is trimmed, or wood is sawn.

Fungicides, such as azaconazole and

chloroprene, are sometimes applied to

wood to prevent the growth of fungi.

Treatment with insecticides and wood

preservatives and wood polish, such as

pentachlorophenol and creosote, is

sometimes used to protect the wood

surface from mechanical wear or

weathering and these may result in

chemical conjunctivitis upon accidental

entry to the eye.4

Studies have elucidated the use and

awareness of eye protective devices (EPD)

in work places including wood market

environment to reduce ocular morbidity

associated with exposure to hazards.4, 5,6

The present study set out to outline ocular

complaints and disorders among wood

market workers in Calabar, their causes

and pattern of occurrence with a view to

comparing them to other population of

industrial workers and the general

population.




SUBJECTS AND METHODS It is a cross sectional descriptive study of

wood market workers carried out over a 2-

month period. Study group was made up

of technical and non-technical workers;

machine operators. Carpenters, sprayers,

and sanders, non-technical workers as

wood carriers, truck pushers(porters), sales

ladies, drivers, food vendors and timber

dealers.

Inclusion criteria

All wood market workers in the selected

markets who have worked for more than

1yr were included in the study.

Exclusion criteria

Customers and visitors to the timber

markets were excluded. Timber market

workers of less than 1-year work

experience were also excluded.

Ethical approval

Ethical approval was obtained from the

Ethical Committee of the University of

Calabar Teaching Hospital, Calabar.

Approval was also obtained from the

executive arm of the wood market workers

union.

Data collection and analysis.

All wood market workers in 2 randomly

selected markets in Calabar metropolis

were included. Four hundred and fifty-

seven wood market workers who met the

inclusion criteria and consented to the

study were included in the results for

analysis. Data was collected after Informed

consent was obtained from each

participant by use of a pretested structured

interviewer administered questionnaire.

The questionnaires were administered in

English and interpretation into local

language was applied when necessary.

Visual acuity was measured at 6 meters in

an illuminated hall using the Snellen’s E

chart, ocular adnexae and anterior segment

examinations were done with the help of a

pentourch and hand-held slit lamp.

Posterior segment examination was done

with a Keeler specialist ophthalmoscope.

Eye examination protocol forms were used

to record ocular examination findings.

Data were collated and analyzed using the

statistical package for social sciences

version 24.0 (SPSS Inc., IBM Corp,

Armonk, NY, USA). Cross tabulation was

made, and statistical significance set at p≤

0.05.

RESULTS

A total of 457 wood market workers were

screened from 2 wood markets out of an

eligible pool of 652 workers. Workers

were mostly males 405(88.6%) while

females were 52 (11.4%). Table 1 shows

the age and occupational distribution of

wood market workers.

The mean age was 40.1yrs, SD 10.8 and

modal age was 40yrs. Majority of the

markets’ work force were in the 31-40 age

group (37.4%), 41-50 age group (29.5%)

and 21-30 age group (16.4%). One

hundred and thirty-four (29.3%) of the

workers were timber dealers, while

64(14%) were machine operators,

53(11.6%) were carpenters and 40(8.8%)

were sales ladies. Others are as shown in

the table1.

Four hundred and thirty-five (95%) wood

market workers had normal vision while

22 (4.8%) had visual impairment (Table

2). No worker had severe visual

impairment or blindness. However, 3

(0.3%) wood market workers had

monocular blindness. Uncorrected

refractive errors were the commonest

cause of visual impairment 12(54.6%)

followed by glaucoma 6(27.3%) and

cataract 3(13.4%).

A total of 297 (65%) workers had history

of ocular complaints. A higher proportion

of the sales ladies 31 (77.5%) and timber

dealers 93 (69.4%) had history of ocular

complaints.

Out of a total of 914 eyes of 457 timber

market workers, 156 (17.3%) eyes had no

form of ocular disorder while 758 (82.7%)




eyes had ocular disorders shows that

presbyopia was the commonest ocular

disorder among timber market workers

(21.6%). This was followed in decreasing

order by pterygium (9.6%), pinguecula

(7.1%) and allergic conjunctivitis (6.4%).

Others are as shown in the table 5.

DISCUSSIONS

Demographics:

The age group distribution of timber

market workers in this study (Table 1) is

like related studies done in Europe,8 and

Nigeria.9-12

This is not surprising since

people in this age group are active, likely

to be married and will require income for

upkeep of their families. However, few

workers 19 (4.1%) were found in the

retirees age group of 61- 80years and less

than 20 years’ age group had 12(2.6%).

There were more males (88.6%) than

females (11.4%) (Table 1) with the male:

female ratio (8:1) The reason for high male

to female ratio in this study is that females

are not allowed to own sheds nor do any

other job in the timber market except being

a food vendor or sales lady due to cultural

and traditional beliefs. The sex distribution

of workers is like some studies on visual

screening or ocular disorders amongst

industrial workers.7,10,13

Timber dealers constituted the highest

number of workers 134 (29.3%), followed

by machine operators 64 (14%) and

carpenters 53 (11.6%). They constitute the

highest number because they are the stake

holders, investors and owners of the wood

sheds and machines.

Majority of the timber market workers

were literate and those in the presbyopia

age group were aware of the need for

reading spectacles.

Pattern of ocular complaints and

disorders

The types of ocular disorders seen in this

study were not different from those seen in

the general population of same sex and

age, since timber market workers are

subset of the general population.14,15

However, ocular itching and conjunctival

surface disorders were expectedly

prominent findings in this study.

Visual acuity

Four hundred and thirty-five (95%) timber

market workers had normal vision while

22 (4.8%) had visual impairment (Table

2). This is similar to other cross-sectional

studies in different population groups in

Nigeria.11,14,15

No worker had severe visual

impairment or blindness. However, 3

(0.3%) timber market workers had

monocular blindness.

Uncorrected refractive errors were the

commonest cause of visual impairment

12(54.6%) followed by glaucoma

6(27.3%) and cataract 3(13.4%) (Table 2).

This contrasts to the landmark study of

causes of visual impairment in Nigeria.16

Ocular complaints

The prevalence of ocular complaints, 65%

(Table 3 and 4) was slightly higher than

that obtained from industrial workers in

India13

where 51.9% of workers had ocular

complaints. This may be due to the

environmental difference and the fact that

6 different industrial establishments were

involved in their study. However, the

result was similar to a study done in Delta

state, Nigeria even though the study was

carried out on technical workers alone.17

Difficulty reading fine prints being the

leading cause of ocular complaints in this

study (38.7%) is not surprising because

majority of the workers fall into the 40-

60-year age group. Most of the workers

were literate and felt that they needed free

glasses for reading. The high prevalence of

ocular itching in this study (20.5%) is not

also surprising since the timber market

environment is full of ocular surface

irritants like wood dust and wood

chemicals. It is interesting to note that 1




worker who had difficulty seeing at night

was later found to have retinitis

pigmentosa during ocular examination.

Ocular disorders

The prevalence of ocular disorders was

82.7% (Table 5) This is similar to some

studies among various industrial workers

in Asia,13

and Nigeria.18

This is however in

contrast to the study in South-south

Nigeria where a prevalence of 66% was

found among different industrial

workers.17

This difference may be related

to the type of industrial workers studied by

Omoti et al17

Presbyopia (21.6%) and refractive errors

(19.7%) were the most common eye

disorders seen in this study. Again, this is

similar to Titiyal et al13

study in North

India where refractive errors (including

presbyopia) was the commonest ocular

disorder. This finding may be due to the

fact that over 1/2 of the workers were

between the ages of 40 and 60 years,

which corresponds to the presbyopic age

group. It is not surprising therefore to have

this prevalence in this study. However, in

Ugheli, Nigeria,17

the findings were at

variance with the prevalence of presbyopia

and refractive errors being 9.7% and 9.4%

respectively. The difference may be

because of younger age group

predominance in the later study. Other

industrial and population based cross-

sectional studies in Africa19

and

Nigeria11,14,15

have documented higher

prevalence of refractive errors including

presbyopia. This shows that refractive

errors are probably the most common

cause of ocular disorder in the African

sub-continent.

Even though refractive errors are

correctable with the aid of vision

correction devices such as spectacles or

contact lenses, it has been found that in

many countries, uncorrected refractive

errors are the second most common cause

of treatable blindness after cataract.20

Conjunctival disorders accounted for

29.9% of ocular disorders coming second

to refractive errors (including Presbyopia)

in this study.

The most common conjunctival disorders

found in this study were pterygium

(15.2%), Pingueculum (7.1%) and Allergic

conjunctivitis (7.0%). Others were

conjunctival foreign bodies and

conjunctival cysts. The pattern and

prevalence of conjunctival disorders

compares favorably with other local

studies among industrial workers.7,10,17,18

This contrasts with findings among heavy

metal workers in Northeastern Europe

where conjunctival disorders constituted

80% in exposed workers8. The reason

might be since exposure to heavy metal

fumes may be more harmful to ocular

surface compared to wood dust.

It is not surprising that conjunctival

disorders were one of the commonest

ocular disorders because of the peculiar

nature of the timber markets environment

which is loaded with wood dust and fumes

from wood chemicals.3,4

Workers are also

exposed to particulate micro-trauma eye

injury from the dust.

In Nigeria, pterygium has been reported as

the most common conjunctival

degenerative change in the general

population.21

The peak age of occurrence

in this study was the third and fourth

decade. Most of the pterygia (90%) seen

were located nasally.

The prevalence of allergic conjunctivitis

(7.0%) in this study was surprisingly not

different from that of other population

group.14,15,18

This contrasts with a study in

petroleum industry workers where the

prevalence of allergic conjunctivitis was

21.5% and ranked next to refractive errors

and presbyopia.11

It is possible that

exposure to wood dust produces less

allergic ocular reaction than fumes from

petrochemical products.




Glaucoma accounted for 4.9% of the

ocular disorders seen in this study. This is

not so different from other studies

17,18 but

much lower than the prevalence of 16%

from data on blindness prevalence in

Nigeria16.

The difference could be because

of the method of screening the subjects.

Confrontation method was used as method

of visual field screening in this study.

Some cases of glaucoma would have been

missed in this study. Most of the workers

with glaucoma in this study were between

the age of 20 and 60 years with 50% of

them below 40yrs of age. Open angle

glaucoma is known to be common and

more aggressive in blacks, occurring at a

younger age than in Caucasians, but the

reasons for the high susceptibility of black

populations to glaucoma remains

unknown.22

Various degrees of corneal opacities were

seen in 26(2.8%) of the workers. Only 2

cases of corneal opacities were significant

enough to cause monocular blindness. Six

cases (23.3%) of the corneal opacities

were secondary to ocular injuries while at

work at timber market. The remaining

cases of corneal opacities were due to

trauma outside the wood market

environment and measles keratitis from

childhood.

Cataract is the leading cause of blindness

and the commonest cause of treatable

blindness accounting for half of the

world’s blind population.23

The prevalence

of cataract in this study was 1.1%.

Majority of the cases 8(80%) were senile

cataract while 2(20%) were due to trauma.

Perhaps the low figure in this study might

be due to the fact that workers age ≥

50years constituted 15.5% of the study

population. In Nigeria, cataract is the

commonest cause of blindness in adult

population and accounts for about half of

adult blindness with senile cataract being

the most prevalent.24

Akinsola et al14

in

their study in Southern Nigeria found a

prevalence of 8% while Rabiu24

in

northern Nigeria found a prevalence of

3.6%.

Other ocular disorders

Retinal disorders accounted for 1.9% of

ocular diseases seen (Table 5). This is not

surprising since more than 1/2 of the study

groups were between the age of 40 - 60

years. These retinal disorders included

chorioretinal scar (0.7%), macular

degeneration (0.6%), diabetic maculopathy

(0.2%), retinitis pigmentosa (0.2%) and

presumed toxoplasma scar (0.1%). Seven

workers (1.5%) had abnormal

confrontational visual field results in at

least one eye.

The prevalence of colour vision defect in

this study was 0.4% with Ishihara pseudo-

isochromatic plate. This is rather low

compared to a cross-sectional study done

in a different population group in

Southeastern Nigeria which recorded a

prevalence of 2.4%15

Lid disorders seen were chalazia 3(0.3%)

and lid wart 1(0.1%). Optic atrophy was

seen in 2 eyes (0.2%). These ocular

problems could be found in the general

population as they do in these wood

market communities.

CONCLUSION

The economic and social handicaps

stemming from refractive errors and

presbyopia among the workers are a

concern. Although their ocular disorders

and complaints status were not

significantly different from that of the

general population in Nigerian, they are

still at greater risk and need eye health

education and accessible quality eye care

services. The choice therefore is to take

eye care services to the grass root through

unrelenting advocacy and targeted eye

health education.

Source of funding.

Nil

Conflict of interest




None

Authors’ contributions

BAE, DGN, and UEA were involved in

research concept, design and drafting of

the man

uscript. BAE and JAO were involved in

field data collection and literature search.

All 4 authors were actively involved in

revising the final manuscript and gave

approval for this publication.

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780




Table 1: age and occupational distribution of wood market workers in calabar.

Occupation

<20yrs (%) 21-30yrs (%) 31-40yrs

(%)

41-50yrs

(%)

51-60yrs

(%)

61-70yrs

(%)

71-

80yrs

(%)

Total

Carpenters Nil 11 (14.6) 18(10.8) 20(15.5) 4(7.1) Nil Nil 53

Drivers Nil 1 (1.3) 16(9.6) 9(7.0) 2(3.8) 1(5.9) Nil 29

Food vendors Nil 3 (4.0) 3(1.8) 2(1.6) 3(5.4) 1(5.9) Nil 12

Machine

operators

1 (8.3) 16(21.3) 23(13.9) 16(12.4) 8(14.3) Nil Nil 64

Sanders 3 (25.0) 10(13.3) 7(4.2) 6(4.7) Nil Nil Nil 26

Sales ladies 4 (33.3) 10(13.3) 17(10.2) 6(4.7) 3(5.4) Nil Nil 40

Sprayers 1 (8.3) 7(9.3) 12(7.2) 10(7.8) 1(1.8) Nil Nil 31

Timber dealers 1 (8.3) 4(5.3) 46(27.7) 39(30.2) 30(53.6) 12(70.6) 2(100) 134

Truck pushers 1 (8.3) 4(5.3) 10(6.0) 14(10.9) 3(5.4) Nil Nil 32

Wood carriers 1 (8.3) 9(12.0) 14(8.4) 7(5.4) 2(3.6) 3(17.7) Nil 36

Total 12 75 166 129 56 17 2 457




Table 2: Distribution of visual acuity in better eye of 457 workers.

Category of

Workers.

Normal

(%)

Low vision

Blindness

(%)

Visual

impairment

(%)

Severe visual

impairment

(%)

6/5 - 6/18 <6/18- 6/60 <6/60-3/60 <3/60

Carpenters

53 (100%)

Nil

Nil

Nil

Drivers 29 (100%) Nil

Nil Nil

Food vendors

11 (91.7%)

1 (8.3%)

Nil

Nil

Machine operators

63 (98.4%)

1 (1.6%)

Nil

Nil

Sanders

26 (100%)

Nil

Nil

Nil

Sales ladies

37 (92.5%)

3 (7.5)

Nil

Nil

Sprayers

30 (96.8%)

1 (3.2%)

Nil

Nil

Timber dealers

123 (91.8%)

11 (8.2%)

Nil

Nil

Truck pushers

29 (90.6%)

3 (9.4%)

Nil

Nil

Wood carriers 34 (94.44%) 2 (5.6%)

Nil Nil

Total 435 (95.2%) 22 (4.8%)

0(0%) 0(0%)

Chi sq. cal =12.930, df = 9, p = 0.166 (NS).




Table 3. Distribution of workers with history of ocular complaints

Workers

Frequency

Percentage

Carpenters

31

54.7

Drivers

21

65.5

Food vendors

7

41.7

Machine operators

39

57.8

Sanders

14

46.2

Sales ladies

33

77.5

Sprayers

17

48.4

Timber dealers

94

69.4

Truck pushers

17

50.0

Wood carriers

24

63.9

Total

297

65

Chi sq. cal = 18.109, df = 9, p<0.05.




Table 4. Distribution of types of ocular complaints

Types of

ocular

complaints

Category of workers (n=297)

Total

(%)

Carpenter Drivers

Machine

operators

Food

vendors

Sales

ladies

Sanders Sprayers Timber

dealers

Truck

pushers

Wood

carriers

Can’t read

fine prints

11 (40.7) 12

(57.1)

14 (38.9) 3(27.4) 15(39.5) 6(42.7) 3 (23.1) 37(38.5) 7(38.9) 7(30.4) 115(38.7)

Itching of

eyes

8 (29.6) 2 (9.5) 5(13.9) 6(54.6) 11(28.6) 1(7.1) 5(8.9) 17(17.7) 1(5.6) 5(21.7) 61(20.5)

Can’t see far

objects

3 (11.1) 2 (9.5) 7(19.4) 0.0 3(7.9) 1(7.14) 2(15.4) 18(18.6) 3(16.7) 4(17.4) 43(14.5)

Growth on

eye

1 (3.7) 2 (9.5) 4(11.1) 0.0 1(2.4) 0 1(7.7) 8(8.3) 3(16.7) 1(4.4) 21(7.1)

Others

4(14.8) 3(14.3) 6(16.7) 2(18.2) 8(21.1) 6(42.9) 2(15.4) 16(16.7) 4(22.2) 6(26.1) 57(19.2)

Total 27(9.1%) 21(7.1) 36(12.1) 11(3.7) 38(12.7%) 14(4.7) 13(4.4) 96(32.3) 18(6.06) 23(7.74) 297(100)




Table 5. Distribution of ocular disorders among wood market workers in calabar.

Ocular disorders

Frequency

Percentage

Presbyopia

198

21.6

Refractive error

Pterygium

180

139

19.7

15.2

Pingueculum 65 7.1

Allergic conjunctivitis

64

7.0

Glaucomatous optic neuropathy

45

4.9

Corneal opacity

26

2.8

Cataract

10

1.1

Chorioretinal Scar

6

0.7

Macular degeneration

5

0.6

Colour vision defect

4

0.4

Conjunctival Foreign Body

4

0.4

<,

Chalazion

3

0.3

Optic Atrophy

2

0.2

Diabetic Maculopathy

2

0.2

Conjunctival Cyst

2

0.2

Retinitis pigmentosa

1

0.1

Lid Wart

1

0.1

Presumed toxoplasma scar

1

0.1

Total 758 82.7

ocular complaints and disorders among wood …...presbyopia 21.6%, refractive errors 19.7% pterygium...

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