occupational ocular problems

1. Occupational Ocular Problems in
Sports, Driving, Agriculture &
Industries
Sabina Poudel
B. Optometry
Institute of Medicine

2. PRESENTATION LAYOUT
 Introduction
 Environmental and occupational optometry
 Classification of occupational ocular hazards and
their effects
 Occupational ocular problems in sports
 Occupational ocular problems in driving
 Occupational ocular problems in agriculture
 Occupational ocular problems in industries

3. Introduction
Occupational eye disorders represent a complex group of
Traumatic
injuries
Harmful
exposures
Uncorrected and
undiagnosed
ocular diseases
Eyestrain and
fatigue
Miscellaneous
ocular complaints
Goldsmith et.al. 2007

4. • Almost all adults spend a significant portion of their
lives working in a variety of occupational settings
• Exposure to hazards in the workplace can cause or
exacerbate ocular illness
• It is crucial to know
The environments of the patients
The type of work they do
How it may affect their eyes, vision
and health

5. Environmental and Occupational
Optometry: Introduction
Environmental Optometry- An Essential Part of
Primary Care
Branch of optometry that broadly considers the
relationship of people’s eyes and vision to all aspects of
their environments, including home, school, work,
recreation, transportation, underwater and outerspace

6. Occupational Optometry
Branch of environmental optometry that considers all
aspects of the relationship between work and vision,
visual performance, eye safety and health
Worker’s eyes and
visual system
Worker and
workplace
environments

7. • Prevention of work
related eye diseases,
injuries & vision
disorders
• Enhanced performance
of workers on the job
Major Priorities

8. Occupational ocular hazards can be broadly classified as
Type of hazards Causative agents
Mechanical Flying objects
Contact with fixed objects
Dusts , powders
Hot solids
Chemical Dusts , powders
Liquids , droplets , splashes
Vapours , fumes , gases
Radiation Glare from visible light
Short circuit electric arc
Ultraviolet rays
Infrared
Laser sources
Combinations of the above

9. Mechanical Hazards
Comprises about 70 – 80 % of all work related eye injuries
Large range of severity- wide range of missile size, mass
and speed that is involved
Large slow moving missiles:
 Contusive or concussive injuries to eye and
adnexa
 Contusion results from direct blow to the eye
 Concussion arises from conduction of energy from
a remote site to target tissue

10. Missile with rough surface or sharp edges:
 Lacerations and abrasions
Foreign bodies in the eye:
 May be superficial, imbedded or intraocular,
depending on size, shape and speed of the
body
 Ferrous foreign body should be removed as
quickly as possible to remove siderosis
(formation of rust in ocular tissues as a result
of oxidation of iron contained in foreign body)

11. Particles less than 0.5 mm diameter
Too small to cause penetrating ocular injuries
May become embedded in the ocular surface if at
high speed
Cause foreign body sensation upon contact with
the eye

12. Chemical Hazards
 common causes of chemical injury:
Alkali Common sources
Ammonia Fertilizers , refrigerants
Lye Drain cleaners
Lime Plaster , mortar, cement
Magnesium hydroxide Sparklers
Potassium hydroxide Caustic potash

13. Acid Common sources
Sulphuric acid Industrial
cleaners,battery acid
Hydrofluoric acid Glass polishing,glass
frosting,gasoline
alkylation
Acetic acid vinegar
Sulphurous acid Fruit and vegetable
preservative, bleach

14. • Alkaline solutions penetrate the eye rapidly by
saponification of cell membranes and cause more
severe injuries than acids of same concentration
• Acids cause coagulation of proteins of ocular tissue
which acts as a barrier for further penetration

15. Electrical Hazards
 Electrocution may result in damage to the central
nervous system
 In rare cases , an electric cataract can be observed

16. Optical Radiation Hazards
Optical radiation ranges from 200 nm to 1 mm in the
electromagnetic spectrum
UV C (FAR) 200 t0 290 nm
UV B (MIDDLE) 290 to 320 nm
UV A (NEAR) 320 to 380 nm
VISIBLE LIGHT 380 to 760 nm
IR A (NEAR) 760 to 1400 nm
IR B (MIDDLE) 1400 to 3000 nm
IR C (FAR) 3000 nm to 1 mm

17. Transmission of Radiation by the Ocular Media
UV (nm) VISBLE (nm) IR (nm)
Tear layer 290 - 380 380 - 760 760 - 3000
Cornea 290 – 380* 380 - 760 760 – 3000*
Aqueous 290 – 380* 380 - 760 760 – 3000*
Lens (child) 310 – 380* 380 - 760 760 – 2500*
Lens (older
adult)
375 – 380* 380 – 760* 760 – 2500*
Vitreous 290 – 380* 380 - 760 760 – 1600*
* Partial transmission

18. Effects of Ultraviolet Radiation
1) Photophthalmia
 Aka photokeratitis or photoconjunctivitis
 Photochemical damage to the corneal epithelium
 Results from absorption of UV of 300 nm and below
2) Pterygia , Pingueculae & Band Shaped Keratopathy
 Result from repeated, long continued exposure to
UV radiation

19. 3) Cataract
 Cumulative effect of UV radiation
 UV B (290-320 nm) is main causative factor
Photo-oxidation of lens crystallins
Photo-oxidation of lens membrane lipids
Damage to lens epithelial DNA
4) Retinal lesions
cataract

20. Effects of Infrared Radiation
Ocular Structure Damage
Cornea Opacification , haze , debris,
exfoliation
Aqueous humor Flare , cells , pigment
Iris Miosis , hyperemia , swelling , necrosis
Lens Cataract
Vitreous humor Haze or flare
Retina Depigmentation , edema , frank burn

21. Effects of Visible Radiation
 Normal levels of visible light not hazardous
 Unusually high levels of visible radiation cause both
photochemical and thermal injury to retina
 Short wavelength – photochemical damage
 Longer wavelength – both photochemical and thermal
damage

22. Occupational ocular problems depend on
 Nature of the work
 Working environment
90 % of the occupational ocular hazards are
preventable

23. Occupational ocular problems in sports
Sports – physical activity carried out under an agreed set
of rules, with a recreational purpose: for competition or a
self enjoyment or a combination of these

24. American Medical Association classifies sports as
Collision
Football
Hockey
Rugby
Contact
baseball
Basketball
Wrestling
Boxing
Non
contact
Running
Tennis
Swimming
Others
Bowling
Golf
Archery

25. On the basis of potential for eye injuries
Low risk sports
• No use of ball, puck, bat, stick, racquet, no body
contact
• Running, swimming, cycling, gymnastics
High risk sports
• Use of ball, puck, bat, stick, racquet, body contact
• Baseball, hockey, football, basketball, racquet
sports, tennis, golf
Very high risk sports
• Boxing, wrestling, contact martial arts
• Eye protectors typically not worn

26. Common mechanism of eye injuries in sports
Blunt trauma
Penetrating injuries
Radiation injuries

27. Blunt Trauma
 Accounts for most sports related eye injuries
 Extent of ocular damage depend on size, hardness
and velocity of blunt object
 Caused by ball, bat, stick, racquet used for playing
 Eye hand collision in games like wrestling, boxing,
so on

28. Penetrating Injuries
 Relatively uncommon but may occur even with
large projectiles
 Range from mild abrasions to serious lacerations
Radiation Injuries
 Occur as a result of exposure to ultraviolet rays
 In snow skiing, water skiing and other water
sports

29.  Use of protective eyewear , filters and performance
sun eyewear help in the prevention of these hazards
 Nature of athletic activity (contact or non contact) ,
weather and atmospheric conditions that may be
encountered by athlete should be considered while
prescribing protective eyewear and filters

30. Purpose of sports eyewear
• Protect eye from ocular injury and UV radiation
• Provide proper vision so that wearers can continue to
perform with least discomfort while getting the right
level of protection

31. Protective eyewear in sports
• Use of polycarbonate, Trivex , NXT lens materials can
provide superior impact resistance over glass and CR
39 lens materials
• However the frame construction does not withstand
the forces encountered in many sports
• Use of protective eyewear required to ensure adequate
protection

32. Two basic types of protective eyewear designs available
 Goggle style
 Shield style protection attached to a helmet

33.  Lightweight frame but resistant to strong impact
 Fitted with an elasticated sports band
 Made of impact resistant plastics, preferably
polycarbonate
 Glass lenses should be avoided

34. • Face-form (wrap) design sun eyewear offers
improved coverage of the ocular surface tissues and a
wider field of view than traditional designs
• The improved coverage increases UV protection by
preventing light leakage around the frame and
protects the eye from the harmful effects of wind and
dust.

35. Protection eyewear used in some sports
1) Racquet Sports
 Includes badminton, handball, tennis, etc
 Ball or shuttlecock is hit with tremendous force and
can travel at speed of upto 90 mph
 The eyewear must protect the eye and orbit from
several angles including the sides

36. 2) Hockey
Full face shield
Half face shield

37. 3) Swimming and water sport
• Most swimmers and divers use a goggle or face mask
so that no adjustment is necessary to the habitual
prescription to compensate for the difference in the
index of refraction of the water medium.
• Some goggle designs have ventilation holes to reduce
lens fogging in highly active water sports such as
water skiing, surfing, windsurfing, and endurance
swimming.

38. 4) Snow skiing
 Snow skier encounters a 15 % increase in UVR for
each km (3000 ft) of altitude above sea level
 May lead to photokeratitis that might ultimately lead
to snowblindness
 Eyewear with UV filters should be used

39. Filters and performance sun eyewear
• Higher level of solar radiation in outdoor sports
saturate the photoreceptors and reduce finer level of
contrast sensitivity
• Properly selected filters reduce glare and improve
contrast
• This enhance the ability to discern the crucial details
and judge depth
• Protection from UV exposure

40. • Protection from light radiation is directly related to
filter lens density
• Transmittance of filter defined in shade number
(higher the shade no. lower the transmittance of
filter)
• Select the darkest shade that allows the task
performance

41. 1) Neutral Gray Tints
• Absorbs all wavelength of visible spectrum almost
equally, natural appearance of colors is preserved
• Preferred by athletes who are sensitive to color
information in their sport and who do not appreciate
even subtle alteration of the natural environment

42. • Often favored by those participating in golf, skiing,
and mountaineering activities
• Athletes must make critical performance decisions
based on subtle terrain details in these sports, and
distortion of natural contour cues can lead to poor
decisions

43. 2) Yellow – Brown Range Tints
• Filter visible spectrum through the attenuation of
the transmittance of the shorter wavelength colors
• Decreases the chromatic aberration between the
longer red wavelengths and the transmitted mid-
range greens

44. • Leads to improved image clarity, and the selective
transmission of yellow wavelength light concentrates
the visible information at the most sensitive portion
of the visible light spectrum
• Filter the glare produced by short wavelength light
• Preferred in shooting, snow sports, tennis, baseball

45. 3) Green Range Tints
• Green portion is selectively transmitted
• Preferred in golf, tennis, woodland shooting
4) Red Tints
• Provides better color perception in low light
condition
• Helps in contrasting object against blue and green
background
• Ideal for night sports

46. 4) Polarized Filters
• Reduce the reflected glare off the horizontal
surfaces, water, snow, pavement, sand
• Useful in fishing, water sports, snow sports, cycling,
driving

47. 5) Photochromic lens
• Plastic photochromic lens suitable for some non
contact sports like running, cycling
• Glass photochromic lenses not used

48. Contact lenses in sports
Choice of refractive correction in highly dynamic
sports
Dynamic sports – baseball, basketball, football,
racquet sports, skiing sports, volleyball, gymnastics,etc
Field of view aberrations
Visual field restrictions
Optical distortion
Frame discomfort
Frame instability
Surface reflections
Lens fogging
Largely avoided by
moving optics on cornea

49.  In aiming sports like shooting and archery, spectacles
preferred over contact lens
 Undesirable visual fluctuation on prolonged gaze due to
lens movement on eye
 Peripheral vision do not affect the performance
 Contact lens movement decrease contrast sensitivity

50. • Soft lens with UV absorbing tints protect only the
ocular tissues covered by contact lens
• Best protection when used in combination with
quality sun eyewear

51. Occupational ocular problems in driving
Driving can be defined as the ability to operate, control and
direct the course of vehicles
Normal visual functioning is an essential requirement for
driving- drivers need to be able to judge the distance
- read road signs and traffic lights
- assists driver to respond to changes in environment
quickly and efficiently

52. • Good visual acuity in addition to normal visual field,
good stereopsis, normal color vision, eye co-
ordination, good retinal adaptation are essential to
avoid RTAs (Nwosu 1989)
• As driving is an outdoor activity, drivers are exposed
to high level of radiations, dusty and windy
environments

53. Common ocular problems:
Pterygium
Pingueculae
Allergic conjunctivitis
Cataract
Presbyopia
Glaucoma
(pattern of eye diseases among commercial intercity vehicle drivers in
Nigeria Bola J Adekoya et.al Nigerian J of Opth 2008)

54. Protective eyewear in driving
For day time driving
 Sunglass lens that transmits less than 67 % of the
incident light can be used
 Excellent absorption in 200 to 300 nm portion of UV
region
 Inadequate absorption in 300 to 400 nm portion of
UV region
 Less than 15 % transmittance in range of 700 to 15oo
nm

55.  Maintain optimum retinal adaptation for night
vision in night driving
 Yellow, green and brownish lenses impair color
vision significantly due to selective shift in the
spectral transmittance of the lenses
so not recommended as sunglass lenses for
drivers

56.  Lenses with anti reflection coating
 Polarizing lenses- reduce reflection from wet road
and snow

57. For night driving
 Only the lightest of the tints should be used
 Poor illumination at night, and use of tint can further
reduce illumination which is unsafe for driving
 Antireflection coating on the lens with lightest tint
maximize the transmission of absorptive lens
 Increase in transmission caused by coating sufficient to
offset the loss from absorption by the tint

58. Occupational ocular problems in agriculture
 Agriculture includes crop farming, livestock rearing
and fishing
 Most of the agricultural works involves use of
agricultural tools, fertilizers, insecticides and pesticides
 Most of them are outdoor works

59. Main causes of agriculture related ocular problems :
 direct trauma with agriculture tools
 vegetable/plant/organic materials hitting the eye
 chemical injuries by pesticides and insecticides
 animal attack injury ( e.g cow horn injury , insect
sting)

60.  soil spillage into the eye
 other foreign bodies in the eye
 constant exposure to wind, dust and allergens
 constant exposure to UV light
( challenges of agriculture related eye injuries in Nigeria, Community Eye Health Journal
2015)

61.  Short term effects of UV exposure- photokeretitis ,
irritation
 Long term effects- pterygia, pingueculae, cataract
and retinal damage
 Allergic conjunctivitis

62. Protection eyewear in agriculture
1) Sunglasses
2) Safety glasses- wrap around
lenses
3) Goggles – protection from
front and side impact
4) Full face shield

63. Occupational ocular problems in industries
Potential eye hazards are found in almost every industries
Common ocular hazards
1) Mechanical injury
- By flying fragments, objects, large chips, sand, dirt
- Common in chipping, grinding, machining , sanding tasks
2) Heat injury
- By hot sparks, splash from molten metals, high temp
exposure
- Common in furnace operations, casting, gas cutting, welding
tasks

64. 3) Chemical injury
- Common in acid and chemicals handling tasks
4) Radiation injury
- Common in welding electric arc, welding gas,
cutting, brazing, soldering

65. Ocular protection devices for industries
These devices must protect the workers from
1) Potential mechanical and chemical injury
2) Possible radiant energy damage
Available in the form of
1) Spectacles
2) Goggles
3) Face shields
4) Helmets

66. 1) Safety Spectacles
- Manufactured in both metal and plastic materials
- Provided with or without sideshields which protect
eye against objects flying from the side
- May be supplied with plano lenses or worker’s RX

67. 2) Chipping goggle
- Aka impact cup goggle
- Useful in tasks involving chipping and grinding
where foreign body may strike the eye from any
direction

68. 3) Impact or dust goggles
- Made from a soft, flexible plastic material that is
molded in a single front
- Lenses inserted into the frame of eye cup to provide
rigidity to goggle

69. - Designed to be worn over a pair of spectacles
- Perforated holes on the side of goggles extending
from mask to facial area allow ventilation that
prevent lenses from fogging

70. 4) Chemical goggles
- Constructed the same as impact goggles except for
ventilation system
- Consists of a series of plastic louvers designed to
provide indirect ventilation while preventing
chemical splashes
- May also be worn over spectacle lenses

71. 5) Welding goggles
- Protect welder’s eye from impact as well as harmful
radiation
- Welding helmet provides the required protection for
the head, neck and eyes during electric arc welding
operations

72. - There is a window through which the welder can
view the welding process
- Window hold a series of filter for protection against
UVR, IR and visible radiation generated by welding
arc

73. 6) Face shield
- Protect the head, neck, face and eyes from flying
particles and chemical and molten metal splash

74. Eye and Face Protection Selection Chart
Source Assessment of Hazard Protection
IMPACT - Chipping, grinding,
machining, drilling, chiseling,
riveting, sanding, etc.
Flying fragments, objects, large chips,
particles, sand, dirt, etc.
Spectacles with side protection,
goggles, face shields.
For severe exposure, use face shield
over primary eye protection.
HEAT - Furnace operations, pouring,
casting, hot dipping, and welding.
Hot sparks
Splash from molten metals
High temperature exposure
Face shields, goggles, spectacles
with side protection. For severe
exposure use face shield.
Face shields, reflective face shields.
Screen face shields, reflective face
shields.
CHEMICALS - Acid and chemicals
handling
Splash
Irritating mists
Goggles, eyecup and cover types. For
severe exposure, use face shield over
primary eye protection
Special-purpose goggles

75. DUST - Woodworking, buffing,
general dusty conditions
Nuisance dust Goggles, eyecup and cover
types.
LIGHT and/or RADIATION
Welding - electric arc
Welding - gas
Cutting, torch brazing, torch
soldering
Glare
Optical radiation
Optical radiation
Optical radiation
Poor vision
Welding helmets or welding
shields. Typical shades: 10-14
Welding goggles or welding
face shield. Typical shades:
gas welding 4-8, cutting 3-6,
brazing 3-4
Spectacles or welding face
shield. Typical shades: 1.5-3
Spectacles with shaded or
special-purpose lenses, as
suitable.

76. CONCLUSION….
• Majority of the occupational ocular hazards are
preventable
• All protective eyewear have certain limitations
• Proper selection of protective eyewear depending on
the nature of work and working environment helps
in the prevention of potential eye hazards

77. REFERENCES
 Environmental Vision, Interactions of the Eye,
Vision, and the Environment-Donald G. Pitts
 Sports Vision – Erickson
 Occupational and Environmental Vision- The
Role of the Optometrist in Occupational Safety
and Health, Ralph G Chou
 Internet sources
 Borish’s Clinical Refraction- William J Benjamin
 Clinical Optics- Theodore Grosvenor
Solutions for Living: Personal Protective
Equipment for Agriculture- Randolph Weigel