Epidemiology of welding-associated ocular injuries
a b s t r a c t
Purpose: Currently, there exists a lack of recent epidemiological data concerning ocular injuries due to welding related activities. Our study analyzes trends in ocular injuries related to usage of welding equipment in the
U.S. from 2010 to 2019.
Methods: Using the Consumer Product Safety Commission’s National Electronic Injury surveillance System (NEISS) Database, we queried data from January 1st 2010 to December 31st 2019 using the corresponding prod- uct code for welding equipment (896). Results were stratified by year, and standard descriptive statistical methods were applied to components including gender, age, diagnoses, and ED disposition. Circumstances lead- ing up to the injuries were reviewed as well.
Results: Between 2010 and 2019 a total of 109,127 welding-associated ocular injuries occurred in the United States (95% CI, 86937-131,316). Estimates show a decreasing trend in cases from 13,415 (95% CI, 9979-16,851) in 2010 to 6944 (95% CI, 4868-9020) in 2019. A majority of cases occurred in men (98.2%) and in the 10-49 year age range (83.8%). 3.3% of cases involved spectators and 44% were bilateral. The top three oc- ular injury diagnoses were flash burns (62.1%), foreign body implantation (19.6%), and contusions/abrasions (11.1%). The number of radiation injuries trended down from 9286 in 2010 to 4023. With respect to a docu- mented location, 38.9% occurred at home and 4.5% occurred in a school setting. Most patients (99.9%) were discharged from the ED; 0.1% were admitted to the hospital.
Conclusions: The data suggests that number of ocular injuries related to welding has decreased significantly over the past 10 years. The most common injuries were radiation burns, foreign body disruption, and contusions/abra- sions of the eye. Patients were predominantly men and between the ages of 10 and 49. Of note, almost half of all ocular injuries due to welding were bilateral, and 3% of ocular injuries were seen in spectators.
(C) 2022
Welding poses a risk of traumatic injury to the eye through ultravi- olet (UV) radiation (also known colloquially as “welder’s flash”), pene- trating corneal injury, corneal abrasion from dust and debris, and irritation from welding fumes and chemicals. Such risks are intrinsic to the activity of welding itself and can occur even in the absence of any mechanical equipment failure or improper usage.
Furthermore, welding related ocular injury is seen in a range of set- tings from industrial workplaces to casual home-garage setups to class- room workshops. No formal licensing for welding is required and training standards can be quite varied. Welding was noted to be the sec- ond leading cause of consumer product related Ocular trauma that pre- sented to the emergency department (ED) in 1995, and in 2000 it was found that eye injuries accounted for 21% of all insurance claims for welders [1,2]. However, within the past decade there has been relatively
* Corresponding author at: Director Vitreoretinal and Macular Surgery, Doctors Office Center, Suite 6100, 90 Bergen St, Newark, NJ 07103, United States.
E-mail address: [email protected] (N. Bhagat).
little to no epidemiologic analysis published for ocular injuries associ- ated with welding.
Our study aims to explore a number of key factors when it comes to building an up-to-date comprehensive idea of trends in ED visits due to ocular-related welding injuries, including yearly incidence, relative pro- portion of injury types, spectator involvement, and laterality of injury.
- Methods
Using the Consumer Product Safety Commission’s National Elec- tronic Injury Surveillance System (NEISS) Database, we queried data from January 1st 2010 to December 31st 2019 using the corresponding product code for welding equipment (896). Results were stratified by year, and standard descriptive statistical methods were applied to com- ponents including gender, age, diagnoses, and ED disposition. Circum- stances leading up to the injuries were reviewed as well. It was not appropriate nor possible to involve patients and/or the public in the de- sign, conduction, or reporting of this study due to the nature of this study being secondary data analysis from a public database.
https://doi.org/10.1016/j.ajem.2022.01.030
0735-6757/(C) 2022
J. Yan, A. Uppuluri, M.A. Zarbin et al. American Journal of Emergency Medicine 54 (2022) 15–16
- Results
Between 2010 and 2019, NEISS estimated a total of 109,127 welding-associated ocular injuries in the United States (95% CI, 86937-131,316). The estimates show a decreasing trend in cases from 13,415 (95% CI, 9979-16,851) in 2010 to 6944 (95% CI, 4868-9020) in
2019. The overwhelming majority of cases occurred in men (98.2%) and predominantly in the 10-49 year age range (83.8%). Overall, 3.1% of cases involved spectators (Table 1). The top three ocular injury diag- noses were flash burns from welding arc UV radiation emissions (62.1%), foreign body implantation (19.6%), and contusions/abrasions (11.1%). Notably, the number of radiation injuries trended down from 9286 (69.2% of injuries) in 2010 to 4023 (27.9% of injuries) in 2019 while injuries due to foreign bodies did not show a clear trend. 16.2% of patients diagnosed with foreign body injury reported using protec- tive eyewear, while 15.3% of patients with radiation burn injuries re- ported wearing eye protection. Interestingly, 44.2% of welding- associated ocular injuries involved both eyes. Radiation injury contrib- uted to 90.1% of cases with bilateral injury, while a majority of unilateral injuries were due to foreign bodies. With respect to a documented loca- tion, 38.9% occurred at home and 4.5% occurred in a school setting. Most patients (99.9%) were treated in the emergency department and discharged; only 0.1% were admitted to the hospital for further manage- ment. No open globe injuries were reported.
- Discussion
The data suggests that the number of ocular injuries related to welding has decreased by almost half over the past 10 years. It is inter- esting to note that according to the Bureau of Labor Statistics, the overall rate of non-fatal eye injuries with days off from work in private industry was found to have decreased by 8% from 2010 to 2015 [3]. The dispro-
Demographics of welding associated ocular injuries 2010-2019.
portionately larger decrease in welding-associated ocular injuries is no- table, and the change can likely be accounted for by either decreased prevalence of welding, improved ocular safety equipment and stan- dards, or a likely a combination of the two.
The most common injuries reported were radiation burns (62.1%), foreign body disruption (19.6%), and contusions/abrasions of the eye (11.1%). Of the three, radiation burns which accounted for 69.2% of inju- ries in 2010 trended downwards significantly to 27.9% while the other sources of injury did not show clear trends across the years. Presumably this can be explained by better protective eyewear which confer more reliable protection against UV rays than projectiles. A significant propor- tion of welders sustained foreign body injuries (16%) and radiation inju- ries (15%) despite wearing eye protection. This data points to an area for potential improvement in modern welding eye protective gear.
The data also found that nearly 40% of emergency visits were a result of welding activities performed in the home setting, and 4.5% in school. This concerning statistic reflects the importance of proper training and standardized equipment which may be lacking in more casual, non- industrial settings. Organized efforts by welding associations should be encouraged to emphasize the importance of proper protective wear. Limitations: NEISS is a database which accrues representative data over 100 emergency departments across the US to generate national es- timates. It has certain limitations. The data only includes ED visits, and may underestimate the total number of welding-associated ocular inju- ries. Second, many of the narrative based parameters such as protection involvement and laterality of injury suffer from inconsistent reporting.
Nonetheless, the comparisons made using relative proportions are valid, as are the trends teased out from the data.
- Conclusion
Many of the ocular injuries due to welding can be largely prevent- able given proper provisions, and much of the data suggests that such injuries are trending downwards. Nonetheless, welding has been esti- mated to result in over 100,000 ED visits for eye injuries over the past decade. The data from this study is presented in hopes of fostering
awareness amongst clinicians of different types of ocular injuries due
Frequency Percent
Unweighted Weighted
Total 1944 109,127 100%
Gender
Female 41 1977 1.8% Laterality
OD 150 8240 7.6%
OS 164 9813 9.0%
Unknown 794 42,841 39.2%
Male Primary welder 1831 103,717 96.8%
Unknown 2 70 0.1%
Female Primary welder 36 1736 87.8%
Spectator 5 241 12.2%
Unknown 0 0 0.0%
to welding which can be seen in the prehospital and hospital setting. Additionally, the analyses here provide useful benchmarks for gauging future trends and offers targetable areas for safety improvement in the public setting.
Declaration of Competing Interest
None.
References
- Sastry SM, et al. Consumer product-related ocular trauma. J Natl Med Assoc. 1995;87 (5):349-52.
- Lombardi DA, Pannala R, Sorock GS, et al. Welding related occupational eye injuries: a narrative analysis. Injury Prevent. 2005;11:174-9.
- Case and demographic characteristics for work-related injuries and illnesses involv- ing days away from work. U.S. Bureau of Labor Statistics; 4 Nov. 2020.stats.bls.gov/ iif/oshcdnew.htm.
16