Major reviewAnimal-inflicted ocular and adnexal injuries in children: A systematic review
Introduction
Children are naturally inquisitive about the world around them, and there are a variety of situations in which they may encounter animals. The dangers associated with animals may be underestimated and underreported. An American study published in 1985 found that approximately 50% of children suffer a dog bite during childhood.12 Eye injury from all causes is the leading reason for monocular blindness in children despite 90% of injuries being potentially preventable.96, 113 To develop appropriate prevention strategies, we need a better understanding of why and how injuries happen. We review the literature to understand the nature and severity of animal-inflicted ocular and adnexal injury in the pediatric population.
Section snippets
Findings
Table 1 provides a summary of the distribution of identified articles by the type of animal involved. The largest number of articles related to insects, followed by domestic mammals.
Assessment of quality and bias
The vast majority of articles identified for inclusion in this review were case studies and series. Any estimates of prevalence presented are based on studies other than these to reduce inaccuracy. Because of the predominance of case studies, there may be publication bias in terms of the types of animals identified and injury outcomes. There may also be geographically based bias, with the studies in the literature not providing an accurate representation of global animal-inflicted pediatric
Conclusions
Children interact with animals in a wide range of environments. The nature and severity of ocular and adnexal injuries inflicted on the pediatric population by animals is extremely varied. There are obvious geographical differences in some exposures, for example, magpie injuries have only been documented in Australia,68 whereas Loxosceles spider injuries have occurred predominantly in Turkey.2, 18, 82, 146
Overall, less than 5% of eye injuries in children are caused by animals.13, 38, 40, 57, 80
Methods of literature search
A systematic search of MEDLINE, PubMed, and EMBASE databases was performed to identify relevant studies. Search terms used included “eye injury” and “children” or “pediatric/pediatric” and “animal” as well as specific animals known to be implicated in eye injuries including “insect,” “mammal,” “reptile,” “cat,” “bird,” “dog,” and “horse”. Non-English articles were excluded. No year limits were imposed.
Methodology and reporting followed MOOSE guidelines.137 Articles containing detailed
Disclosures
Anne-Marie E. Yardley and Annette K. Hoskin received funding from the Joyce Henderson Bequest Fund. The remaining authors have no conflicts of interest to disclose.
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