Bilateral blindness due to trauma in Cambodia

Ocular trauma is a major cause of monocular blindness in both the developed and developing world, but is not seen as a significant cause of bilateral blindness. Trauma is therefore generally thought of as a major cause of blind eyes without being a major cause of blind people. Because of the difficulties of surgical treatment of ocular trauma in many developing countries, long-term management is usually aimed at prevention, e.g. by improving safety standards in the workplace. The situation in countries such as Cambodia, which have high landmine densities, is different. Cambodia has an estimated 4-10 million landmines which cause significant morbidity and mortality. This hospital-based study of blindness in the north-west of Cambodia found that of 453 bilaterally blind individuals, 17 (4%) were blind as a result of trauma, and 14 of these were males 15-35 years old. Fourteen cases were due to bilateral penetrating injuries caused by landmine explosions, and usually occurred in association with other severe injury. The other main causes of blindness were cataract (59%), glaucoma (14%) and corneal scarring (12%). Penetrating ocular trauma is a significant cause of bilateral blindness in Cambodia, and predominantly affects young men. It is estimated that it would take 250 years to clear Cambodia of landmines at current activity levels.