Ocular trauma is an important cause of preventable visual impairment and monocular blindness worldwide. The global burden is substantial because ocular injuries commonly affect children, adolescents and economically productive adults, leading not only to visual morbidity but also to loss of education, occupational disability, psychological distress and socioeconomic consequences for affected individuals and their families [1]. Although trauma may involve any ocular structure, injuries affecting the anterior segment are particularly important because they directly compromise ocular surface integrity, corneal transparency, anterior chamber anatomy, pupillary function and lenticular clarity. Damage to the conjunctiva, sclera, cornea, anterior chamber, iris, ciliary body or crystalline lens may result in corneal scarring, irregular astigmatism, hyphema, traumatic mydriasis, iridodialysis, secondary glaucoma, traumatic cataract, infection and permanent reduction of vision. Standardised terminology is essential for the clinical documentation and scientific reporting of ocular trauma. The Birmingham Eye Trauma Terminology system subdivided mechanical trauma into closed-globe and open-globe injuries, thereby reducing vagueness in the description of contusions, lamellar lacerations, ruptures, penetrating injuries, perforating injuries and intraocular foreign bodies [2]. The Ocular Trauma Classification Group further emphasised systematic documentation of injury type, grade, pupillary status and zone of injury, allowing comparison of outcomes across centres and studies [3]. Use of such terminology is particularly relevant in tertiary care hospitals, where the clinical spectrum may include blunt trauma, penetrating trauma, occupational injuries, road traffic accidents, assault-related trauma, sports injuries, chemical burns and fire-related injuries. The mechanism of injury largely determines the anatomical pattern and prognosis of anterior segment trauma. Blunt trauma may produce subconjunctival haemorrhage, corneal epithelial defect, hyphema, traumatic iritis, angle recession, sphincter tear, traumatic mydriasis, iridodialysis, lens subluxation or traumatic cataract. Sharp or penetrating trauma may lead to corneal or corneoscleral laceration, iris prolapse, anterior chamber collapse, lens capsule rupture and anterior segment intraocular foreign body. Careful history-taking, visual acuity assessment, pupillary evaluation, slit-lamp biomicroscopy, fluorescein staining, Seidel testing, intraocular pressure measurement where safe and posterior segment evaluation are central components of initial assessment [4]. Chemical ocular injuries form a distinct subgroup of anterior segment trauma and require immediate recognition and management. Alkali injuries are particularly dangerous because of rapid penetration into ocular tissues and the risk of limbal stem cell deficiency, corneal melting, symblepharon, cataract, glaucoma and irreversible visual loss [5,6]. Thermal and fire-related injuries may also involve the eyelids, conjunctiva, cornea and anterior chamber, and may be associated with delayed ocular surface morbidity. The early phase of management is therefore directed towards rapid assessment, removal of the offending agent, restoration of ocular surface stability, prevention of infection and inflammation control. Advances in ocular imaging and microsurgical management have improved the evaluation and treatment of anterior segment trauma. Slit-lamp biomicroscopy remains the principal clinical tool, but anterior segment optical coherence tomography can provide non-contact, high resolution assessment of corneal wounds, corneal foreign bodies, traumatic cataract, anterior chamber abnormalities and angle pathology, particularly when clinical visualisation is limited by corneal oedema, opacity or hyphema [7,8]. Surgical techniques such as corneal and scleral wound repair, anterior chamber reformation, iris reposition or iridectomy, cataract extraction, removal of anterior segment foreign bodies and ocular surface reconstruction have expanded the scope of anatomical restoration and visual rehabilitation. With time, corneal transplantation, amniotic membrane transplantation, tissue adhesives such as fibrin glue and cyanoacrylate, and anterior segment reconstruction have evolved and has definitely increase our therapeutic options for complex ocular injuries. The epidemiology of ocular trauma varies with geography, occupation, socioeconomic conditions, safety practices and access to emergency ophthalmic care. Industrial and work-related injuries remain important in India and other developing settings, where lack of protective eyewear and inadequate workplace safety measures contribute to preventable ocular morbidity [9]. Rural Indian data have also shown that ocular trauma occurs predominantly among males and working-age individuals, with a mixture of closed-globe and open-globe injuries presenting to tertiary care centres [10]. These patterns highlight the importance of centre-specific data, because local mechanisms of injury and referral pathways influence both clinical presentation and outcomes. Visual outcome following ocular trauma is influenced by presenting visual acuity, type and severity of injury, corneal involvement, lens involvement, presence of hyphema, pupillary abnormality, intraocular foreign body, delay in presentation, need for surgery and associated ocular complications. In open-globe injuries, poor presenting visual acuity and adverse clinical signs have been shown to predict poor final outcome [11]. In anterior segment injuries, early diagnosis, appropriate medical therapy, timely surgical intervention and structured follow-up are therefore essential to reduce avoidable visual loss. The present study was undertaken to describe the pattern, clinical profile, management and short-term visual outcome of anterior segment ocular injuries presenting to a tertiary care centre in Northeast India. The study specifically aimed to document the distribution of anterior segment injuries by age, sex, laterality, mechanism of injury, ocular structure involved, intervention performed and visual acuity outcome at one month. SYMPTOMS Pain – ranging from mild discomfort to severe ocular pain. Redness – due to conjunctival or circum-ciliary congestion. Photophobia – sensitivity to light, especially seen in corneal injuries and traumatic iritis. Diminution of vision– visual acuity varies depending on the structure involved. Excessive watering (epiphora). Foreign body sensation. Diplopia SIGNS - Conjunctival congestion, Subconjunctival hemorrhage, Conjunctival laceration, Chemosis - Corneal abrasion, Corneal edema, Corneal laceration, Epithelial defects staining with fluorescein, Corneal foreign body - Hyphema, Cells and flare indicating traumatic iridocyclitis, Shallow or deep anterior chamber, Aqueous leakage (positive Seidel test) - Traumatic mydriasis, Iridodialysis, Sphincter tears, Irregular pupil, Iris prolapse through wound - Traumatic cataract, Lens subluxation and dislocation, Phacodonesis - Scleral laceration, Uveal tissue prolapse PREVALENCE It is reported that 2.4 million ocular trauma cases occur annually worldwide. As a whole, there are approximately 6 million people who are blind from ocular injuries, 2.3 million people who are visually impaired bilaterally; these facts make ocular trauma one of the most common causes of unilateral blindness. In India, the overall prevalence of ocular trauma is estimated between 1% and 5% of the general population. OBJECTIVES  To identify various types of anterior segment injuries of eye  To study the distribution of anterior segment injuries according to visual acuity, age, sex and occupation  To study the visual outcome after treatment of anterior segment injury of eye.

Study design and setting This was a prospective, hospital-based observational study conducted in the Department of Ophthalmology, Assam Medical College and Hospital, Dibrugarh, India. The study was conducted over a period of one year, from 1st December 2024 to 30th November 2025. The department receives ophthalmic emergency and referral cases from Dibrugarh and surrounding regions, including rural, semi-urban, occupational, agricultural and road traffic-related trauma populations. The manuscript was prepared in accordance with the principles of transparent reporting for observational studies, as recommended by the STROBE statement [12]. Study population All consecutive patients presenting during the study period with anterior segment ocular injury and fulfilling the eligibility criteria were screened for enrolment. A total of 104 patients were included in the study. Ninety-five patients had unilateral ocular injury and nine patients had bilateral involvement; therefore, the final eye-level analysis included 113 injured eyes. Patient-level variables, including age, sex, occupation and laterality, were analysed using 104 patients as the denominator. Eye-level variables, including mechanism of injury, clinical diagnosis, intervention performed and visual acuity outcome, were analysed using 113 injured eyes as the denominator. Eligibility criteria Patients of either sex aged more than 10 years presenting with recent ocular trauma involving one or more anterior segment structures were included. The anterior segment structures considered were the conjunctiva, cornea, sclera, anterior chamber, iris, ciliary body and crystalline lens. Eligible mechanisms included occupational mechanical injury, chemical injury, road traffic accident, assault-related injury, animal-related injury, sports equipment-related injury and fire- or thermal-related trauma. Patients younger than 10 years of age were excluded. Critically ill or disoriented patients in whom reliable ophthalmic examination or follow-up assessment could not be performed were also excluded. Patients with isolated posterior segment injury or combined anterior and posterior segment injury were excluded from the primary analysis in order to maintain the study focus on anterior segment trauma. In patients with suspected posterior segment involvement, posterior segment examination and ultrasound B-scan were performed where indicated. Definitions and classification of variables Anterior segment ocular injury was defined as trauma involving the conjunctiva, sclera, cornea, anterior chamber, iris, ciliary body or crystalline lens, either alone or in combination. Injury mechanism was categorised as occupational mechanical/industrial injury, chemical injury, road traffic accident, physical assault, animal-related injury, sports equipment-related injury or fire-related trauma. Laterality was recorded at the patient level as unilateral or bilateral. For bilateral cases, each injured eye was recorded separately for eye-level variables. When more than one anterior segment finding was present in the same eye, the principal clinical diagnosis was assigned according to the lesion most relevant to treatment and visual prognosis. Similarly, each injured eye was assigned one principal treatment or intervention category for tabulation. Anterior segment intraocular foreign body was recorded only when the foreign body was confined to the anterior segment. Occupation was recorded at presentation and grouped into clinically relevant categories, including industrial/manual worker, agricultural or tea-garden worker, student, driver or transport worker, homemaker, office/shop/service worker, retired or dependent person and other outdoor/unskilled worker. Clinical assessment A detailed history was obtained from each patient or accompanying guardian. Information recorded included age, sex, occupation, affected eye, place of injury, mechanism of injury, nature of the offending agent, time interval between injury and presentation, prior treatment received and relevant ocular or systemic history. All patients underwent ophthalmic examination using a standardised case record form. Presenting distance visual acuity was recorded using a Snellen visual acuity chart. Near vision was recorded where clinically appropriate. Torchlight examination and slit-lamp biomicroscopy were performed to assess conjunctival congestion, subconjunctival haemorrhage, conjunctival laceration, chemosis, corneal abrasion, corneal oedema, corneal foreign body, corneal laceration, anterior chamber depth, hyphema, cells and flare, iris prolapse, traumatic mydriasis, sphincter tear, iridodialysis, phacodonesis, lens subluxation, lens dislocation and traumatic cataract. Fluorescein staining under cobalt blue illumination was used to identify corneal epithelial defects and aqueous leakage. Seidel testing was performed when corneal or corneoscleral wound leakage was suspected. Intraocular pressure was measured using Goldmann applanation tonometry or non-contact tonometry only when globe integrity was not in doubt. Intraocular pressure measurement was avoided in suspected or confirmed open-globe injury until the globe was surgically secured. Posterior segment evaluation was performed using direct ophthalmoscopy, indirect ophthalmoscopy or slit-lamp biomicroscopy with a 90D lens wherever media clarity permitted. Ultrasound B-scan was performed when posterior segment visualisation was obscured and when open-globe injury had either been excluded or repaired. Gonioscopy and anterior segment imaging were performed where clinically indicated and feasible. INCLUSION CRITERIA 1. All Patients of either sex more than 10 years of age 2. The patients with definite history of recent blunt ocular trauma like RTA, sports injuries, occupational and non-occupational injuries, blast injuries, assault and trauma 3. All patients with anterior segment injuries. EXCLUSION CRITERIA 1. Critically ill and disoriented patient, 2. Associated Posterior segment injuries. 3. Less than 10 years of age STUDY VARIABLES 1.Study Materials The study included all patients presenting with anterior segment ocular injuries to the Ophthalmology Department during the study period. Materials evaluated included:  Patient demographic data (age, sex, occupation)  Comprehensive history of ocular trauma  Type and mechanism of injury (blunt, penetrating, chemical, thermal)  Affected eye (right, left, or both)  Documentation of visual acuity  Clinical findings involving the conjunctiva, cornea, anterior chamber, iris, lens, and sclera  Treatment details and follow-up records MANAGEMENT Management was based on the type and severity of injury. Medical management included topical antibiotics, lubricants, cycloplegics, anti-inflammatory therapy, analgesics and intraocular pressure-lowering medication where indicated. Chemical injuries were treated as ophthalmic emergencies with immediate copious irrigation, removal of retained particulate matter and subsequent medical or surgical treatment according to severity [5,6]. Surgical or procedural interventions were performed when clinically indicated. These included conjunctival repair, corneal foreign body removal, corneal repair, scleral repair, anterior chamber paracentesis, iridectomy, cataract extraction and intraocular foreign body removal. Eyes requiring more than one procedure were recorded under the most appropriate combined-procedure category or under the principal intervention category most relevant to treatment and visual outcome. Systemic antibiotics and tetanus prophylaxis were administered where indicated according to institutional practice. OUTCOME MEASURES The primary outcome was visual acuity at one month after injury. Secondary outcomes included distribution of age, sex, occupation, laterality, mechanism of injury, principal anterior segment diagnosis, intervention performed and visual acuity category at presentation, day 3, day 7 and one month. Visual acuity was grouped into the following categories: 6/6–6/12, 6/18–6/36, 6/60–4/60, 3/60 to hand movements positive, and perception of light positive to perception of light negative. The one-month visit was considered the final short-term visual outcome assessment for this study. DATA HANDLING Data were entered into a predefined case record form and checked for completeness and internal consistency before analysis. Patient-level variables were analysed using 104 patients as the denominator. Eye-level variables were analysed using 113 injured eyes as the denominator. In bilateral cases, each injured eye was included separately for eye-level analysis. Percentages were calculated using the appropriate denominator for each variable. STATISTICAL ANALYSIS Data were analysed using IBM SPSS version 22. Categorical variables were summarised as frequency and percentage. Patient-level percentages were calculated using 104 patients as the denominator, whereas eye-level percentages were calculated using 113 injured eyes as the denominator. Since the present analysis was descriptive, no inferential statistical testing was performed. Visual acuity outcomes were described by comparing the distribution of visual acuity categories at presentation, day 3, day 7 and one month. ETHICAL CONSIDERATIONS The study was conducted after approval from the Institutional Ethics Committee of Assam Medical College and Hospital, Dibrugarh. The ethics approval number was [AMC/BC/2433, Dated 03/062024]. Written informed consent was obtained from all adult participants. For participants younger than 18 years, written informed consent was obtained from a parent or legal guardian, with assent from the participant where appropriate. The study adhered to the principles of the Declaration of Helsinki. Patient confidentiality was maintained by anonymising all study records before analysis.

A total of 104 patients with anterior segment ocular injuries were included in the study. Of these, 74 patients were male and 30 were female, giving a male-to-female ratio of approximately 2.5:1. The majority of patients belonged to the younger and middle-age groups. The most commonly affected age group was 20–29 years, comprising 25 patients (24.0%), followed by 30–39 years with 22 patients (21.2%) and 40–49 years with 20 patients (19.2%). Patients aged 10–19 years accounted for 13 cases (12.5%), while 15 patients (14.4%) were in the 50–59-year age group. The least represented groups were 60–69 years and >70 years, contributing 5 patients (4.8%) and 4 patients (3.8%), respectively. With respect to laterality, 95 patients (91.3%) had unilateral ocular injury, whereas 9 patients (8.7%) had bilateral involvement. The 104 patients therefore contributed a total of 113 injured eyes for eye-level analysis. (Table1 and 2). Among the 113 injured eyes, the most frequent mechanism was mechanical/industrial injury, which accounted for 39 eyes (34.5%). Road traffic accidents were the second most common mechanism, involving 22 eyes (19.5%), followed by sports equipment-related injury in 18 eyes (15.9%). Fire-related trauma was documented in 12 eyes (10.6%), while chemical injury accounted for 9 eyes (8.0%). Physical assault and animal-related injury were less frequent, involving 8 eyes (7.1%) and 5 eyes (4.4%), respectively. Right-eye involvement was noted in 61 eyes, while left-eye involvement was noted in 52 eyes. Mechanical/industrial injuries were more frequent in the right eye, whereas sports equipment-related and fire-related injuries showed slightly greater left-eye involvement (Table 4). The clinical findings showed a broad spectrum of anterior segment involvement. The most common principal diagnosis was conjunctival laceration with subconjunctival haemorrhage, observed in 20 eyes (17.7%). This was followed by hyphema in 17 eyes (15.0%). Subconjunctival haemorrhage and corneal foreign body were each recorded in 16 eyes (14.2%). Corneal laceration with iris prolapse was present in 14 eyes (12.4%), while isolated corneal laceration and traumatic cataract were each seen in 8 eyes (7.1%). Corneal abrasion was recorded in 7 eyes (6.2%). Less frequent findings included anterior segment intraocular foreign body in 3 eyes (2.7%), traumatic mydriasis in 2 eyes (1.8%), and iridodialysis in 2 eyes (1.8%). The corrected total number of principal anterior segment diagnoses was 113 eyes (Table 5). The largest proportion of eyes were managed medically. Medical management only was performed in 39 eyes (34.5%). Among surgical or procedural interventions, corneal repair was the most frequent, performed in 21 eyes (18.6%), followed by corneal foreign body removal in 16 eyes (14.2%). A combined procedure consisting of corneal repair with iridectomy and cataract extraction was performed in 12 eyes (10.6%). Anterior chamber paracentesis was performed in 8 eyes (7.1%), while scleral repair was done in 6 eyes (5.3%). Conjunctival repair was performed in 5 eyes (4.4%). Cataract extraction alone and intraocular foreign body removal were each performed in 3 eyes (2.7%). The corrected intervention total was 113 injured eyes, with 61 right eyes and 52 left eyes represented in the treatment distribution (Table 6). At presentation, only 11 eyes (9.7%) had visual acuity in the 6/6–6/12 category. 23 eyes (20.4%) had visual acuity between 6/18 and 6/36, while 32 eyes (28.3%) had visual acuity between 6/60 and 4/60. Poorer presenting visual acuity was observed in a substantial proportion of eyes: 28 eyes (24.8%) were in the 3/60 to hand movements positive category, and 19 eyes (16.8%) were in the perception of light positive to perception of light negative category (Table 7). On the third day of follow-up, the number of eyes with visual acuity of 6/6–6/12 increased to 16 eyes (14.2%), while 25 eyes (22.1%) were in the 6/18–6/36 category. The 6/60–4/60 category included 29 eyes (25.7%), while 25 eyes (22.1%) had visual acuity from 3/60 to hand movements positive. The lowest visual acuity category decreased slightly to 18 eyes (15.9%) (Table 7). By the seventh day, 27 eyes (23.9%) had visual acuity of 6/6–6/12, and 28 eyes (24.8%) were in the 6/18–6/36 category. The number of eyes in the 6/60–4/60 category was 25 (22.1%). The 3/60 to hand movements positive category decreased to 19 eyes (16.8%), while the perception of light positive to perception of light negative category decreased to 14 eyes (12.4%) (Table 7). At one month, 27 eyes (23.9%) had visual acuity in the 6/6–6/12 category, and 31 eyes (27.4%) had visual acuity between 6/18 and 6/36. 28 eyes (24.8%) were in the 6/60–4/60 category. Poor visual acuity categories were less frequent at one month compared with presentation, with 18 eyes (15.9%) in the 3/60 to hand movements positive category and 9 eyes (8.0%) in the perception of light positive to perception of light negative category. Thus, at the final one-month follow-up, 58 eyes (51.3%) had visual acuity of 6/36 or better, while 27 eyes (23.9%) remained in the two poorest visual acuity categories combined (Table 7). 1.DISTRIBUTION ACCORDING TO AGE Age groups (years) Male Female Total Percentage 10-19 10 3 13 13% 20-29 18 7 25 24% 30-39 16 6 22 21% 40-49 13 7 20 19% 50-59 12 3 15 14% 60-69 3 2 5 5% >70 2 2 4 4% Total 74 30 104 100 2.DISTRIBUTION ACCORDING TO GENDER Category Number Percentage Male:Female Male 74 71% Female 30 29% Total 104 100% 3.DISTRIBUTION ACCORDING TO LATERALITY Category Number Percentage Unilateral 95 91% Bilateral 9 9% 4.MECHANISM OF ANTERIOR SEGMENT OCULAR INJURYBY INJURED EYE(n=113) MECHANISM OF INJURY RIGHT EYE, n LEFT EYE, n TOTAL EYES,n(%) Mechanical/industrial injury 23 16 39 (34.5) Chemical injury 4 5 9 (8.0) Road traffic accident 13 9 22 (19.5) Physical assault 5 3 8 (7.1) Animal-related injury 3 2 5 (4.4) Sports equipment-related injury 8 10 18 (15.9) Fire-related trauma 5 7 12 (10.6) Total 61 52 113 (100.0) 5.CLINICAL SPECTRUM OF OCULAR FINDINGS(n=113) PRINCIPAL CLINICAL DIAGNOSIS RIGHT EYE, n LEFT EYE, n TOTAL EYES,n(%) Conjunctival laceration with subconjunctival haemorrhage 11 9 20 (17.7) Subconjunctival haemorrhage 9 7 16 (14.2) Corneal abrasion 4 3 7 (6.2) Corneal laceration 5 3 8 (7.1) Corneal foreign body 11 5 16 (14.2) Corneal laceration with iris prolapse 8 6 14 (12.4) Hyphema 7 10 17 (15.0) Traumatic cataract 3 5 8 (7.1) Traumatic mydriasis 1 1 2 (1.8) Anterior segment intraocular foreign body 2 1 3 (2.7) Iridodialysis 0 2 2 (1.8) Total 61 52 113 (100.0) 6.TREATMENTORINTERVENTION PERFORMED(n=113) INTERVENTION PERFORMED RIGHT EYE, n LEFT EYE, n TOTAL EYES,n(%) Conjunctival repair 2 3 5 (4.4) Corneal foreign body removal 11 5 16 (14.2) Corneal repair 9 12 21 (18.6) Cataract extraction 2 1 3 (2.7) Corneal repair with iridectomy and cataract extraction 7 5 12 (10.6) Scleral repair 5 1 6 (5.3) Anterior chamber paracentesis 3 5 8 (7.1) Intraocular foreign body removal 2 1 3 (2.7) Medical management only 20 19 39 (34.5) Total 61 52 113 (100.0) 7. VISUAL ACUITY AT PRESENTATION AND FOLLOW UP (n=113) VISUAL ACUITY CATEGORY AT PRESENTATION, n (%) DAY 3, n(%) DAY 7, n (%) 1 MONTH, n (%) 6/6–6/12 11 (9.7) 16 (14.2) 27 (23.9) 27 (23.9) 6/18–6/36 23 (20.4) 25 (22.1) 28 (24.8) 31 (27.4) 6/60–4/60 32 (28.3) 29 (25.7) 25 (22.1) 28 (24.8) 3/60 to hand movements positive 28 (24.8) 25 (22.1) 19 (16.8) 18 (15.9) Perception of light positive to perception of light negative 19 (16.8) 18 (15.9) 14 (12.4) 9 (8.0) Total 113 (100.0) 113 (100.0) 113 (100.0) 113 (100.0)

The present prospective hospital-based study describes the demographic profile, mechanisms, clinical spectrum, management pattern and short-term visual outcome of anterior segment ocular injuries presenting to a tertiary care centre in Northeast India. The study included 104 patients and 113 injured eyes, reflecting the need to distinguish clearly between patient-level and eye-level denominators in ocular trauma research. This distinction is important because bilateral injuries, although less frequent than unilateral trauma, can otherwise lead to denominator errors and overestimation or underestimation of clinical findings. A marked male predominance was observed, with males accounting for 71.2% of patients and a male-to-female ratio of approximately 2.5:1. This finding is consistent with previous Indian and international ocular trauma literature, where male predominance has been repeatedly attributed to greater exposure to outdoor activity, occupational hazards, road traffic, industrial work, agricultural work, sports-related risk and interpersonal violence [1,10,13–16]. Population-based Indian studies from rural South India and urban Delhi have similarly shown that ocular trauma is more frequent among males and younger individuals [13–15]. In the present study, the highest proportion of patients belonged to the 20–29-year age group, followed by the 30–39-year and 40–49-year groups. Together, patients aged 20–49 years formed nearly two-thirds of the study population, indicating that anterior segment trauma mainly affected the economically productive age group. This has important social and occupational implications because even temporary visual impairment in this group may result in loss of working days, reduced productivity and financial burden. Most injuries were unilateral, with bilateral trauma seen in only 8.7% of patients. The predominance of unilateral injury is expected in ocular trauma because most mechanical, occupational, sports-related and assault-related injuries affect one eye at the time of impact. However, bilateral involvement remains clinically important, particularly in chemical injuries, fire-related injuries and blast-type trauma, where exposure may affect both eyes simultaneously [5,6]. In the present study, bilateral injuries contributed to the eye-level denominator of 113 injured eyes, emphasising the importance of separate reporting of patient-level and eye-level outcomes in ophthalmic trauma studies. Mechanical or industrial injury was the most frequent mechanism, accounting for 34.5% of injured eyes. This pattern reflects the occupational and referral characteristics of the study setting, which serves patients from rural, semi-urban, industrial and agricultural catchment areas. Occupational ocular trauma has been widely recognised as a preventable cause of visual morbidity, particularly in developing countries where protective eyewear may be unavailable, uncomfortable, inconsistently used or poorly enforced [9,17,21]. Vasu et al. reported occupational open-globe injuries as an important subset of serious ocular trauma, while Adams et al. showed that provision of protective eyewear with sustained educational intervention could improve compliance and reduce ocular injuries among stone-quarry workers in Tamil Nadu [17,21]. The high proportion of mechanical/industrial injuries in the present study therefore supports the need for workplace-based eye safety programmes, mandatory use of protective eyewear and targeted counselling of high-risk workers. Road traffic accidents were the second most common mechanism, accounting for 19.5% of injured eyes. This finding is consistent with recent emergency department-based Indian data, where road traffic accidents constituted a major mode of ocular injury [18]. Two-wheeler use, lack of helmet visor protection, high-velocity impact, roadside debris, broken glass and associated facial trauma may contribute to anterior segment involvement in road traffic-related injuries. Sports equipment-related injuries were also common in the present study, accounting for 15.9% of eyes. This highlights the need for age-appropriate protective strategies in schools, playgrounds and recreational settings, particularly because preventable ocular injuries may occur during informal or unsupervised sports activity. The clinical spectrum in this study demonstrated that conjunctival, corneal, anterior chamber, iris and lens injuries were all represented. Conjunctival laceration with subconjunctival haemorrhage was the most common principal diagnosis, followed by hyphema, subconjunctival haemorrhage and corneal foreign body. The exposed anatomical position of the conjunctiva and cornea makes these structures especially vulnerable to direct trauma. Corneal foreign bodies and corneal abrasions are common in occupational and mechanical injuries, while corneal laceration with iris prolapse reflects more severe penetrating trauma. The use of standardised terminology such as the Birmingham Eye Trauma Terminology system remains important for such injuries because it allows clear distinction between closed-globe and open-globe injuries and improves comparability between studies [2,3]. Hyphema was recorded in 15.0% of injured eyes, making it one of the common anterior chamber findings. Traumatic hyphema usually results from blunt trauma causing disruption of iris or ciliary body vessels and may be associated with raised intraocular pressure, corneal blood staining, angle recession and secondary glaucoma. Although the present study excluded posterior segment injuries, hyphema still requires careful follow-up because complications may occur after the acute phase. Similarly, traumatic mydriasis and iridodialysis, though less frequent in this study, indicate iris sphincter or iris root injury and may be associated with glare, photophobia, cosmetic symptoms and long-term angle-related complications. Lens involvement was observed in the form of traumatic cataract, either as an isolated principal diagnosis or as part of combined injury requiring corneal repair with iridectomy and cataract extraction. Lens involvement is clinically important because it may indicate significant blunt or penetrating trauma and often requires surgical intervention for visual rehabilitation. In open-globe injuries, poor presenting visual acuity, lens involvement, wound characteristics, afferent pupillary defect, retinal involvement and zone of injury have been associated with poorer visual outcome [11,19,20]. Although the present study focused on anterior segment injuries and excluded associated posterior segment trauma, lens and corneal involvement still represented important determinants of treatment burden and short-term visual recovery. Medical management alone was sufficient in 34.5% of injured eyes, indicating that approximately one-third of cases were managed without operative intervention. These cases likely included relatively less severe injuries such as subconjunctival haemorrhage, superficial corneal injury, mild chemical exposure or inflammatory anterior segment trauma. However, a substantial proportion of eyes required procedural or surgical management. Corneal repair was the most common surgical intervention, followed by corneal foreign body removal and combined corneal repair with iridectomy and cataract extraction. This distribution reflects the dual nature of anterior segment trauma: many injuries are minor and medically manageable, but a clinically significant subset is vision-threatening and requires urgent surgical expertise. The visual acuity distribution showed a favourable shift over the one-month follow-up period. At presentation, only 30.1% of eyes had visual acuity of 6/36 or better, whereas this proportion increased to 51.3% at one month. Conversely, the two poorest visual acuity categories decreased from 41.6% at presentation to 23.9% at one month. This suggests meaningful short-term visual recovery after treatment in a proportion of injured eyes. Similar improvement after treatment has been reported in rural Indian ocular trauma studies, where early presentation, appropriate repair and absence of posterior segment involvement were associated with better visual outcome [10,16]. However, the interpretation of improvement in the present study should remain cautious because the available table provides aggregate visual acuity categories rather than paired eye-level visual acuity transitions. The persistence of poor visual acuity in nearly one-fourth of eyes at one month remains clinically important. Eyes with corneal laceration, iris prolapse, traumatic cataract, intraocular foreign body, hyphema or chemical injury may require longer follow-up and secondary procedures before final visual potential can be assessed. One-month outcome is therefore best considered a short-term functional outcome rather than a final visual endpoint. Studies of open-globe injury have shown that presenting visual acuity is one of the strongest predictors of final outcome, and prognostic tools such as the Ocular Trauma Score rely heavily on initial visual acuity and associated adverse clinical features [19,20]. Although the Ocular Trauma Score was not applied in the present study, its incorporation in future studies may improve risk stratification and facilitate comparison with published trauma cohorts. Chemical injuries represented 8.0% of injured eyes in this study. Although less common than mechanical and road traffic-related trauma, chemical injuries deserve special attention because their prognosis depends heavily on immediate irrigation, severity of limbal involvement, corneal clarity, intraocular pressure and prompt institution of anti-inflammatory and ocular surface-preserving therapy [5,6]. The presence of chemical injuries in a tertiary care trauma series reinforces the need for first-aid education at workplaces, schools and community settings. Immediate irrigation before referral should be emphasised because delay in initial management may worsen ocular surface damage and visual outcome. The findings of this study have several preventive implications. First, the predominance of mechanical/industrial injuries supports the need for protective eyewear in industrial, construction, workshop and agricultural environments. Second, the contribution of road traffic accidents highlights the importance of helmet visor use, traffic safety measures and public awareness regarding ocular protection. Third, sports-related trauma suggests a role for protective eye gear during high-risk recreational activities. Preventive strategies must be locally adapted because the mechanism of ocular trauma varies with occupation, environment, transport patterns and safety behaviour [13–18,21]. The study has some strengths. It was prospective in design, conducted over a defined one-year period, and included serial visual acuity assessment at presentation, day 3, day 7 and one month. The study also focused specifically on anterior segment injuries, allowing detailed description of conjunctival, corneal, anterior chamber, iris and lens involvement. The corrected analysis further separates patient-level variables from eye-level variables, which improves clarity and reduces reporting error. The study also has limitations. It was conducted at a single tertiary care centre, which may introduce referral bias and may not reflect the true community burden of minor ocular injuries. Patients younger than 10 years and patients with posterior segment involvement were excluded, limiting generalisability to paediatric trauma and combined globe injuries. The follow-up period was limited to one month; therefore, late complications such as secondary glaucoma, corneal scarring, traumatic cataract progression, angle recession, irregular astigmatism and need for secondary visual rehabilitation could not be fully assessed. Occupational details, time from injury to presentation, use of protective eyewear, open-globe versus closed-globe subgroup outcomes and paired logMAR visual acuity analysis were not available in the current aggregated tables. Future studies should include these variables and apply multivariable analysis to identify independent predictors of poor visual outcome.

Anterior segment ocular injuries in this tertiary care setting predominantly affected young and middle-aged males, with mechanical/industrial trauma emerging as the leading mechanism of injury. The clinical spectrum was broad, ranging from conjunctival and corneal injuries to hyphema, iris prolapse, traumatic cataract and intraocular foreign body. Although a substantial proportion of eyes required surgical or procedural intervention, visual acuity showed improvement over the one-month follow-up period, reflecting the value of timely diagnosis and appropriate management. However, persistent poor vision in a notable proportion of eyes highlights the need for early referral, structured follow-up and stronger preventive measures, particularly the routine use of protective eyewear in occupational, traffic and sports-related settings.

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