There was a numerically significant decrease in eye emergency department visits during the pandemic period in all seasons compared to the pre-pandemic period. The reason for this may be the protective measures against coronavirus or that our patients are more cautious about applying to the emergency department. We think that the information announcements of the Turkish Ophthalmology Association are also guiding in this regard to warn our patients and raise awareness so as not to delay the treatment of emergency eye diseases in our country.
It was found that eye emergency department admission rates due to infectious/inflammatory and allergic diseases decreased most significantly during the pandemic period. In a study by Carvalho et al. [18], it was reported that approximately 55% of patients admitted to the eye emergency department had infectious/inflammatory diagnoses. In our study, infectious/inflammatory causes were the most common admission diagnoses (61.6% and 51.1%, respectively) in both the pre-pandemic and pandemic periods. In our study, the reason for the decrease in infectious and allergic conjunctivitis, and keratitis cases during the pandemic period may be that the decrease in exposure to infectious microorganisms in the external environment and the positive improvements in personal hygiene habits [11, 14, 15]. In view of this result, it would be appropriate to draw attention to this issue by increasing information and educational efforts on personal hygiene in order to protect against these diseases and preserve public health.
In a 1-year prospective study conducted by Henriquez et al. [19] before the pandemic, it was reported that the most common diagnoses for an emergency eye examination in children were infectious conjunctivitis, corneal abrasions, and noninfectious conjunctivitis. In a 1-year prospective study conducted in the pre-pandemic period, Sen et al [20] reported that children most commonly referred to the emergency room due to allergic and infectious conjunctivitis. In our study, similar to the above studies it was found that children were most frequently admitted to the emergency department for infectious and allergic conjunctivitis, and ocular surface damage due to foreign bodies both before and during the pandemic. Educating parents about preventive measures and raising awareness among school-age children about the prevention and transmission of these diseases can reduce the incidence of these diseases in childhood.
A study by Pellegrini et al [12] found that there was a significant decrease in eye injuries during the pandemic period due to both occupational and non-occupational causes (sports, violence, falls, etc.). Similarly, in our study, there was a significant decrease in blunt and penetrating eye injuries during the pandemic period. The reason for this decrease could be working from home or rotation system during the pandemic period. There are studies in the literature reporting that ocular traumas occur mainly in males and between the ages of 15-45 years [21, 22]. In this study, ocular trauma was found to be most common in males and the 17-40 age group for all age groups, both in the first one-year period of the pandemic and in the one year before the pandemic. To prevent people of working age from being exposed to eye trauma, the provision of protective measures by the employer and the observance of their implementation by the employee is of great importance for protection.
In our study, it was observed that there was a significant decrease in the rate of applications from individuals aged 16 years and under and above 65 years of age. This decrease could be due to the transition to distance education in the age group of children and the decline in outdoor activities. In the cases of those above 65 years of age, we assume that stricter closure measures implemented for this age group in our country may be effective in this decrease. In addition, in patients aged 65 years and older, the incidence of sight-threatening diseases such as retinal diseases (retinal vascular diseases. age-related macular degeneration, and other retinopathies. etc.), iridocyclitis, and glaucoma was significantly higher during the pandemic period than in other age groups. As expected in the older age group, the increase in risk for these diseases with age may explain the higher incidence in this age group.
One of the limitations of our study is its retrospective design. The other limitation is; requests made within the first 10 days by patients who revisit the emergency department are accepted in our country's health system with the same protocol number, but a separate control number is assigned for repeat requests after 10 days. This may have resulted in repetition for some diagnoses in patients who reapplied after 10 days from the first visit. However, due to the large study population, we think that these patients will not affect the overall statistical results. The strongest aspect of our study is that it covers a large number of patients by comparing the first year of the pandemic with the period of one year before the pandemic. Our hospital is the only eye-specific public hospital in Ankara and the surrounding provinces. Unlike other centers that were extremely busy due to other branch patients during the Covid 19 pandemic, our hospital served only ophthalmology patients. Due to the above-mentioned reasons, our hospital has become a center preferred by emergency eye patients and patients are referred from other hospitals. This allowed our study to include a large number of patients. As can be seen from these data, our hospital has taken care to provide health services to all applicants during the pandemic period as a center where outpatient treatment services for ocular emergency patients are successfully carried out.
As a result of this study, it was determined that in the first year of the pandemic, applications to the emergency department of a tertiary eye hospital decreased significantly compared to the pre-pandemic period thanks to the protective measures against coronavirus. In the pediatric age group, both before and during the pandemic the most common presentations were thought to be conjunctivitis and foreign bodies in the eye, and it was thought that there was a need to increase awareness among parents and children of protective measures against these.
We are concerned that the decrease in emergency room admissions during the pandemic period may be due to the fact that ocular symptoms and diseases are neglected by patients due to the risk of contracting Covid-19. We think that patients with risk factors and chronic eye diseases should be aware that they should not neglect eye diseases during this period and should pay attention to eye control visits. Ophthalmologists should also take into account that the decrease in emergency department applications during the pandemic period may lead to intensive patient admissions and they may encounter more complicated diseases during the recovery period. Health-care delivery planning should be carried out considering these situations.