Vol.1, No.3, 197-202 (2009)
doi:10.4236/health.2009.13033
SciRes Copyright © 2009 Openly accessible at http://www.scirp.org/journal/HEALTH/
Health
Incidence and economic impact of ophthalmological
occupational accidents in Greece
Kyriakos Souliotis1,4, Michalis Angelou2 , Christina Golna3, Yannis Tountas4
1Faculty of Social Sciences, University of Peloponnese, Corinth, Greece
2Institute of Social Security, Athens, Greece
3MSc Health Regulation, Athens, Greece
4Center for Health Services Research, Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens,
Greece
Received 15 September 2009; revised 15 October 2009; accepted 16 October 2009
ABSTRACT
Scope: This article seeks to assess the eco-
nomic impact of industrial accidents with ref-
erence to the incidence of opthalmological in-
dustrial injuries occurring in the Thriacion Plain
industrial zone in Greece during the period
1991-2000. Material and Methods: Data provided
by 53 industrial units have been collected and
classified. During the study period, 2,011 adults
and juveniles out of the 15,600 people employed
in the area (a 13% aggregate) suffered opthal-
mological injuries occurring at the workplace.
Results: The highest percentage of injuries were
due to trauma (61% of adults, 67% of juveniles),
followed by chemical burns. In the majority of
cases (75% of adults and 50% of juveniles)
treatment was provided at the local IKA (Social
Security Fund) health care unit, in the town of
Elefsis. It was estimated that a total of 10,192
working days were lost, with compensation
costs (benefit payments) alone amounting to
approximately € 118,000.00, not allowing for in-
direct employer costs such as loss of produc-
tivity, substitution and replacement costs. Con-
clusions: The high incidence of industrial acci-
dents in combination with the high percentage of
child labor in the area of Thriacion Industrial Plain
were striking and contributed significantly to high-
er rates of work-related injuries of ocular interest
in Greece. The latter were shown to result in a sig-
nificant deterioration of the employees’ health
status, with the majority of the accidents being
due to the lack of safety precautions at the work-
place at a considerable financial burden on the
social security system in direct benefit payments.
The social security system needs to press for
tighter work safety regulations and their proper
implementation if to minimize the burden these
accidents impose on its budget.
Keywords: Occupational Health; Cost of Care;
Ophthalmological Accidents
1. INTRODUCTION
One of the primary objectives of the social security sys-
tems in most European countries is to cover for risks due
to industrial injuries and occupational related diseases [1].
Over the past twenty years, changes in the manufacture
and production process, largely aimed at an improvement
of the work environment for employees, have led to the
introduction of advanced technologies and the minimiza-
tion of human interaction with high-risk machinery, in an
effort to limit the extent of occupational / industrial acci-
dents [2].
An occupational / industrial accident is “any violent,
sudden and unforeseen incident occuring to the employee
during or because of his work and resulting in a disability
for work of a duration of more than 4 days” and, as such,
manifests the effect of economic activity on the health of
an employee [3], leading to a deterioration of the health
status of the injured person, an increase in the social se-
curity burden of treatment and rehabilitation, abseintism,
decrease in productivity and lost revenue [4].
Whereas improvements in working conditions in Greece
from 1970 onwards resulted in a decrease in the incidence of
industrial accidents, and especially fatal ones, related mor-
bidity remained relatively high until 1989. During the next
decate, morbidity decreased substantially [5,6]. Industrial
accidents in Greece were largely related to the low level of
work safety standards, the unsuitability of the work envi-
ronment, the lack of sufficient measures to monitor safety
regulations and collect and analyze relevant information, the
recruitment of non-specialized workers for specialized tasks
and the lack of state control over enterprises, particularly in
monitoring compliance with safety regulations [7].

198 K. Souliotis et al. / HEALTH 1 (2009) 197-202
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Table 1. Work accidents to IKA insured employees and consequences (1991-1995).
Accidents -consequences 1991 1992 1993 1994 1995
Death 222 227 240 229 206
Absence from work and
compensation 25,611 25,582 24,524 23,231 21,946
Temporary disability and
retirement 673 474 504 507 392
Permanent disability and
retirement 290 300 311 317 253
Minor injury with no impact
on ability to perform tasks 74 84 75 78 145
Total work accidents 26,870 26,667 25,654 24,362 22,942
Source: National Statistical Service of Greece, Statistical year book of Greece, 1999
Table 2. Subsidies paid due to industrial accidents to IKA insureds, 1995.
Benefit data Total
Cases 22
Days of subsidy 689
Bonus days 52
Total days 741
Cost in euros 8,516,327.77
Cost per case 395.37
Days per case 34
Source: Social Security Institute, Statistical Report 1996, Athens.
In 1995, 0.90% of accidents at the workplace resulted
in death, 95.66% resulted in absence from work and
payment of compensation, 1.71% resulted in temporary
disability, 1.10% resulted in permanent disability and
0.63% related to minor injury that did not hinder the
employee from performing his duties (Table 1).
In the same year, IKA, the largest social security fund,
where 55% of the population are insured (compulsory
health / social insurance), paid out € 8.5 million in com-
pensation (benefits) for 21,540 industrial accidents [8].
Compensation covered an average of 34 days per incident
with the per capita benefit amounting to € 395 (Table 2).
It should be noted that this figure did not include
benefits in kind for treatment, which were paid sepa-
rately to the insureds, or the cost of health services actu-
ally provided at the IKA local health units or hospitals.
Nonetheless, in 1996, this compensation in kind for in-
dustrial accidents amounted to 6% of IKA’s total provi-
sion for illness in money terms [8], which is considered
high especially as it is an “avoidable” cost that could
potentially lead to catastrophic health care expenditure
for the security fund, the employee and the employer.
In the remit of industrial accidents, work related injuries
of ophthalmologic interest have been in the center of recent
scientific analysis and debate [9-11]. While ocular injuries
appear to be relatively higher in industrial settings at some
countries, such as Southeastern Nigeria, where 12.5 % of
industrial accidents affected the eye [9], comparably high
incidence rates are also observed in the agricultural sector in
both USA and Italy [10,11].
In the view of 1) the growing importance of ocular
accidents occurring at the workplace and 2) the significant
economic burden imposed on the social security system
by occupational accidents in Greece, this paper assesses
the economic impact of ocular injuries at the workplace in
one of the most industrialised areas of the country.
2. METHODS
This paper analyses the incidence and the economic
consequences of ophthalmological industrial accidents in
the Thriasion Plain industrial zone in Greece over the
period 1991-2000. Data were collected from fifty three (53)
industries that operate in the greater area of the Thriacion
Plain and employee health records at the primary health
care clinic of the IKA local health unit in Elefsis. Cost data
were obtained from the Annual IKA Statistical Bulletin.
The cost of the accidents was estimated in monetary terms
both for the social security system and the individuals
(injured employees and employers) alike.

K. Souliotis et al. / HEALTH 1 (2009) 197-202 199
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Table 3. Employees per category/sex and opthalmological accidents in the industrial area of Thriacion Plain (1991-2000).
EMPLOYEES ACCIDENTS
Adults Cases
% (compared to the total
of accidents)
Employees per acci-
dent
MEN 8,150 1,785 89% 8.12
% (compared to the adults total) 56.21
WOMEN 6,350
% (compared to the adults total) 43.79
TOTAL 14,500
% (compared to the total of employees) 92.95
Juveniles
MEN 995 226 11% 4.87
% (compared to the juvenile total) 90.45
WOMEN 105
% (compared to the juvenile total) 9.55
TOTAL 1,100
% (compared to the total of employees) 7.05
All Employees 15,600 2,011 100% 7.76
Table 4. Work opthalmological accidents in adults and juvenile in the industrial area of Thriacion Plain (1991-2000).
Year Adult Accidents % Juvenile Accidents % Total of accidents
1991 228 86.36 36 13.64 264
1992 114 83.82 22 16.18 136
1993 78 85.71 13 14.29 91
1994 76 84.44 14 15.56 90
1995 68 94.44 4 5.56 72
1996 116 95.87 5 4.13 121
1997 149 94.90 8 5.10 157
1998 234 89.66 27 10.34 261
1999 366 87.98 50 12.02 416
2000 356 88.34 47 11.66 403
TOTAL 1,785 88.76 226 11.24 2,011
3. RESULTS
A total of 15,600 workers were employed in the area over
the study period, of whom 14,500 were adults and 1,100
juveniles. Of them, an aggregate 13 % (1,785 adults and
226 juveniles) suffered ocular casualties over the study
period (Table 3). This percentage is a striking 4.5 times
higher than the average representation of ocular injuries
in the overall industrial accidents (2.8% of total accidents)
reported by IKA for that period.
The number of opthalmological injuries sustained by
both adults and juveniles varied significantly between
1991-1996 and 1996-2000. Table 4 depicts a 70% decline
in opthalmological industrial accidents (from 228 to 68)
for adults and an 88% decline (from 36 to 4) for juvenile
workers between 1991 and 1996. Conversely, over the
period 1996-2000, there was a marked increase of 206%
(from 116 to 356) in adult ophthalmological industrial
accidents and 840% (from 5 to 47) in juvenile ones,
despite the introduction of additional European Union
legislation on tighter safety controls in the workplace (6
new legislative acts over the study period).
A large proportion of the employees seeking treatment
for ophthalmological industrial injuries had not been
legally employed and were uninsured, with the rate of
child labor in the area being quite significant (7.05%).
Children displayed a greater propensity towards accidents
at the workplace (a chance of 1 in 4.87 for juveniles as

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Table 5. Adult work accidents by eye anatomical area subjected to injury (1991-2000).
Eye anatomical area 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Eyelids 65 40 20 25 20 25 21 48 100 90
Conjunctivae 25 4 8 15 7 5 25 40 43 20
Cornea 110 70 46 30 41 63 79 134 209 219
Sclera 17 4 6 16 14 10 11 20
Iris 7 2 5 2 4
Lens 2 5 5 2 1 3
Hyaloid 2
Table 6. Juvenile work accidents by eye anatomical area subjected to injury (1991-2000).
Eye anatomical area 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Eyelids 13 11 4 7 2 5 6 20 30 31
Conjuctivae 10 2 8 5 2 2 5 3 7
Cornea 2 4 1 1 2 5 9
Sclera 9 5 1 7
Iris 1 4
Lens 1 1
Hyaloid
Table 7. Cost estimation surcharged to IKA by absence reimbursement due to adult industrial opthalmological accidents in the Thriacion Plain (1991- 2000).
Anatomical
area Incidents
Average
recovery
period
Total days
of recovery
Days paid
by em-
ployer
Days paid
by IKA
Employer
cost IKA cost
Total re-
imburse-
ment cost
Eyelids 454 4 1,816 1,362 454 15,836.37 5,278.79 21,115,.16
Conjuctivae 192 4 768 576 192 6,697.32 2,232.44 8,929.76
Cornea 1,001 3 3,003 3,003 0 34,916.76 0.00 34,916.76
Sclera 98 23 2,254 294 1,960 3,418.42 22,789.49 26,207.92
Iris 20 23 460 60 400 697.64 4,650.92 5,348.55
Lense 18 23 414 54 360 627.87 4,185.83 4,813.70
Hyaloid 2 23 46 6 40 69.76 465.09 534.86
TOTAL 1,785 8,761 5,355 3,406 62,264.15 39,602.56 101,866.71
Table 8. Cost estimation surcharged to IKA by absence reimbursement due to juvenile employees work opthalmological accidents in
the Thriacion Plain (1991-2000).
Anatomical
area Incidents
Average
recovery
period
Total days of
recovery
Days paid
by em-
ployer
Days
paid by
IKA
Employer
cost IKA cost Total reim- bursement cost
Eyelids 129 4 516 387 129 4,499.76 1,499.92 5,999.68
Conjuctivae 44 4 176 132 44 1,534.80 511.60 2,046.40
Cornea 24 3 72 72 0 837.17 0.00 837.17
Sclera 22 23 506 66 440 767.40 5,116.01 5,883.41
Iris 5 23 115 15 100 174.41 1,162.73 1,337.14
Lense 2 23 46 6 40 69.76 465.09 534.86
TOTAL 226 1,431 678 753 7,883.30 8,755.35 16,638.66

K. Souliotis et al. / HEALTH 1 (2009) 197-202 201
SciRes Copyright © 2009 Openly accessible at http://www.scirp.org/journal/HEALTH/
compared to 1 in 8.12 for adults). This uninsured popu-
lation (including illegally employed children) did not
generate revenue (compulsory insurance fees) for the
social security fund but, nonetheless, sought and received
treatment for their accidents at the IKA local health care
unit, at a considerable, additional and unaccounted for,
cost for the fund.
Tables 5 and 6 depict the steady increase in injuries
involving the eyelids both for adults and juveniles, espe-
cially after 1998, and the cornea (especially in adults),
while injuries involving the conjunctivae have also dis-
played a relative increase. Eye injury was most com-
monly caused by metal chips, cement dust, fragments of
wood, pieces of coal stone and arc rays, all of which could
be prevented by wearing appropriate protective eye cov-
erings. Mechanical injuries accounted for 1,076 of adult
injuries (60.3%), chemical burns for 630 (35.3%) and
clashes for 79 (4.4%). Injury causes in juveniles were
distributed similarly, though no injuries were attributed to
clashes.
Seventy-five percent of the adults thus injured were
treated at the local health unit of IKA in Elefsis, whereas
the remainder was transported to the opthalmological
Clinics of Athens and Piraeus (National Health System –
NHS-Clinics). Of the juveniles injured, 50% were treated
at the local health unit and the others were transported to
the two Children’s Hospitals in Athens (NHS Hospitals)
[12,13]. It should be noted that according to the Greek
NHS principles, it is compulsory that treatment is pro-
vided to everyone in need, irrespective of insurance status.
In this light, even if uninsured or illegally employed, all
employees that suffered ocular industrial accidents re-
ceived treatment either at a cost that fell on the social
security fund or directly the NHS (the hospital budget).
IKA, which insures the majority of employees in the
area, apart from covering treatment expenses, pays out
compensation, sick-leave subsidies and a disability pen-
sion for either permanent or temporary disability. Based
on the average compensation per day of absence from
work, the cost to IKA for each employee amounts to:
IKA cost = Days of absence – 3 (paid by the employer)
x average daily compensation
Whereas days of leave are estimated using the formula:
type of injury x factor n (which expresses the days re-
quired for recovery for each category of injury).
Thus, the cost to social security (IKA) in 1995 prices for
the coverage of opthalmological injuries occurring in the
Thriacion Plain industrial zone in 1995 wages amounted
to € 39,602.56 for adults (Table 7) and € 8,755.35 for
juveniles (Table 8), at a total burden of injury of €
48,357.91. The above estimation is based on an average
daily compensation multiplied by the days required until
recovery; the days required for recovery are on average 4
(3-5) for injuries to the eyelids and conjuctivae, 3 (2-4)
for injuries to the cornea and 23 (5-30) for injuries sus-
tained to sclerae, iris, lens and vitreous.
The burden of disease on employees amounted to ap-
proximately € 62,264.15 for adults and € 7,883.30 for
juveniles, at a total of € 70,144.46. Overall, the total cost
of opthalmological industrial accidents in the Thriacion
Plain industrial zone during the 1990s was estimated at €
118,505.36. It should be noted that this was the cost in-
curred for sick leave only and, thus, an underestimate of
the full economic burden of disease, as it does not allow
for indirect employer costs such as replacement costs,
productivity losses, delays in order processing or in-
voicing and adverse publicity.
As mentioned before, compensation costs paid out by
the social security did not include the provision of ser-
vices or payments in kind for treatment of the insured,
which were exponientially higher than the compensation
cost. Given the lack of published hospital and IKA treat-
ment data [14], this cost could not be estimated in a
credible manner. Compensation costs are thus used in this
paper as an indicator of the extent of preventable and
avoidable expense to the social security system (and to
the NHS) that stricter implementation of work safety
regulations could result to.
4. DISCUSSIONS
Data analysed in this paper show that the conditions ex-
isting in the Thriacion Plain industrial zone favor the
occurrence of opthalmological industrial accidents, due to
the lack of implementation of strict safety regulations,
lack of information, ignorance of risks (resulting to care-
lessness), difficult working conditions, diminished per-
ception, inexperience and insufficient physical strength.
The probability of an accident occurring is further ag-
gravated by the high rate of child labor that is essentially
more vulnerable to such accidents.
These accidents, that to a great extent could be pre-
vented through the use of protective eye coverings and
more appropriate safety regulations, effect a high health
and economic burden on social security, the employee
and the employer alike and can ultimately lead to unem-
ployment in an area where the primary source of income
is from employment in the industrial sector [12-13]. It is
recommended that in accordance with European guide-
lines on health and safety at work [15], legislation ad-
dressing the use of protective devices in high-risk indus-
tries should be vigorously enforced and compliance better
monitored. This would not only improve the eye health of
industrial workers in Greece but, most crucially, prevent
avoidable expense to the fragile social security system
and the NHS, which face major economic constraints on
their budgets.
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