Less-Lethal Weapons Resulting in Ophthalmic Injuries: A Review and Recent Example of Eye Trauma

Abstract

Introduction: Prior reports have highlighted the dangers of crowd control weapons such as rubber bullets, paintball guns, and pepper spray. Many of these reports were written decades ago and outside of the USA. We summarize a review of the literature and discuss a contemporary case of a ruptured globe and facial trauma secondary to a projectile weapon. This case serves to highlight the severity of eye trauma caused by less-lethal weapons; severe morbidity or even mortality can occur. Clinical Description: A civilian presented after a projectile weapon reportedly fired by Denver law enforcement struck his face during one of the recent protests in May 2020 in Denver. Upon ophthalmic examination, we observed no light perception (NLP) vision, periorbital ecchymosis, and devastating globe trauma. Primary Diagnosis, Interventions, and Outcomes: Further examination revealed a severely ruptured globe with extensive hemorrhage and extrusion of intraocular contents. Attempts to repair the ruptured globe failed because of the lack of remaining scleral tissue and expulsion of intraocular contents. Postoperatively, the visual acuity remained NLP and the eye was unable to hold pressure. Subsequently, the patient elected for enucleation. Conclusion: Despite the purported safety advancements of less-lethal weapons, we continue to see high levels of morbidity and mortality. Permanent vision loss, loss of the eye, and death caused by these weapons have been reported. We hope that this information will serve as an example to help promote judicious use of these weapons by the proper authorities. Additionally, protesters and bystanders should be aware of these dangers and utilize highquality eye protection.

Fratura orbitária provocada por projetil de borracha: Relato de caso

“…Um estudo retrospectivo sobre lesões oftálmicas causadas por armas não letais demonstrou que de 43 casos, 25 resultaram em fraturas orbitárias e rompimento de globo ocular (Ifantides et al, 2020). Outro estudo realizado no Chile, demonstrou que dentre 182 casos suspeitos de trauma ocular por balas de borracha 33 evoluíram com amaurose e 90 exibiram deficiência visual grave (Rodriguez et al, 2020).…”

“…A cápsula que a envolve geralmente é constituída por propelente de pólvora e espoleta (Cruz, 2018). As dimensões desses projéteis podem variar de 3,5cm a 9,15cm, pesar entre 135 a 140g e ultrapassar a velocidade de 70m/s (Ifantides et al, 2020).…”

“…Quando essas recomendações não são seguidas, estruturas nobres como o globo ocular e a órbita estão ainda mais em risco, pois são delicados e com enorme potencial de serem lesionados. Embora não sejam consideradas letais, as balas de borracha podem causar a perda de visão, qualidade visual ou até mesmo do globo ocular, comprometendo a qualidade de vida e restringindo o indivíduo de inúmeras atividades (Ifantides et al, 2020).…”

Ocular foam round injury: A case report and literature review

“…1 More recently, Ifantides et al describe a case of globe rupture likely caused by a foam round during the 2020 George Floyd protests. 2 A meta-analysis showed that 85% of all KIP-related ocular injuries globally resulted in permanent blindness. 3% of all KIP-related injuries resulted in death.…”

Noxious effects of riot control agents on the ocular surface: Pathogenic mechanisms and management

“…Aircraft, vehicle, and drone-guided technologies are also used as delivery systems. Additionally, non-lethal projectile weapons have a high risk of inducing severe traumatic injuries when fired at a person ( Ifantides et al, 2020 ).…”