Observations on 300 Consecutive Cases of Ocular War Injuries*

Bellows, John G.

doi:10.1016/0002-9394(47)91977-6

Cited by 42 publications

(16 citation statements)

References 17 publications

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“…This had been already suggested when ocular PBI was initially reported in 1945 22,23 but never tested any further, although even Duke-Elder 24 postulated that both positive and negative pressures contributed to eye damage.…”

Section: Discussionmentioning

confidence: 95%

Primary Blast Injury to the Eye and Orbit: Finite Element Modeling

Rossi¹,

Boccassini

Esposito

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Primary blast injury (PBI) mostly affects air-filled organs, although it is sporadically reported in fluid-filled organs, including the eye. The purpose of the present paper is to explain orbit blast injury mechanisms through finite element modeling (FEM).METHODS. FEM meshes of the eye, orbit, and skull were generated. Pressure, strain, and strain rates were calculated at the cornea, vitreous base, equator, macula, and orbit apex for pressures known to cause tympanic rupture, lung damage, and 50% chance of mortality. RESULTS.Pressures within the orbit ranged between þ0.25 and À1.4 MegaPascal (MPa) for tympanic rupture, þ3 and À1 MPa for lung damage, and þ20 and À6 MPa for 50% mortality. Higher trinitrotoluene (TNT) quantity and closer explosion caused significantly higher pressures, and the impact angle significantly influenced pressure at all locations. Pressure waves reflected and amplified to create steady waves resonating within the orbit. Strain reached 20% along multiple axes, and strain rates exceeded 30,000 s À1 at all locations even for the smallest amount of TNT.CONCLUSIONS. The orbit's pyramidlike shape with bony walls and the mechanical impedance mismatch between fluidlike content and anterior air-tissue interface determine pressure wave reflection and amplification. The resulting steady wave resonates within the orbit and can explain both macular holes and optic nerve damage after ocular PBI. (Invest Ophthalmol Vis Sci. 2012;53:8057-8066) DOI:10.1167/iovs.12-10591 P rimary blast injury (PBI) refers to biological damage caused by the peak incident overpressure (PIO) wave generated by an explosion. Initially described exclusively in hollow, air-filled organs, 1,2 the spectrum of PBI progressively enlarged to encompass fluid-filled organs, including the central nervous system 3,4 and the eye. 3-6Macular holes, choroidal rupture, and optic nerve damage occur relatively frequently after blunt trauma, 7 and although the pathogenic mechanism remains unclear, vitreous traction, 8 globe deformation, differential eye layer stiffness, 9 shockwave propagation, and multiaxial strain 10 likely participate.Finite element modeling (FEM) is a numerical analysis method largely used to simulate multiphysics problems. Previous applications to ophthalmology [11][12][13] and, specifically, to blunt eye trauma 10 have been reported. The purpose of the present paper is to create a computational model of ocular PBI, simulate the propagation of blast waves through the orbit, and explain its pathogenesis. The study was prompted by the observation of macular holes, multiple choroidal ruptures, subretinal bleeding, and optic atrophy after blast exposure, in the absence of any contact with splinters and/or flying objects (Fig. 1). MATERIALS AND METHODS Finite Element ModelingThe eye model has been previously described, 10,14 while orbit and retrobulbar fat tissue were reconstructed based on patient computed tomography scan and magnetic resonance imaging ( Fig. 2; see the Appendix for further technical details on FEM). C...

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Section: Discussionmentioning

confidence: 95%

Primary Blast Injury to the Eye and Orbit: Finite Element Modeling

Rossi¹,

Boccassini

Esposito

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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“…To a much lesser degree, injury to the eye can occur through tertiary blast effects -the orbital region striking a stationary object as the individual is propelled by the blast wave. The existence of secondary and tertiary ocular blast injury is indisputable (3,5,9,12,13). Less conclusive is the evidence presented regarding primary blast injury to the eye.…”

Section: Ocular Injuries Related To Blastmentioning

confidence: 99%

“…Wiener related cases of exophthalmos, choroid rupture and aneurysm of the lateral sinus, without obvious external cuts or bruising, upon which he blames blast exposure (16). Bellows cited thirteen cases of pure blast injury with 'no apparent injuries by impact or penetration of a foreign body', displaying pathologies including optic nerve atrophy, choroidal and retinal lesions, intraocular haemorrhage or vitreous opacity, lens, iris and pupil changes, and extra-ocular muscle paralysis (5).…”

Section: Historical Reportsmentioning

confidence: 99%

“…This increase has been attributed to the increased use and efficacy of fragmenting munitions (e.g. land mines) and Armoured Fighting Vehicle warfare (where the externally exposed body area is limited to the head and neck) (5,6). It also reflects increased survival rates from injuries that historically would have been fatal, due largely to the increased incidence of body armour use, and developments in military medicine (6).…”

Section: Introductionmentioning

confidence: 99%

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Primary Blast Injuries to the Eye: A Review of the Evidence

2007

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Objectives Eye injuries are relatively common following detonations. The majority of these are caused by secondary fragments. Primary blast injury to the eye (from the air-blast alone) has been described historically, but the differentiation of air-blast and fragment aetiologies in the reports is not clear. The aim of this review is to consider the evidence in the literature for true primary blast injury to the eye. Methods A literature review using Medline, Pub-med and Web of Knowledge databases. Conclusions Overall, there is little conclusive evidence that primary ocular blast injury occurs in survivors of explosions. However, some case reports do surmise its occurrence and it cannot be unequivocally ruled out. If it does occur, it is more likely to be at high overpressures that will produce life-threatening injuries. The development of enhanced blast weapons may result in an increased incidence. At present however, the most severe and damaging threat to the eyes from blast remains the impact of fragments and debris.

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“…With these adaptations in military tactics, injury patterns sustained by combatants have also changed. For example, the incidence of ocular injuries has increased during combat from 0.65% of all injuries during the Crimean war of 1854-1856 to 13% during Operation Desert Storm in 1991 [1][2][3][4][5][6][7][8][9][10][11][12][13]. Multiple explanations have been proposed for these changes, including the use of explosive fragmentation from artillery and aircraft rather than low-velocity projectiles shot from muzzle-loading rifles.…”

Section: Introductionmentioning

confidence: 99%