Ocular injuries from improvised explosive devices

Abstract

Purpose To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs). Methods Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre. Results In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20-42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury.In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twentytwo (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4-34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (o5/200, Po0.05).In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P40.05). Conclusion Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.

Ocular blast injuries related to explosive military ammunition

“…The mean age of the casualties in this report (24.5 years) is similar to other reports of ocular trauma,4 19–22 and all of the casualties are men because female soldiers are exempted from military operations in the Turkish army.…”

“…This report confirms the severe visual loss observed following military ammunition explosions; a VA of NLP was found in 21.7% of the injured eyes compared with 37.3% in a mine-clearing operation19 and 36% in IED blasts4—the NLP VA in mine blasts in this report was 4/30 (13.3%). We believe that the higher frequency of NLP VA in mine-clearing operations is likely related to the closer proximity to the exploded mines, whereas the mine blasts detailed in our report generally occurred during deployments and had a greater stand-off distance from the mine blast accounting for the lower incidence of ocular injury.…”

“…However, eye removal rates have remained relatively stable over the last several wars: 20% in Vietnam, 18% in Operation Desert Storm, below 10% in the Iraq–Iran war, 13% in Croatia, Bosnia and Herzegovina,9 and 13% in Operation Iraqi Freedom 9. For IED-related open-globe injuries, the eye removal rate has been reported to be 28% in Turkey4—the rate of eye removal in the present report was 16.9%.…”

Indications for Surgical Removal of the Eye in Rural Areas in Cameroon

“…Erdurman et al13 reported that 28% of patients with ocular injuries resulting from improvised explosive devices required DES as a primary surgical intervention. Several investigators2,13 have reported eye trauma as one of the most common indication for DES in the urban milieu. The main goal of a destructive procedure is the prevention of sympathetic ophthalmia which, from a pathophysiological perspective, is believed to be an immunologic response to the exposure of previously sequestered intraocular tissue 14.…”

Unusual intraocular foreign bodies after an explosion: patient's hand bone fragments

“…IOFBs have been reported in 26%–76% of open globe injuries in combat eye trauma 4 7 8. Thach et al 1 evaluated IOFB injuries in military personnel and reported that the most common types of IOFB were metal (68%), glass (14%), stone/cement (14%), bone (5%) and cilia (3%); the origin of the bone fragments was unreported in this article.…”