Severe Eye Injuries in the War in Iraq, 2003–2005

Thach, Allen B.; Johnson, Anthony J.; Carroll, R. B.; Huchun, Ava; Ainbinder, Darryl J.; Stutzman, Ray E.; Blaydon, Sean M.; DeMartelaere, Sheri L.; Mader, Thomas H.; Slade, Clifton S.; George, Roger K.; Ritchey, John P.; Barnes, Scott D.; Fannin, Lilia A.

doi:10.1016/j.ophtha.2007.04.032

Cited by 110 publications

(75 citation statements)

References 28 publications

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“…Intraocular foreign bodies (IOFBs) cause 14 -17% of all ocular war injuries [43,44]. They are a very important subset of eye injuries as they have a modifiable outcome using modern diagnostic, therapeutic and surgical techniques.…”

Section: Types Of Blast Injury (A) Primary Blast Injurymentioning

confidence: 99%

The injured eye

Scott

2011

Phil. Trans. R. Soc. B

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Eye injuries come at a high cost to society and are avoidable. Ocular blast injuries can be primary, from the blast wave itself; secondary, from fragments carried by the blast wind; tertiary; due to structural collapse or being thrown against a fixed object; or quaternary, from burns and indirect injuries. Ballistic eye protection significantly reduces the incidence of eye injuries and should be encouraged from an early stage in Military training. Management of an injured eye requires meticulous history taking, evaluation of vision that measures the acuity and if there is a relative pupillary defect as well as careful inspection of the eyes, under anaesthetic if necessary. A lateral canthotomy with cantholysis should be performed immediately if there is a sight-threatening retrobulbar haemorrhage. Systemic antibiotics should be prescribed if there is a suspected penetrating or perforating injury. A ruptured globe should be protected by an eye shield. Primary repair of ruptured globes should be performed in a timely fashion. Secondary procedures will often be required at a later date to achieve sight preservation. A poor initial visual acuity is not a guarantee of a poor final result. The final result can be predicted after approximately 3-4 weeks. Future research in eye injuries attempts to reduce scarring and neuronal damage as well as to promote photoreceptor rescue, using posttranscriptional inhibition of cell death pathways and vaccination to promote neural recovery. Where the sight has been lost sensory substitution of a picture from a spectacle mounted video camera to the touch receptors of the tongue can be used to achieve appreciation of the outside world.

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Section: Types Of Blast Injury (A) Primary Blast Injurymentioning

confidence: 99%

The injured eye

Scott

2011

Phil. Trans. R. Soc. B

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“…Powerful explosives are an increasingly common cause of TBI [1][2][3][4][5][6][7][8][9]. The majority of 797 severe eye injuries in OIF between 2003 and 2005 were caused by blast [10]. Of 88 patients with blast injuries from OIF and Operation Enduring Freedom (OEF) screened by the Defense and Veterans Brain Injury Center at WRAMC, 61 percent had TBI; more than half of these injuries were classified as moderate or severe (www.dvbic.org).…”

Section: Introductionmentioning

confidence: 99%

Eye and visual function in traumatic brain injury

Cockerham¹,

Goodrich²,

Weichel³

et al. 2009

JRRD

142

107

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Abstract-Combat blast is an important cause of traumatic brain injury (TBI) in the Department of Veterans Affairs polytrauma population, whereas common causes of TBI in the civilian sector include motor vehicle accidents and falls. Known visual consequences of civilian TBI include compromised visual acuity, visual fields, and oculomotor function. The visual consequences of TBI related to blast remain largely unknown. Blast injury may include open globe (eye) injury, which is usually detected and managed early in the rehabilitation journey. The incidence, locations, and types of ocular damage in eyes without open globe injury after exposure to powerful blast have not been systematically studied. Initial reports and preliminary data suggest that binocular function, visual fields, and other aspects of visual function may be impaired after blast-related TBI, despite relatively normal visual acuity. Damage to the ocular tissues may occur from blunt trauma without rupture or penetration (closed globe injury). Possible areas for research are development of common taxonomy and assessment tools across services, surgical management, and outcomes for blast-related eye injury; the incidence, locations, and natural history of closed globe injury; binocular and visual function impairment; quality of life in affected servicemembers; pharmacological and visual therapies; and practice patterns for screening, management, and rehabilitation.

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“…25,26 In this study, 16 cases (14%) had contusion injury due to explosive materials used in terrorist acts. Contrary to those reported in Sobaci et al's 27 series with open-globe injury from the same hospital, contusion injuries from explosives had favorable visual outcomes in this series of closed-globe injury (P ¼ 0.389).…”

Section: Discussionmentioning

confidence: 71%