Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

Expert Rev Ophthalmol. 2008;3(2):229-246. 

In This Article

Penetrating Eye

Although the eye is subject to all the types of injuries described previously, the most common and devastating ocular injuries result from the missiles created by a blast (i.e., secondary blast injuries). Just as with wartime ocular injuries, those associated with terrorist blasts are most commonly due to fragments that damage the eye.[1,42–44]

Although the number of ocular penetrating injuries is high due to conventional combat shell fragments, the number of penetrating eye injuries due to IEDs is far higher (and we should expect this to continue to increase) as the rate of attacks rises in high-risk populated areas.

The victim that sustained blast facial injury that led to a crushed eggshell NOE injury also suffered a penetrating right eye injury. Symptoms included eye pain, foreign body sensation, peri-orbital ecchymosis, corneal haze, periocular contusions and decreased visual acuity. In suspected cases of open globe injury, direct manual globe pressure palpation is contraindicated.

Unfortunately, ophthalmologists in front-line hospitals in most of the third-world local wars lack proper microsurgical equipment, the experience of vitreoretinal surgery and endure a high casualty influx rate and limited medical facilities and expertise. Patients receive appropriate antibiotics and are evacuated to the military base hospital. The NOE injury was treated by using portex tracheotomy nasal tubes and the intercanthal space approach Figure 7.

Penetrating eye blast injury with nasal–orbital–ethmoidal region fractures.

The highly qualified ophthalmologlly specialist may be surprised as to why these technical specialties and sophisticated instruments are unavailable. The modern vitreoretinal techniques have improved and decreased enucleation rates for severely traumatized eyes due to blast injuries. However, many war-torn or terrorist-ridden countries would need decades to achieve the facilities available to the Western armies. Furthermore, the chances are minimal that these countries will have the budget that can afford the same standard of treatment and expertise available to the US army or NATO armies. The author wonders if he can suggest that WHO and ophthalmology societies play a role in this field in the current hot zones directly or indirectly, by supplies equipment and training.

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