Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

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

In This Article

RPG-7 Injury

A 35-year-old soldier standing on tank turret sustained RPG-7 blast injury. On examination, there were signs of cyanosis on his lips and nails, paler cold skin, dyspnoea, pneumothorax, hemothorax and pneumomediastinum. Immediate oro-tracheal intubation and oxygen not under pressure was used. On examination, he had numerous facial lacerations, burned facial skin, eyebrows and lashes, in addition to an open globe injury that showed numerous orbital small metallic fragments.

Chest lateral and postero–anterior radiograph revealed a collapsed left lung that was treated by chest tube.

Circum-orbital ecchymosed and multiple penetrating facial injuries were caused by spall metal fragments. Thermal burn injury from radiant energy usually results from contact with hot gases leading to cell death and thermal necrosis and penetration, which can affect a large ocular surface area. Because of the very high temperature from enhanced-blast explosives, we should be expecting more ocular injuries especially when eye visor protections are not used (Figures 11 & 12).

Rocket-propelled grenade-7 multisystems blast injuries. (A) Rocket-propelled grenade-7 blast facial injuries, bilateral ruptured eyes, thermal flash burn to the face and eyebrow. (B) Patient intubated connected to oxygen. (C) Lateral left lung radiograph showing collapsed lung. (D) Normally inflated lung , chest x-ray showing the chest tube. (E) Patient lost both eyes, photographs showing burned eyebrow and supera orbital unhealed burned ulcers, left as tissue delayed healing of burned ulcers.

Improvised explosive devices injuries. (A & B) Improvised explosive device multiple foreign bodies facial injury, demonstrating the amount of metallic fragments used with these improvised bombs to ensure injuries to many victims. Courtesy of Dr Aliaa Mackey, Medical City, Baghdad, Iraq.

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