Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

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

In This Article

Five-year View

The clinical consequences of blast injuries and strategies outlined for the immediate management of eye blast trauma and specific effects resulting from explosion are of prime medical importance. Recently, blasts are the main causes of injury or death in non-military war action and will continue to be so for the next 5 years or more.

Between the years 1947 and 2000, there were 280 local wars with 25 million deaths and 100 million casualties (Canadian Red Cross) 15 million of them expected to have some sort of eye/orbital injuries; now there are approximately 40 violent conflicts are currently active.[64]

The introduction of pars–plana vitrectomy in the 1970s resulted in new techniques to permit controlled access to intraocular foreign bodies (IOFBs) and related intraocular complications. Only recently have modern vitreoretinal techniques been used to treat penetrating war injuries with IOFBs. With modern vitreoretinal techniques, enucleation rates for severely traumatized eyes with blast injuries has improved.[65–67]

In the previtrectomy era, occupational and industrial enucleation rates were as high as 20–23%, but these have been recently reduced to 3–6%.[68]

In blast wave-related penetrating injuries, foreign bodies are smaller than the conventional war missile and there appears to be a trend toward fewer ocular enucleations. Kuhn (2006) found the reduction in enucleating rates may be attributed to vitreoretinal techniques that address secondary complications of the initial injury,[114] the use of intraocular antibiotics, and the combination of vitrectomy and antibiotics in managing post-traumatic endophthalmitis.[69–71]

In the next 5 years, better body armor and visor (eye armor) designs will help break the stress of the wave pressure and provide protection against blast-induced injuries, especially the upper middle-third facial, ocular–orbital region, as and brain injury through cribriform plates, ocular and orbital medium.

More thermal burns to the eye due to the increase in using thermobaric enhanced-blast explosives and RPG-29 that partly employ the thermobaric explosive are expected. Burnt ocular epithelium will need more research and better topical medicine. In the case of severe ocular/orbital injuries, the eye socket needs immediate packing when evisceration or inoculation takes place and should be specifically prepared for it when this pack is needed.

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