Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker


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

In This Article

Explosive Devices & Eye-orbital Blast Injury Patterns

Explosions have the potential to cause life-threatening multisystemic injuries and mass casualties, one of these vulnerable systems to blast are the eyes and orbits. These patterns of injuries are a result of the explosive composition and type of explosive and carrier/container delivery method. Also, the distance between the victim and the blast epicenter, whether the blast occurred in a closed or open space, and any surrounding environmental barriers or hazards may be contributing factors. The major blast weaponry that leads to eye injuries includes IEDs, mines, rocket-propelled grenades (RPG-7 to the recently and more powerful RPG-29), conventional war bombs, enhanced-blast explosives as thermobaric and explosive formed projectiles (EFPs).

In its annual global survey of terrorism, the US State department said that 14,338 attacks took place in 2006, mainly in Iraq and Afghanistan. The report stated that 6600, or 45% of the attacks, took place in Iraq, killing approximately 13,000 people, or 65% of the worldwide total of terrorist-related deaths in 2006.[107]

Mader et al. (2004) prospectively examinated severe ocular and ocular adnexal injuries that were treated at the 31st Combat Support Hospital during the portion of the Iraqi insurgency that took place from 20 January to 12 September 2004.[33] The main outcome measures were incidences and characteristics of ocular and ocular adnexal injuries. The results were that during the time observed, 207 patients suffered severe ocular or ocular adnexal injuries, including 132 open globes. Blast fragmentation from munitions caused 82% of all injuries. The most common single cause of injury was the IED, which caused 51% of all injuries. Of 41 eye excisions, 24 were caused by IEDs.

In a study carried out on ocular injuries in survivors of IED attacks on a commuter train, Mehta et al. (2007) found that 16 of 28 patients (57.1%) had ocular injuries whereas 12 (42.8%) were found to be normal.[34] Injuries were seen unilaterally in ten patients and bilaterally in six, yielding a total of 22 injured eyes. The common injuries were periorbital hemorrhages (nine eyes; 40%); first or second-degree burns to the upper or lower lids (seven eyes; 31.8%) and corneal injuries (eight eyes; 36.3%). Open globe injuries were seen in two eyes of two patients (9%). One patient (4.5%) had a traumatic optic neuropathy.

These two studies indicate the higher effect of secondary blast effects in the outdoors in ocular injuries because the amount of secondary flying debris is far higher, although the primary blast effects inside are far higher. In a commuter train the expected glass fragmentations would travel outside owing to the primary blast wave.


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