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Quiroga-Garza ME, Ruiz-Lozano RE, Azar NS, Mousa HM, Komai S, Sevilla-Llorca JL, Perez VL. Noxious effects of riot control agents on the ocular surface: Pathogenic mechanisms and management. FRONTIERS IN TOXICOLOGY 2023; 5:1118731. [PMID: 36733462 PMCID: PMC9887149 DOI: 10.3389/ftox.2023.1118731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Riot Control Agents (RCAs) are chemical compounds used by law enforcement agencies to quell violent demonstrations as an alternative to lethal force and as part of police/military training. They are also known as tear gases because of the hallmark ocular irritation and lacrimation they cause. The most common RCAs include oleoresin capsicum (contained in Mace and pepper spray), chlorobenzylidene malononitrile, dibenzoxazepine, and chloroacetophenone (previously the main content of Mace); some of which have been in use for decades. Their immediate incapacitating effects are mediated through polymodal afferent fibers innervating the corneal surface, inducing the release of peptides that cause neurogenic inflammation. Although previously thought to have only transient effects on exposed patients more severe complications such as corneal stromal opacities, corneal neovascularization, neurotrophic keratopathy, conjunctival necrosis, and pseudopterygium can occur. Concerningly, the lack of research and specific therapies restrict the current management to decontamination and symptom-tailored support. This manuscript will provide an overview of the toxic mechanisms of RCAs, their clinical manifestations, and current therapy after exposure to tear gases.
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Affiliation(s)
- Manuel E. Quiroga-Garza
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Nadim S. Azar
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Seitaro Komai
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Jose L. Sevilla-Llorca
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Victor L. Perez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States,*Correspondence: Victor L. Perez,
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Darwazeh R, Darwazeh M, Elzain MA, Hoz SS, Al-Kanash R. Rubber bullet-related craniocerebral injuries. Br J Surg 2022; 110:403-405. [PMID: 36073201 DOI: 10.1093/bjs/znac316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/10/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Rami Darwazeh
- Department of Neurosurgery, Arab Women’s Union Hospital , Nablus , Palestine
| | - Mazhar Darwazeh
- Department of Neurosurgery, Arab Women’s Union Hospital , Nablus , Palestine
| | - Mohammed A Elzain
- Department of Neurosurgery, King Saud Medical City , Riyadh , Saudi Arabia
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati , Cincinnati, Ohio , USA
| | - Rasha Al-Kanash
- Endoscopic Spine Department, Razi Spine Clinic , Amman , Jordan
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Amin SV, Otti VE, Farooq AV, Shah HA. Ocular injuries from drive-by paintball shootings. Am J Ophthalmol 2022; 242:139-143. [PMID: 35594916 DOI: 10.1016/j.ajo.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To characterize ocular injuries from drive-by paintball shootings with a focus on the severity of injuries sustained, clinical management, and visual outcomes. DESIGN Retrospective, interventional case series. METHODS Setting: University practice and emergency department. PATIENT POPULATION Patients evaluated by the ophthalmology service for paintball injuries. OBSERVATION PROCEDURE Age, gender, eye laterality, mechanism of injury, initial best-corrected visual acuity (BCVA), and initial diagnosis. MAIN OUTCOME MEASURES Clinical intervention(s), BCVA at last follow-up visit, and severity of injuries with a focus on ruptured globes. RESULTS Twenty patients suffered unilateral ocular injuries from drive-by paintball shootings between January 2020 and December 2021. Median follow-up interval was 7.1 weeks (range: 3 days - 11.4 months). Average patient age at presentation was 36.6 years (range: 13 - 64 years-old). Fourteen patients (70%) had an initial BCVA of counting fingers (CF) or worse. Six patients (30%) suffered ruptured globe injury requiring surgical repair, of whom three (15%) underwent subsequent evisceration. Twelve patients (60%) suffered ocular injuries requiring surgical intervention. Fifteen ocular surgeries were performed on 9 patients (45%) at our institution with 3 patients referred to outside providers for definitive surgical management due to insurance. BCVA at last-follow up visit was no light perception (NLP) in five patients. CONCLUSIONS The severity of injury following paintball-induced ocular trauma is higher in this case series than what has previously been reported in the literature. Paintball guns can cause devastating ocular injury when used as an assault weapon and their use in unregulated settings bears further scrutiny.
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Chemical Agents Encountered in Protests. Emerg Med Clin North Am 2022; 40:365-379. [DOI: 10.1016/j.emc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gajardo AI, Wagner TD, Howell KD, González-Santa Cruz A, Kaufman JS, Castillo-Carniglia A. Effects of 2019's social protests on emergency health services utilization and case severity in Santiago, Chile: a time-series analysis. LANCET REGIONAL HEALTH. AMERICAS 2021; 5:100082. [PMID: 36776456 PMCID: PMC9903909 DOI: 10.1016/j.lana.2021.100082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 10/19/2022]
Abstract
Background On October 18th, 2019, protestors gathered across Chile to call for social equity, resulting in widespread civil unrest and violent confrontation with the police. In this study, we quantify the effects of the 2019 Chilean protests on emergency health services utilization and inpatient admission in Santiago. Methods We used weekly emergency department (ED) admissions (2015-2019) from three large public hospitals near the focal point of protests in Santiago. The exposure period was from October 18th to December 31st, 2019. The outcomes were the number of weekly consultations and hospitalizations by trauma and respiratory causes and the proportion of hospitalizations among consultants per 1,000. We implemented Bayesian structural time series models to calculate the absolute and relative effects and 95% credible intervals (CrI). Findings During the first ten weeks of protests ED consultations declined on average by 14% for trauma (95%CrI: -40·2%, 11·5%) and 30% for respiratory causes (95%CrI: -89·4%, 30·2%), 7% for respiratory hospitalizations (95%CrI: -43·6%, 30·8%); however, none of these three results were statistically distinguishable from the null. Trauma hospitalizations, on the other hand, increased by 15% (95%CrI: 4·0%, 26·4%), and the proportion of hospitalizations per consultations increased by 40% for trauma (95%CrI: 13·1%, 68·0%) and 59% for respiratory causes (95%CrI: 29·4%, 87·9%). Interpretation The 2019 Chilean protests affected the use of emergency health services by increasing the trauma hospitalizations and the case hospitalization ratio per 1,000 consultations for trauma and respiratory causes. Crowd-control protocols must be reviewed to prevent the negative effects of civil unrest.
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Affiliation(s)
- Abraham I.J. Gajardo
- Intensive Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Universidad de Chile. Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
| | - Thomas D. Wagner
- Vagelos College of Physicians & Surgeons, Columbia University. 630 W 168th St, New York, NY 10032, USA
| | - Kristina Devi Howell
- Mailman School of Public Health, Columbia University. 722 W 168th St, New York, NY 10032, USA
| | - Andrés González-Santa Cruz
- Society and Health Research Center and School of Public Health, Universidad Mayor, Chile. Badajoz 130, Las Condes, Santiago, Chile
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University. 1020 Pine Avenue West, Montreal, QC H3A1A2, Canada
| | - Alvaro Castillo-Carniglia
- Society and Health Research Center and School of Public Health, Universidad Mayor, Chile. Badajoz 130, Las Condes, Santiago, Chile,Department of Population Health, New York University Grossman School of Medicine. 180 Madison Avenue, New York, NY 10016, USA,Corresponding author: Alvaro Castillo-Carniglia, Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Chile. Badajoz 130, Suite 1305, Las Condes, Santiago, Chile. Phone: +56.2.2518.9800
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Kim HJ, Ali S, Kelly LD. Ocular foam round injury: A case report and literature review. Am J Ophthalmol Case Rep 2021; 23:101149. [PMID: 34195480 PMCID: PMC8239431 DOI: 10.1016/j.ajoc.2021.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/19/2021] [Accepted: 06/12/2021] [Indexed: 11/11/2022] Open
Abstract
Purpose To report the case of a 25-year-old male who sustained significant ocular trauma from a confirmed foam round. To review the scientific literature on kinetic impact projectiles and legislation currently proposed to regulate their use. Observations A 25-year-old male presented to the emergency department with acute pain and vision loss in his left eye after being struck by a foam round. Initial exam showed significant periorbital ecchymosis, multiple eyelid lacerations, microhyphema, and vitreous hemorrhage. Computed tomography revealed fractures of the inferior and medial orbital walls. Optical coherence tomography also demonstrated full-thickness macular hole. Microhyphema resolved after 15 days with steroid and mydriatic drops. Vision at 60 days after injury stabilized at 20/60. Repeat OCT at this time revealed closure of the macular hole. Care for the patient is ongoing. Conclusions and Importance Foam rounds can cause a pattern of vision-threatening ocular trauma similar to that of rubber bullets with the additional risk of chemical injury. During the George Floyd protests, isolated reports of significant foam round-related ocular injuries have been reported in the press, but systematic epidemiologic and clinical data on the subject remains lacking. While accurate identification of the causative weapon is not required in the management of ocular trauma, it may impact advocacy efforts undertaken by physicians and the subsequent legislative efforts they inspire. Current state and federal law does not adequately protect individuals from these munitions. Multiple proposals in Congress aptly recognize the significant risk of blinding injury and mortality posed by all kinetic impact projectiles.
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Affiliation(s)
- Hyun Jun Kim
- University of Cincinnati College of Medicine, CARE/Crawley Building Suite E-870, 3230 Eden Avenue PO Box 670555, Cincinnati, OH, 45267-0555, USA
| | - Sameerah Ali
- Department of Ophthalmology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, 5th Floor, Cincinnati, OH, 45267-0527, USA
| | - Lisa D Kelly
- Department of Ophthalmology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, 5th Floor, Cincinnati, OH, 45267-0527, USA
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Abstract
PURPOSE OF REVIEW With social media use continuing to increase in popularity, ophthalmologists use social media daily for interactions with patients, colleagues, and the academic community. RECENT FINDINGS The potential reach of social media is overwhelmingly encouraging, but academic organizations have much work to do in order to compete for viewership on social media platforms, and users need to remain vigilant of easily spread misinformation. Individual ophthalmology practices can tailor their social media presence to attract and educate patients. Using hashtags to supplement the experience of academic conferences has boosted engagement both of attendees and other interested parties. As an effective indicator of the popularity of different subjects in medicine, new studies are leveraging social media for epidemiological models. Finally, social media is emerging as a powerful tool for patient advocacy in ophthalmology. SUMMARY The accessibility of social media uniquely positions it to educate patients, disseminate public eye health initiatives, and increase the reach of individual physicians. It is also able to enhance the academic experience of conferences, connecting new research colleagues, and is becoming the subject of epidemiologic studies itself. Whether using social media for patient education, research, clinical practice, or patient advocacy, ophthalmologists will find social media an increasingly important workplace contributor.
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Affiliation(s)
| | - Simon S M Fung
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Edmund Tsui
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Abstract
ABSTRACT Rubber bullets have long been known to cause, on rare occasions, traumatic brain injury (TBI). However, neurosurgical literature on this occurrence is limited, and no focused review of this injury pattern has been conducted. The authors present the case of a 28-year-old male struck by a rubber bullet in the left periorbital region, causing TBI in addition to complete left visual loss and complex facial fractures. After developing a cerebrospinal fluid (CSF) leak, the patient was taken to the operating room for combined neurosurgical-craniofacial intervention. Utilizing frameless intraoperative computation tomography navigation assistance, a successful repair was made of both the patient's CSF leak and complex craniofacial injuries. TBI due to a rubber bullet is a rare but severe occurrence. Unfortunately, much of the limited literature on this topic is bereft of demographic, clinical course, injury pattern, and imaging data. Presented here is the first operative case report of TBI due to a rubber bullet. Volume rendered imaging is provided to demonstrate the extent of trauma incurred. Additionally, a methodology for frameless intraoperative computation tomography navigation assistance is shared for consideration, as it served as a helpful adjunct for a combined intracranial-craniofacial surgical repair. The experience of treating the patient's traumatic CSF leak in the context of severe craniofacial and ophthalmologic injuries highlights the need for a multidisciplinary surgical approach that may arise when treating patients with TBI due to a rubber bullet.
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Liu W, Yu B, Bursztyn L, Malvankar-Mehta MS. Eye injuries sustained during protests due to non-lethal weaponry: a systematic review. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1931124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Winnie Liu
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Ontario, Canada
| | - Brian Yu
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Ontario, Canada
| | - Lulu Bursztyn
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, the University of Western Ontario, Ontario, Canada
| | - Monali S. Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, the University of Western Ontario, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, the University of Western Ontario, Ontario, Canada
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Ifantides C, Christopher KL, Deitz GA, Smith JM, Patnaik JL, SooHoo JR, Subramanian PS. Ophthalmic Injuries by Less-Lethal Kinetic Weapons During the US George Floyd Protests in Spring 2020. JAMA Ophthalmol 2021; 139:242-244. [PMID: 33270094 DOI: 10.1001/jamaophthalmol.2020.5325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cristos Ifantides
- Department of Ophthalmology, University of Colorado, Aurora.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Karen L Christopher
- Department of Ophthalmology, University of Colorado, Aurora.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Galia A Deitz
- Department of Ophthalmology, University of Colorado, Aurora
| | - Jesse M Smith
- Department of Ophthalmology, University of Colorado, Aurora.,Department of Surgery, Denver Health Medical Center, Denver, Colorado
| | | | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado, Aurora.,Department of Surgery, Denver Health Medical Center, Denver, Colorado
| | - Prem S Subramanian
- Department of Ophthalmology, University of Colorado, Aurora.,Department of Neurology, University of Colorado, Aurora.,Department of Neurosurgery, University of Colorado, Aurora
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