Opthalmological sequelae due to paintball injuries: Case studies

Ocular injuries from drive-by paintball shootings

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.

Ocular injuries from gel blasters: not just a harmless toy

Gel blasters fire a hydrated gel polymer and are developed to circumvent the restrictions placed on paintball and airsoft guns. Because there are no reported cases of injury caused by gel blasters in the literature, some Australian jurisdictions have categorised them as a toy. Presented here are two cases of potentially blinding blunt ocular trauma which question the misguided notion they are a harmless toy. Two children each with a macrohyphaema were managed at a tertiary ophthalmology centre within 2 weeks of each other after being struck by a gel blaster projectile. Their vision ultimately returned to normal, but both face lifelong risks of ocular complications. These cases highlight the need for vigilance, and the appropriate restriction of powerful weapons, with the inherent need for eye protection when operating any such projectiles reiterated. It is recommended their licensing is made congruous with paintball guns to prevent false reassurance of their safety.