Ocular paintball injuries

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.

Empty Bullet-Related Ocular Injuries During Military Shooting Training: A 20-Year Review

INTRODUCTION

Empty bullet-related ocular injuries (EBOI) are rare and may result in unfavorable visual outcomes due to both open globe and closed globe injuries. To our knowledge, no reports of such injuries in terms of outcomes have been previously described in the literature. The aim of this study was to describe the treatment performed and ocular outcomes of such injuries.

MATERIALS AND METHODS

EBOI of 23 cases were reviewed who were referred to Gulhane School of Medicine Department of Ophthalmology between January 1998 and January 2018. Patient demographics, ocular signs (initial and final), injury types, type and number of interventions, and ocular trauma scores were recorded.

RESULTS

In total, 23 eyes of the 23 patients with an average age of 22.3 ± 4.54 years (range, 20-41 years) were included in the study. All of the patients were male, and all injuries were due to empty bullets during shooting training. None had ocular protection at the time of ocular injury. Fourteen patients (60.9%) were open globe injuries, whereas nine (39.1%) of them were closed globe injuries. Mean ocular trauma scores category of the cases was 2.52 ± 1.03. The baseline and final visual acuity was 20/200 or better in 21.7% and 69.5% of eyes, respectively. Nineteen eyes (82.7%) had undergone a total of 31 surgeries with a 1.34 ± 0.88 surgery average.

CONCLUSIONS

The prognosis of EBOI is unpredictable and is dependent on the severity of ocular damage. The best treatment option is prevention of EBOI with protective eyewear.

Paintball related ocular injuries: First case report in Saudi patients

Paintball is a popular recreational sport. This case series describes three Saudi patients exposed to paintball ocular injuries with sever ocular trauma. Two patients developed hyphema and traumatic cataract and one patient had vitreous hemorrhage, choroidal detachment, commotio retinae and retinal tear. All patients require surgical intervention. Final best corrected visual acuity was 20/200, 20/30 and 20/50 respectively. Paintball related ocular injuries can result in severe visual loss and in most of the time requires surgical intervention. Most injuries occur in under-supervised settings and are easily preventable. Our main aim was to increase awareness among local ophthalmologists and eye professionals about this new game. Improved safety measures and appropriate public education could prevent such serious ocular injuries.

Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012

PURPOSE

To identify epidemiologic trends in nonpowder gun-related pediatric eye injuries and to determine factors associated with severe injury requiring hospital admission.

METHODS

US emergency department data on pediatric eye injuries between 2002 and 2012 were reviewed using the National Electronic Injury Surveillance System. Literature review was conducted to determine trends in visual outcomes after treatment and use of eye protection.

RESULTS

In 2012 roughly 3,161 children were treated in US emergency departments for nonpowder gun-related eye injuries. Since 2010 rates of severe nonpowder gun pediatric eye injury have increased by over 500% (P = 0.039). Specifically, while rates of hospital admission due to paintball gun eye injury have dropped precipitously (P = 0.0077), rates of admissions for air gun eye injuries have increased by over 600% since 2010 (P = 0.033). Children sustaining eye injury due to air guns are more likely to be diagnosed and admitted with foreign body or ocular puncture injury. Roughly 28% of documented cases of airsoft or BB gun-related injury had visual acuity worse than 20/50 after initial treatment. Over 98% of injuries occurred without eye protection.

CONCLUSIONS

Air guns are rising in popularity and now account for the majority of pediatric eye injuries requiring hospital admissions. These eye injuries occur without ocular protection and may lead to permanent eye injury. Increasing regulations for eye protection, sales, and usage of air guns are needed to prevent serious pediatric eye injuries.

Corneal transparency: genesis, maintenance and dysfunction

Optimal vision is contingent upon transparency of the cornea. Corneal neovascularization, trauma and, surgical procedures such as photorefractive keratectomy and graft rejection after penetrating keratoplasty can lead to corneal opacification. In this article we identify the underlying basis of corneal transparency and factors that compromise the integrity of the cornea. With evidence from work on animal models and clinical studies, we explore the molecular mechanisms of both corneal avascularity and its dysfunction. We also seek to review therapeutic regimens that can safely salvage and restore corneal transparency.

Ocular findings following trauma from paintball sports

PURPOSE

To raise awareness of potential significant ocular damage and visual loss secondary to paintballs in those not wearing ocular protection and to report high incidence of chorioretinitis sclopetaria from paintball contusion.

METHODS

We reviewed cases of eye injury presenting to a single institution from 2000 to 2005. Those cases in which the injury was attributed to paintballs were identified and evaluated to determine ocular findings and visual prognosis.

RESULTS

Ocular paintball injuries occurred in eight male subjects and one female subject (nine eyes) with an average age of 16 years (range, 11-26). None had ocular protection at the time of ocular injury. On initial examination, vitreous haemorrhage was present in six eyes (67%), maculopathy, hyphema, cataract, and commotio retinae were each present in four eyes (44%). Two eyes suffered retinal detachment and one eye an optic nerve avulsion. Chorioretinitis sclopetaria occurred in four eyes (44%). The final visual acuity was > or =20/40 in three eyes, 20/50 to 20/150 in two eyes, and < or =20/200 in four eyes.

CONCLUSION

Injuries owing to paintballs can result in severe ocular damage and visual loss. Increased awareness and need for proper ocular protection should be emphasized by ophthalmologists. Chorioretinitis sclopetaria occurs with a high frequency and its presence should be recognized, as its management is different from retinal tear or detachment.

Circumstance and outcome of ocular paintball injuries

PURPOSE

To determine the circumstance and outcome of ocular injuries attributable to paintball projectiles.

DESIGN

Retrospective interventional case series.

METHODS

Institutional review board approved retrospective chart review of 19 consecutive eyes with paintball injuries with minimum follow-up of 3 months.

RESULTS

Ten eyes (53%) had final visual acuity of 20/40 or better, while seven (36%) were 20/200 or worse. Ten eyes were injured in paintball games, (two formal and eight informal), while nine (47%) were injured by accidents or assaults not associated with any "game."

CONCLUSIONS

Paintball injuries often cause severe and permanent visual loss. Nearly half of these injuries occur outside a war game setting as accidents or assaults.

The wandering eye: eye infection in the returning traveller

The eye may represent the presenting features of an illness in the returning traveller. In other patients it may serve as a useful marker of severity. Clinicians seeing this group of patients need to have an understanding of the ocular mainfestations of travel related illnesses. The article reviews the features of major imported infections such as malaria, dengue and brucella, in addition to other clinically important conditions that may present to ophthalmologists and travel health specialists.

Injuries from paintball game related activities in the United States, 1997-2001

OBJECTIVE

To quantify and characterize injuries resulting from paintball game related activities among persons >/=7 years in the United States.

SETTING

Hospitals included in the National Electronic Injury Surveillance System (NEISS); these are composed of a stratified probability sample of all hospitals in the United States with emergency departments.

METHODS

Using NEISS, non-fatal injury data for paintball game related injury cases from 1997-2001 were obtained from emergency department records. Participation estimates used to calculate injury rates were obtained from a yearly survey funded by the National Sporting Goods Association.

RESULTS

An estimated 11 998 persons >/=7 years with paintball game related injuries were treated in emergency departments from 1997-2001, with an annual average rate of 4.5 per 10 000 participants (95% confidence interval 3.3 to 5.7). The paintball game related injury rate was highest for 18-24 year olds (4.9 per 10 000 participants) and most injuries (94.0%) occurred among males. Almost 60% of all injured persons >/=7 years were treated for paintball pellet wounds of which most were to the eye. While 76.9% of injured persons ages 7-17 years were treated for paintball pellet wounds, almost 40% of those >/=18 years were treated for injuries resulting from overexertion or a fall. Lower extremity injuries were also common (23.0%), mostly from overexertion. Most injured persons (95.5%) were treated and released.

CONCLUSIONS

As paintball games become more popular, efforts are needed to increase training, enforce rules, and educate participants about how to stay safe, such as wearing protective eye gear, when engaged in paintball games at home, in a public area, or in a sports field.

Modern sports eye injuries

AIMS

To determine the severity and long term sequelae of eye injuries caused by modern sports that could be responsible for significant ocular trauma in the future.

METHODS

Prospective observational study of 24 (25 eyes) athletes with sports related ocular injuries from health clubs, war games, adventure, radical and new types of soccer, presenting to an eye emergency department between 1992 and 2002 (10 years).

RESULTS

Modern sports were responsible for 8.3% of the 288 total sports eye injuries reported. Squash (29.2%) was the most common cause, followed by paintball (20.8%) and motocross (16.6%). The most common diagnosis during the follow up period was retinal breaks (20%). 18 (75%) patients sustained a severe injury. The final visual acuity remained <20/100 in two paintball players.

CONCLUSIONS

Ocular injuries resulting from modern sports are often severe. Adequate instruction of the participants in the games, proper use of eye protectors, and a routine complete ophthalmological examination after an eye trauma should be mandatory.

Paintball injuries in children: more than meets the eye

OBJECTIVE

To describe the increasing incidence of ocular injuries in the pediatric population caused by paintballs. The awareness of this trend will help the physician who treats the child to give appropriate care as well as educate physicians, who counsel children, about this growing mechanism of pediatric injuries.

METHODS

Previously unpublished data from the US Consumer Product Safety Commission were analyzed to find the frequency of ocular injuries in children. A review of the English-language literature was also conducted to describe trends with regard to age, sex, location at the time of injury, use of eye protection, types of injuries sustained, and long-term visual outcome.

RESULTS

The incidence of paintball eye injuries treated in emergency departments has risen from an estimated 545 in 1998 to >1200 in 2000. The proportion of these injuries that occurred in the pediatric population may be well over 40%. These injuries are seen predominantly in boys, a growing proportion of whom are playing informally in unsupervised settings and not wearing eye protection. The cases previously reported include large numbers of hyphemas, retinal detachments, cataracts, corneal abrasions, vitreous hemorrhages, and commotio retina. Many of the patients in these cases sustained permanent visual impairment, with 43% having best vision at follow-up of 20/200 or worse.

CONCLUSIONS

Pediatric eye injuries caused by paintballs are an unrecognized cause of severe injury and permanent visual loss. The advances in eye protection for participants in "war games" have had little if any effect on the youngest population. Children and teens are unlikely to wear eye protection voluntarily when playing at undesignated or unsupervised locations. Changes should be made to restrict availability of these very dangerous but easily acquired guns and ammunition. Practitioners must counsel young people and their caregivers to avoid injuries by wearing appropriate eye protection. Parents should supervise the use of paintball equipment as they would other activities that involve high-speed projectiles.