Ophthalmic Casualties resulting from Air Raids

Aspects of ocular war injuries

Eye injuries are common in warfare with an incidence of approximately 10%. They carry a high morbidity, as they can determine an injured person’s future independence and employability. The majority are a combination of primary and secondary blast mechanisms, though tertiary and quaternary types are common. There is some evidence of quinary types from toxic elements from the explosion. Eye protection significantly reduces the incidence and severity of ballistic eye injury but does not eliminate it. Thermal ocular burns are relatively common in warfare. The treatment goal is to minimise limbal stem cell damage. Human amniotic membrane can be used to promote this. Retinal and optic nerve injury following closed eye trauma are currently untreatable, but neuroprotective and neuroregenerative agents are being developed to improve outcomes. Sensory substitution of the sense of touch for sight can help orientate blinded individual in their surroundings. Ophthalmology has a major impact on the lives of the war wounded.

The injured eye

Eye injuries come at a high cost to society and are avoidable. Ocular blast injuries can be primary, from the blast wave itself; secondary, from fragments carried by the blast wind; tertiary; due to structural collapse or being thrown against a fixed object; or quaternary, from burns and indirect injuries. Ballistic eye protection significantly reduces the incidence of eye injuries and should be encouraged from an early stage in Military training. Management of an injured eye requires meticulous history taking, evaluation of vision that measures the acuity and if there is a relative pupillary defect as well as careful inspection of the eyes, under anaesthetic if necessary. A lateral canthotomy with cantholysis should be performed immediately if there is a sight-threatening retrobulbar haemorrhage. Systemic antibiotics should be prescribed if there is a suspected penetrating or perforating injury. A ruptured globe should be protected by an eye shield. Primary repair of ruptured globes should be performed in a timely fashion. Secondary procedures will often be required at a later date to achieve sight preservation. A poor initial visual acuity is not a guarantee of a poor final result. The final result can be predicted after approximately 3-4 weeks. Future research in eye injuries attempts to reduce scarring and neuronal damage as well as to promote photoreceptor rescue, using post-transcriptional inhibition of cell death pathways and vaccination to promote neural recovery. Where the sight has been lost sensory substitution of a picture from a spectacle mounted video camera to the touch receptors of the tongue can be used to achieve appreciation of the outside world.