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Fierz A. Risks and regulation of rubber scattershot in Switzerland: a narrative review. Eye (Lond) 2024:10.1038/s41433-024-03215-w. [PMID: 38977820 DOI: 10.1038/s41433-024-03215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
Multiple kinetic impact projectiles (KIPs) are responsible for most eye injuries by crowd-control weapons. This review aims to outline an underreported, ongoing series of eye injuries by rubber scattershot in Switzerland, and to relate current knowledge about thresholds for lasting visual loss to the energy limits set on KIPs in crowd control, by way of a retrospective compilation of cases from publicly available records and a review of the pertinent literature. Scattershot can cause irreversible visual loss. Since 1980, there have been 36 known cases of eye injuries by rubber pellets in Switzerland. In 2023, the incidence was higher here than at the peak of protests in France. KIPs were originally cleared for use in crowd control at kinetic and area-normalised energies assumed to lie below the threshold for ocular penetration. However, closed globe injuries suffice to cause permanent visual loss. Lower energy thresholds for lasting damage have been confirmed by the newer literature on paintballs, airbags, air guns and toys. These values may differ in vivo versus in vitro, and in humans versus in animals. There is no clear consensus on how best to predict loss of vision. Underreporting the risks of crowd-control weapons may contribute to their prolonged and increasingly liberal use. Regulations should consider what is known on energy thresholds for permanent visual loss. It is critical for ophthalmologists to be involved in the evaluation and monitoring of eye injuries caused by projectiles, including KIPs and toys. An interdisciplinary approach could help to elucidate damage thresholds.
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Affiliation(s)
- Anna Fierz
- Ophthalmologist in private practice, Kalkbreitestr. 8, 8003, Zürich, Switzerland.
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Simanjuntak GW, Raju B, Simanjuntak GA, Natali R. Outcome of Primary Management of Scleral Rupture without Vitrectomy Jakarta Eye Trauma Study. Open Ophthalmol J 2022. [DOI: 10.2174/18743641-v16-e2207220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
To report the outcome of primary management of scleral rupture without vitrectomy.
Methods:
Descriptive retrospective study of primary surgical management of scleral rupture located anterior to the equator. Initial and final visual acuity (FVA, intra ocular pressure, type of injury (sharp/blunt/projectile), wound length, time interval between the incident and primary repair and cause of injury were recorded. Encircling scleral buckle was placed in case of scleral laceration reaching muscle insertion. Patients who had a follow up of 3 months after the primary repair were included in the study .
Results:
There were 41 patients out of 78 who had scleral rupture anterior to the equator. The average age was 21.27 + 9.73 years (range 3-50 years). Thirty-three (80.4%) were males and eight (19.6%) were females. Rupture was located superiorly) in 28 (68.3%) patients, and inferiorly in 13 (31.7%) patients. Eight patients underwent encircling buckle. The time interval from the injury till the primary repair less than 8 hours (p 0.000) and 8-24 hours (p 0.000) were associated significantly with FVA improvements. Initial VA correlated with FVA improvement significantly (p 0.001). Two patients with initial VA of LP became NLP, and they had a wound length 11 mm and 12 mm respectively.
Conclusion:
The primary management of scleral rupture anterior to the equator, without vitrectomy, improves VA significantly. Time interval less than 24 hours and shorter wound length correlated with significant improvement of final VA.
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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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El Zahran T, Mostafa H, Hamade H, Mneimneh Z, Kazzi Z, El Sayed MJ. Riot-related injuries managed at a hospital in Beirut, Lebanon. Am J Emerg Med 2021; 42:55-59. [PMID: 33453616 DOI: 10.1016/j.ajem.2020.12.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/05/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Between October 2019 and February 2020, massive crowds protested in Lebanon against economic collapse. Various less than lethal weapons including riot control agents and rubber bullets were used by law enforcement, which led to several traumatic and chemical injuries among victims. This study describes the clinical presentation, management, outcome, and healthcare costs of injuries. METHODS A retrospective review of the hospital records of all the casualties presenting to the Emergency Department of the American University of Beirut Medical Center between October 17th, 2019, and February 29th, 2020, was conducted. RESULTS A total of 313 casualties were evaluated in the ED, with a mean age of 30.2 +/- 9.6 years and a predominance of males (91.1%). Most were protestors (71.9%) and arrived through EMS (43.5%) at an influx rate of one patient presenting every 2.7-8 min. Most patients (91.1%) presented with an Emergency Severity Index of 3. Most patients (77.6%) required imaging with 10% having major findings including fractures and hemorrhages. Stones, rocks, and tear gas canisters (30.7%) were the most common mechanism of injury. Musculoskeletal injuries were most common (62.6%), followed by lacerations (44.7%). The majority (93.3%) were treated and discharged home and 3.2% required hospital admission, with 2.6% requiring surgery. CONCLUSION Less-than-lethal weapons can cause severe injuries and permanent morbidity. The use of riot control agents needs to be better controlled, and users need to be well trained in order to avoid misuse and to lessen the morbidity, mortality, and financial burden.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Hala Mostafa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Hamade
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Mneimneh
- Quality Accreditation and Risk Management Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - Mazen J El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Rodríguez Á, Peña S, Cavieres I, Vergara MJ, Pérez M, Campos M, Peredo D, Jorquera P, Palma R, Cortés D, López M, Morales S. Ocular trauma by kinetic impact projectiles during civil unrest in Chile. Eye (Lond) 2020; 35:1666-1672. [PMID: 32839560 PMCID: PMC7443815 DOI: 10.1038/s41433-020-01146-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/17/2020] [Accepted: 08/12/2020] [Indexed: 11/09/2022] Open
Abstract
Background The use of kinetic impact projectiles (KIPs) for crowd-control has increased worldwide. Despite having been created as non-lethal weapons, significant damage to several organs, including the eye, has been reported. In this study, we investigated cases of ocular trauma from KIPs during the civil unrest in Chile. To our knowledge, this is the largest case series recorded in international literature. Methods We included all patients who sought care or were referred to the Eye Trauma Unit, a national referral centre in Santiago, Chile, during the civil unrest from October 18 to November 30, 2019. We reviewed paper medical records and extracted data on suspected cause of trauma, type of trauma, visual acuity and sociodemographic data. Results We included 259 patients, out of which in 182 cases (70.5%) KIPs were the suspected cause. Cases by KIPs were predominantly male (86.6%), young (median age 26.3, interquartile range 22.0–31.4) and living in the Metropolitan Region. Eighty-nine patients (48.9%) had severe visual impairment or were blind at the first examination. The trauma was an open-globe injury in 20.3% of cases and 13 cases required evisceration of the ocular content. Compared to other causes of ocular trauma, KIPs were related to a more severe loss of visual acuity and a higher frequency of open-globe injuries. Conclusions The use of KIPs during a period of civil unrest in Chile resulted in severe ocular trauma, visual impairment and permanent disability. KIPs should be avoided as a method of crowd-control.
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Affiliation(s)
- Álvaro Rodríguez
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile.
| | - Sebastián Peña
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland.,Facultad de Medicina, University Diego Portales, Ejército 233, Santiago, Chile
| | - Isabel Cavieres
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - María José Vergara
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Marcela Pérez
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Miguel Campos
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Daniel Peredo
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Patricio Jorquera
- Department of Mechanical Engineering, Faculty of Engineering, University of Chile, Blanco Encalada 2002, Santiago, Chile
| | - Rodrigo Palma
- Department of Mechanical Engineering, Faculty of Engineering, University of Chile, Blanco Encalada 2002, Santiago, Chile
| | - Dennis Cortés
- Department of Ophthalmology, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4686, Santiago, Chile
| | - Mauricio López
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Sergio Morales
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
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Haar RJ, Iacopino V, Ranadive N, Dandu M, Weiser SD. Death, injury and disability from kinetic impact projectiles in crowd-control settings: a systematic review. BMJ Open 2017; 7:e018154. [PMID: 29255079 PMCID: PMC5736036 DOI: 10.1136/bmjopen-2017-018154] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE We conducted a systematic review of the available literature on deaths, injuries and permanent disability from rubber and plastic bullets, as well as from bean bag rounds, shot pellets and other projectiles used in arrests, protests and other contexts from 1 January 1990 until 1 June 2017. DATA SOURCES PubMed, Scopus, JSTOR and grey literature. DATA SYNTHESIS We report on descriptive statistics as well as data on injury severity, permanent disability and death. We analysed potential risk factors for injury severity, including the site of impact, firing distance and access to medical care. RESULTS Of 3228 identified articles, 26 articles met inclusion criteria. These articles included injury data on 1984 people, 53 of whom died as a result of their injuries. 300 people suffered permanent disability. Deaths and permanent disability often resulted from strikes to the head and neck (49.1% of deaths and 82.6% of permanent disabilities). Of the 2135 injuries in those who survived their injuries, 71% were severe, injuries to the skin and to the extremities were most frequent. Anatomical site of impact, firing distance and timely access to medical care were correlated with injury severity and risk of disability. CONCLUSIONS Kinetic impact projectiles (KIPs), often called rubber or plastic bullets, are used commonly in crowd-control settings. We find that these projectiles have caused significant morbidity and mortality during the past 27 years, much of it from penetrative injuries and head, neck and torso trauma. Given their inherent inaccuracy, potential for misuse and associated health consequences of severe injury, disability and death, KIPs do not appear to be appropriate weapons for use in crowd-control settings. There is an urgent need to establish international guidelines on the use of crowd-control weapons to prevent unnecessary injuries and deaths.
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Affiliation(s)
- Rohini J Haar
- School of Public Health, Division of Epidemiology, University of California, Berkeley, California, USA
| | | | | | - Madhavi Dandu
- Department of Medicine, University of California, San Francisco, California, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
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Haar RJ, Iacopino V, Ranadive N, Weiser SD, Dandu M. Health impacts of chemical irritants used for crowd control: a systematic review of the injuries and deaths caused by tear gas and pepper spray. BMC Public Health 2017; 17:831. [PMID: 29052530 PMCID: PMC5649076 DOI: 10.1186/s12889-017-4814-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/03/2017] [Indexed: 11/30/2022] Open
Abstract
Background Chemical irritants used in crowd control, such as tear gases and pepper sprays, are generally considered to be safe and to cause only transient pain and lacrimation. However, there are numerous reports that use and misuse of these chemicals may cause serious injuries. We aimed to review documented injuries from chemical irritants to better understand the morbidity and mortality associated with these weapons. Methods We conducted a systematic review using PRISMA guidelines to identify injuries, permanent disabilities, and deaths from chemical irritants worldwide between January 1, 1990 and March 15, 2015. We reviewed injuries to different body systems, injury severity, and potential risk factors for injury severity. We also assessed region, context and quality of each included article. Results We identified 31 studies from 11 countries. These reported on 5131 people who suffered injuries, two of whom died and 58 of whom suffered permanent disabilities. Out of 9261 total injuries, 8.7% were severe and required professional medical management, while 17% were moderate and 74.3% were minor. Severe injuries occurred to all body systems, with the majority of injuries impacting the skin and eyes. Projectile munition trauma caused 231 projectile injuries, with 63 (27%) severe injuries, including major head injury and vision loss. Potentiating factors for more severe injury included environmental conditions, prolonged exposure time, and higher quantities of chemical agent in enclosed spaces. Conclusions Although chemical weapons may have a limited role in crowd control, our findings demonstrate that they have significant potential for misuse, leading to unnecessary morbidity and mortality. A nuanced understanding of the health impacts of chemical weapons and mitigating factors is imperative to avoiding indiscriminate use of chemical weapons and associated health consequences.
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Affiliation(s)
- Rohini J Haar
- University of California, 3136 College Avenue, Berkeley, CA, 94705, USA.
| | - Vincent Iacopino
- Physicians for Human Rights, 256 W 38th Street, 9th Floor, New York, NY, 10018, USA
| | - Nikhil Ranadive
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, 533 Parnassus, Box 1031, San Francisco, CA, 94143, USA
| | - Madhavi Dandu
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, 533 Parnassus, Box 1031, San Francisco, CA, 94143, USA
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Mansouri MR, Tabatabaei SA, Soleimani M, Kiarudi MY, Molaei S, Rouzbahani M, Mireshghi M, Zaeferani M, Ghasempour M. Ocular trauma treated with pars plana vitrectomy: early outcome report. Int J Ophthalmol 2016; 9:738-42. [PMID: 27275432 DOI: 10.18240/ijo.2016.05.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/20/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate demographic variables and visual outcomes, among patients with ocular injuries involving the posterior segment, managed with pars plana vitrectomy. METHODS The records of patients were studied retrospectively from March to September 2010, to determine the age, gender, place of occurrence of trauma, visual acuity, anatomical site, nature of injury, wound length, the presence of an afferent pupillary defect, and the timing of vitrectomy. The Ocular Trauma Score was measured. The minimum follow-up from presentation was 6mo. RESULTS Ninety patients (77 males, 13 females), with a mean age of 32.7±15.8y were included over the 6-month period. The majority of cases occurred in the workplace (47 patients), followed by home (14 patients). The mean visual acuity (logMAR) of patients significantly improved from 2.36±0.72 preoperatively to 1.50±1.14 postoperatively. Twenty-three patients had preoperative vision better than 2.0 logMAR, the postoperative visual acuity was significantly better among these patients than patients with worse than 2.0 logMAR (P<0.001). Visual improvement between groups with early vitrectomy (<7d) and delayed vitrectomy (>7d) was not significantly different (P=0.66). Postoperative visual acuity was not significantly different between patients with injury in Zone I and II (P=0.64), but patients with injury in Zone III had significantly poorer visual acuity (P=0.02). Patients with relative afferent pupillary defect had significantly poorer postoperative visual acuity (P=0.02). Preoperative visual acuity, the difference of preoperative and postoperative visual acuity, and postoperative visual acuity were significantly different between groups with different ocular trauma scores (P<0.001). CONCLUSION Trauma is more likely to occur in men under 40y of age and in the workplace. The favorable final visual outcome is associated with the absence of afferent pupillary defect, ocular trauma score and presenting visual acuity as well as the zone of injury, and not associated with the timing of vitrectomy.
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Affiliation(s)
- Mohammad Reza Mansouri
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Seyed Ali Tabatabaei
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mohammad Soleimani
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mohammad Yaser Kiarudi
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Saber Molaei
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mehdi Rouzbahani
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Meysam Mireshghi
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mohsen Zaeferani
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mehrbod Ghasempour
- Department of Ocular Trauma and Emergency, Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
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