Airsoft gun-related ocular injuries: novel findings, ballistics investigation, and histopathologic study

Ocular injury from plastic airsoft bullet through protective steel mesh mask

The importance of protective eyewear during activities which involve high velocity projectiles is often emphasized to patients, however the material and design of such eyewear is also important. We present the case of a boy who sustained ocular injury from a plastic airsoft bullet while wearing a protective mask issued by the manufacturer. The patient was found to have decreased vision, a corneal abrasion and hyphema. The patient fully recovered with topical prednisolone, cyclopentolate, and moxifloxacin. It is important to advocate for using polycarbonate protective eye wear for our patients who are engaging in activities which involve high velocity projectiles.

Resolution of traumatic mydriasis and accommodative dysfunction eight years after sweetgum ball ocular injury

Purpose

Observations

Conclusion and Importance

Epidemiology of Ocular Injuries Related to Toy Guns in Pediatric Patients From 2000 to 2019

The popularity of toy guns among children is a growing public health concern due to reports of ocular injury. Most ocular injuries caused by toy guns occur in children younger than 10 years and at home. Dissemination of this information to parents and pediatricians is important to formulate safety measures. [J Pediatr Ophthalmol Strabismus. 2022;59(3):e29-e31.].

Creation of a New Explosive Injury Equipment to Induce a Rabbit Animal Model of Closed Globe Blast Injury via Gas Shock

To establish a rabbit animal model of closed globe blast injury with an application of self-developed explosive injury equipment, we tend to explore the anatomic and pathological changes of eyes under different gas pressure. The device comprises of high-pressure air source compression pump, air channel, and gas shock. There were 36 healthy bluish blue rabbits exposed to one of five blast pressures (500, 1,000, 1,500, 2,000, and 5,000 Kpa). Slit lamp microscope, B-mode ultrasonography, fundus photography, optical coherence tomography (OCT), and intraocular pressure (IOP) examination were performed at 0-, 1-, 3-, and 7-days post exposure, while gross histopathology was assessed with H&E stain at 7 days. The contralateral eyes and non-blast exposed rabbits were used as controls. Definitive evidence of closed globe blast injury was obtained. Corneal edema and hyphema were observed in the models under all pressures with no full-thickness globe injury, or lens rupture, as the severity was pressure independent. There was no obvious retinal abnormality on B ultrasound or OCT scan, while light vitreous hemorrhage, commotio retinae, and heavy retinal pigmentation presented on one eye, respectively, in the eyes exposed to 5,000 Kpa. Increased retinal thickness with disorganizations on the retinal ganglion cell (RGC) layer and RGC apoptosis in groups under higher pressure (>500 Kpa). IOP of injured eyes were statistically decreased at day 1 and 7 post injury (p < 0.05). Conclusively, the rabbit animal model induced by self-developed equipment could mimic the clinical features of closed ocular blast injury successfully that was feasible and easy to operate. This will be a new rabbit animal model for investigating mechanisms and new therapeutic interventions of closed globe blast injury in the future.

TRAUMATIC RETINAL DETACHMENT CAUSED BY NERF GUN SHOT IN A PEDIATRIC PATIENT

PURPOSE

To present a case of retinal detachment caused by a Nerf-gun shot in a pediatric patient.

METHODS

Single case report.

RESULTS

A 16-year-old white man presented with a nasal visual field deficit and floaters in his left eye for 1 month after being shot with a foam-ball Nerf gun by a friend. Fundus examination revealed a midperipheral retinal dialysis extending from 1 to 4:30 clock hours with a macula-on retinal detachment and superficial proliferative vitreoretinopathy. He underwent successful 25-gauge pars plana vitrectomy with membrane peel, retinectomy, injection of perfluoron, endolaser, and use of 1,000 centistoke silicone oil for tamponade.

CONCLUSION

This is the first reported case of traumatic retinal detachment secondary to a Nerf-gun shot.

Self-sealing posterior scleral perforation in airgun ocular trauma, surgical tip: a case report

Background

Intraorbital metallic foreign bodies have varied clinical presentations. Here, we report the unusual case of intraoperative evidence of spontaneously healed posterior scleral perforation in a severe ballistic trauma without previous instrumental signs of penetrating wound and complete visual restoration after surgery.

Case presentation

The patient was hit by several lead hunting pellets in the chest, abdomen, limbs, face and orbit. Computed Tomography (CT) images revealed the presence of a pellet within the orbitary cavity, close to the optic nerve, with no signs of penetrating ocular wound. While performing vitrectomy for severe vitreous hemorrhage, a point of strong adherence between a old hemorrhage and retinal surface was identified and managed conservatively, as it was attributed to trauma related-impact area. So, lead foreign body took an unusual trajectory impacting the globe and finally lodging back in the deep orbitary cavity, in absence of significant ocular injury and with visual prognosis preservation.

Conclusions

Our findings provide further information on orbital injuries from airguns, a theme of growing popularity and concern. Intraoperative recognition of hardly removable old hemorrhagic clot as self-blockage site of posterior scleral penetrating trauma, allowed for surgical stabilization and minimal solicitation of the area to avoid inadvertent perforation.

Gun-related eye injuries: A primer

Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.

Toy gun eye injuries - eye protection needed Helsinki ocular trauma study

PURPOSE

We report the epidemiology, findings, treatment, long-term outcome and use of resources for eye injuries caused by toy guns in southern Finland.

METHODS

All new patients injured by toy guns in one year (2011-2012) and treated at Helsinki University Eye Hospital were included. Follow-ups occurred at 3 months and 5 years.

RESULTS

Toy guns caused 15 eye traumas (1% of all eye traumas). Most patients were male (n = 14) and children aged under 16 years (n = 13). Toy guns involved were airsoft guns (n = 12), pea shooters (n = 2) and paintball (n = 1). Eleven patients did not use protective eyewear, and four patients discontinued their use during the game. Seven patients were not active participants in the game. Blunt ocular trauma was the primary diagnosis in 13 patients and corneal abrasion in two. Seven patients had retinal findings. In the 5-year follow-up, eight of 15 patients had abnormal ocular findings: three had artificial intraocular lens, two iridodialysis, and one each retinal plomb, mydriasis or iris tear. None had glaucoma. Seven patients had permanent subjective impairment due to pain, lowered visual acuity, blur or difficulty in focusing. Four patients needed seven operations. The number of outpatient visits was 90. One patient required hospitalization.

CONCLUSION

Toy guns cause serious eye traumas. No glaucoma was found. Proper use of toy guns and protective eyewear during the whole game should be emphasized to both players and bystanders. We recommend that in Finland the selling of airsoft guns be placed under the Firearms Act to make the hazards of airsoft guns known.

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.

PENETRATING INJURY FROM PLASTIC AIRSOFT PELLET SHOWS BEAM-HARDENING ARTIFACT ON COMPUTER TOMOGRAPHY

PURPOSE

To describe a case of left eye corneal perforation, cataract, hyphema, and intraocular foreign body after airsoft pellet injury.

METHODS

The authors reviewed the medical history and diagnostic imaging of a 12-year-old boy injured by a pellet from an airsoft gun. Typically, plastic airsoft pellets cause blunt trauma to the globe, which can lead to visual disability from corneal abrasion or hyphema. Initial computed tomography of the left orbit showed a 6.1 mm × 7.6-mm radiodense foreign body with beam-hardening artifact, a radiographic feature associated with metallic objects.

RESULTS

The patient was taken to the operating room for globe repair, lensectomy, vitrectomy, and removal of intraocular foreign body. The removed foreign body was a plastic airsoft pellet.

CONCLUSION

This is the first report of a plastic intraocular foreign body showing beam-hardening artifact. This finding may have implications in the diagnosis and management of retained intraocular or intraorbital plastic foreign bodies.

Airsoft gun-related ocular injuries: long-term follow-up

PURPOSE

To describe the long-term ocular effects of airsoft gun pellet injuries.

METHODS

The present study extends by 7-10 years the results of a 2010 study on the acute ocular findings related to airsoft gun pellet injuries in 59 patients, wherein we found a variety of anterior and posterior segment injuries, including hyphema (66%), corneal edema (61%), corneal erosions (59%), and traumatic mydriasis (25%), as well as retinal edema in (22%), retinal hemorrhages and mild vitreous hemorrhage in (2.1%), and, in 1 patient, elevated intraocular pressure and traumatic cataract.

RESULTS

Of the 59 patients in the original study, up-to-date medical records were available for 26 (44%; 20 males). The mean follow-up time was 8 years (range, 7.2-10.3 years); the mean age, 17.1 years. Persistent abnormal findings included traumatic cataract in 3 cases (11.5%) and iris dialysis in 1 case (3.8%). In all traumatic cataract cases, cataract was not present at the time of initial examination after injury. Final mean best-corrected visual acuity was 0.92 (range 0.67-1.0), logMAR 0.03 (range 0.18-0).

CONCLUSIONS

While most acute airsoft gun-related ocular injuries are transient, some patients may develop significant and potentially sight-threatening ocular damage, even in the absence of significant pathologic findings at the time of the injury. Long-term follow-up on these patients is advisable.

Pellet gun injury as a source of ocular trauma; a retrospective review of one hundred and eleven cases

Purpose

To report the demographic data, treatment methods, and outcomes among patients with pellet gun eye injuries.

Methods

This study was a retrospective review of all pellet gun eye injuries coming to Farabi Eye Hospital, a referral ocular trauma center in Iran, from February 2009 to November 2013. Patients' demographics, type of injury, choice of management, complications, and post-treatment visual acuity were recorded.

Results

One hundred eleven patients with a mean age of 25.7 ± 15.6 years entered the study. The most common age group was younger adults (16–45 years old) (61.3%). The mean uncorrected visual acuity after treatment was 2.05 (20/2240) ±1.5 logMAR. The most prevalent ocular zone was zone III (38.7%), and an intraocular foreign body was present in 97 patients (87.4%). Lid laceration and periocular tissue damage were present in 27 patients (24.3%). Lensectomy and vitrectomy were the most common treatment (31.5%). In most patients (87.4%), the injury was non-deliberate, and the most common time of hospitalization was the same day (45.0%). The only statistically significant indicator of post-treatment visual acuity was ocular trauma score (OTS) at admission (P < 0.001). At the end of follow-up, enucleation was performed for 20 patients (18%), and thirty-six patients (32%) had no light perception (NLP) in vision.

Conclusion

Pellet gun injuries were more common among young male patients, and the only statistically significant indicator of post-treatment visual acuity was OTS at admission.

The Spectrum of Pediatric Orbital BB Gun Injuries: A Case Series

Three cases of pediatric BB orbital injury are reported demonstrating varying outcomes. Pediatric orbital BB injuries have a wide spectrum of clinical outcomes depending on the ocular structures involved. Improved safety education of patients and parents is necessary to reduce the burden of these vision-threatening injuries.

Vitreoretinal surgery for shotgun eye injuries: outcomes and complications

PURPOSE

To analyse the postoperative anatomic and functional outcomes in addition to complications after vitreoretinal surgery for patients with shotgun eye injuries related to hunting accidents.

MATERIALS

Retrospective review of the clinical records of all cases of shotgun eye injuries presented between January 2000 and January 2011 and with a minimum follow-up of 1 year. Collection of demographics, type of injury, choice of management, complications and final surgical success with final visual acuity is reported.

RESULTS

Twenty eyes of 19 patients (all male) with a mean age of 36.1 years (range 16-60 years) were included in the study. Mean postoperative follow-up was 47.5 months (range 15-118 months). Best corrected visual acuity (BCVA) at presentation ranged from perception of light to 20/200. Ten eyes had a penetrating injury and 10 others had a perforating injury. All the eyes underwent an initial vitrectomy and the intraocular pellet was removed in all the 10 penetrating injuries. Concurrent cataract surgery was performed in 12 cases, internal tamponade was used in 15 cases and a supplemental encircling scleral buckle was inserted in 12 cases. One additional vitreoretinal surgery was required in seven cases (35%) and two additional surgeries required in two other cases (10%). At last follow-up BCVA ranged from NPL to 20/20 and was 20/100 or better in 10 eyes (50%). All patients had a flat retina except for two cases (10%) that developed severe proliferative vitreoretinopathy.

CONCLUSION

These results suggest that vitreoretinal surgery can offer good visual rehabilitation in patients with shotgun eye injuries.

Penetrating ocular trauma associated with blank cartridge

Background

Blank cartridge guns are generally regarded as being harmless and relative safe. However recent published articles demonstrated that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall, abdominal muscle, small intestine and the skull. And there has been a limited number of case reports of ocular trauma associated with blank cartridge injury. In addition, no report on case with split extraocular muscle injury with traumatic cataract and penetrating corneoscleral wound associated with blank cartridge has been previously documented. This report describes the case of patient who sustained penetrating ocular injury with extraocular muscle injury by a close-distance blank cartridge that required surgical intervention.

Case presentation

A 20-year-old man sustained a penetrating globe injury in the right eye while cleaning a blank cartridge pistol. His uncorrected visual acuity at presentation was hand motion and he had a flame burn of his right upper and lower lid with multiple missile wounds. On slit-lamp examination, there was a 12-mm laceration of conjunctiva along the 9 o'clock position with two pinhole-like penetrating injuries of cornea and sclera. There was also a 3-mm corneal laceration between 9 o'clock and 12 o'clock and the exposed lateral rectus muscle was split. Severe Descemet's membrane folding with stromal edema was observed, and numerous yellow, powder-like foreign bodies were impacted in the cornea. Layered anterior chamber bleeding with traumatic cataract was also noted. Transverse view of ultrasonography showed hyperechoic foreign bodies with mild reduplication echoes and shadowing. However, a computed tomographic scan using thin section did not reveal a radiopaque foreign body within the right globe.

Conclusion

To our best knowledge, this is the first case report of split extraocular muscle injury with traumatic cataract and penetrating ocular injury caused by blank cartridge injury. Intraocular foreign bodies undetectable by CT were identified by B-scan ultrasonography in our patient. This case highlights the importance of additional ultrasonography when evaluating severe ocular trauma. And ophthalmologists should consider the possibility of penetrating injury caused by blank ammunition.

[Contextual study of Airsoft gun related ocular injuries]

INTRODUCTION

Airsoft guns have become more common in France since the Decree of March 24, 1999, allowing people over 18 years of age to use weapons with an energy level below 2J. The present study aimed to assess the relationship between the context of Airsoft gun pellet related ocular injuries and their clinical consequences, in order to determine an effective prevention strategy.

METHODS

A retrospective analysis of ocular injuries due to Airsoft gun pellets was conducted in two hospitals in northern France between September 2009 and August 2010.

RESULTS

Six patients with a mean age of 12.6 ± 3.2 years were included. The most frequent injuries were corneal abrasion, hyphema and iris trauma. Functional sequelae were observed in 50% of cases and surgical intervention was necessary in one third of cases. A direct shot had occurred in all cases. In 83% of cases, the accident took place while playing in or around the house. In one out of every two cases, the gun had been won at a booth in a fair or had been purchased in a big-box store and in no cases did the patients own safety glasses.

CONCLUSION

The strong appeal of Airsoft guns to minors leads us to propose several practical measures to help protect them, with the main one being to forbid selling these guns outside of specialized stores.

Gunshot wound to the eye and orbit: a descriptive case series and literature review

BACKGROUND

The objective of this study is to report ocular and orbital findings in a series of six patients (8 eyes) with gunshot wounds and to review the literature on the pathophysiology, management, and outcome of such patients.

METHODS

Retrospective case series and review of the literature. Main outcome measures were ocular and orbital injury, surgical intervention, and presenting and final visual acuity.

RESULTS

Six male patients (mean age, 32 years) were enrolled. Three patients with globe concussion and low presenting visual acuity were treated by observation. Two patients (25%) underwent primary enucleation or evisceration. Retinal detachment developed in one patient who had a globe perforation, and he underwent vitrectomy and lensectomy with silicone oil injection. Visual acuity remained unchanged in all but one patient who underwent retinal detachment surgery. Final visual acuity was poor in all patients, with five eyes ending in no perception of light. Four patients had orbital fractures, two of whom underwent orbital reconstruction. One of these patients also underwent drainage of orbital abscess, eyelid surgery, and a dacryocystorhinostomy. The mean follow-up time was 26 months.

CONCLUSIONS

Gunshot wounds to the eye and orbit cause severe open and closed ocular injuries with guarded outcome and poor visual acuity. When feasible, initial wound closure may preserve the globe and allow further surgical rehabilitation. Primary evisceration may be required in cases of a severely ruptured globe. Orbital surgery may be needed in cases of infection, orbital wall disruption with disfigurement, or late enophthalmos.

Clinical presentation and outcome of perforating ocular injuries due to BB guns: a case series

PURPOSE

To describe the clinical presentations and treatment modalities of a series of BB gun-related perforating ocular injuries.

METHODS

Clinical records of all consecutive cases of perforating BB gun injuries to the globe seen between September 2004 and September 2008 were reviewed retrospectively. At the time of the trauma and after final treatment, all patients underwent a complete ocular examination, including visual acuity,applanation tonometry for intraocular pressure, slit lamp biomicroscopy, indirect ophthalmoscopy and fundus photography, if possible. In all cases, primary globe repair was performed in the first session, and then appropriate surgery took place based on the individual situation.

RESULTS

In this study, 13 patients (11 males and 2 females) with a mean age of 20.8 years (range 9–50 years) were enrolled. The mean follow-up period was 7.2 4.3 months (range 1–25 months). Initial visual acuity (VA) ranged from no-light perception (NLP) to finger counting (CF). Vitreous haemorrhage and retinal detachment were present in all involved eyes. Hyphema (30.76%), uveal and retinal prolapse (30.8%), retinalin carceration (30.8%) and retinal haemorrhage (53.8%) were other ocular findings. VA remained stable in 46.2% of the patients (6 cases). The best achieved final VA was CF at 2 min one case after 6 months follow-up.After several surgical procedures, enucleation was necessary in only 2/13 (15.4%) cases.

CONCLUSION

Despite several surgical procedures which decreased the number of enucleations, BB gunperforating ocular injuries still lead to a grim visual outcome. This implies the importance of political strategies targeting on education of parents and restriction for children to access to these guns.