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Kodali S, He CH, Patel S, Tao A, Szlechter M, Parsikia A, Mbekeani JN. Characteristics of ocular injuries associated with mortality in patients admitted with major trauma. BMC Ophthalmol 2024; 24:125. [PMID: 38504178 PMCID: PMC10949718 DOI: 10.1186/s12886-024-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries. METHODS A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05. RESULTS Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity. CONCLUSIONS Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.
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Affiliation(s)
- Sruthi Kodali
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Catherine H He
- Department of Ophthalmology & Visual Sciences, Yale School of Medicine, New Haven, Conn, USA
| | - Sheel Patel
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Alice Tao
- Department of Ophthalmology, Jamaica Hospital Medical Center, New York Medical College, Queens, NY, USA
| | - Moshe Szlechter
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA
| | - Afshin Parsikia
- Department of Research Services, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce N Mbekeani
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA.
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA.
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Dentel A, Boulanger E, Chapron T, Senicourt L, Metge F, Dureau P, Vignal-Clermont C, Caputo G, Martin GC. Incidence and Outcomes of Eye Trauma Associated With Recreative Use of Nonpowder Toy Guns: A 12-Year Retrospective Study. Am J Ophthalmol 2024; 265:73-79. [PMID: 38373584 DOI: 10.1016/j.ajo.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Nonpowder toy guns (NPTGs) are responsible for many ocular traumas. This study aims to detail the outcomes of these injuries depending on the causative NPTG. DESIGN Retrospective, observational case series. METHODS Cases of NPTG-associated ocular trauma managed in a Parisian eye emergency department between August 1, 2010, and January 1, 2023, were reviewed. The date of trauma, causative NPTG, patient demographics, initial and follow-up eye examinations, any surgical procedure, and visual outcomes for each ocular trauma were analyzed. RESULTS Over 12 years, NPTGs were responsible for 324 eye injuries and 980 visits. Patients were mostly male (77.5%), and mean age at trauma was 16.2 years. Foam bullets or foam dart blasters accounted for 54.9% of traumas and were mainly responsible for corneal injuries and hyphema (30.9% and 27%, respectively). BB guns and airsoft guns were frequently responsible for anterior segment lesions, as well as intravitreal hemorrhages (14.7%) and commotio retinae (21.1%). Paintball guns accounted for the largest proportion of posterior segment lesions (eg, intraretinal or subretinal hemorrhages leading to macular atrophy/contusion maculopathy), and one-third of casualties had undergone ocular surgery. Among all traumas, final visual acuity was lower than 20/200 in 6.5% of cases. Phthisis occurred in 8 cases: Two were related to foam bullets or foam dart blaster injuries (1 contusion and 1 rupture), 2 other cases followed a rupture due to BB guns/airsoft guns, 1 case occurred after a rupture related to a paintball gunshot, and 3 others were due to other types of compressed air guns (1 rupture, 1 intraocular foreign body, and 1 total retinal detachment). CONCLUSIONS NPTG-related ocular trauma outcomes differ according to the causative toy. Paintball guns and BB guns/airsoft gun-related traumas were more likely to be associated with severe lesions, but an increasing number of ocular injuries related to the use of foam bullets or foam dart blasters are reported in younger and younger children. Public health policies should promote the use of protective eyewear.
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Affiliation(s)
- Alexandre Dentel
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France (A.D., E.B., T.C., F.M., P.D., C.V.-C., G.C., G.C.M.); Institut de la Vision, INSERM, CNRS, Sorbonne Université, Paris, France (A.D.)
| | - Etienne Boulanger
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France (A.D., E.B., T.C., F.M., P.D., C.V.-C., G.C., G.C.M.)
| | - Thibaut Chapron
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France (A.D., E.B., T.C., F.M., P.D., C.V.-C., G.C., G.C.M.); Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France (T.C.)
| | - Lucile Senicourt
- Data Science Unit, Rothschild Foundation Hospital, Paris, France (L.S.)
| | - Florence Metge
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France (A.D., E.B., T.C., F.M., P.D., C.V.-C., G.C., G.C.M.)
| | - Pascal Dureau
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France (A.D., E.B., T.C., F.M., P.D., C.V.-C., G.C., G.C.M.)
| | - Catherine Vignal-Clermont
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France (A.D., E.B., T.C., F.M., P.D., C.V.-C., G.C., G.C.M.)
| | - Georges Caputo
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France (A.D., E.B., T.C., F.M., P.D., C.V.-C., G.C., G.C.M.)
| | - Gilles C Martin
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France (A.D., E.B., T.C., F.M., P.D., C.V.-C., G.C., G.C.M.).
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Shah FQ, Qureshi TS, Nawaz S, Kaushik M. Clinical spectrum and functional outcome of firearm pellet-related eye injuries: A prospective follow-up study. Injury 2022; 53:2998-3004. [PMID: 35691765 DOI: 10.1016/j.injury.2022.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the prognostic significance of various clinical features and surgical techniques concerning anatomical and visual outcomes in shotgun pellet-inflicted ocular trauma. METHODS This prospective follow-up study was done at a tertiary care institute in Kashmir, India. Six hundred sixty-four eyes of 643 patients with firearm pellet-related ocular trauma were followed up for 6 months. RESULTS Ocular injury involved one eye in 622 (96.7%) patients and both eyes in 21 (3.3%) patients. Open globe injury (OGI) occurred in 451 (67.9%) eyes with perforating injury being the commonest type (248 eyes, 54.9%). For perforating injuries, entry wounds in the cornea and limbus had the worst prognosis. Closed globe injury (CGI) occurred in 213 (32.1%) eyes. An anatomical success rate of 66.3% (n = 250) was achieved for 56.8% (377/664) eyes requiring an average of 2.8 (SD 0.5) surgeries per eye. OGI was associated with poor outcomes in 259 (57.4%) and CGI with good outcomes in 200 (93.9%) eyes. The visual outcome had a significant association with grade and zone of injury both in OGI and CGI, and with the type of injury in OGI (p < .0001 each). Ocular trauma score (OTS) had a significant association with the degree of vision impairment (p < .0001). WHO category 0 visual impairment was seen in 270 (40.7%) eyes, category 1 in 85 (12.8%), category 2 in 35 (5.3%), category 3 in 30 (4.5%), category 4 in 172 (25.9%), and category 5 in 72 (10.8%) eyes irrespective of type of injury at 6 months post-treatment. CONCLUSIONS The perforating injury was the commonest type of injury caused by shotgun pellets. The site of the entry wound in perforating injury had prognostic significance. The outcome was generally poor in OGI and good in CGI.
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Affiliation(s)
- Faisal Qayoom Shah
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Tariq Syed Qureshi
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shah Nawaz
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Madhurima Kaushik
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
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Zhou Y, Osuji E, Beal C. Ocular injury from plastic airsoft bullet through protective steel mesh mask. Am J Ophthalmol Case Rep 2022; 26:101567. [PMID: 35514802 PMCID: PMC9065884 DOI: 10.1016/j.ajoc.2022.101567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Yujia Zhou
- Corresponding author. 1185 SW 9th Rd, Gainesville, FL, 32601, United States.
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Guven S, Durukan AH. Empty Bullet-Related Ocular Injuries During Military Shooting Training: A 20-Year Review. Mil Med 2020; 185:e799-e803. [PMID: 31808913 DOI: 10.1093/milmed/usz400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Soner Guven
- Department of Ophthalmology, Kayseri City Hospital, Kayseri, Turkey
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Aldoais TM, Bamashmus MA, Aldubhani AN. Pediatric Ocular Trauma during Eid Festivities in Yemen. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:187-191. [PMID: 32495526 PMCID: PMC7269732 DOI: 10.3341/kjo.2019.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/19/2020] [Accepted: 02/14/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We sought to elucidate causes of ocular trauma in children younger than 17 years of age during the Eid festivities in Sana'a, Yemen. METHODS A prospective observational case series study was conducted in two tertiary emergency hospitals (Al-Thawra and Magrabi Hospital). The Eid Al-Fitr festive holidays in 2016 lasted 10 days from July 3 to 12. All children up to 17 years of age presenting with ocular trauma were included in the study. All patients underwent detailed history-taking and examination concerning ocular trauma. RESULTS One hundred sixty children presented to the two hospitals with ocular injury. All were males (100%). The mean ± standard deviation age was 9.59 ± 4.92 years (range, 4-15 years). The injury involved the right eye in 84 children (52.5%) and the left eye in 76 (47.5%) children. The majority of injuries (n = 152, 95.0%) had occurred in the street, while eight (5.0%) had happened at home. The most frequent cause of injury was toy guns and fireworks, while the most frequent findings were hyphema, corneal laceration, and corneal abrasion. CONCLUSIONS The causes of ocular injuries are diverse and tend to vary by geographical area. In particular, their incidence can increase during holidays, especially long ones. Usually, eye injuries with toy guns result in significant trauma that requires medical intervention and hospitalization with potential long-term eye complications. Public health workers need to conduct health education program to alert parents and health professionals to the danger of such toys.
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Affiliation(s)
- Tariek M Aldoais
- Ophthalmic Department, Al-Thawra Teaching Hospital, Sana'a, Yemen.,Pediatric Unit, Magrabi Eye Hospital, Sana'a, Yemen
| | - Mahfouth A Bamashmus
- Eye Department, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Amal N Aldubhani
- Pediatric Unit, Magrabi Eye Hospital, Sana'a, Yemen.,Eye Department, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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Hayes R, Dai S. Ocular injuries from gel blasters: not just a harmless toy. BMJ Case Rep 2019; 12:12/6/e229629. [DOI: 10.1136/bcr-2019-229629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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