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Hunold T, Wittschieber D, Ortmann C, Niederegger S, Eckardt N, Mall G, Muggenthaler H. Blunt force trauma and blast injuries to head and chest caused by a potent pyrotechnic device: a case report. Int J Legal Med 2024; 138:295-299. [PMID: 36609734 PMCID: PMC9823255 DOI: 10.1007/s00414-022-02943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
In times of peace and except for terrorist attacks, fatalities by explosions are rare. Fireworks have deadly potential, especially self-made or illegally acquired devices. The use of professional pyrotechnics by untrained persons poses a life-threatening hazard. We present a case of devastating blunt force and blast injuries to the head and chest of a young man. After ignition of a display shell (syn. a real shell or mortar shell) without the use of a launching pipe, the device hit the man's face, nearly simultaneously followed by the explosion of the burst charge. The autopsy revealed injuries to the face and forehead as well as extensive tissue structure damage and a massive contusion with a bloody edema of the lungs. Autopsy results are supplemented with CT imaging and 3D reconstruction of the fractured mid face, as well as histological and toxicological examinations. This case of a misused display shell demonstrates both its devastating destructive potential and the corresponding and rarely observed injury pattern.
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Affiliation(s)
- Thomas Hunold
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Daniel Wittschieber
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Christian Ortmann
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Senta Niederegger
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Niklas Eckardt
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Gita Mall
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Holger Muggenthaler
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Changing Trends in Firework-Related Eye Injuries in Southern China: A 5-Year Retrospective Study of 468 Cases. J Ophthalmol 2020; 2020:6194519. [PMID: 32832138 PMCID: PMC7428839 DOI: 10.1155/2020/6194519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Firework-related eye injury is a horrible medical problem and creates huge health and social burdens. Herein, we explored the changing trends and demographic and clinical features of firework-related eye injury, in an effort to inform strategies to prevent this injury. We reviewed the data of 468 hospitalized patients who underwent surgery for firework-related eye injury at the Zhongshan Ophthalmic Center between January 2013 and December 2017. During this period, the trend in firework-related eye injuries was stable (mean, 93 ± 14 cases per year), and fireworks were the major cause of explosive eye injury. The average age of the patients was 24 ± 18 years and 87% of the patients were male, with boys under 10 years of age comprising the largest group (27% of patients). There were an average of 24 ± 7 cases per year from urban areas and 70 ± 8 cases from rural areas (P < 0.05). Furthermore, 21 ± 5% of cases occurred during Spring Festival. After treatment, the best corrected visual acuity was increased compared to that before treatment, and the intraocular pressure tended to become normal by the final visit (P < 0.05). The top three diagnoses were cataract (39%), retinal detachment (18%), and choroidal detachment (14%). Additionally, the most common surgery was cataract extraction (25%), followed by pars plana vitrectomy (19%) and pars plana vitrectomy plus pars plana lensectomy (10%). Over the five-year study period, day surgery hospitalization increased from 1% to 32%. This was associated with a corresponding decrease in the length of hospitalization, without adverse events, demonstrating that day surgery is feasible in firework-related eye injury cases. The present study results suggest that greater attention should be paid to firework-related eye injury, and a variety of measures should be taken to prevent this kind of ocular tragedy.
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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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Diagnostik und Akuttherapie von Augenverletzungen durch Feuerwerkskörper. Ophthalmologe 2019; 116:1152-1161. [DOI: 10.1007/s00347-019-01000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mittelviefhaus H, Lang S, Auw-Hädrich C. [Surgical management of firework-induced eyelid injuries]. Ophthalmologe 2019; 116:1162-1170. [PMID: 31713068 DOI: 10.1007/s00347-019-00999-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fireworks injuries are frequently caused by malfunction or incorrect operation of fireworks. Injuries often affect the eyeball and the periorbit. After treatment of life-threatening bleeding, injuries of the eyeball have priority over the treatment of periorbital lacerations and burns. The aim of eyelid surgery in firework-related injuries is to prevent delayed damage, such as lagophthalmos, symblepharon, entropion with trichiasis, and keratinization of the conjunctiva of the eyelid and eyelid margin. The treatment requires a considerable amount of time and patience both for the elaborate surgical procedures as well as for the necessary healing and rest phases. Many patients, however, are left with serious visual impairments and stressful esthetic deformities, which result in considerable occupational and social impairments.
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Affiliation(s)
- H Mittelviefhaus
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Deutschland.
| | - S Lang
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Deutschland
| | - C Auw-Hädrich
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Deutschland
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Gabel-Pfisterer A, Böhringer D, Agostini H. [3-year results of the German nationwide survey on eye injuries caused by fireworks]. Ophthalmologe 2019; 116:1138-1151. [PMID: 31659430 DOI: 10.1007/s00347-019-00967-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND On festive days worldwide eyes are severely injured by fireworks. The data on the number and severity are to date not registered in Germany. OBJECTIVE How frequent are firework-induced injuries in Germany, who are the affected, how serious are the injuries, which forms of treatment are necessary and how frequent are accompanying injuries? METHOD A German nationwide online-based survey was carried out in all inpatient eye departments and data over the last 3 consecutive years were descriptively analyzed. RESULTS From New Years Eve 2016/2017, when 41 eye departments sent in data, the participation could be increased to 51 eye departments in 2018/2019. More than one third (33-39%) of all 1356 patients over 3 years were minors, 60% were younger than 25 years old and roughly 60% of patients were injured as bystanders or in an unclear situation. In total 25% of all eye injuries were considered severe and required inpatient treatment. Accompanying injuries of the other eye, the face and hands were more frequent in minors than in adults. Eyeball ruptures were reported in 10 minors and 38 adults over the 3 years. CONCLUSION Particularly minors and bystanders need better protection.
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Affiliation(s)
- A Gabel-Pfisterer
- Augenklinik, Klinikum Ernst-von-Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland.
| | - D Böhringer
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland
| | - H Agostini
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland
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Huth A, Löffler L, Viestenz A. Feuerwerksverletzungen am Auge in den letzten 11 Jahren. Ophthalmologe 2019; 116:1171-1176. [DOI: 10.1007/s00347-019-0941-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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