33 cases of airsoft gun pellet ocular injuries in Copenhagen, Denmark, 1998-2002

Ocular trauma in the pediatric age group: a systematic review

Background

Ocular traumas are the leading cause of acquired unilateral blindness in the pediatric age group. The aim of this study is to determine the incidence of pediatric ocular injuries, the etiological factors that cause them, and to make some preventive recommendations.

Methods

This was a retrospective observational study of pediatric ocular trauma (age < 18 years) presented to the pediatric emergency unit of our tertiary university hospital between January 2016 and December 2020. Demographic data such as age, gender, season, duration of admission, trauma etiology, and type of injury were recorded. Patients with missing medical records were excluded from the study.

Results

Two hundred two patients aged a mean of 107.4 ± 40.7 months including 87 females (43.07%) and 115 males (56.93%) were included in the study. Most of the patients (n = 135, 66.83%) were in the 7–11 years of age group. The vast majority of the study population lived in the urban area (n = 119, 58.91%). Most injuries were seen in the summer (n = 108, 53.47%). 59.41% of all patients had closed globe injuries. Hyphema (32.5%) and endophthalmitis (26.6%) were the most common in closed globe injuries. Of the open globe injuries, 39 were penetrating (47.5%), 12 were perforated (14.6%), and 23 were intraocular foreign body injuries (28%). It was determined that the places where the injury occurred were mostly in situations where family control was reduced, such as weddings, holidays, and playgrounds (80.69%). The most common causes of injury were toy guns (35.15%), stones (28.71%), and fireworks (16.34%).

Conclusion

This analysis is the first study to provide data on childhood ocular trauma in Aksaray. Most of the childhood ocular injuries can be prevented with simple precautions. For this purpose, effective and preventive strategies should be developed such as raising public awareness, providing parental control, and early intervention.

Clinical Profile, Etiology, and Management Outcomes of Pediatric Ocular Trauma in Saudi Arabia

OBJECTIVE

To evaluate cases of pediatric ocular trauma at a tertiary eye hospital in central Saudi Arabia and determine the demographics, causes, ocular injuries, and visual status before and after management.

METHODS

A retrospective review was performed of health records of children younger than 16 years with ocular trauma managed from January 1998 to December 2019. Data were collected on patient demographics, eye involved, cause of trauma, the presenting and final vision, and the duration of follow-up. Best-corrected visual acuity at the last follow-up was compared between open and closed eye injury groups. The Birmingham Eye Trauma Terminology was used to classify the ocular injuries.

RESULTS

Among 1003 patients, 728 (72.6%) had open globe and 275 (27.4%) had closed globe injuries. The main causes of trauma were unsafe playing-related activities (n = 394; 39.3%), unsafe home environment (n = 158;15.8%) and injury by metallic objects (n = 166; 16.6%). Gunshot-related ocular trauma was noted in 62 (6.2%) children. Presenting vision less than 20/400 was noted in 292 (40.1%) eyes with open globe injuries and 110 (40%) eyes with closed globe injuries (P = 0.4). After a median follow-up of 13.3 months, best-corrected visual acuity was 20/20 to 20/200 in 393 (53%) eyes with open globe injuries and 137 (49.8%) eyes with closed globe injuries (P = 0.03).

CONCLUSIONS

Despite proper management, children in this study sustained significant permanent visual loss secondary to ocular trauma. Public health efforts in Saudi Arabia are needed to reduce preventable injury-related childhood blindness.

A series of 777 pellet gun ocular injuries over a 4-month period in Kashmir

Purpose

To examine the incidence, clinical findings and management of pellet gun-related ocular injuries that occurred during protests in Kashmir region.

Methods

This retrospective study included records from 777 patients diagnosed with pellet gun-related ocular injuries admitted to a tertiary hospital in Srinagar, India, between July and November 2016. By reviewing the clinical records, the following data were collected: demographics, clinical information pertaining to the injury, imaging reports including computer tomography and ultrasonography B-scan, management in the emergency setting, and follow-up treatment.

Results

Mean age was 22.3 ± 7.2 years and majority patients were male (97.7%). In terms of laterality, 94.3% and 5.7% of the patients sustained monocular and binocular injuries, respectively. In terms of the nature of injury, 76.3% of the eyes had open globe injury while 23.7% of the eyes had closed eye injury. Emergency surgical exploration was performed in 67.7% of closed globe injuries while emergency primary repair was done in 91.1% of open globe injuries. The vast majority of patients (98.7%) who required surgery underwent surgical intervention on the day of admission or the next day. Final best-corrected visual acuity (BCVA) after treatment was counting fingers or worse in 82.4% of the eyes.

Conclusion

Pellet gun-related ocular injuries resulted in significant ocular morbidity, mostly manifesting as open globe injuries. Treatment often required surgical interventions, but despite expeditious management, visual prognosis remained poor for most of the patients.

Impact of Value Co-Creation on International Customer Satisfaction in the Airsoft Industry: Does Country of Origin Matter?

The paper’s objective is to investigate the impact of value proposition co-creation on international customer satisfaction in the airsoft industry. This empirical paper aims at answering a question “Which factors influence satisfaction of the international customers involved in the process of value co-creation in the airsoft industry” and sets a hypothesis that value co-creators’ country of origin has a positive impact on customers’ satisfaction. A case study approach of an entrepreneurial company (GATE) was supplemented with data collected via a survey (n = 176), where consumers’ perception of the firm’s value proposition and its influence on their satisfaction were investigated. The study contributes to the value creation theory by identifying the main factors influencing customer satisfaction in the airsoft industry and verifying whether the co-creators’ origin affects the factors’ ratings. The results indicate that the most crucial factors influencing international customer satisfaction in this industry are quality level and product functionality and that the country of origin of customers has no significant impact on international customer satisfaction.

Pediatric Ocular Trauma during Eid Festivities in Yemen

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.

Alles nur Spielzeug? Eine Untersuchung verschiedener Geschossspielzeuge hinsichtlich ihres Gefahrenpotenzials

Geschossspielzeuge wie die der Marke Nerf werden von der Allgemeinheit zumeist als harmlos und ungefährlich angesehen. In den letzten Jahren wurden die bunten Waffen ständig weiterentwickelt und verschießen mittlerweile Projektile mit Geschwindigkeiten von deutlich über 100 km/h. Unlängst wurde von Augenverletzungen im Zusammenhang mit Geschossspielzeugen dieser Art berichtet. Eine Untersuchung verschiedener auf dem Markt erhältlicher Modelle hinsichtlich ihrer ballistischen Eigenschaften sollte Aufschluss darüber geben, welche Gefahr von ihnen ausgeht. Sowohl die im Versuch ermittelten kinetischen Energien und Kontaktflächen der Geschosse als auch die ungleichmäßige Verteilung des Drucks beim Auftreffen lassen darauf schließen, dass Augenverletzungen im Umgang mit Geschossspielzeugen nicht auszuschließen sind.

Percutaneous removal of air-bullet gunshot: case report and literature review

Background

Cardiac air bullet injuries are rare but can be associated with significant morbidity and mortality.

Case presentation

We are presenting a young male child who sustained an accidental injury to the chest by an air rifle. Bullet entered the right ventricle from the anterior part of the chest and was identified in the RV side of the interventricular septum by echocardiography and chest CT scan. There was mild pericardial effusion but no valvular injury. The bullet was removed in the cath lab, and the patient was discharged home on the second day.

Conclusions

It is reasonable to try foreign body removal in the cath lab, for certain cases, and avoid cardiac surgery.

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.

Removal of large foreign bodies made of thermoplastic material from the eye

PURPOSE

To present the results of research aimed at developing a new method of minimally invasive removal of an intraocular foreign body (IOFB) from the eye cavity.

METHODS

The main idea was to fix the IOFB onto the edge of a laser probe, which is transsclerally injected into the eye. After that, the IOFB is fixed at the end of the laser probe and removed transpupillary from the eye through an incision in the cornea. In order to fix the IOFB on the laser probe edge, this edge should be brought closely to the IOFB surface. The material of the IOFB should be locally fused using the laser emission. During this process, the probe edge should be submerged into the liquid melt. After laser emission is turned off, the material around the probe is hardened and the IOFB is hardly fixed on the laser probe edge.

RESULTS AND CONCLUSIONS

The main laser emission parameters and their influence on the eye tissue were investigated within a thermodynamic model. It is shown that for IOFB made from polyethylene terephthalate the optimal laser power is close to 2 W, the rate of rise of light energy is more than 10 ms, and the wavelength is approximately 0.905 μm. With these parameters (taking into account multiple scattering effects), the light impact on the retina will not exceed 100 mW/cm2, which is not dangerous for eye tissue. Efficiency is supported by clinical testing. The method was used for intraocular extraction of an Airsoft ball bearing (6 mm sphere of polyethylene terephthalate).The overall extraction time was approximately 4 minutes.

Paediatric eye injuries in Finland - Helsinki eye trauma study

PURPOSE

To determine the current population-based epidemiology, treatment, use of resources and outcomes of children's eye injuries in Finland.

METHODS

The study included all new patients, 16 years of age or under, with ocular or orbital traumas taken into care to the Helsinki University Eye Hospital (population base 1.5 million people) in 1 year. The follow-up period was 3 months.

RESULTS

Two hundred and two children's eye injuries were treated. The eye injury incidence was 5.2-8.3 per 10 000 per year, including all minor and major eye traumas. Eye injury most likely occurred at the junior high school age (13-16 years). Thirty-three percentage of accidents took place at home and 24% at school or in day care. The most common causes were sports equipment (15%), contact with human body (12%) and superficial foreign bodies (11%). Excluding minor injuries, contusion was the most common diagnosis (n = 60, 30%). Eighty-seven percentage of contusion patients were estimated to need lifelong follow-up due to elevated glaucoma risk. Nine percentage of all patients had a permanent disability. Guns, fireworks, tools and pellet guns were relatively the most dangerous objects. Pellet guns caused 6% of eye injuries, 36% of them causing permanent impairment. The number of outpatient visits was altogether 443, inpatient days were 49, and 60 children had major surgeries.

CONCLUSIONS

Use of protective eyewear would have prevented or diminished eye traumas caused by pellet gun, floorball, most of the firework and in many superficial foreign body. The use of pellet guns and protective eyewear should be more supervised. Fireworks and tools are not suitable toys for children.

Ocular traumas in working age adults in Finland - Helsinki Ocular Trauma Study

PURPOSE

To describe epidemiology, causes, treatments and outcomes of ocular injuries in adults aged 17 to 60 in southern Finland.

METHODS

All new ocular trauma patients admitted to the Helsinki University Eye Hospital (HUEH), during 1 year in 2011-2012. The data were from hospital records and prospectively from patient questionnaires. The follow-up time was 3 months.

RESULTS

The incidence for ocular injury was 88/100 000/year. From 831 trauma patients, 80% were men, 34% were work-related injuries, and 11% were assaults. Most of the injuries were minor traumas (54%). Contusions (22.5%) and chemical injuries and burns (13%) were common. Fractures (5%), lid wounds (3%), open globe injuries (OGI, 2%) and optic nerve injuries (0.5%) were rare. The main causes of ocular injury were superficial foreign bodies (33%), chemicals (13%), body parts (13%) and sports equipment (10%). The most dangerous objects were needles, stones, pellet guns, tools and guns. No patient with OGI used protective eyewear. All OGI and most of contusions needed a lifelong follow-up. Permanent impairment (73 patients, 9%) was caused most often by body parts, sports equipment and work tools.

CONCLUSION

A typical ocular trauma patient was a man aged 31-45 with a minor trauma caused by a foreign body at work and a final visual acuity of 20/20. Most common serious injuries were contusion, OGI or fracture at home or at work and were caused by a body part, sport equipment or work tool. Factors causing common and serious eye injuries provide the targets for protective measures.

Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012

PURPOSE

To identify epidemiologic trends in nonpowder gun-related pediatric eye injuries and to determine factors associated with severe injury requiring hospital admission.

METHODS

US emergency department data on pediatric eye injuries between 2002 and 2012 were reviewed using the National Electronic Injury Surveillance System. Literature review was conducted to determine trends in visual outcomes after treatment and use of eye protection.

RESULTS

In 2012 roughly 3,161 children were treated in US emergency departments for nonpowder gun-related eye injuries. Since 2010 rates of severe nonpowder gun pediatric eye injury have increased by over 500% (P = 0.039). Specifically, while rates of hospital admission due to paintball gun eye injury have dropped precipitously (P = 0.0077), rates of admissions for air gun eye injuries have increased by over 600% since 2010 (P = 0.033). Children sustaining eye injury due to air guns are more likely to be diagnosed and admitted with foreign body or ocular puncture injury. Roughly 28% of documented cases of airsoft or BB gun-related injury had visual acuity worse than 20/50 after initial treatment. Over 98% of injuries occurred without eye protection.

CONCLUSIONS

Air guns are rising in popularity and now account for the majority of pediatric eye injuries requiring hospital admissions. These eye injuries occur without ocular protection and may lead to permanent eye injury. Increasing regulations for eye protection, sales, and usage of air guns are needed to prevent serious pediatric eye injuries.

Traumatic glaucoma with features of unilateral pigment dispersion

We report a patient with traumatic glaucoma with features of unilateral pigment dispersion. This rare form of secondary glaucoma has only been reported twice previously, with both patients demonstrating angle recession, indicating associated damage to the trabecular meshwork. To our knowledge, this is the first such case reported in which angle recession was absent.

[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.

Review of 345 eye amputations carried out in the period 1996-2003, at Rigshospitalet, Denmark

PURPOSE

The aim of this study was to identify the number of eye amputations, and the causative diagnoses, indications for surgery and surgical techniques applied, and to evaluate a possible change in surgical technique in a tertiary referral centre in Denmark.

METHODS

The hospital database was screened using surgery codes for patients who had undergone bulbar evisceration, enucleation or orbital exenteration in the period 1996-2003. Patient records were reviewed for gender, age, time since surgery, causative diagnosis (the disease process leading to the indication for amputation), indication for eye amputation, type of surgery and whether an implant was applied.

RESULTS

A total of 345 patients were identified as having undergone eye amputation during the 8-year period. Indications for eye amputation were: painful blind eye (127); neoplasm (119); infection (42); recent injury (25); disfiguring blind eye (25); prevention of sympathetic ophthalmia (5), and other reasons (2). Surgical procedures included 174 eviscerations, 154 enucleations and 17 orbital exenterations. The mean number of surgeries per year was 43.1. An orbital implant was applied in 168 patients.

CONCLUSIONS

The most frequent indications for eye amputation were painful blind eye (37%) and neoplasm (34%). During the study period, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used in 33% of patients in 1996 and 67% in 2003.

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

PURPOSE

To describe the ocular injuries related to airsoft gun bullets, investigate the ballistics of airsoft bullets, record real-time impact of the bullets on an eye, and investigate the histopathologic changes within the cornea after being hit by an airsoft gun bullet.

DESIGN

Retrospective, interventional case series and experimental animal study.

METHODS

All consecutive cases of patients with airsoft gun-related ocular injuries during 2006 to 2008 were included in this study. Porcine eyes were used for high-speed video photographs of bullet impacts. Rabbit eyes were used for the histopathologic investigation. All patients were treated in the Department of Ophthalmology at Soroka University Medical Center, Beer-Sheva, Israel. Laboratory investigations were performed at Ben-Gurion University of the Negev, Beer-Sheva, Israel. The main outcome measures were ocular injuries of the patients, ballistics of the airsoft bullets, nature of corneal deformation upon impact, and corneal histopathologic changes after the hit.

RESULTS

Fifty-nine patients with a mean age of 9.8 +/- 3.8 years (range, 2.8 to 26 years) were examined; 49 were male (83.1%). The ocular injuries included hyphema, corneal edema, corneal erosion, traumatic mydriasis, and posterior segment involvement. A novel, "donut" form of corneal erosion was seen and also demonstrated by the histopathologic investigation. Substantial anterior segment deformation was recorded in real-time using the high-speed video camera.

CONCLUSIONS

Airsoft gun injuries affect mainly young men and can be visually threatening. Typical ocular injuries along with a unique form of corneal erosion can be seen.

Causes and treatments of traumatic secondary glaucoma

PURPOSE

To study the cause, treatment, and cure of traumatic secondary glaucoma in 103 cases (103 eyes).

METHODS

The records of 103 patients (103 eyes) were reviewed. Causes of the high intraocular pressure (IOP) were analyzed according to the time after trauma. Most patients achieved a better visual acuity and ideal IOP after positive medical, neodymium:Yttrium aluminium garnet (Nd:YAG) laser, or surgical treatment. The operations included anterior chamber irrigation, filtering operation combined with mitomycin C, lensectomy, vitrectomy, and combination surgery.

RESULTS

Clinical findings of secondary glaucoma associated with ocular trauma are complex. Causes resulting in high IOP include intraocular bleeding, lens dislocation, phacoanaphylaxis, angle recession, and siderosis. After medical, laser, or surgical treatment, the IOP of most patients could be ideally controlled. After follow-up for half a year, the IOP of 3 cases (2.91%) was below 10 mmHg and 92 (89.32%) cases between 10 and 21 mmHg; only 8 cases (7.77%) still had IOP over 21 mmHg.

CONCLUSIONS

In traumatic secondary glaucoma, antiglaucoma medication should be used at the early stage, and surgery should be carried out when medical treatment does not reduce the elevated IOP, or in difficult cases to avoid severe complications. The postoperative IOP of most injured eyes was controlled within the safe range.