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Review

Mechanism and emergency management of blast eye/orbital injuries

Pages 229-246
Published online: 09 Jan 2014
 

Nonconventional combat is ever-present around the world. In recent years, there has been an unprecedented increase in suicides, homicides and insurgents using improvised explosive devices such as improvised explosive devices, land mines, rocket-propelled grenades (RPG-7 to -29), thermobaric ‘enhanced-blast explosives’ and explosive-formed projectiles. All of these devices have been shown to dramatically increase eye/orbital injuries. The pathophysiology, biophysics and mechanism of primary and secondary blast-wave front effects are primary causative factors of war-induced eye injuries. This review aims to reappraise eye/orbit blast injuries, thus helping in their management and protection. Blast ocular orbital trauma includes rupture of the globe, serous retinitis, hyphema, corneoscleral lacerations, penetrating eyeball, traumatic cataracts and injury of the optic nerve, nasal–orbital–ethmoidal injuries, brain injury, maxillofacial crushed middle-third fractures and associated multisystem injuries. If the eye is significantly damaged as a result of an initial blast wave, such that it cannot be properly repaired, primary enucleation may be a reasonable option. Another instance where enucleation is possible is if a patient with a significant injury cannot obtain adequate follow-up and be monitored for signs of sympathetic ophthalmia, or in instances where other injuries prevent the patient from actively participating in the decision to save or enucleate an eye in the first 14 days after injury; as in associated head injury. Wearing a visor can protect against eye/orbital damage caused by foreign body penetration and will provide reasonable protection against blast induced eye/orbital injuries.

Acknowledgements

The author thanks the staff of West Bloomfield library in Michigan for their help while preparing this article.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

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