Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes

Abstract

Background Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis. Methods We retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed. Results Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes. Conclusions Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.

Sympathetic Ophthalmia in Patients with Enucleation or Evisceration: Pathology Laboratory and IRIS® Registry Experience

“…When focusing on more epidemiologically centered recent cross-sectional studies, SO frequency rates range from 0 to 0.6% in studies with histopathologic evaluation [8, 31] and from zero to 1.1% [5, 9, 22, 30, 32–34, 36, 38, 42, 45, 47, 54] in clinical database studies. Nonsurgical trauma was identified as the predisposing event for SO in 55–93% [8, 29, 31, 43, 52] cases of histopathology-based studies and in 7–85% [4, 35, 39–41, 50, 51, 53] cases of clinical-based studies.…”

Case report: Bilateral eye injuries in members of one family due to a cluster munition in Ukraine

“…In a recent study by Zhang et al ( 10 ), explosive eye injuries of 1,449 eyes in 1115 patients in China have been evaluated. Bilateral eye injuries were reported in 29.96% of cases.…”

“…A cluster munition is a kind of bomb that scatters into smaller sub-munitions intended to kill or mutilate on impact ( 9 ), and it can lead to injuries to the head and face regions. The eyeball is extremely vulnerable to explosive injuries since it is an exposed and incompressible spherical organ full of liquid and rich in vascular networks, with fragile tissues and fine structures ( 10 ). Due to the complexity of explosive injury mechanisms, the difficulty of diagnosis and treatment increases in patients with ocular explosive injuries.…”

“…Due to the complexity of explosive injury mechanisms, the difficulty of diagnosis and treatment increases in patients with ocular explosive injuries. A detailed description of ocular blast injuries is particularly important for timely and accurate treatment to minimize the visual disability rate ( 10 ).…”

Biomechanics of open-globe injury: a review

“…Patients with ocular trauma caused by blast waves are common in clinical practice [ 55 ]. Military operations and holiday celebrations are common injurious scenes [ 56 , 57 ]. Blast wave is characteristic of high conduction velocity and pressure-rise speed.…”