PURPOSE. Primary blast injury (PBI) mostly affects air-filled organs, although it is sporadically reported in fluid-filled organs, including the eye. The purpose of the present paper is to explain orbit blast injury mechanisms through finite element modeling (FEM).METHODS. FEM meshes of the eye, orbit, and skull were generated. Pressure, strain, and strain rates were calculated at the cornea, vitreous base, equator, macula, and orbit apex for pressures known to cause tympanic rupture, lung damage, and 50% chance of mortality.
RESULTS.Pressures within the orbit ranged between þ0.25 and À1.4 MegaPascal (MPa) for tympanic rupture, þ3 and À1 MPa for lung damage, and þ20 and À6 MPa for 50% mortality. Higher trinitrotoluene (TNT) quantity and closer explosion caused significantly higher pressures, and the impact angle significantly influenced pressure at all locations. Pressure waves reflected and amplified to create steady waves resonating within the orbit. Strain reached 20% along multiple axes, and strain rates exceeded 30,000 s À1 at all locations even for the smallest amount of TNT.CONCLUSIONS. The orbit's pyramidlike shape with bony walls and the mechanical impedance mismatch between fluidlike content and anterior air-tissue interface determine pressure wave reflection and amplification. The resulting steady wave resonates within the orbit and can explain both macular holes and optic nerve damage after ocular PBI. (Invest Ophthalmol Vis Sci. 2012;53:8057-8066) DOI:10.1167/iovs.12-10591 P rimary blast injury (PBI) refers to biological damage caused by the peak incident overpressure (PIO) wave generated by an explosion. Initially described exclusively in hollow, air-filled organs, 1,2 the spectrum of PBI progressively enlarged to encompass fluid-filled organs, including the central nervous system 3,4 and the eye.
3-6Macular holes, choroidal rupture, and optic nerve damage occur relatively frequently after blunt trauma, 7 and although the pathogenic mechanism remains unclear, vitreous traction, 8 globe deformation, differential eye layer stiffness, 9 shockwave propagation, and multiaxial strain 10 likely participate.Finite element modeling (FEM) is a numerical analysis method largely used to simulate multiphysics problems. Previous applications to ophthalmology [11][12][13] and, specifically, to blunt eye trauma 10 have been reported. The purpose of the present paper is to create a computational model of ocular PBI, simulate the propagation of blast waves through the orbit, and explain its pathogenesis. The study was prompted by the observation of macular holes, multiple choroidal ruptures, subretinal bleeding, and optic atrophy after blast exposure, in the absence of any contact with splinters and/or flying objects (Fig. 1).
MATERIALS AND METHODS
Finite Element ModelingThe eye model has been previously described, 10,14 while orbit and retrobulbar fat tissue were reconstructed based on patient computed tomography scan and magnetic resonance imaging ( Fig. 2; see the Appendix for further technical details on FEM).
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