Ocular injuries incurred by Israeli defense forces during low-intensity conflicts

Daphna Prat; Erez Tsumi; Shiran Madgar; Hila Goldberg; Ofira Zloto; Perach Osaadon; Liza Tal Mushinski; Jacob Chen; Roy Nadler; Joseph Moisseiev; Amir Alhalel; Guy J Ben Simon

doi:10.1016/j.injury.2020.09.041

Ocular injuries incurred by Israeli defense forces during low-intensity conflicts

Injury. 2021 Feb;52(2):292-298. doi: 10.1016/j.injury.2020.09.041. Epub 2020 Sep 18.

Authors

Affiliations

¹ Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
² Ophthalmology Department, Soroka Medical Center, Beer Sheva, Israel, affiliated to Ben-Gurion University of the Negev, Beer-Sheva, Israel.
³ Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel.
⁴ Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: guybensimon@gmail.com.

PMID: 32972723
DOI: 10.1016/j.injury.2020.09.041

Abstract

Background: To describe ocular injuries sustained by Israeli Defense Forces (IDF) soldiers during low-intensity conflicts from 1998 to 2017, and to evaluate the use of protective eyewear.

Methods: Retrospective analysis of data retrieved from two tertiary Israeli medical centers and the military trauma registry. The analysis included all IDF soldiers with ocular injuries who were referred to these centers between 1998 and 2017. Data on injury type, the use of protective eyewear, and interventions were retrieved and analyzed. Additional data regarding the use of protective eyewear and ocular injuries in 108 patients with head and neck injuries in one operation was analyzed.

Results: A total of 126 soldiers, all males, mean age 22 (SD 5.3) years, sustained ocular injuries during low-intensity conflicts and treated at one of the two participating medical centers. Blast was the most common type of injury (n = 70/126, 56%), followed by shrapnel (n = 37/126, 29%) and gunshot wound (n = 12/126, 9%). The Birmingham Eye Trauma Terminology System (BETTS) injury pattern disclosed lamellar laceration (n = 34/126, 27%), intraocular foreign body (n = 27/126, 21%), penetrating (n = 10/126, 8%), and perforating (n = 7/126, 6%) injuries. Average VA improved from 20/140 at presentation to 20/60 after surgical or conservative intervention, the median VA improved from 20/40 to 20/30 (P < 0.001). Forty-nine patients (49/126, 39%) had poor visual outcome. The mean follow-up lasted 22 (SD 31) months. The use of protective eyewear was correlated with better initial VA(20/30 vs 20/217, P = 0.07). Among 108 patients with head and neck injuries, there was a higher rate of ocular injuries in the group of patients who did not use protective eyewear (n = 26/73, 36% vs n = 4/35, 11%, P = 0.016).

Conclusions: Ocular injuries are common occurrences in low-intensity conflicts. The use of protective eyewear significantly reduces these injuries and should be mandatory.

Level of evidence: III, prognostic.

Keywords: BETTS; Combat; Conflict; Ocular trauma; Protective eyewear.

MeSH terms

Adult
Blast Injuries* / epidemiology
Blast Injuries* / prevention & control
Eye Foreign Bodies*
Eye Injuries* / epidemiology
Eye Injuries* / prevention & control
Humans
Male
Military Personnel*
Registries
Retrospective Studies
Wounds, Gunshot* / epidemiology
Wounds, Gunshot* / prevention & control
Young Adult