|Year : 1999 | Volume
| Issue : 3 | Page : 194-195
Blindness due to firearm eye injuries in rural western Uttar Pradesh
A Gupta, S Mittal
Upgraded Department of Ophthalmology, L.L.R.M. Medical College, Meerut, India
Upgraded Department of Ophthalmology, L.L.R.M. Medical College, Meerut
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta A, Mittal S. Blindness due to firearm eye injuries in rural western Uttar Pradesh. Indian J Ophthalmol 1999;47:194-5
|How to cite this URL:|
Gupta A, Mittal S. Blindness due to firearm eye injuries in rural western Uttar Pradesh. Indian J Ophthalmol [serial online] 1999 [cited 2019 Sep 23];47:194-5. Available from: http://www.ijo.in/text.asp?1999/47/3/194/14915
In a retrospective analysis of 440 cases of firearm injuries, 104 patients had ocular injuries. Following treatment only 14 patients (13.5%) could regain visual acuity of > or = 6/60.
Rapid industrialization without safety measures, increased number of roadside accidents and firearm injuries due to terrorism have resulted in an increased incidence of ocular trauma. The effect is obvious at base hospitals where patients are referred from adjoining areas for specialized management. Earlier gunshot injuries in eyes were seen only during war. These days, however, the large number of gunshot injuries involving the eyes is becoming a matter of concern as a new ocular hazard in Meerut, a prosperous, agriculture-based district of western Uttar Pradesh.
| Materials and Methods|| |
In a retrospective study, 440 cases of gunshot injuries were examined from October 1991 to September 1993 in the Department of Ophthalmology at Medical College, Meerut. The cases were referred from other hospitals within 24-48 hours of injury. All the patients were examined with the help of flash-light, loupe and slit lamp, under local anesthesia. Fundus was seen and vision was tested wherever possible. X-ray orbit and skull, B-scan ultrasound and CT scan were done where needed.
All the perforating injuries were subjected to surgery, after an initial medical management. Radical surgery such as evisceration or enucleation was advised in cases where the eyes were extensively damaged with loss of perception of light. The patients were followed up weekly for 2 months.
| Results|| |
Of the 440 cases of gunshot injuries seen, the eyes were involved in 104 cases (23.6%). Eighty four patients were males (80.8%) and 20 were females (19.2%). Most of the patients were young adults 21-30 years of age (46 cases, 46.6%). In 75 cases (73.0%) one eye was involved and in 29 cases (27.0%) both eyes were involved. Seventy eight cases (75.6%) were farmers; 54% (56 cases) presented to the hospital within 48 hours of injury. The firearm used most often was country-made pistol (64 cases, 62.2%). Other firearms used were double-barreled gun (9.0%), and single-barreled gun (5.8%); in 23% cases the firearm was unknown.
The ocular lesions found included: corneal perforation in 36 cases (35.1%), scleral perforation in 8 cases (8.1%), and corneal-scleral [Figure - 1] in 11 cases (10.8%). Other eye injuries were: lid tear, proptosis, conjunctival tear, hyphaema, iris prolapse, uveitis and traumatic cataract [Table - 1]. 28 patients (27.0%) had complete loss of vision. In 11 of these, (10.8%) the eye was so badly damaged that it could not be repaired and destructive surgery in the form of enucleation or evisceration was done [Figure - 2], while in other cases the eye had gone into phthisis bulbi. In 65 cases (62.1%) surgery was performed according to need and in 8 cases (37%) medical treatment was given Only in 14 cases (13.5%) the final vision after treatment was better than 6/60.
| Discussion|| |
This study discusses a cause of blindness that is preventable. Terrorism, lawlessness and easy availability of firearms in the hands of uneducated and unemployed young people have led to an increase in the incidence of such injuries, many of which lead to permanent loss of vision with the majority of the cases (80%) being young male farmers, the injury resulting from robbery or personal vendetta. Weapons used mostly were country-made pistols (62.6%) which were manufactured and sold by the local people freely among the rural and urban population. These guns when fired from a close range (4-5 meters) can shower 15-20 pellets in each shot and cause severe ocular damage. The wounds caused by these pellets and gun powder are extensive and cause more damage than other standard firearms. The pellets can penetrate and damage soft tissue organs easily but do not always go deep enough in the body to cause death by damage to vital structures. That is why in 11 cases (10.8%) destructive surgery was performed, although the patients survived. Injury to eye led to hyphaema in 48.6%, iris prolapse in 54%, and cataract in 16.2% of the cases, rates which are comparable with those observed by Shukla et al.
Ideally the perforating wound should be closely examined making use of such facilities as ultrasound and CT scan, which may only be available at the base hospital. Skilled surgery under microscope may need to be performed to save such eyes. When such eyes are examined by general doctors without proper precautions, the condition may get aggravated. Despite providing the best treatment and care, vision of 6/60 or better could be restored only in 13.5% cases. Ophthalmologists, who are engaged in a difficult battle against to prevent known blinding diseases, face yet another challenge from blindness due to gunshot injuries
| References|| |
Parikh CK. Firearm injuries. Parikh's Text Book of Medical Jurisprudence and Toxicology.
Vth ed. CBS Publishers, 1990.p 258
Shukla IM, Verma RN. A clinical study of ocular injuries. Indian J Ophthalmol
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2]