|Year : 1984 | Volume
| Issue : 5 | Page : 277-279
Ocular war injuries
MS Boparai, RC Sharma
Department of Ophthalmology, Army-Hospital Delhi Cantt, India
M S Boparai
Department of Ophthalmology, Army Hospital, Delhi Cantt-110 010
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Boparai M S, Sharma R C. Ocular war injuries. Indian J Ophthalmol 1984;32:277-9
The injuries sustained in wars have varied in type over the years due to the change in techniques of warfare as a result of mechanisation, extent of involvement of air and naval forces and development of more sophisticated weapons. We have had the experience of handling war injuries during two short wars that our country had in 1965 and 1971. This paper is based on 265 ocular injuries during the 1965 conflict and 266 during the 1971 conflict. Some of the cases were treated by us directly and about others information was obtained from other centres through service channels.
Incidence of Ocular Casualties
The incidence of ocular battle casualties is high proportionately to other parts of the body. Eye is only 11375 of the surface area of the body and only 0.10 percent of the erect frontal silhoutte. The likelihood of severe ocular injury however is enhanced by various postures assumed during combat. With weapons becoming more destructive and wars becoming more fast-moving the incidence of ocular battle casualties has been going up. Infact, shorter and more intense the war the higher is the incidence of ocular battle casualties. [Table - 1] shows the incidence during the various wars and [Table - 2] shows comparative analysis of injuries to different parts of the body. The ocular injuries are included under the heading of head and neck.
Causes and type of ocular Injuries
Bullets, fragments off shells and grenades, flying debris and missiles were the main causes of ocular injury but explosions, mine bursts, burns and chemical injuries also contributed their bit. [Table - 3] shows the causes by way of weapons and other modes during the 1965 and 1971 wars. Perforating injuries far outweighed the other injuries. [Table - 4] is relevant. Nearly half the cases with perforations also had intra-ocular - foreign bodies. Gross tissue loss of adenexa and appendages and fractures of the orbit and adjoining bones were quite common. Foreign nodies of various sizes and some measuring as big as 52X32X4mm (25 gm) were found lodged in the globes and orbits.
Ocular injuries were part of multiple injuries and other severe injuries rather than being alone. The attention therefore first went to the general condition of the patient rather than to the eyes.
Method of evacuation and its bearing on Ocular injuries
Ocular trauma was part of general more wide spread multiple injuries and it was natural therefore that first attention went to saving of life. At the forward most field medical units the rule of triage is applied and priorities are given for resuscitation treatment and evacuation.
Priority I are the gunshot wounds of abdomen, sucking wounds of the chest, extensive limb injuries with damage to large blood vessels, severe burns, tension pneumothorax and so on.
Priority II are abdominal injuries without complications, limb injuries, closed head inury, moderately severe burns and head and neck injuries etc.
Priority III are the remainder minor wound and abarasions etc. They can travel as sitting cases.
As ocular trauma is a part of multiple injuries, priority will depend upon the extent of these injuries. I.t is obvious therefore that there is a time gap between the time of injury and treatment depending on the nature of warfare, time of evacuation, terrain availability of transport, weather and expertise of the medical officers in forward medical units in allotting priorities.
Management of perforating injuries at Eye Centres/Hospitals
1. Resuscitation and attention to vital organs
was the first necessity.
2. Completely shattered globes when there was no likelyhood of useful vision and useful cosmetic look were removed/eviscerated. However even if there was the slightest possibility of some vision the globe was repaired. The dreaded sympathetic ophthalmitis was not seen at all in any of the two wars. One need not therefore get unduly alarmed by it.
3. Lid injuries were repaired as meticulously as possible and perforation was especially looked for in these cases.
4. Radiographs of all cases were done to see any intraocular foreign bodies. The only method useful considering the number of cases was the, limb al ring and the measuremenu -sub of the schematic eye. Ophthalmoscopic examination and visualisation under direct vision was also tried. Radiographs were also important from the point of view of fractures of orbit and other bones around it.
5. The magnetisability of the foreign bodies was tested by Roper Hall/Berman locater. It was generally found that most of the FB's were magnetic but in future wars, it may not be so, as more and more alloys are being used than the ferous metals. Modern mines are made from non metalic material to avoid detection by mine detectors.
6. Role of vitreous surgery in these wars was nil and lot of eyes were lost for want of this type of surgery. Intraocular haemorrhages organised and vitreous strands formed in many a cases resulting in late complications. In future wars, immediate/early vitreous surgery will play a big role in saving many eyes.
7. After repair and removal of FBs, all cases were given subconjunctival antibiotics, mydriatics and steroids to reduce postoperative iritis and infection.
8. Late reconstruction of the orbit and cosmetic correction were undertaken in due course of time.
| Summary and conclusions|| |
1. Diversity of injuries is a big factor and ophthalmic surgeons in the armed forces must have training with special bias towards trauma.
2. Multi or intra and interdisciplinary approach is necessary. Maxilo facial, neurosurgeon, plastic surgeon and a prosthetic man have to be involved.
3. Data is never perfect and there is difficulty in assigning proper diagnosis.
4. Statistics are generally low as the injuries of those lost in action never come to light
5. Requirement of special combat glasses requires to be looked into.
6. It is not always possible to evacuate cases directly to specialised centres. However an endeavour can be made.
7. The problem of rehabilitation of the blind and visually handicapped is great.
| References|| |
Banerji R, 1967. Armed Forces MedicalJournal Vol XXIV.
Banerji R, 1982. Personal communication.
Boruchoff A.S., 1974. International Ophthalmol Clinics, Vol 14 No. 4.
Manual of Armed Forces Medical Services 1974.
Sihota G.S., 1967. Procs. All Ind. Ophthalmol. Soc. Vol XXIV.
Duke, Elder. Stewart, 1972. System ofOphthalmology Vol XIV. Henry Kinpton, London.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]