Terroristic sniper shot ocular injuries: military and police casualties: case series

Sniper shot ocular injuries (SSOI) are rare and result in poor ocular outcomes due to high energy transfer both to the eye and the adjacent brain. To our knowledge, no reports of such injuries in terms of outcomes have been previously described in the literature. The aim of this case series was to describe the treatment performed and ocular outcomes of such injuries.

Five cases of terroristic SSOIs referred to Gulhane Military Medical Academy Department of Ophthalmology between 22 July 2015 and 30 January 2017 were reviewed. Comparisons were made between the location and mechanism of injury, initial and final ocular signs, interventions and additional extraocular injuries.

Two cases were of police officers and the remaining were Turkish military soldiers. All of our cases were injured in urban district by terrorist snipers hidden in apartments. Four individuals were injured in the right eye and the other was injured bilaterally. Initial visual acuities (VA) ranged from no light perception (NLP) to 0.0 with logMAR. Final VA raised to 0.0 in three patients whereas in two of NLP patients it remained the same. Mean Ocular Trauma Score was 2.2. Two eyes necessitated evisceration and the others underwent vitrectomy surgery.

The prognosis of SSOI is unpredictable and is highly dependent on the trajectory and energy deposition. Primary evisceration or enucleation should be reserved to severely ruptured globe cases with no chance of globe-saving procedures. If the globe remains intact, retinal and vitreal damage should be repaired. Due to risk of associated intracranial injury, all patients should be referred for neurosurgical opinion.