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Combat-related ocular injuries in the Israel Defense Forces during the years 2013 to 2019
Nitzan Shakarchy-Kaminsky1, Jacob Megreli, Dan Kaminsky
1From the Trauma and Combat Medicine Branch (N.S.-K., J.M., D.K., A.M.T., R.N., I.R., S.G., A.B.), Surgeon General's Headquarters, Israel Defense Forces; Department of Medicine "B" (A.M.T.), Sheba Medical Center, Tel Hashomer, Ramat Gan, affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of General Surgery and Transplantation-Surgery B (R.N.), Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv; The Azrieli Faculty of Medicine (E.G., A.B.), Bar-Ilan University, Safad, Israel; Uniformed Services University of the Health Sciences (E.G.), Bethesda, Maryland; Surgeon General's Headquarters (E.G.), Israel Defense Forces; and Research and Academic Division (A.F.), Israel Defense Forces Medical Corps, Ramat Gan; Department of Military Medicine (A.F.), Jerusalem, Israel.
Background:
Ocular injuries account for up to 13% of battle injuries, despite the implementation of advanced protective eyewear (PE). The aim of this study was to describe the extent of ocular injuries over the last years among Israel Defense Forces soldiers and to examine the change in PE policy introduced in 2013 and the effect of a high-intensity conflict on ocular injury characteristics.
Methods:
This retrospective registry-based analysis derived data from the Israel Defense Forces Trauma Registry and included soldiers who sustained combat-related ocular injuries between the years 2013 and 2019. Demographic data and injury characteristics of casualties, as well as information regarding the use of PE, were collected and analyzed.
Results:
A total of 2,312 military casualties were available for this study; the incidence of combat-related ocular injuries was 8.9% (n = 113). Ocular injuries occurred among male soldiers (98.2%) with a mean ± SD age of 22.7 ± 4.6 years; mechanism of injury was penetrating in 59.3% of the casualties and blunt in 22.1% of the casualties, ocular injury was isolated in 51.3% of the casualties, and others sustained concomitant injuries including head (32.7%), upper extremity injury (17.7%), lower extremity (15.9%), torso (8.0%), neck (6.2%), and other (5.9%) injuries. Ocular injuries rate was similar among casualties who used PE (11.2%) and those who did not use PE (13.0%) while injured (p = 0.596). Rate of open globe injuries was 9.1% in casualties who used PE and 39.5% (p = 0.002) in casualties who did not.
Conclusion:
Eye protection may significantly reduce ocular injuries severity. Education of the combatants on the use of PE and guidance of medical teams on proper assessment, initial treatment, and rapid evacuation of casualties are needed to improve visual outcomes of the casualties further.
Level Of Evidence:
Epidemiological study, level IV.