Eye Loss, Orbital Sequelae, and Prosthetic Rehabilitation Following Crowd-Control Kinetic Impact Projectile Injuries:...

During the 2019-2020 Chilean social unrest, massive police use of kinetic impact projectiles (KIPs) caused unprecedented severe ocular traumas, initially affecting over 460 individuals. We examined the largest civilian cohort with complete globe loss to characterize orbital/peri-orbital sequelae, analyze projectile-specific injury patterns, and assess factors affecting rehabilitation.

This retrospective cohort evaluated 57 individuals requiring ocular prostheses at Chile's national referral center (2019-2022). Sociodemographic, clinical, and prosthetic variables were analyzed, encompassing immediate and delayed globe loss (secondary evisceration/phthisis bulbi). Sequelae count associations were assessed via the Kruskal-Wallis test.

KIPs caused 94.7% of irreversible globe losses (pellets 73.7%, a tear-gas projectile 21.1%, blunt trauma 5.3%). A tear-gas projectile was significantly associated with a higher number of concurrent orbital/peri-orbital sequelae per individual (p = 0.002). Prevalent sequelae included palpebral scarring (43.9%), ptosis (26.3%), and orbital fractures (22.8%). Prior conformer shell installation correlated with significantly more sequelae (p = 0.002). This high sequelae burden also correlated with initial prosthetic complications, specifically rotation and intense mucoid discharge (p = 0.011). Overall prosthetic adherence reached 93.0%; notably, 17.5% of users selected non-mimetic (novelty) prostheses.

During the repression of the 2019-2020 protests, "non-lethal" KIPs proved highly destructive. Beyond the globe loss itself, a tear-gas projectile was significantly associated with a high number of concurrent sequelae, uniquely causing widespread trauma, including maxillofacial fractures. Conversely, pellets-the most frequent KIP-frequently resulted in isolated globe loss but caused specific severe outcomes, including all cases of anophthalmic cavity syndrome and persistent conjunctivitis, alongside most ptosis. Complete globe loss occurred immediately or following a prolonged trajectory. High prosthetic adherence (93.0%) was achieved by offering non-mimetic designs when conventional prostheses were refused, preserving orbital integrity and addressing psychosocial needs. These findings reinforce the global need for multidisciplinary rehabilitation and provide medical evidence to demand the strict regulation of these weapons.