Conflict-related globe rupture requiring eye removal: a six-year experience from Somalia

To evaluate the clinical characteristics, injury mechanisms, and associated trauma patterns of traumatic open-globe injuries (OGIs) requiring globe removal in a prolonged conflict setting.

This retrospective observational study included patients who underwent enucleation or evisceration following traumatic OGIs at a tertiary referral hospital in Somalia between January 2020 and December 2025. Injuries were classified as conflict-related or non-conflict-related based on mechanism. Demographic data, clinical presentation, surgical characteristics, associated orbital and craniofacial injuries, and postoperative outcomes were analysed and compared between groups.

69 eyes from 67 patients underwent globe removal for traumatic OGIs. Conflict-related mechanisms accounted for 73.9% of cases, predominantly caused by blast injuries and gunshot wounds. Most patients were young males, and 97.1% of eyes underwent primary globe removal due to catastrophic structural damage at presentation. Globe rupture was present in all cases, with frequent associated orbital wall fractures (72.5%), maxillofacial fractures (56.5%), and intracranial injuries (50.7%). Intraorbital metallic foreign bodies were significantly more common in conflict-related injuries (p = 0.007). Postoperative follow-up was limited, particularly in conflict-related cases, but early socket-related complications were uncommon, and no cases of sympathetic ophthalmia were identified during the available follow-up period.

Conflict-related OGIs constitute a distinct pattern of ocular trauma characterised by high-energy mechanisms, severe associated injuries, and a predominance of primary globe removal. These findings reflect injury severity rather than surgical preference and underscore the need for context-specific management strategies in conflict-affected, resource-limited settings.