Mechanism and emergency management of blast eye/orbital injuries

Nonconventional combat is ever-present around the world. In recent years, there has been an unprecedented increase in suicides, homicides and insurgents using improvised explosive devices such as improvised explosive devices, land mines, rocket-propelled grenades (RPG-7 to 29), thermobaric 'enhanced-blast explosives' and explosive-formed projectiles. All of these devices have been shown to dramatically increase eye/orbital injuries. The pathophysiology, biophysics and mechanism of primary and secondary blast-wave front effects are primary causative factors of war-induced eye injuries. This review aims to reappraise eye/orbit blast injuries, thus helping in their management and protection. Blast ocular orbital trauma includes rupture of the globe, serous retinitis, hyphema, corneoscleral lacerations, penetrating eyeball, traumatic cataracts and injury of the optic nerve, nasal-orbital-ethmoidal injuries, brain injury, maxillofacial crushed middle-third fractures and associated multisystem injuries. If the eye is significantly damaged as a result of an initial blast wave, such that it cannot be properly repaired, primary enucleation may be a reasonable option. Another instance where enucleation is possible is if a patient with a significant injury cannot obtain adequate follow-up and be monitored for signs of sympathetic ophthalmia, or in instances where other injuries prevent the patient from actively participating in the decision to save or enucleate an eye in the first 14 days after injury; as in associated head injury. Wearing a visor can protect against eye/orbital damage caused by foreign body penetration and will provide reasonable protection against blast induced eye/orbital injuries.