Ophthalmic injuries in British Armed Forces in Iraq and Afghanistan

Abstract

Aim: British military ophthalmologists have not been deployed in support of operations since 2003. Eye injuries in British forces receive definitive treatment on return to the United Kingdom. We report the injury patterns, management strategies, and outcomes for eye injuries in British Armed Forces in Iraq and Afghanistan.

Methods: Retrospective consecutive case series of eye injuries in British Armed Forces in Iraq or Afghanistan from July 2004 to May 2008. Outcomes assessed by final best-corrected visual acuity (VA; few patients lost to follow-up), rates of endophthalmitis, and proliferative vitreoretinopathy (PVR).

Results: There were 630 cases of major trauma, 63 sustained eye injuries (10%), and 48 sustained significant eye injuries. There were 21 open-globe injuries: 9 ruptures and perforating injuries, of which 7 were enucleated/eviscerated; 11 intraocular foreign body (IOFB) injuries, of which 1 was eviscerated. Primary repair was combined with posterior segment reconstruction in 9/11 cases with IOFB. Mean time to primary repair was 1.9 days (range 0-5). Intravitreal antibiotics were given at primary repair in five cases. All cases received early broad-spectrum systemic antibiotics. Median final VA was logMAR 0.25 excluding evisceration/enucleations. There were two cases of PVR and none of endophthalmitis.

Conclusions: The number of eye injuries as a proportion of all casualties is lower than recently reported. The injuries are more severe than in civilian practise. The outcomes were comparable with previous reports, this demonstrates that, in certain cases, primary repair can be safely delayed beyond 24 h in the patient's best interests, in order to optimise the conditions for treatment.

Figure 1

Number of injuries classified by the Birmingham Eye Trauma Terminology System. An additional 24 minor injuries are not shown here (subconjunctival haemorrhage, corneal abrasion, and superficial foreign body).

Figure 2

Outcomes displayed by the classification and regression tree (CART) analysis. (a) Visual survival (≥LP) vs no vision (NLP). Sufficient data was available on 15 open-globe injuries. Sensitivity to predict visual survival is 86%, specificity to predict no vision is 87.5%. (b) Minimal to severe vs profound visual loss. Sufficient data was available on 15 open-globe injuries. Sensitivity to predict minimal to severe loss is 100%, specificity to predict profound loss is 80%. RAPD, relative afferent pupillary defect; HM, hand movements; LP, light perception; NLP, no light perception.