Ultrasound triage of ocular blast injury in the military emergency department

Abstract

Introduction: Ultrasound (US) provides rapid effective assessment of the globe. In Afghanistan, ocular blast injuries are common. We present a case series demonstrating the value of US in this context.

Methods: 29 patients with suspected blast eye injury had both computed tomography (CT) of the head and ocular US as part of their standard care in a military hospital in Afghanistan. The US images were assessed by blinded consultants (emergency department and radiology) and compared with the CT reports.

Results: 18 patients had an intraocular injury on either CT or US. CT identified 11 injuries. US detected 18, including all 11 detected by CT. Inter-rater agreement was high (28/29).

Discussion: This series suggests that US may be as good as CT at detecting ocular blast injuries. However, inability to follow up local national patients meant that the clinical relevance of these findings cannot be quantified. US is likely to have a role on deployed operations in triaging possible ocular injuries.

Conclusions: US is an easy, cheap alternative to CT for the assessment of blast injury to the eye. It appears to have identified all injuries detected by CT in this series and can be accurately interpreted by emergency physicians.