Improvised Explosive Devices and Eye Injury

Salim Khan

Purpose:
We report our experience in the evaluation of ocular trauma patients injured by an Improvised Explosive Device (IED) used in a suicide attack on a public gathering.

Method:
Head injuries from the event were transported to the Accident and Emergency Service of our hospital. Three patients presenting with severe loss of vision were referred to the Ophthalmology Department. We performed a complete ocular, orbital and neurological examination. Ultrasound, X-ray and Computerized Tomography (CT) scans were ordered.

Results:
All three patients had no light perception in the left eye and severe visual impairment in the fellow eye. CT demonstrated spherical objects lodged at the orbital apex in two cases. The third had multiple spherical objects embedded in his face and scalp. His left eye had a detached retina. Visual loss in the fellow eyes remained unexplained. No patient had intracranial foreign bodies. No neurological deficit, apart from the loss of vision was found. External signs of injury were minimal.

Conclusions:
Recent explosions by suicide bombers have introduced new and unique profiles of injury. Spherical pellets in IEDs have special injuring characteristics. If loss of vision had not occurred in these patients, the tiny entry wounds would easily have been overlooked. IEDs can result in orbital foreign bodies without apparent external tissue damage. First responders and emergency department personnel need to know expected injury patterns from an IED. This has implications for triage, diagnosis, treatment and hospital organization.