Less-Lethal Weapons Resulting in Ophthalmic Injuries: A Review and Recent Example of Eye Trauma.

INTRODUCTION: Prior reports have highlighted the dangers of crowd control weapons such as rubber bullets, paintball guns, and pepper spray. Many of these reports were written decades ago and outside of the USA. We summarize a review of the literature and discuss a contemporary case of a ruptured globe and facial trauma secondary to a projectile weapon. This case serves to highlight the severity of eye trauma caused by less-lethal weapons; severe morbidity or even mortality can occur. CLINICAL DESCRIPTION: A civilian presented after a projectile weapon reportedly fired by Denver law enforcement struck his face during one of the recent protests in May 2020 in Denver. Upon ophthalmic examination, we observed no light perception (NLP) vision, periorbital ecchymosis, and devastating globe trauma. PRIMARY DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: Further examination revealed a severely ruptured globe with extensive hemorrhage and extrusion of intraocular contents. Attempts to repair the ruptured globe failed because of the lack of remaining scleral tissue and expulsion of intraocular contents. Postoperatively, the visual acuity remained NLP and the eye was unable to hold pressure. Subsequently, the patient elected for enucleation. CONCLUSION: Despite the purported safety advancements of less-lethal weapons, we continue to see high levels of morbidity and mortality. Permanent vision loss, loss of the eye, and death caused by these weapons have been reported. We hope that this information will serve as an example to help promote judicious use of these weapons by the proper authorities. Additionally, protesters and bystanders should be aware of these dangers and utilize high-quality eye protection.

Outcomes and Complications Associated with Noninfectious Uveitis in Patients Presenting with Rhegmatogenous Retinal Detachment.

PURPOSE: To evaluate the visual outcomes and complications associated with noninfectious uveitis in patients presenting with a rhegmatogenous retinal detachment (RRD). DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 554 eyes of 523 patients presenting for RRD repair at the Department of Ophthalmology, University of Colorado School of Medicine, between July 2011 and September 2016. METHODS: Analysis of risk factors, anatomic outcomes, and visual outcomes related to a history of noninfectious uveitis. MAIN OUTCOME MEASURES: End point rate of reattachment, end point visual acuity (VA), postoperative proliferative vitreoretinopathy (PVR), and rate of reoperation. RESULTS: A history of uveitis was identified in 5.4% of eyes. Eyes with a history of uveitis were found to have a higher risk for development of any degree of PVR (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.1-4.4, P = 0.030) and a higher risk of PVR necessitating an additional procedure (HR, 2.7; 95% CI, 1.2-6.0, P = 0.014). Anatomic and visual outcomes did not differ between the 2 groups. Preoperative VA, the distribution of race/ethnicity, age, gender, lens status, macula status, and lattice degeneration status did not vary significantly between the groups. In the analysis of a PVR subgroup, uveitis was not associated with a higher risk of PVR necessitating an additional procedure and did not show a statistically significant difference in end point VA. CONCLUSIONS: A history of uveitis is associated with an increased risk of any degree of PVR and an increased risk of PVR necessitating an additional procedure. However, subgroup analysis suggests that patients with a history of uveitis who develop PVR do not necessarily have a worse visual outcome or a higher risk of additional surgery. There may be a role for perioperative steroids in patients with a history of uveitis who present with a retinal detachment, but further study is warranted to determine if this decreases the risk of PVR or improves visual outcomes.

Childhood Vision Screening in Western South Dakota: Examining Barriers to Post-Vision Screening Follow-up Referral.

BACKGROUND: Poor follow-up after post-screening referral is a challenge faced by vision screening organizations. This study examines barriers to follow-up eye care in children who were referred for a comprehensive eye exam following a vision screening event in western South Dakota. METHODS: Children referred for a comprehensive eye exam following a screening event by Northern Plains Eye Foundation Western South Dakota Lions Children's Vision Screening Initiative (CVSI) from September 2014 to February 2015 were identified for a telephone survey. Parents/guardians of these children were contacted and asked a series of questions aimed at assessing the barriers to obtaining eye care. RESULTS: Of the 282 children identified, parents/guardians of 63 were successfully surveyed (22.3 percent), 38 had attended an appointment (60.3 percent), and 19 (30.2 percent) brought the CVSI referral form when they attended the appointment. When parents/guardians of the 25 children who had not attended an appointment were surveyed, 12 (19 percent) were not aware the screening results indicated a full eye exam was recommended, 10 (15.9 percent) identified barriers to scheduling an appointment, and three (4.8 percent) had an appointment scheduled in the future or forgot a scheduled appointment. CONCLUSION: The majority of surveyed parents/guardians reported their children having seen an eye care provider. Appropriate documentation has been limited due to reliance on parents/guardians to give referral forms to eye care providers and subsequent dependence on providers to forward completed referral forms to CVSI. Improved documentation is needed to assess the accuracy of the screening, support screening prevalence data, and evaluate the impact of CVSI.