Eye doctors teach combat trauma management
March 18, 2013
BETHESDA, Md. (March 18, 2013) -- Walter Reed National Military Medical Center ophthalmologists Col. Raymond I. Cho and Maj. Marcus Colyer presented health care professionals with an overview of combat eye trauma as part of the nine-day trauma symposium lecture series held at the medical center last month. Both shared their expertise and insight to help providers treat patients with either combat- or civilian-related eye injuries.
Trauma to the eye and its associated structures account for a significant number of combat-related injuries, according to the book "Combat Casualty Care: Lessons Learned from OEF and OIF," published by the Department of the Army, Office of Surgeon General in 2012. OEF stands for Operation Enduring Freedom, and OIF stands for Operation Iraqi Freedom.
Cho, the director of oculoplastic and orbital surgery at Walter Reed National Military Medical Center, or WRNMMC, deployed in support of Operation Iraqi Freedom from 2005 to 2006, and contributed to "Lessons Learned from OEF and OIF." He explained incidence of combat ocular trauma has shown a steady rise in frequency over the last century of warfare.
Ocular trauma accounted for less than 1 percent of total battle injuries in the Civil War, and increased incrementally through World Wars I and II. The rate of combat ocular trauma more than doubled by the Korean War, and rose steadily to reach 13 percent by Operation Desert Storm.
"In recent conflicts, combat ocular trauma stabilized in the 10 to 15 percent range. A lot of that may be due to eye protection which has been widely implemented," Cho said. "This is a significant percentage of potentially debilitating injuries."
He shared statistics for traumatic eye injury in the civilian population.
"A large percentage, 31 percent, of these are due to blunt objects," said Cho, who explained only a very small percentage is due to gun shots or explosions. "In combat situations, it's quite the opposite."
The ophthalmologist said the vast majority of combat eye injuries are due to explosions, such as high energy projectiles and improvised explosive device, or IED, blasts.
"Ocular trauma is ocular trauma," Cho said. "In a combat situation, it's just to a more severe degree and in a very special environment."
Combat ocular trauma is more complicated, and likely to involve more than one body system compared to the civilian sector, so accommodations and modifications in treatment may need to be made, explained Colyer, a vitreoretinal surgeon.
High energy projectiles cause explosive ocular ruptures, globe lacerations, as well as severe tissue damage or loss, Colyer said. Blast and fragmentation eye injuries are sometimes accompanied by associated craniofacial injury along with multi-system trauma.
Medical personnel at care echelon levels I, medic or battalion aid station, and II, forward surgical team, play an important role in identifying open globe injury and protecting the eye from further injury, Colyer explained. Health care providers at these levels can determine if the globe is open and if there is chemical exposure, or orbital compartment syndrome. They can also determine if the patient has decreased vision, pain, double vision, lid laceration or any other reason they should see an ophthalmologist.
Patients with combat eye injuries sometimes experience corneal scarring, glaucoma, traumatic cataract, retinal detachment and intraocular foreign bodies as a result of their ocular trauma, Colyer said.
New techniques and innovations emerge from the study of combat ocular trauma, according to Colyer. For two years, he studied how to use an ophthalmic endoscope, which involves utilizing a one-millimeter camera, to operate in a two centimeter space. The technique allows the eye surgeon to repair eyes otherwise not repairable. He said studies are under way to develop a retinal prosthesis.
The Vision Center of Excellence, or VCOE, headquartered at WRNMMC, integrates vision care in the Department of Defense and Veterans Affairs health care systems. Colyer said the VCOE is forming an eye trauma registry that will help determine what's needed in the areas of research and ophthalmologic regulation.