Eye Injuries during the American Civil War

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View that Confederate soldiers had of the Lower Bridge (now known as Burnside’s Bridge) over Antietam Creek. On September 17, 1862, Union troops under Maj. General Ambrose Burnside occupied the bridge after heavy fighting and proceeded to engage rebel forces under General Robert E. Lee southeast of Sharpsburg, Maryland.

From http://ww.artificialeyeclinic.com/aecpdfs/civilwar.pdf:

Many physicians who performed surgery during the American Civil War had no prior surgical experience at all, still less had training or experience in military surgery.  However, the nature of Civil War injuries meant surgery was often necessary if soldiers were to have a chance of surviving their wounds. The devastating injuries caused by advances in artillery, combined with field surgeons’ lack of training and experience, meant a high rate of surgical mortality, especially in the war’s early years….

The incidence of eye injury in general is 20 to 50 times higher than would be expected by ocular surface area alone. The human eye makes up just 0.27% of the body’s surface area and less than 4% of facial surface area. Because Civil War soldiers firing muskets from the standing or prone position needed to sight in their arms, their heads, faces, necks, and eyes were frequently exposed during combat. The eye and orbital areas were usually unprotected. (While eye shields were available to protect against the force of exploding gun caps, they were not always effective even when worn.) Soldiers’ eyes were thus exceptionally vulnerable to injury from small arms, fragments of shrapnel, rock, battlefield debris, and dirt. Because of the Minié ball’s explosiveness and tendency to destroy all tissue near the entry wound, the eyelids of Civil War soldiers rarely escaped injury from gunshot wounds to the face, neck, or head. In addition, missiles seldom penetrated or destroyed the eyeball without injuring the bones of the orbit. A study of eye injuries in Civil War solders reported that the loss of one eye occurred in two-thirds of 1,190 soldiers with isolated eye injuries, while only 5% of these soldiers lost sight in both eyes or died from their wounds.

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Diagram of the Minie Ball (developed by Claude-Etienne Minie), a spin stabilized conical rifle bullet designed to inflict more damage than round balls from smoothbore muskets.

When The Rubber Breaks

Be careful when training with elastic exercise bands.  Here’s a case report from  http://www.hindawi.com/journals/criopm/2013/189837/ regarding an injury sustained during a CrossFit training session:

This patient had a traumatic giant retinal dialysis and retinal detachment as a consequence of elastic resistance band breakage during CrossFit training. To our knowledge, this type of injury has not been reported. Elastic bands are being used increasingly as an exercise accessory to provide resistance, not only in CrossFit, but also in other popular exercise programs, such as P90X. Some elastic bands consist of latex strips of variable lengths and resistance while others are elastic tubes with soft grip handles on the ends (Figure 1). With repeated use, elastic bands can weaken and eventually break. When it is under tension, a broken elastic band can snap into the eye causing injuries such as hyphema, cataract, or retinal detachment. Dialyses and giant retinal tears are responsible for 69 percent of traumatic retinal detachments.

Elastic bungee cords have been reported to cause a variety of ocular injuries. Elastic resistance bands might appear to be safer since they do not have metallic hooks on their ends as bungee cords do, although some have soft handles. Nevertheless, an elastic band, under high tension, can snap causing a high velocity missile impact with the eye, causing similar injuries to a bungee cord. Exercise participants and trainers should be aware of the potential for this type of injury. Precautions include the use of protective eyewear and regular replacement of worn elastic bands. Examining bands before and after use, looking for nicks, punctures, or tears, and discarding worn bands may prevent these injuries.

Pugilism and Eye Injuries

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Manny Pacquiao (right) en route to defeating Antonio Margarito in November 2010. Margarito suffered a right orbital fracture during the bout and eventually developed right eye traumatic cataract.

A 1987study of 74 boxers found at least one ocular injury in 66% of the enrolled boxers.  Vision-threatening injuries, defined as significant damage to the angle, lens, macula, or peripheral retina, occurred in 58% of boxers.  Nineteen percent of boxers had angle abnormalities.  Nineteen percent of boxers had pathologic cataracts, and over 70% of these were posterior subcapsular.  Six boxers had macular lesions and a total of 24% of boxers had retinal tears.

Source: Giovinazzo et al, The ocular complications of boxing, Ophthalmology, June 1987.

‘Tis the Season

In 2012, there were 265,000 children and teens treated in American emergency rooms for toy-related injuries.  As Thanksgiving and Christmas 2014 approach, parents should be mindful of toys that pose a danger to children’s eyes.  Here are some tips to consider when choosing toys and gifts for children:

  • in general, avoid toys with sharp parts that can injure the eye
  • projectile toys such as airsoft guns, BB guns, and paintball guns can propel objects into the eye and severely damage it
  • when choosing toys with laser light, make sure the toy has a compliance statement with 21 CFR Subchapter J of the Code of Federal Regulations to ensure that the power of the laser is within safe limits
  • sports equipment with eyewear should include lenses made of shatter-resistant polycarbonate material
  • choose toys that are age-appropriate and supervise accordingly