Blast Eye Injury In A Child During Wartime

The most common cause of civilian casualties during hostilities in Ukraine is mine blast injuries, in which damage to the eye is observed in 9-14% of cases. A wartime eye injury is characterized by greater severity, late hospitalization, a large number of complications and a worse prognosis, with injuries to other organs and systems. In this paper we would like to demonstrate the importance of a correct treatment tactics in the case of a blast injury.

The work was done in the Pediatric Department of the Dnipropetrovsk Regional Clinical Ophthalmological Hospital, which has been providing highly specialized surgical ophthalmic care to children affected by hostilities in eastern Ukraine for a year.

A 7-year-old child, while staying at home, received a blast trauma, including open injury of the anterior chest wall, a rib fracture, and the right lung rupture. Within 10 days the child was treated in a multidisciplinary pediatric hospital. The patient was admitted to our department on the 11^th day after the injury for surgical treatment of traumatic cataract. Upon admission, visual acuity was impossible to be checked because of the severe status of the child. The right eye was slightly irritated, in the 12 o'clock meridian there was a defect of the sclera with adapted margins, the cornea was transparent, the anterior chamber was of average depth, the lens was diffusely opaque, the anterior capsule was ruptured. According to ultrasonic b-scanning, a hyperechoic inclusion, an intraocular foreign body (FB), was found in the lower part of the vitreous in the 5 o'clock meridian. The clinical condition of the left eye was normal. The patient underwent cataract removal with IOL implantation, posterior capsulorhexis, posterior vitrectomy, removal of the FB, under which a retinal hole was found. Additionally, laser coagulation of the retina using argon laser was performed (power 200 mW, spot size 200 μm), and silicone oil was injected into the vitreous cavity. Examination after 2 months: the best corrected visual acuity of the right eye is 20/25, IOP is 20 mm Hg, the eye is not irritated, the IOL is centered, there is silicone oil in the vitreous cavity, the retina is adjacent.

Treatment of patients with blast injuries requires the readiness to adjust the surgical tactics right in the operating room, so, such treatment is more appropriate to be done in clinics providing highly specialized care. Our case demonstrates that patients with blast wartime injuries should undergo a thorough examination, since the severe general condition of the patient does not always allow focusing on subjective complaints. This approach allows avoiding complications and obtaining good functional results of treatment.