Ocular Trauma Among Civilians In A Conflict Zone: A Hospital-Based Observational Study

To describe the mechanisms, types and surgical management of conflict-related ocular injuries among the civilian Palestinian population during the war on Gaza between March and September 2025.

Gaza Ophthalmic Specialized Hospital and Public Society Hospital with some data from Al-Ahli Hospital, Gaza, State of Palestine.

Retrospective observational study analysed clinical data from civilian patients presenting with traumatic eye injuries to two tertiary ophthalmic centres in the Gaza Strip with supplementary data from a third hospital. All patients underwent complete ophthalmic examination and globe injuries were classified according to the Birmingham Eye Trauma Terminology System (BETTS). Demographic data, injury laterality, mechanism of injury and primary surgical interventions were recorded. The study followed STROBE reporting guidelines.

A total of 1891 patients (2077 injured eyes) were included. Most patients were male (71%), and 30% were paediatric (≤18 years). Ocular injuries accounted for approximately 10.5% of all hospital-admitted trauma cases. Blast-related mechanisms, including explosions and shrapnel, were responsible for 86.7% of injuries, followed by gunshot wounds (12.1%). Open-globe injuries predominated, including ruptures (17.1%) and penetrating or lacerating injuries involving the cornea, sclera, or corneoscleral wounds. Intraocular foreign bodies were identified in 12.5% of eyes. Evisceration was required in 18% of cases due to severe, unsalvageable injuries. Bilateral involvement occurred in 9% of patients and 69% had associated polytrauma.

Ocular injuries among civilians during the war on Gaza were frequent, severe and predominantly blast-related, resulting in a high burden of irreversible visual loss and globe-sacrificing surgery. Children were disproportionately affected compared with previous conflict-related studies. These findings highlight the devastating impact of modern warfare on civilian eye health and underscore the urgent need for strengthened emergency ophthalmic services, trauma preparedness and post-conflict rehabilitation. As a hospital-based retrospective study conducted during active conflict, findings likely underestimate the true burden of ocular trauma, exclude pre-hospital fatalities and lack long-term visual outcome data.