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| CASE REPORT |
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| Year : 2022 | Volume
: 10
| Issue : 3 | Page : 127-129 |
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Blindness due to landmine blast injury
Rajarathna V Hegde, Chhaya A Shinde, Sushmitha S Shetty, Afzal T Khan
Department of Ophthalmology, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| Date of Submission | 31-Jan-2022 |
| Date of Decision | 23-Jul-2022 |
| Date of Acceptance | 06-Jun-2022 |
| Date of Web Publication | 21-Feb-2023 |
Correspondence Address:
Rajarathna V Hegde
Department of Ophthalmology, Lokmanya Tilak Municipal Medical College, Sion, Mumbai
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/DYPJ.DYPJ_10_22
This case report describes a case of ocular blast injury and its management. A 35-year-old male patient was referred to a tertiary hospital with a history of landmine blast injury. The right eye examination revealed full-thickness lacerated wound in the right upper eyelid and globe rupture. The left eye examination revealed a partial-thickness scleral tear, multiple foreign bodies in the cornea, foreign body embedded in the iris, and traumatic cataract. The evisceration of the right eye with scleral tear repair in the left eye was performed under general anesthesia. Multiple foreign bodies from the cornea and one embedded in the iris were removed from the left eye. At the final follow-up at 3 months, the right socket showed a good healing with an implant in place. The visual acuity in the left eye was 6/24 with foreign bodies in the deeper corneal stroma and traumatic cataract. Keywords: Evisceration, globe rupture, scleral tear, traumatic cataract
How to cite this article:
Hegde RV, Shinde CA, Shetty SS, Khan AT. Blindness due to landmine blast injury. D Y Patil J Health Sci 2022;10:127-9 |
| Introduction | |  |
Blast injury occurs with the detonation of high-order explosives and the deflagration of low-order explosives.[1]
Explosives are of two types:
- High-order explosives produce a defining supersonic overpressurization shock wave called the blast wave, e.g., C-4 and nitroglycerin.[1]
- Low-order explosives have a subsonic explosion and lack the high-order explosive blast wave, e.g., pipe bombs and petroleum-based bombs.[1]
Mechanism of blast injury by high-order explosives
- Primary injury—by direct pressure effects of the blast wave on the body surface
- Secondary injury—by the flying debris and bomb fragments
- Tertiary injury—from individuals being thrown by the blast wind
- Quaternary injury—by inhalation of dust and toxic gases, exposure to radiation, and thermal burns.[1]
| Case History | | |
A 35-year-old male patient was injured in a mine blast at his workplace. He was admitted to a private hospital for 2 days and received first-aid care and then referred to a tertiary hospital for further management.
The patient had an intense pain, redness, and watering in both eyes.
He was conscious, cooperative, and oriented in time, place, and person and hemodynamically stable.
There was no perception of light in the right eye, and the visual acuity was finger counting at half meter in the left eye. The extraocular movements were severely restricted in the right eye and moderately restricted in the left eye.
Both the eyes were congested with swollen eyelids. The right eye had a full-thickness oblique lacerated wound measuring 10 × 5 mm over the right upper eyelid. The right globe was ruptured with a total uveal tissue and vitreous prolapse. Cornea, sclera, and anterior chamber could not be identified.
The left eye had multiple small foreign bodies embedded in the corneal epithelium, stroma, and grade two hyphema. Two-millimeter-sized metallic intraocular foreign body was embedded in the iris at the 2 o’clock position. Posterior synechiae were present, and the pupil reacted sluggishly to light. The lens was cataractous suggestive of traumatic cataract. The intraocular pressure was digitally normal. The posterior segment was not visible because of hazy cornea and cataract. B scan was within normal limits.
Computed ocular tomography confirmed the right globe rupture and intraocular foreign body in the left eye and revealed few hyperdense contents in the preseptal region of the right eye suggestive of foreign bodies. Comminuted fracture along the right medial wall with linear minimally displaced fracture of the floor of right orbit was noted.
The patient was started on prophylactic intravenous antibiotics preoperatively. Because the right eye was not salvageable and had nil visual prognosis, evisceration was performed. Eighteen-millimeter-sized polymethyl methacrylate sphere nonintegrated solid orbital implant was placed in the orbit [Figure 1]. The upper eye lid laceration was sutured. | Figure 1: Polymethyl methacrylate sphere nonintegrated solid orbital implant
Click here to view |
In the left eye, 15-number blade was used to scrape off the superficial foreign bodies, but those embedded in the deep stroma could not be removed. The anterior chamber wash was done, and the foreign body embedded in the iris was removed with Kelman McPherson’s forceps.
The globe exploration revealed a partial-thickness 3 × 4 mm sized scleral tear at the 1 o’clock position, 5 mm away from the superior limbus. Scleral tear repair was done with 6/0 silk interrupted sutures.
The case was then taken over by the Department of Plastic Surgery for the debridement of the wounds over face, chest, and shoulder followed by collagen dressing.
Postoperative management
On postoperative day 1, the right orbital socket showed no evidence of bleeding with an implant in place. The left eye had corneal epithelial defect with no hyphema or infection [Figure 2].
He was started on topical fortified amikacin 2.5%, moxifloxacin 0.5% plus dexamethasone 0.1%, 1% atropine for the left eye and polymyxin B plus chloramphenicol ointment for both the eyes.
The patient was discharged after a week. During 1-month follow-up, the right socket showed good healing [Figure 3]. The visual acuity in the left eye was 6/36 showing no improvement.
The patient was followed up for 8 more weeks. During the follow-up, the right socket healed completely [Figure 4]. The visual acuity in the left eye was 6/24 with no improvement. The patient was advised the left eye cataract surgery, but was lost to follow-up.
| Discussion | | |
In a case report by Giri et al. titled “Accidental blast of an improvised bird scarer gun” in 2018, a 32-year-old male patient with a history of blast injury caused by a mixture of Gandhak and Potash in an improvised bird scarer gun succumbed to his injuries.[1]
In a case report by Krishnacharya titled “A case study of blast eye injury at work place” in 2013, a 45-year-old male patient with a history of blast injury underwent the right eye corneal laceration repair, extraction of the ruptured lens, and anterior vitrectomy with a removal of intraocular foreign body. After 4 months, penetrating keratoplasty with scleral fixated intraocular lens implantation was performed.[2]
In a case report by Nagpal et al. titled “Accidental ocular blast injury to a farmer’s eye by Gandhak Potash” in 2021, a 54-year-old male patient with a history of blast injury had conjunctival hyperemia and subconjunctival hemorrhage bilaterally with multiple foreign bodies embedded in the superficial and deep layers of the cornea. In both eyes, lens was unaffected and posterior segment was normal. The patient was managed conservatively and did not require surgical intervention.[3]
| Conclusion | | |
High-order explosives can result in severe ocular injuries. So, early intervention by the ophthalmic surgeon might increase the chance of salvaging the eye and vision. Blast injuries often result in penetrating ocular injury where the debris with the small fragments of metal, glass, or stone particles penetrate and get lodged in the eye. Computed tomography should be done, and foreign body should be removed to prevent complications. Prompt management and care prevented postoperative complications in the present case. Following proper safety protocol by the workers handling explosives will help prevent casualties.
Declaration of patient Consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Giri SK, Sharma L, Kumar V, Dhattarwal S, Keshwani P et al. Accidental blast of an improvised bird scarer gun: A case report. Int J Curr Adv Res 2018;28:9212-4.  |
| 2. | Krishnacharya PS A case study of blast eye injury at work place. Burns Trauma 2013;1:140-3. |
| 3. | Nagpal N, Prasher P, Kaur I Case report: Accidental ocular blast injury to a farmer’s eye by Gandhak Potash. Delhi J Ophthalmol 2021;32:58-61. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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