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G. C. Cockerham, T. A. Rice, E. H. Hewes, K. P. Cockerham, G. W. Wang, C. M. Glynn-Milley; Ocular and Adnexal Damage in Veterans With Combat Blast-Induced Traumatic Brain Injury. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5326.
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To determine visual acuity and the incidence of ocular damage in a population of veterans with traumatic brain injury (TBI) caused by exposure to combat blast.
This study protocol received Stanford IRB and VA Research Committee approval. 37 consecutive inpatients at a VA Polytrauma Rehabilitation Center who met inclusion criteria underwent visual acuity testing by projected Snellen chart or illuminated cabinet with high-contrast Early Treatment Diabetic Retinopathy (ETDRS) optotypes. A complete eye examination, undilated and dilated, including gonioscopy, was performed. No eyes with penetrating injury were included in the analysis. 10 age and gender-matched controls underwent similar testing.
Study patients included 34 men and 3 women, with an age range of 20 to 45 years, and a mean age of 27. Control ages ranged from 19 to 42 years, with a mean age of 31. Seven of 74 eyes (9%) in the TBI group were enucleated or non-sighted. In the 67 sighted eyes, best-corrected visual acuity (BCVA) ranged from 20/10 to 20/200, with a mean acuity of 20/25; 94% were better than 20/40 and 82% were 20/20 or better. All controls had BCVA of 20/20 or better. Incidence and types of eye damage in study eyes included: cornea 7% (superficial scars, embedded debris, rupture of Descemet’s membrane); chamber angle 18% (angle recession, iridodialysis); lens 6% (traumatic anterior or posterior subcapsular cataract); retina 12% (choroidal rupture, retinal hemorrhage, retinal holes, retinal detachment, retinal thinning, macular hole; and optic nerve damage in 3% (optic atrophy, relative afferent pupillary defect). Oculoplastic data was available on 30 study patients: facial or orbital fractures were present in 40%, with facial or lid scarring and lid or brow ptosis in 35%. No ocular or adnexal damage was detected in the control population.
Combat blast injury exposes the eye and ocular adnexa to various forces, including primary blast wave, secondary effects of airborne objects, and acceleration/deceleration. Eye injuries seen in our study are consistent with a blunt trauma mechanism. Significant ocular damage may be present in combat veterans exposed to blast, despite good visual acuity and few or no symptoms. A complete eye examination and regular follow-up is recommended in this population.
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