Abstract
Purpose :
Nerf guns are perceived as safe for children, especially in comparison to BB/pellet and paintball guns, yet they frequently cause hyphemas. We aim to characterize the acute ocular manifestations and management burden from nerf gun-associated hyphema.
Methods :
We conducted a retrospective cohort study of pediatric cases with hyphema from nerf guns seen at the Vanderbilt Eye Institute between Nov 2017 and May 2022. We collected data regarding intraocular pressure and visual acuity (at presentation, first follow up, and last visits), prescribed medications, and the total number of eye visits and days of recommended activity restrictions.
Results :
Of the 308 hyphema cases, 29 (9.4%) were from nerf guns, representing 72.5% of the 40 cases injured by toy guns. Most patients injured by nerf guns were male (75.9% P = 0.0053) and <10 years old (72.4%) with an average age at presentation of 9 (range: 3-19; median: 9 years old). Visual acuity was worse than 20/40 in the affected eye in 46% of patients at some point during follow up, and in 9% of cases at last recorded eye exam. Of the nerf gun-associated hyphema cases with recorded intraocular pressure (IOP, mmHg), 25%, 24%, and 9% had elevated IOP (> 21) in the injured eye at presentation, first, and last follow up, respectively (vs 5%, 4%, and 0% in the unaffected eye). Almost 2/3 of cases had high IOP at some point in follow-up, with an average highest affected eye IOP of 24 (range 12-49). However, only 17.24% received pressure lowering eye drops. On the other hand, 86.2% patients received steroids and 79.3% atropine drops. Out of 29 patients, 3 (10.3%) were lost to follow up while still on steroid drops. The average number of clinical encounters per patient was 5.19. The average number of restricted activity days was 16.12, collectively representing 419 days among all 26 patients who completed follow up. Considering these children needed at least one adult to supervise them in this period, this represents one YEAR of lost activity/productivity in an individual per every 11.36 traumatic hyphema cases.
Conclusions :
In conclusion, we argue that nerf guns, although regarded as relatively safe in comparison to other toy guns, cause ocular damage (e.g. high IOP) that not only threatens ocular health (acutely and long term) but also represents a burden on health care and patient resources.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.