Ocular injuries after the pagers explosion in Lebanon: A novel form of modern warfare.

Abstract

Background: The incidence of ocular injuries in modern conflicts has significantly increased, particularly in explosive device-related incidents. This study aims to investigate and characterize the nature and outcomes of ocular injuries resulting from the September 2024 pagers explosions in Lebanon, which caused over 37 deaths and 3,000 injuries.

Methods: This retrospective descriptive study analyzed 38 patients (76 eyes) with ocular injuries who presented to the Hôtel-Dieu de France hospital following the Pager explosion in Lebanon on September 17-18, 2024. Patients were identified from emergency department, OR, and ophthalmology clinic records. Data was collected from ED, OR, ophthalmology and imaging records.

Results: Thirty-six patients (95 %) were male, and the mean age was 32.8 ± 9 years (SD), ranging from 5 to 52 years. Bilateral eye injuries were observed in 28 patients (74 %). One-third of the eyes had no light perception (NLP) at presentation. Five patients (13 %) had bilateral NLP vision on presentation. Open globe injuries were present in 42 (57 %) eyes and required immediate surgical reparation. Twenty-one percent of eyes presented expulsive injury and were eviscerated. Twenty-seven patients (36 %) had intraocular foreign bodies. Ocular surface injuries were present in 42 % of eyes. Thirty-six eyes (47 %) had superior and/or inferior lid lacerations requiring surgical repair. Twenty-four percent of eyes had an orbital wall fracture. Vitreous hemorrhage was reported in 20 eyes (26 %), while two eyes (3 %) had total hyphema. Cataract was identified in two eyes (3 %), and lens subluxation in four eyes (5 %). One eye had retrobulbar hematoma and required a lateral canthotomy. On the follow-up, four eyes developed endophthalmitis, while two eyes progressed to phtisis bulbi and were eviscerated. Five eyes developed cataract. Visual acuity remained unchanged in 60 % of eyes and deteriorated in 40 %.

Conclusion: This study highlights the severity of ophthalmic injuries in modern warfare, emphasizing the need for immediate surgical intervention to optimize patient outcomes.