Toy Gun Eye Injury in Kids Is Up

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Mirroring other findings in recent years, data from a French study suggest that the incidence of ocular trauma in children related to foam bullets and other types of projectiles from toy guns has risen over the past decade.¹

TREACHEROUS TOYS. Eye injuries from foam projectiles can be serious.

Methodology. The researchers set out to examine the estimated annual incidence and severity of toy gun injuries seen at the Rothschild Foundation Hospital in Paris. They reviewed every case involving eye trauma related to use of nonpowder toy guns—including paintball guns, air guns, BB guns, airsoft guns, and foam bullet and dart blasters—treated at their eye emergency department between January 2010 and June 2022.

In all, 304 pediatric patients were seen during the study time frame, the majority (234) of whom self-reported as male, and the mean age was 16 years. The researchers reported 151 ocular injuries from foam projectiles, 110 from BB or airlift guns, 31 from paintball guns, and 12 from “unspecified” toy guns.

Worrying trends. The scientists said the data show a rise in the incidence of injuries from foam projectiles between 2014 and 2022. Meanwhile, during the same eight-year span, the mean age of pediatric patients injured by foam projectiles decreased from age 16 in 2014 to age 10 in 2022.

“We were surprised by the trend showing that kids are being injured younger and younger. We even recorded a trauma in a one-month-old child,” said lead study author Alexandre Dentel, MD.

The injuries. He said that heading into this research, he and his colleagues underestimated the proportion of young people injured by foam “Nerf-type guns.” Foam projectile–related ocular trauma led to 51 intraocular hemorrhages, 45 corneal injuries, 22 iris injuries, 19 retinal injuries (including two retinal tears and one retinal detachment), 12 cases of ocular hypertension, three cataracts, and two open-globe injuries, the authors reported.

Dr. Dentel said that most cases of corneal abrasions “generally heal well within a few days” when treated with antibiotic eye drops. “For management, particular attention must be paid to intraocular pressure and examination of the central and peripheral retina—retinal lesions are quite frequent, such as Berlin’s edema [retinal swelling related to blunt trauma] and retinal breaks,” Dr. Dentel said. He noted that some of the more severe injuries involved chronic intraocular hypotony, including some that “led to total blindness by phthisis bulbi.”

A global problem. While the study focused on one medical center in France, it reflects a growing concern among ophthalmologists in the United States and other countries over the widespread dangers posed by toy guns.²

Erin Shriver, MD, at the University of Iowa Hospitals and Clinics in Iowa City, who was not involved with the Paris research, said, “The term ‘toy guns’ gives one a sense that these guns are harmless when in fact they can cause significant ocular injuries and even result in permanent vision loss.”

She said there should be a national public awareness campaign on the risk of injuries from guns that shoot foam bullets, air soft guns (“‘soft’ is a misnomer”), and gel pellet guns.

“All children and adults should wear eye protection when using or when near others who are using nonpowder projectile weapons,” Dr. Shriver said, adding that parents should supervise children who are using toy weapons.

Dr. Dentel echoed those thoughts, saying that responsibility rests on the shoulders of toy manufacturers, too—that they should supply protective goggles with each toy weapon and include images of children wearing goggles in their ads that promote toy guns.

—Brian Mastroianni

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1 Dentel A et al. JAMA Ophthalmol. 2023;141(6):604-605.

2 Cohen S et al. Eur J Pediatr. 2023;182(3):1099-1103.

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Relevant financial disclosures: Dr. Dentel—None. Dr. Shriver—None.

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