Nonlethal crowd control measures can cause serious ocular injuries

Crowd control measures used to disperse protesters can cause a unique set of serious ocular injuries, and in some cases even lead to blindness.

Study design

A web-based survey using Google Forms was developed to capture cases of ocular trauma related to civil unrest. The link was disseminated from June 3 to July 1, 2020, via social media and multiple ophthalmic society listserves and newsletters, including those from the Academy, the Ophthalmology Moms Group, and the Cornea Society. A systematic literature review was conducted around studies related to ocular injuries resulting from rubber bullets and tear gas published between 1990 and 2020.

Outcomes

Thirty participants responded to the survey and 7 articles were identified in the literature review. Among the respondents, the most common injury suffered was a ruptured globe, often due to a projectile, and 7 respondents needed enucleation surgery. In the literature, the most commonly reported serious ocular injuries from rubber bullets were open globe trauma, retinal/vitreous hemorrhage, hyphema, iridodialysis, and orbital fracture, while the most commonly reported ocular injuries from tear gas were conjunctivitis, corneal opacities, and corneal epithelial defects.

Limitations

The main limitation was the small sample size, which was likely due to underreporting.

Clinical significance

With the recent Supreme Court Ruling to reverse Roe vs. Wade, civil protests are sure to be on the rise and oculoplastics surgeons should be well-versed in the “non-lethal” tactics used in crowd control measures, as the associated potentially disabling consequences will call upon the surgical intervention of eye surgeons and their colleagues. We should revisit the lessons learned from the civil unrest of 2020 and the devastating ophthalmologic impact it had on many unfortunate individuals and apply these lessons to our future patients.