• Opinion

    Rubber Bullets and Responsibilities

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    Ruth D. Williams, MD

    By Ruth D. Williams, MD, Chief Medical Editor, EyeNet

    On Friday, May 29, Linda Tirado, a photojournalist covering the Minneapolis protests that followed the death of George Floyd, was shot in the left eye with a rubber bullet. True to her calling as a journalist, she tweeted about her experience on her way to the OR. Ophthalmolo­gists and news outlets reported dozens of similar devastating ocular injuries from the rubber bullets that police use for crowd control.

    The right to protest is embedded in the political culture of many countries. Indeed, the First Amendment of the U.S. Constitution reads, “Congress shall make no law … abridging the freedom of speech, or of the press; or the right of the peo­ple peaceably to assemble, and to petition the government for a redress of grievances.” Peaceful public protest is a hallmark of a vibrant democracy. However, as some large protests have led to violence and riots, police and security forces have used a variety of crowd-control weapons that are meant to cause pain without causing death.

    Rubber bullets, a type of kinetic impact projectile (KIP), come in a variety of styles. Some are single projectiles; others are fired as a group of pellets. While KIPs may be nonlethal, they can cause harm, including significant harm to the eye.

    Ocular injuries from rubber bullets aren’t new. Last fall, with the backdrop of unrest over economic issues, protesters packed the streets in Santiago, Chile. Several hundred people suffered severe ocular injury from rubber bullets—and the image of a bandaged eye became a rallying symbol.1 Even though Chile’s president defended the use of force to main­tain order, in response to the outcry, the police chief sus­pended their use except in circumstances of extreme danger.2

    Law enforcement in the United States needs similar guidelines. After performing emergency surgery on two young men who sustained penetrating ocular injuries from KIPs—one was peacefully protesting, while the other was merely walking a half block to his car—Prem Subramanian wrote the Denver mayor. He explained the balance between the need for order and the need for restraint: “I am a former U.S. Army officer with 21 years of service. I believe in the rule of law, and I also believe in the concept of a proportional response. Police should not unleash violence, lethal or not, upon individuals who may be protesting peacefully or even violating laws such as curfews. Arrest, detention, fines—these are all appropriate penalties for legal violations. Blindness from exercise of police force from a distance is not.” I would add that police need crowd control measures when riots or looting develop, but that these measures must not permanently maim.

    The Academy condemns the use of KIPs, publicly stating that, “Following numerous serious injuries … the American Academy of Ophthalmology calls on domestic law enforce­ment officials to end the use of rubber bul­lets to control or disperse protesters. The Academy asks physicians, pub­lic health officials and the public to condemn this practice.”3 Our approach to these issues isn’t through a political lens; rather, it reflects our commitment to saving vision.

    What can an individual ophthalmologist do? Many have participated in the Acad­emy social media campaign #NoRubberBullets #NotOneMore­Eye. A letter from a treating surgeon, like Prem’s, to the local police chief or mayor is impactful. Another option: Consider writing a Letter to the Editor in the local newspaper.

    As for Linda Tirado, after her surgery, she tweeted, “No worries, I’ve been back at work for five hours now. My job is to witness and they only got my left eye.” Just as Ms. Tirado is deeply committed to her work—even after being partially blinded—we ophthalmologists are commit­ted to our work of saving vision. And right now, in addition to treating ocular injuries, that work includes public action.


    1 www.nytimes.com/2019/11/19/world/americas/chile-protests-eye-injuries.html.

    2 www.cnnchile.com/pais/mario-rozas-suspende-uso-balines-antidisturbios_20191119/.

    3 aao.org/newsroom/news-releases/detail/statement-on-rubber-bullets-crowd-dispersion. Accessed June 17, 2020.