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  • Nation’s Ophthalmologists Condemn Use of Rubber Bullets

    The American Academy of Ophthalmology offers advice to help mitigate the inevitable injuries these tactics inflict


    SAN FRANCISCO, Calif. – Rubber bullets may be non-lethal, but they can blind. This week, rubber bullets and similar projectiles blinded at least two Americans and caused serious eye injuries in many others. Life-altering eye injuries are a common result of urban warfare and rioting. We have seen it around the world1 and we now see it in the United States. The American Academy of Ophthalmology calls on domestic law enforcement officials to immediately end the use of rubber bullets and similar projectiles to control or disperse crowds of protesters. 

    The Academy asks physicians, public health officials and the public to condemn this practice. Americans have the right to speak and congregate publicly and should be able to exercise that right without the fear of blindness. You shouldn’t have to choose between your vision and your voice.  

    “Ophthalmologists, like many Americans, have mobilized to protect their communities from COVID-19 in recent weeks,” said Anne L. Coleman, MD, PhD, president of the American Academy of Ophthalmology.  “We are saddened that these same communities now need our professional skill to treat blinding eye injuries from senseless violence.”

    We offer the following advice in the hope that it will mitigate some of the inevitable eye injuries from rubber bullets, tear gas, as well as paintball guns used to “mark” people.

    Although, eye protection may help prevent injury from rubber bullets and projectiles, they do NOT give 100 percent protection. If your eye is injured, protect the eye immediately. This is a medical emergency!

    1. Do not touch the eye
    2. Do not rub the eye
    3. Stay upright
    4. Place a hard shield around eye. Even a temporary eye shield, such as paper cup or Styrofoam cup, may work in an emergency
    5. If the eye ruptures, the contents inside must be preserved, seek emergency room and ophthalmology consultation immediately

    Tear gas typically doesn’t cause irreversible eye injuries, but tear gas has caused serious eye injuries, including hyphema, uveitis, necrotizing keratitis, coagulative necrosis, symblepharon, secondary glaucoma, cataracts and traumatic optic neuropathy and loss of sight.2

    Eye protection may help avoid exposure to tear gas, but they do NOT provide 100 percent protection. If exposed to tear gas, you should3:

    1. Remove yourself from the contaminated area as quickly and safely as possible.
    2. Flush the eyes with lots of clean water or eyewash (available at most pharmacies).
    3. Remove clothing near the face.
    4. Seek fresh air.
    5. Seek higher ground (aerosolized tear gases are heavier than air).
    6. Blink frequently (to promote tearing).
    7. Do not rub eyes (may spread crystals within the eye).
    8. Remove contact lenses.
    9. Seek emergency ophthalmic evaluation.

     If exposed to pepper spray: 

    1. Don’t touch the eye area. Pepper spray is oil-based. Touching the area will spread the oil.
    2. Blink to help flush the eyes.
    3. Flush the eyes with lots of clean water or eyewash (available at most pharmacies). A small, randomized, controlled trial compared these five treatments (Maalox, 2% lidocaine gel, baby shampoo, milk, water) and found no difference in pain relief. Milk is NOT recommended for flushing the eyes; it's not sterile.
    4. Wash the skin around the eyes with baby shampoo; it will breakdown the oil without irritating the eyes.


    1. An Epidemic of ‘Dead Eyes’ in Kashmir as India Uses Pellet Guns on Protesters, The New York Times, A Bullet to the Eye Is the Price of Protesting in Chile, The New York Times

    2. (Schep LJ, Slaughter RJ, McBride DI. “Riot control agents: the tear gases CN, CS and OC—a medical review.” BMJ Military Health 2015;161:94-99.)

    3. Ravi D. Goel, MD, Protecting