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  • Ocular Injuries in Iranian Protesters

    Vitreoretinal surgeons in Iran have organized a petition to prevent the nation’s morality police from inflicting eye injuries on those protesting the death of Mahsa Amini, a 22-year-old woman arrested for “improperly” wearing her hijab.

    The petition, which has already garnered hundreds of signatures, asks police to stop shooting at people’s faces and heads because ocular trauma  can cause devastating injuries and permanent blindness. Civil unrest erupted in Iran in September 2022, after Amini was severely beaten and later died after wearing her hijab too loosely in public. In response, Iranians began protesting government restrictions on freedom. Although most demonstrations have been peaceful, such as women burning their headscarves, many have suffered brutality from armed police. The death toll is estimated to be in the hundreds, although the exact number cannot be verified. 

    The exact number of traumatic injuries to protesters’ eyes is impossible to calculate, primarily because some injured protesters have fled to escape arrest. But Iranian ophthalmologists report being overwhelmed by the number of ocular trauma cases, including ruptured globes, severed optic nerves and damaged retinas. 

    Much of the irreparable damage is caused by police’s use of guns with rubber bullets. Rubber bullets are being aimed at eyes, rather than at the lower body our ground. Police also use weapons with paint balls to mark protestors’ faces for identification and later arrest. Hollow-point metal bullets expand on impact, ensuring that they wreak maximum damage on orbital structures and remain lodged in soft tissues. Orbital CT scans show numerous metal pellets lodged behind and around the eye. In news reports from outside Iran, the injuries include mutilated retinas and punctured irises.

    Eye injuries have also been reported worldwide when civil unrest has erupted, including the United States, where police have fired rubber bullets into demonstrating crowds. 

    The Academy identified rubber bullets as a threat in a June 2020 article and drew a parallel between eye trauma suffered by protestors in countries undergoing political turmoil and in U.S. citizens participating in peaceful demonstrations. 

    The article identified the misuse of rubber bullets and other “kinetic-impact projectiles” fired directly at eyes to be dangerous to ocular structures which are too delicate to withstand the impact. Despite the Academy’s #NotOneMoreEye Campaign, legislation to control the use of these projectiles against civilians has yet to be passed in the U.S. 

    The details of Iran's ocular injuries are still obscure. Communications are hampered by government threats, censorship and internet shutdowns. Much of the information comes from secure network messages from vitreoretinal surgeons in Iran, cautious about speaking out for fear of becoming political targets themselves. 

    Iranian ophthalmologists have also reported receiving multiple calls from people seeking advice on their eye injuries. Many of the injured are fearful of going to hospitals where police are waiting to make arrests. Even patients who manage to get treatment privately for eye injuries can be taken to jail immediately after surgery. 

    There are reports of staff in smaller cities asking for ocular traumas to be diverted to larger medical centers, explaining that they no longer have enough resources to care for patients. Some survive only by fleeing the country. 

    Ophthalmologists in Iran have made their position clear with this petition urging leaders to bar the police from causing further cranial and ocular damage.

    The list of signatures from vitreoretinal surgeons around the country has grown to almost 150, and the petition has been distributed over secure messaging systems. Although it would be ideal for the government to cease attacks against people, it is unlikely.

    But as long as they continue, ophthalmologists must ask that security officers refrain from pointing guns at people's heads or necks. Ocular injuries of this nature are permanent; vision is a vital sense that, once lost, cannot be restored. 

    Headshot of Elahhe Afkhamnejad About the author: Elahhe Afkhamnejad, MD, is an ophthalmology resident at the University of Texas Medical Branch Galveston. She is interested in education and hopes to go into academic medicine.