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Dr. Hiranmoyee Das, D16233

Abstract

Aim- A systematic review of literature was done to study various types of eye injuries following disaster which includes natural disaster, accidents, or terrorist attacks.

Methods- A Pub-med search was conducted to find out various literatures on eye injuries following major disaster in history.

Results & discussions -Erupting volcanoes affect the eyes mainly through the irritation, abrasions & foreign body caused by ash-laden air. Earthquake generally causes blunt trauma. Compressive eye injuries have also been reported in victims buried in debris for extended periods .Cyclones & explosions usually causes penetrating eye injury by object like glasses, nails, stones etc. Exposure to certain weapons of mass destruction (WMD) causes characteristic ocular signs and symptom which one must use to deduce the nature of the agent.

Conclusion -Dedicated eye care professional capable of recognizing the ocular s/s WMD-related exposure & manage them should be included when devising disaster preparedness plan.

Key words:  Injury, disaster, explosions

Introduction

In humans, the eyes account for only 0.1 % of the total body surface area, yet during an explosion as many as 10% of survivors may suffer eye trauma.1

Disaster preparedness teams often find that eye injuries are among the most commonly encountered morbidities in responding to contingencies.2, 3

The presentation of eye injuries during a disaster can be subtle, and it is often difficult to diagnose and appropriately triage these eye conditions during the acute phase. It often require the care of an ophthalmologic surgeon and can result in considerable disability if not managed in an urgent fashion. So to devise a disaster preparedness plan it is very important to study various types of eye injuries following disaster which includes natural disaster, accidents, or terrorist attack.

Materials and methods

A Pub-med search was conducted to find out various literatures on eye injuries following major disaster in history which includes natural disaster, accidents, or terrorist attack.
Results

Erupting volcanoes affect the eyes mainly through the irritation, abrasions & foreign body caused by ash-laden air. Volcanic ash causes direct eye irritation among the residents and rescue workers exposed to ash. The irritative conjunctivitis caused by ash can present as chemosis and hyperemia, and usually persists for 24 to 48 hours after leaving the ash environment.

Earthquake generally causes blunt trauma. Compressive eye injuries have also been reported in victims buried in debris for extended periods. They suffer extreme eye compression with decrease retinal blood flow and eventual thrombosis and occlusion of the retinal arteries.4

Cyclones & explosions usually cause penetrating eye injury by high velocity projectile object like glasses, nails, stones etc.

Exposure to certain weapons of mass destruction (WMD) causes characteristic ocular signs and symptom which one must use to deduce the nature of the agent.

Discussion

Following the eruption of Mount St. Helens in Washington State in 1980, emergency department visits increased for corneal abrasions, eye foreign bodies and conjunctival inflammation.5 Similar studies in Japan have shown no major eye effects due to ash exposure, with most eye complaints resulting from simple mechanical irritation.6

Injury mechanism is generally blunt trauma, and compressive eye injuries have also

been reported in victims buried in debris, sometimes for extended periods 7.

Penetrating eye injuries, metallic corneal foreign bodies, chemical exposures, hyphemas, retinal detachments, and orbital and ocular trauma are typically caused by cyclones, explosions and terrorist attacks. Recent experiences, including the World Trade Center bombing in New York City in 1993,8 the Alfred P. Murrah Federal Building bombing in Oklahoma City in 1995,9 and the bomb attack at a U.S. military base in Dhahran, Saudi Arabia in 1996, emphasize the importance of understanding and being prepared to treat blast injuries.10  After the September 11, 2001, attacks on the World Trade Center, the incidence rate for eye injury was higher than any other diagnosis, with a rate of 59.7 injuries per 100 worker-years.11

The eye is particularly vulnerable in toxic exposure events such as chemical plant explosions; disasters at hazardous waste dumps; train derailments or terrorist attacks involving biological, chemical,12 or radiological agents.

In the 1984 Bhopal gas tragedy, India, the first indication of Methyl isocyanate spill was eye irritation among those living next to the plant. This immediate reaction included persistent watering (described as ‘streaming eyes’), photophobia, profuse lid swelling and ulcerations of the cornea .13 In the 1995 Tokyo subway sarin attack, 99% of the patients presented with miosis; in addition, eye pain was present in 45% of the patients.14

Exposure to certain weapons of mass destruction (WMD) causes characteristic ocular signs and symptoms15 including emergency personnel who are more capable of recognizing the ocular signs and symptoms of WMD-related exposure, as well as manage and treat WMD victims, in disaster management team would be a valuable first step in saving the sight of exposed individuals.

In the aftermath of a disaster, victims and rescue workers alike may present to a health post seeking treatment for eye problems. Presenting complaints may be as mundane as contact lens over wear (due to disruption of sleep cycles or loss of wetting solution) or as dramatic as an untreated injury that has progressed into a devastating globe infection.16

Conclusion

Ophthalmic injuries are very common in disasters, particularly in cases of terrorism or the use of WMD. Due to the emergent nature of ocular injuries, dedicated eye care professionals should be included in disaster preparedness plans to facilitate appropriate triage and stabilization of vision threatening conditions.

In assembling teams to protect the public, it is our public health responsibility to use the data we have from previous episodes to anticipate and prepare for predictable future needs.

References

  1. Mines M, Thach A, Mallonee S, et al. Ocular injuries sustained by survivors of the Oklahoma City bombing. Ophthalmology. 2000; 107(5): 837-43
  2. Mimran S, Rotem R, Mimran S, Rotem R. Ocular trauma under the shadow of terror. Insight. 2005;30:10–12
  3. Centers for Disease Control and Prevention. Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center—New York City, September 2001. Morbidity and Mortality Weekly Report. 2002;51:1–5.
  4. Cai YS, Zhou GJ. Compressive eye injuries caused by earthquake. Chin Med JOct 1983; 96(10): 731-6.
  5. Mount St. Helens Volcano Health Report 18. Atlanta, GA. Centers for Disease Control. August 15, 1980.
  6. Yano E, Yokoyama Y, Higashi H, et al. Health effects of volcanic ash: a repeatstudy. Arch Environ Health. Nov-Dec 1990; 45(6): 367-73.
  7. Cai YS, Zhou GJ. Compressive eye injuries caused by earthquake. Chin Med JOct 1983; 96(10): 731-6.
  8. Quenemoen LE, Davis YM, Malilay J, et al. The World Trade Center Bombing:injury prevention strategies for high-rise building fires. Disasters. 1996; 20: 125-132.
  9. Dellinger AM, Waxweiler RJ, Mallonee S. Injuries to rescue workers followingthe Oklahoma City bombing. Am J Ind Med Jun 1997; 31(6): 727-32.
  10. Thach AB, Ward TP, Hollifield RD, et al.Eye injuries in a terrorist bombing:Dhahran, Saudi Arabia, June 25, 1996. Ophthalmology May 2000; 107(5): 844-7.
  11. Berrios-Torres SI, Greenko JA, Phillips M, Miller JR, Treadwell T, Ikeda RM. World Trade Center rescue worker injury and illness surveillance, New York, 2001. Am J Prev Med. 2003;25:79–87.
  12. Javadi MA, Yazdani S, Sajjadi H, et al. Chronic and delayed-onset mustard gas keratitis: report of 48 patients and review of literature. Ophthalmology. 2005;112:617–625.
  13. Andersson N, Muir MK, Mehra V. Bhopal eye. Lancet Dec 1984; 2(8417-18):1481.
  14. Tokuda Y, Kikuchi M, Takahashi O, Stein GH. Prehospital management of sarin nerve gas terrorism in urban settings: 10 years of progress after the Tokyo subway sarin attack. Resuscitation. 2006;68:193–202.
  15. Hom GG, Hom GG. Chemical, biological, and radiological weapons: implications for optometry and public health.[see comment]. Optometry. 2003;74: 81–98.
  16. 16.Heldt JP, Frye BA, Wessels IF. Refugee eye care: a frequently overlookeddimension of disaster assistance. Ophthalmic Surg Jun 1988; 19(6): 440-9.

 

 

 

 

 

 

 

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