Since the introduction of so-called less-lethal weapons in France in the late 1990s, there has been no legal requirement to collect data on injuries induced by kinetic impact projectiles, and no epidemiological surveys have been planned. To estimate the number of patients with ocular injuries caused by the use of these defensive tools, a retrospective survey was sent to all ophthalmology department chairs in French university hospitals, which are where the most severe cases are managed. Demographic data, date of trauma, initial ophthalmological examination and any specialised investigations, initial and immediate surgical management of the injury, follow-up, and visual prognosis were documented and transmitted anonymously.

Figure Distribution of kinetic impact projectile-induced ocular injuries in France between February, 2016, and August, 2019 We compiled data from patients seen between February, 2016, and August, 2019 ( figure ). 43 cases were identified, of which 20 (47%) were managed in Paris. The cases included 38 men and five women, with a median age of 26 years (range 15–59).

Ocular injuries were unilateral and involved all parts of the eye. Less-lethal weapons (40-mm rubber projectile launchers and sting ball grenades) were the suspected cause of most ocular lesions, with 25 cases of open-globe injury and 18 cases of blunt-force bruising. Retinal bruising (n=10), hyphaema (n=10), iridodialysis (n=3), lens dislocation (n=1), and cataract (n=2) were the main types of blunt ocular lesion. CT scans showed 25 cases of orbital fractures, 12 cases of simple or complex facial fractures, and two cases of brain injury. Of note, all patients with open-globe injuries had no light perception at the time of referral. The initial visual acuity was less than 20/100 for the other patients, with the exception of five people who had preserved visual acuity. 30 of the 43 patients with injuries needed one or more surgical procedures to repair the eyeball, eyelids, orbit, or head. Delayed ocular surgery was necessary in 15 cases, including enucleation (n=9), retinal surgery (n=3), cataract surgery (n=2), and conjunctival flap (n=1).

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Weiser SD Death, injury and disability from kinetic impact projectiles in crowd-control settings: a systematic review. The increase in severe, blinding, traumatic eye injuries in France in the past 10 months could be related to use of guns for crowd control.Kinetic impact projectiles have been reported as possibly dangerous weapons for the eye in various countries and regions, including the USA, the Middle East, Europe, and China.

To date, these results have not led to a moratorium on the use of these weapons.

We declare no competing interests.

Article Info Publication History Identification DOI: https://doi.org/10.1016/S0140-6736(19)31807-0 Copyright © 2019 Elsevier Ltd. All rights reserved. ScienceDirect Access this article on ScienceDirect