The Naval Flight Surgeon's Pocket Reference to Aircraft Mishap Investigation

"Along with saving the lives and limbs of our soldiers, sailors, and airmen injured in battle, the preservation of their eyes and eyesight is an extremely important goal. Despite comprising as little as 0.1% of the total body surface area and 0.27% of the frontal silhouette, the proportion of eye injuries in nonfatal casualties has been escalating in recent conflicts.

Several reasons account for the increasing risk of eye injuries:

preferential exposure of the eyes during combat (eg, foxholes, tank turrets);
improved body armor protecting the head, thorax, and abdomen, leading to fewer fatal injuries to these regions of the body;
improved surgical techniques and rapid evacuation of the wounded, which allow physicians to repair wounds that at one time would have resulted in the death of a soldier; and
improved munitions, which create more and smaller fragments that can cause severe, even blinding, injuries.

Given the trends in modern warfare, as well as the expected increased use of laser devices, the percentage of ocular injuries will continue to increase. Because of advances in the care of eye trauma, however, injuries to the eye that once were deemed unsalvageable can now be repaired—often with the return of useful vision to the soldier. There are five echelons of care for troops injured on the modern battlefield, although their battlefield locations and the number of ophthalmologists at each echelon constantly change to meet the demands of our mobile fighting force...

The first section of this textbook provides a history of military eye care, including the lessons learned from the Vietnam and Persian Gulf wars.

The second section describes some of the basic techniques needed to evaluate an eye injury (history, examination, and ancillary studies) and the techniques available to provide anesthesia to a patient with an eye injury. Included in this section is a discussion of an ocular trauma score (similar to the Glasgow Coma Scale). This trauma score was developed to assist the frontline medics and physicians with an easy-to-use guide for triaging and providing emergency treatment to the injured soldier.

The third section deals with injuries to the anterior segment of the eye (ie, the cornea, lens, and conjunctiva), and includes a discussion of injuries to the eye from industrial chemicals and chemical warfare agents.

"The fourth section covers injuries of the posterior segment, with chapters on intraocular foreign bodies, sympathetic ophthalmia, and endophthalmitis.

The fifth section describes the evaluation and treatment of injuries to the orbit, optic nerve, extraocular muscles, and ocular adnexa.

The final section covers a variety of issues important to the military ophthalmologist such as terrorist blasts, laser injuries, eye protection, and geographical ophthalmology.

Although not an all-inclusive treatise on the subject, we hope that this textbook will provide a ready reference for all medical personnel dealing with eye-injured soldiers. Unlike the ophthalmologist in the civilian sector, who usually sees patients with a single injury in a relatively sterile environment, the military ophthalmologist will be faced with numerous casualties who have multisystem injuries in a setting that may be less than ideal. This textbook deals with some of these key issues that will face the military ophthalmologist in wartime situations.

It seems that with each conflict in the 20th century, every new generation of medics and physicians has had to learn—on its own—the lessons from earlier conflicts. We hope that the wisdom, experience, and lessons learned reported in this volume of the Textbooks of Military Medicine will enable optimal care to be provided in a timely manner to our eye-injured service members on the battlefield in future conflicts."

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The Borden Institute
Office of the Surgeon General
AMEDD Center & School
U.S.Army