Closed globe macular injuries after blasts in combat

Retina. 2013 Feb;33(2):371-9. doi: 10.1097/IAE.0b013e318261a726.


Purpose: To describe the macular findings after closed globe ocular injuries sustained from blasts.

Methods: A retrospective chart review from February 2003 to March 2010 of all soldiers with closed globe ocular injuries sustained during combat with macular findings of trauma on examination was completed.

Results: There were 36 eyes that met the inclusion criteria. The mean age of the soldiers was 29.5 years and 97% were men. The average follow-up time was 18.6 months. Improvised explosive device blasts accounted for 86% of injuries. Forty-five percent of soldiers had bilateral ocular injuries. Eight of 36 eyes (22.2%) developed a macular hole. One eye had spontaneous closure and five eyes underwent surgical repair. There was a range of macular findings from retinal pigment epitheliopathy alone to retinal pigment epitheliopathy with full-thickness atrophy. Eight eyes (22.2%) had macular scarring on examination but no optical coherence tomography study. One eye (2.8%) developed phthisis bulbi. Fifteen eyes (42%) had an orbital fracture. Seven eyes (19%) sustained optic neuropathy.

Conclusion: Closed globe injuries after blasts resulted in a spectrum of macular findings. The integrity of the foveal inner segment/outer segment junction was the most important retinal factor in visual outcomes. Orbital fractures were not found to be a risk factor for developing optic neuropathy and may improve visual outcomes. The rate of long-term complications is unknown, and it is important for ophthalmologists to follow these patients closely.

MeSH terms

  • Adult
  • Atrophy
  • Blast Injuries / complications*
  • Choroid / injuries*
  • Eye Injuries / diagnosis
  • Eye Injuries / etiology*
  • Eye Injuries / surgery
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Humans
  • Iraq War, 2003-2011
  • Male
  • Middle Aged
  • Military Personnel
  • Orbital Fractures / diagnosis
  • Orbital Fractures / etiology*
  • Orbital Fractures / surgery
  • Retina / injuries*
  • Retinal Perforations / diagnosis
  • Retinal Perforations / etiology*
  • Retinal Perforations / surgery
  • Retinal Pigment Epithelium / pathology
  • Retrospective Studies
  • Rupture
  • Tomography, Optical Coherence
  • United States
  • Visual Acuity / physiology
  • Wounds, Nonpenetrating / diagnosis
  • Wounds, Nonpenetrating / etiology*
  • Wounds, Nonpenetrating / surgery
  • Young Adult