Comparing the management of eye injuries by coalition military surgeons during the Iraq and Afghanistan conflicts

Abstract Objective To compare incidences, ocular injury types and treatment performed on US and UK military service members and host nation civilians within the Iraq and Afghanistan conflicts in order to inform future military surgical training requirements and military medical planning. The US routinely deployed ophthalmologists while the UK did not. Design Retrospective cohort study of the US and UK military Joint Theatre Trauma Registries. Subjects All patients with eye injuries presenting to a deployed Military Treatment Facility between March 2003 and October 2011. Testing An adjusted multiple logistic regression model was performed using enucleation/evisceration and primary open-globe repair as dependent variables and casualty nationality, location and the presence of an ophthalmic surgeon as independent variables. Main outcome measures Incidence of eye removal (enucleation, evisceration) or primary repair for open globe injury. Results 5719/67586 (8%) of survivors or those who died of wounds were recorded to have eye injuries. The most common eye injuries were open globe injury without intraocular foreign body (3201/5719; 56%). Adnexal injuries (eyelid lacerations and damage to lacrimal apparatus) were recorded in 1265/5719 (22%). The odds of undergoing evisceration or enucleation for open globe injury was highest in host nation civilians (OR: 9.23, p Conclusions Eye injuries were more likely to have been definitively treated in US MTF, reflecting the absence of ophthalmologists in most deployed UK MTF. The Iraq and Afghan conflicts were notable for coalition air dominance; the shape of future conflicts may mandate delays in evacuation which may negatively affect visual outcomes, particularly if primary repair of patients with open globe injuries is delayed. This study provides evidence to support the maintenance of specialist ophthalmic surgical competencies in deployed coalition MTF for future conflicts.