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Care of Ophthalmic Casualties

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Aeromedical Evacuation

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Abstract

Aeromedical evacuation (AE) is often performed in order to preserve “Life, Limb, or Eyesight.” Of these, often sight is most highly valued by patients. During AE, appropriate medical care of ocular casualties is essential. The goal is to prevent future eye injury while providing rapid and efficient transportation to a facility capable of providing ophthalmologic care. AE patients with serious ocular injuries are commonly transported as litter patients. Those who are ambulatory will require additional assistance, orientation, and guidance while entering or exiting the aircraft. Altitude-related decreases in pressure are typically not issues for most ocular injuries. Important exceptions are patients recently treated with intraocular gas or the rare occurrence of intraorbital or intraocular air after open orbit injury or ocular surgery: Decreased pressure at cruise altitude will increase gas volume and thus intraocular pressure. A sudden increase in eye pain in patients with serious ocular injuries can indicate an ophthalmologic emergency such as orbital compartment syndrome or acute glaucoma. In-flight recognition and timely response to increased symptoms in these patients is necessary to preserve sight.

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References

  1. Scott AW, Bressler NM, Ffolkes S, Wittenborn JS, Jorkasky J. Public attitudes about eye and vision health. JAMA Ophthalmol. 2016;134(10):1111–8.

    Article  Google Scholar 

  2. Mazzoli RA, Gross KR, Butler FK. The use of rigid eye shields (Fox shields) at the point of injury for ocular trauma in Afghanistan. J Trauma Acute Care Surg. 2014;77:S156–62.

    Article  Google Scholar 

  3. Yonekawa Y, Hacker HD, Lehman RE, Beal CH, Veldman PB, Vyas NM, et al. Ocular blast injuries in mass-casualty incidents: the marathon bombing in Boston, Massachusetts, and the fertilizer plant explosion in West Texas. Ophthalmology. 2014;121:1670–6.

    Article  Google Scholar 

  4. Ficke JR, Eastridge BJ, Butler FK, Alvarez J, Brown T, Pasquina P, Stoneman P, Caravalho J. Dismounted complex blast injury report of the army dismounted complex blast injury task force. J Trauma Acute Care Surg. 2012;73(6 SUPPL 5).

    Article  Google Scholar 

  5. Scott RAH, Blanch RJ, Morgan-Warren PJ. Aspects of ocular war injuries. Trauma. 2015;17:83–92.

    Article  Google Scholar 

  6. Scott R. The injured eye. Philos Trans R Soc Lond Ser B Biol Sci. 2011;366(1562):251–60.

    Article  Google Scholar 

  7. Williams ST, Harding TH, Statz JK, Martin JS. Blast wave dynamics at the cornea as a function of eye protection form and fit. Military Med. 2017;182:226–9.

    Article  Google Scholar 

  8. Cockerham GC, Rice TA, Hewes EH, Cockerham KP, Lemke S, Wang G, et al. Closed-eye ocular injuries in the Iraq and Afghanistan Wars. N Engl J Med. 2011;364:2172–3.

    Article  CAS  Google Scholar 

  9. Cockerham GC, Lemke S, Rice TA, Wang G, Glynn-Milley C, Zumhagen L, et al. Closed-globe injuries of the ocular surface associated with combat blast exposure. Ophthalmology. 2014;121:2165–72.

    Article  Google Scholar 

  10. Vlasof A, Ryan DS, Ludlow S, Weichel ED, Colyer MH. Causes of combat ocular trauma-related blindness from Operation Iraqi Freedom and Enduring Freedom. J Trauma Acute Care Surg. 2015;79:S210–5.

    Article  Google Scholar 

  11. Wade AL, Dye JL, Mohrle CR, Galarneau MR. Head, face, and neck injuries during Operation Iraqi Freedom II: results from the US navy-marine corps combat trauma registry. J Trauma. 2007;63:836–40.

    Article  Google Scholar 

  12. Thomas R, McManus JG, Johnson A, Mayer P, Wade C, Holcomb JB. Ocular injury reduction from ocular protection use in current combat operations. J Trauma. 2009;66:S99–103.

    Article  Google Scholar 

  13. Godbole NJ, Seefeldt ES, Raymond WR, Karesh JW, Morgenstern A, Egan JA, Colyer MH, Mazzoli RA. Simplified method for rapid field assessment of visual acuity by first responders after ocular injury. Mil Med. 2018 Mar 1;183(suppl_1):219–23.

    Article  Google Scholar 

  14. Joint Trauma System Clinical Practice Guideline. Initial care of ocular and adnexal injuries by non-ophthalmologists at Role 1, Role 2, and non-ophthalmic Role 3 facilities. San Antonio: Institute of Surgical Research, Joint Base San Antonio; 2014.

    Google Scholar 

  15. Committee on Tactical Combat Casualty Care. Tactical combat casualty care guidelines for medical personnel. San Antonio: Institute of Surgical Research, Joint Base San Antonio; 2018.

    Google Scholar 

  16. Gerstenblith AT, Rabinowitz MP, editors. The Wills Eye Manual. 6th ed. Philadelphia: Lippincott, Williams & Wilkins; 2012. p. 46.

    Google Scholar 

  17. Stallard HB. The eye department in a middle east general hospital. Br J Ophthalmol. 1946;28:261–75.

    Article  Google Scholar 

  18. Greenwood A. Ophthalmology in the American Expeditionary Forces. In: Ireland MW, editor. Medical Department of the United States Army in the World War. Vol 11, Part 2. Washington, DC: War Department, Government Printing Office; 1924. p. 659–728.

    Google Scholar 

  19. Cho RI, Bakken HE, Reynolds ME, Schlifka BA, Powers DB. Concomitant cranial and ocular combat injuries during Operation Iraqi Freedom. J Trauma. 2009;6:516–20.

    Article  Google Scholar 

  20. La Piana FG, Mader TH. Lessons learned. In: Thach AB, editor. Ophthalmic care of the combat casualty: textbook of military medicine. Washington, DC: Office of The Surgeon General of the United States Army, Borden Press US Government Printing Office; 2003. p. 17–39.

    Google Scholar 

  21. Committee on Trauma. Resources for optimal care of the injured patient. Chicago: American College of Surgeons; 2014.

    Google Scholar 

  22. Department of the Air Force. Air Force Instruction 48–307. En route care and aeromedical evacuation medical operations. Washington, DC: US Government Printing Office; 2017.

    Google Scholar 

  23. Caring for patients who are blind or visually impaired: a fact sheet for the outpatient care team. 2014. DoD-VA Vision Center of Excellence, Bethesda, MD. Available at https://vce.health.mil/Resources/Products. Accessed 15 Oct 2018.

  24. Caring for patients who are blind or visually impaired: a fact sheet for the inpatient care team. 2014. DoD-VA Vision Center of Excellence, Bethesda, MD. Available at https://vce.health.mil/Resources/Products. Accessed 15 Oct 2018.

  25. Weichel ED, Colyer MH, Ludlow SE, Bower KS, Eiseman AS. Combat ocular trauma visual outcomes during Operations Iraqi and Enduring Freedom. Ophthalmology. 2008;115:2235–45.

    Article  Google Scholar 

  26. Sullivan SR, Ahmadi AJ, Singh CN, Sires BS, Engrav LH, Gibran NS, et al. Elevated orbital pressure: another untoward effect of massive resuscitation after burn injury. J Trauma. 2006;60:72–6.

    Article  Google Scholar 

  27. Rodriguez-Cabrera L, Rodrigues-Loaiza JL, Tovilla-Canales JL, Zuazo F. Orbital emphysema as a rare complication of retinal surgery. Ophthal Plast Reconstr Surg. 2017;33:e141–2.

    Article  Google Scholar 

  28. Reynolds ME, Hoover C, Riesberg JC, Mazzoli RA, Colyer M, Barnes S, Calvano CJ, et al. Evaluation and treatment of ocular injuries and vision-threatening conditions in Prolonged Field Care. J Spec Opns Med. 2017 Winter;17(4):115–26.

    Google Scholar 

  29. Emanuel ME, Parrish RK 2nd, Gedde SJ. Evidence-based management of primary angle closure glaucoma. Curr Opin Ophthalmol. 2014;25(2):89–92.

    Article  Google Scholar 

  30. Turnbull AM, Smith M, Ramchandani M. Angle-closure glaucoma on long-haul flights. JAMA Ophthalmol. 2014;132:1474–5.

    Article  Google Scholar 

  31. Ivan DJ. Ophthalmic patients. In: Hurd WW, Jernigan JG, editors. Aeromedical evacuation: Management of Acute and Stabilized Patients. New York, NY: Springer-Verlag; 2003. p. 215–24.

    Chapter  Google Scholar 

  32. Aerospace Medical Association Medical Guidelines Task Force. Medical Guidelines for Airline Travel, 2nd ed. Aviat Space Environ Med. 2003;74(5Suppl):A1–19.

    Google Scholar 

  33. Chang S. Retina, vol. 3. chapter 131,. Philadelphia: Mosby; 1994. p. 2115–29.

    Google Scholar 

  34. Dieckert JP, O’Connor PS, Schacklett DE, Tredici TJ, Lambert HM, Fanton JW, et al. Air travel and intraocular gas. Ophthalmology. 1986;93:642–5.

    Article  CAS  Google Scholar 

  35. Lincoff H, Weinberger D, Reppucci V, Lincoff A. Air travel and intraocular gas. I. The mechanisms for compensation. Arch Ophthalmol. 1989;107:902–6.

    Article  CAS  Google Scholar 

  36. Mills MD, Devenyi RG, Lam WC, Berger AR, Beijer CD, Lam SR. An assessment of intraocular pressure rise in patients with gas-filled eyes during simulated air flight. Ophthalmology. 2001;108:40–4.

    Article  CAS  Google Scholar 

  37. Rosenwasser GO, Holland S, Pflugfelder SC, Lugo M, Heidemann DG, Culbertson WW, Kattan H. Topical anesthetic abuse. Ophthalmology. 1990;97(8):967–72.

    Article  CAS  Google Scholar 

  38. Wu H, Hu Y, Shi XR, Xu F, Jiang CY, Huang R, Jia H. Keratopathy due to ophthalmic drug abuse with corneal melting and perforation presenting as Mooren-like ulcer: a case report. Exp Ther Med. 2016;12(1):343–6.

    Article  CAS  Google Scholar 

  39. Musa F, Tailor R, Gao A, Hutley E, Rauz S, Scott RA. Contact lens-related microbial keratitis in deployed British military personnel. Br J Ophthalmol. 2010;94:988–93.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. MAJ, MC, USA, Department of Surgery, Tripler Army Medical Center, Uniformed Services University of the Health Sciences, Honolulu, HI, USA

    Nathan Aschel Jordan

  2. COL, MC, USA (ret.), Department of Ophthalmology, Ophthalmic Plastic, Reconstructive, and Orbital Surgery, Madigan Army Medical Center, Tacoma, WA, USA

    Robert A. Mazzoli

  3. Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Robert A. Mazzoli

  4. Former Consultant to the US Army Surgeon General, DoD-VA Vision Center of Excellence, Bethesda, MD, USA

    Robert A. Mazzoli

  5. CDR, MC, USN, Department of Ophthalmology, Naval Medical Center San Diego, San Diego, CA, USA

    Bryan Propes

  6. Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, USA

    Jo Ann Egan

  7. DoD-VA Vision Center of Excellence, Bethesda, MD, USA

    Jo Ann Egan

Authors
  1. Nathan Aschel Jordan
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  2. Robert A. Mazzoli
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  3. Bryan Propes
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  4. Jo Ann Egan
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Corresponding author

Correspondence to Nathan Aschel Jordan .

Editor information

Editors and Affiliations

  1. Col, USAF, MC, SFS (ret.), Chief Medical Officer, American Society for Reproductive Medicine, Professor Emeritus, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA

    William W. Hurd

  2. Col, USAF, MC, CFS (ret.), Senior Medical Director, lntermountain Life Flight and Virtual Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA

    William Beninati

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Jordan, N.A., Mazzoli, R.A., Propes, B., Egan, J.A. (2019). Care of Ophthalmic Casualties. In: Hurd, W., Beninati, W. (eds) Aeromedical Evacuation. Springer, Cham. https://doi.org/10.1007/978-3-030-15903-0_14

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  • DOI: https://doi.org/10.1007/978-3-030-15903-0_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15902-3

  • Online ISBN: 978-3-030-15903-0

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