Eye injury in the Israeli Defense Force: “An ounce of prevention is worth a pound of cure”

BackgroundThe eye occupies 0.1% of the total body surface yet it accounts for 8-13% of battle injuries in modern warfare worldwide. Protective eyewear can prevent over 90% of these eye injuries in both military and civilian settings. This study presents an analysis of a military casualty database and describes the proportion and distribution of eye injuries among Israel Defense Force (IDF) Soldiers.MethodsAll trauma patients recorded in the IDF Trauma Registry (ITR) in whom ocular injury related to combat or to training was documented were reviewed.ResultsThere were 129 patients with documented eye injury sustained during combat or training between 1997 and 2013: 75% of injuries were related to combat and the remainder occurred during training. Penetrating fragmental injuries accounted for 74% of combat related injuries and 28% of training related injuries. Sixty-six percent (66%) of these casualties were subsequently re-classified as no longer fit for combat duties. Combat related injuries resulted in a higher incidence of severe injuries compared to training related injuries (P < 0.05).ConclusionsDespite optimal medical care, the majority of soldiers who sustain eye injuries during military service suffer from substantial disability and most are no longer fit for combat service. A majority are discharged from military service. Protective eyewear could potentially prevent penetrating fragmental wounds which are the most common cause of injury.Further research on optimal orbital protection is critical for both the military and the civilian sectors.