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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 2
| Issue : 1 | Page : 5 |
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How lethal is a pellet gun for eyes?
Suhail Rafiq1, Musaib Ahmad Dar1, Jan Muhammad Suhail1, Arshid Ahmad Bhat2, Irshad Mohideen1
1 Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, Jammu and Kashmir, India
2 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, Jammu and Kashmir, India
| Date of Submission | 21-Jan-2020 |
| Date of Acceptance | 08-Feb-2020 |
| Date of Web Publication | 27-Feb-2020 |
Correspondence Address:
Dr. Musaib Ahmad Dar
Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, Jammu and Kashmir
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/PAJO.PAJO_6_20
Background: Etiologically ocular injuries can be classified into domestic, occupational, sports, road traffic accidents, iatrogenic, fights and assaults, and war injuries. In the 1960s and 1970s, road traffic accidents became the most common cause of serious ocular injuries. In the 1980s, sports and leisure activities became a common cause of severe eye injury. The home is now the most common location for eye injuries. However, bomb blast and battlefield ocular injuries are becoming increasingly common in different parts of the world. Recently introduced non-lethal pellet guns used by law enforcement Indian agencies in Kashmir were the most common cause of ocular injuries in the valley.
Objective: The objective of this study was to evaluate ocular pellet gun injuries in patients of a conflict zone by a so called non-lethal weapon as a mass control measure.
Method: The study was conducted in post graduate department of Radiodiagnosis and imaging, Government Medical College, Srinagar Jammu and Kashmir. Our study was conducted between January 2019 to 15th May 2019. A total of 30 patients with ocular pellet injuries were taken up for study.
Results: The most common type of injuries encountered were corneal laceration in 66.7 % eyes, vitreous haemorrhage in 52.8% and scleral laceration in 33.3% of eyes. Indirect signs like decreased volume of anterior chamber were suggestive of corneal laceration.
Retained intraocular foreign body (IOFB) was seen in 7 patients and intraorbital foreign body excluding intraocular foreign body in 3 patients.
Conclusion: In conclusion a so called non-lethal pellet gun used by law enforcement agencies has the potential to cause devastating ocular injuries.
Keywords: Globe, Kashmir, lethal, pellet, vitreous
How to cite this article:
Rafiq S, Dar MA, Suhail JM, Bhat AA, Mohideen I. How lethal is a pellet gun for eyes?. Pan Am J Ophthalmol 2020;2:5 |
| Introduction | |  |
The purpose of this study was to evaluate the ocular injuries which occurred due to pellet gunfire in Kashmir. Etiologically, ocular injuries can be classified into domestic, occupational, sports, road traffic accidents, iatrogenic, fights and assaults, and war injuries.[1] In the 1960s and 1970s, road traffic accidents became the most common cause of serious ocular injuries.[2] In the 1980s, sports and leisure activities became a common cause of severe eye injury.[3] The home is now the most common location for eye injuries.[4] However, bomb blast and battlefield ocular injuries are becoming increasingly common in different parts of the world.[5] Weapons used by the law enforcement agencies in civil unrest can be divided into:
- Lethal weapons including traditional sharp-pointed firearms such as pistol or rifle
- Less lethal or nonlethal weapons, including
- Weapons that utilize chemical or electronic methods
- Rubber bullets
- Pellet gun.
Considered a “less-lethal” or “nonlethal” weapon, rubber or plastic-coated nonlive rounds are used across the world to manage agitating mobs with the intention of causing no severe injury or death.[6],[7] However, studies across the world,[6],[7],[8],[9] including from Kashmir,[10],[11] have repeatedly shown that the use of these “nonlethal” weapons often leads to serious injuries, permanent disability, and death. First used in response to the civil unrest in Northern Ireland in the 1970s, such “nonlethal” weapons have been documented to cause injuries and death.[12] In India, the paramilitary forces first used pellet guns during mob demonstrations in 2010 in Kashmir, which resulted in the death of 120 people; since then, these guns have been used for crowd control in Kashmir.[13]
The “nonlethal” guns are reported to be shotguns of 12-gauge pump action, which are primarily used in hunting with a wide range of pellet sizes and numbers.[14] The smaller the size of the pellet, the larger the number of pellets in one cartridge; hence, a number 1 cartridge has a smaller number of bigger size pellets, while a number 12 cartridge has a larger number of smaller size pellets.[14] In the current protests in Kashmir, mostly, cartridges number 6 (300 pellets of 2.79 mm each) and number 9 (600 pellets of 2.30 mm each) were used.[14] As for as extent of damage was concerned, size of pellet was not as much important as the distance from which it was fired.
If used at closer ranges, the pellets do not have enough time to disperse and travel in a compact group, which move at very high velocities, making them extremely harmful, almost behaving like handgun bullets, enough to penetrate deep, and cause severe damage to softer tissues, especially eyes.[15],[16] The velocity and distance of the pellet can determine the nature of the eye injury.
Objective
The objective of this study was to evaluate the ocular pellet gun injuries in patients of a conflict zone by a so-called nonlethal weapon as a mass control measure.
| Methods | | |
The study was conducted in Postgraduate Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, Jammu and Kashmir. Our study was conducted between January 2019 and May 15, 2019. A total of thirty patients with ocular pellet injuries were taken up for the study.
Inclusion criteria
Inclusion criteria were patients with ocular pellet gun injuries without any immediate life-threatening injury, such as head injury, cardiac injury, or major vessel injury, and patients willing to be part of study.
All the patients were initially received in the accident and emergency department of our institute. Complete history was taken, and examination of all the patients was done. Relevant investigations were ordered for all the patients.
Radiographs of all the patients were studied. Computed tomography (CT) scan was done, when needed. We obtained thin-section axial CT scans (0.625-“1.25 mm) with multiplanar reformation. Proper treatment follow-up was available from the department of ophthalmology.
| Results | | |
Thirty patients with ocular pellet injuries who met the inclusion criteria were included in this study. Of total 30 patients with pellet injuries, 28 were male and two were female.
There was a wide range in the age of the patients (14-“49 years). Maximum number of the patients were in age group of 11-30 years as shown in [Table 1].
Ocular injuries were unilateral in 24 cases and bilateral in six cases. The pattern of eye injuries among 36 eyes of 30 patients is shown in [Table 2].
The most common type of injuries encountered was corneal laceration in 66.7% of eyes, vitreous hemorrhage in 52.8%, and scleral laceration in 33.3% [Figure 1]. Indirect signs such as decreased volume of anterior chamber were suggestive of corneal laceration. | Figure 1: Bar diagram showing percentage of ocular injury type due to pellet gun
Click here to view |
Retained intraocular foreign body (IOFB) was seen in seven patients and intraorbital foreign body excluding IOFB in three patients. Many of the patients had combined spectrum of injuries. CT findings of open-globe injury include change in globe contour, loss of volume, flat tire sign, scleral discontinuity [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], intraocular air, and IOFB [Figure 7], [Figure 8], [Figure 9]. However, posttraumatic orbital hematoma may deform the globe mimicking an open-globe injury. Traumatic rupture of the sclera may permit the vitreous to prolapse through the defect. Because of the decreased volume of the posterior segment, the lens can move posteriorly by a few millimeters, while the zonular attachments remain intact. Posterior movement of the lens enlarges or deepens the anterior chamber. A deep anterior chamber has been described as a clinical finding in patients with a ruptured globe and can also be a useful clue on CT images. | Figure 2: Right eye showing evidence of posterior chamber hemorrhage with pellet within posterior chamber
Click here to view |
 | Figure 3: Evidence of pellet along right optic nerve and ophthalmic artery. Patient had clinically proven optic nerve injury
Click here to view |
 | Figure 4: Axial CT showing posterior chamber hemorrhage and scleral irregularity in the left eye suggestive of scleral laceration. Right eye showing evidence of pellet traversing anterior scleral coat
Click here to view |
 | Figure 5: Axial Ct showing flat tire sign with pellet within right eye, suggestive of globe rupture
Click here to view |
 | Figure 6: Axial CT showing left corneal laceration with small air containing collection (arrow) with multiple pellets in the left eye and one pellet close to lateral wall of nose
Click here to view |
 | Figure 7: There is evidence of air-containing collection seen with discontinuity of posterior sclera on the left side
Click here to view |
 | Figure 8: Non contrast CT showing air containing collection in relation to left lens with posterior chamber hemorrhage. Patient also had mild subluxation of left lens
Click here to view |
 | Figure 9: Air attenuation areas seen in posterior chamber of right eye with vitreous hemorrhage. Another air containing collection adjacent to right bulky optic nerve
Click here to view |
Lens subluxation or dislocation was found in five patients. CT images can readily show the displacement of the lens, as well as any associated injuries. Trauma is the most common cause of lens dislocation; it accounts for more than half of all cases. An important pitfall for the radiologist to avoid is that of the spontaneous dislocated lens. Nontraumatic lens dislocation may be associated with systemic connective tissue disorders, such as Marfan syndrome, Ehlers-“Danlos syndrome, and homocystinuria.
The treatment varied according to the type of injury. Six eyes with closed-globe injury were managed conservatively. Others underwent single/multiple surgical procedures. Corneoscleral repair was the most commonly performed surgery. Scleral autografting was done in one patient because of tissue loss. Four patients needed intraocular lens implantation. Vitreoretinal surgery was performed in patients who had nonresolving vitreous hemorrhage, retinal detachment, or retained postsegment IOFB.
Two eyes with optic nerve injuries completely lost vision beyond repair. Of 24 corneal lacerations, 16 were superficial which were treated by laser and recovered completely. Among remaining eight, six had deep corneal involvement and permanent scar remains in their cornea while two corneas were injured beyond repair and are waiting for appropriate corneal transplant. No loss of vision was noted due to scleral injuries. Subluxed lenses were removed, and artificial intraocular lenses were implanted to restore normal visual acuity. Intraorbital foreign bodies were left as such and are followed by close monitoring. Of seven eyes with intraocular foreign body, five were never able to see again with that eye and the rest two patients had some vision and were not intervened.
| Discussion | | |
Ocular injury is an important and preventable cause of ocular morbidity.[17] Even though the eye comprises only a small part of the surface area of the human body,[5] it is still injured quite frequently.[18] Over the past few years, security forces in Kashmir Valley have been using pump action shotgun or pellet gun to disperse violent mobs. Pellet guns have been introduced as nonlethal weapons for crowd control. The review of the age and sex of these patients demonstrates that the “typical” gun pellet casualties are young males. This was due to the fact that these agitated mobs comprised primarily young males. The female patients in our study were accidentally hit by the pellet while walking on the road. Both hospital- and population-based studies indicate a large preponderance of ocular injuries affecting young males,[19],[20] as was the case in our study.
We noted corneal laceration with hyphema to be the most common manifestation of gun pellet injuries. This was found to be in accordance with the consequences of nonpowder firearm injuries reported previously.[21] In this study, we found that the majority of the injuries were open-globe penetrating type. This pattern could be explained by the fact that nonpowder firearms can generate muzzle velocities of 200-“900 foot pounds/s,[22] whereas ocular penetration can occur at velocities as low as 130 foot pounds/s.[23] Moreover, from a single cartridge, more than 500 pellets can be fired, thus accounting for the high incidence of penetrating trauma in our study.
| Conclusion | | |
A so-called nonlethal pellet gun used by the law enforcement agencies has the potential to cause devastating ocular injuries.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
[Table 1], [Table 2]
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