Ocular blast injuries in mass-casualty incidents: the marathon bombing in Boston, Massachusetts, and the fertilizer plant explosion in West, Texas.
OBJECTIVE
To report the ocular injuries sustained by survivors of the April 15, 2013, Boston Marathon bombing and the April 17, 2013, fertilizer plant explosion in West, Texas.


METHODS
Multicenter, cross-sectional, retrospective, comparative case series.


METHODS
Seventy-two eyes of 36 patients treated at 12 institutions were included in the study.


METHODS
Ocular and systemic trauma data were collected from medical records.


METHODS
Types and severity of ocular and systemic trauma and associations with mechanisms of injury.


RESULTS
In the Boston cohort, 164 of 264 casualties were transported to level 1 trauma centers, and 22 (13.4%) required ophthalmology consultations. In the West cohort, 218 of 263 total casualties were transported to participating centers, of which 14 (6.4%) required ophthalmology consultations. Boston had significantly shorter mean distances to treating facilities (1.6 miles vs. 53.6 miles; P = 0.004). Overall, rigid eye shields were more likely not to have been provided than to have been provided on the scene (P<0.001). Isolated upper body and facial wounds were more common in West largely because of shattered windows (75.0% vs. 13.6%; P = 0.001), resulting in more open-globe injuries (42.9% vs. 4.5%; P = 0.008). Patients in Boston sustained more lower extremity injuries because of the ground-level bomb. Overall, 27.8% of consultations were called from emergency rooms, whereas the rest occurred afterward. Challenges in logistics and communications were identified.


CONCLUSIONS
Ocular injuries are common and potentially blinding in mass-casualty incidents. Systemic and ocular polytrauma is the rule in terrorism, whereas isolated ocular injuries are more common in other calamities. Key lessons learned included educating the public to stay away from windows during disasters, promoting use of rigid eye shields by first responders, the importance of reliable communications, deepening the ophthalmology call algorithm, the significance of visual incapacitation resulting from loss of spectacles, improving the rate of early detection of ocular injuries in emergency departments, and integrating ophthalmology services into trauma teams as well as maintaining a voice in hospital-wide and community-based disaster planning.
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Yoshihiro
Y
Yonekawa
Department of Ophthalmology, Scott & White Eye Institute, Texas A&M Health Science Center College of Medicine, Temple, Texas.
Henry D
HD
Hacker
Department of Ophthalmology, Scott & White Eye Institute, Texas A&M Health Science Center College of Medicine, Temple, Texas.
Roy E
RE
Lehman
Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
Casey J
CJ
Beal
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Peter B
PB
Veldman
Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Neil M
NM
Vyas
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Ankoor S
AS
Shah
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
David
D
Wu
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Dean
D
Eliott
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Matthew F
MF
Gardiner
Department of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Mark C
MC
Kuperwaser
Department of Ophthalmology, Scott & White Eye Institute, Texas A&M Health Science Center College of Medicine, Temple, Texas.
Robert H
RH
Rosa
Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Jean E
JE
Ramsey
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Joan W
JW
Miller
Department of Defense and Veterans Administration Vision Center of Excellence, Bethesda, Maryland; Department of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Robert A
RA
Mazzoli
Department of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Mary G
MG
Lawrence
Department of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: jarroyo@bidmc.harvard.edu.
Jorge G
JG
Arroyo
D000328:Adult; D001753:Blast Injuries; D054042:Bombs; D001900:Boston; D002648:Child; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D053834:Explosive Agents; D005131:Eye Injuries / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013781:Texas
D053834:Explosive Agents