CAMP LEMONNIER, DJIBOUTI — Modern-day combat trauma results in complicated ocular injuries causing nearly a third of injured military personnel to be declared legally blind in the affected eye, according to a new study.

Researchers from the Naval expeditionary base at Camp Lemonnier and colleagues sought to update the epidemiology of ocular injuries in soldiers admitted to Walter Reed Army Medical Center (WRAMC) from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Results were published in Ophthalmic Epidemiology.1

The study team collected data from the Walter Reed Ocular Trauma Database. A Bayesian Network Analysis was completed to better understand the relationships between different ocular demographic variables, injuries, surgeries, ocular trauma scores (OTS) and visual outcomes.

Results indicated that 890 consecutive globe or adnexal combat injuries, or both, were sustained by 652 U.S. servicemembers treated at WRAMC between 2001 and 2011. Most, 62.47%, occurred as a result of improvised explosive devices.

Researchers reported that many patients (62.0%) had final visual acuity (VA) grades of 1-2 (20/15-20/200), while 29.9% of patients had final VA grades of 3-5 (less than 20/200), and 8.1% had unknown final VA grades.

Bayesian Network Analysis demonstrated that the injury variables of retina (47.9%), lens (44.6%), posterior segment (43.7%) and anterior segment (40.3%) and the surgical variables of enucleation (97.6%) and cataract extraction and posterior capsule intraocular lens placement (CEPCIOL; 43.3%) all had probabilities greater than 40% for a poor final visual acuity, while all other variables were less than 40%.

“Modern-day combat trauma results in complicated ocular injuries causing 30% of patients to be left legally blind in their injured eye,” the authors concluded. “It is critical to maintain a wide variety of deployable, specialty trained ophthalmologists to ensure the best visual outcomes for wounded warriors and to maintain mission-readiness.”


  1. Harvey MM, Justin GA, Brooks DI, Ryan DS, Weichel ED, Colyer MH. Ocular Trauma in Operation Iraqi Freedom and Operation Enduring Freedom from 2001 to 2011: A Bayesian Network Analysis. Ophthalmic Epidemiol. 2020 Sep 30:1-10. doi: 10.1080/09286586.2020.1828494. Epub ahead of print. PMID: 32998604.