Ophtalmologie de guerre

Clic sur l'image pour accéder à la table des matières

Trauma sonore: Protection et corticoïdes

Acute Acoustic Trauma among Soldiers during an Intense Combat.

Yehudai N et All. J Am Acad Audiol. 2017 May;28(5):436-443

 

 

-----------------------------------

On a toujours tendance à l'oublier un peu. Mais mieux vaut prévenir que guérir par le port de protections adaptées en particulier chez les porteurs d'armes lourdes et les opérateurs radios qui doivent faire l'objet d'un ciblage "éducationnel". Le port de bouchons de protection de type EAR semblerait plus complexe à utiliser. Une amélioration notable peut être obtenue par une corticothérapie avec un équivalent de 1 mg/kg de prednisone démarré dans la première semaine 

-----------------------------------

BACKGROUND:

During military actions, soldiers are constantly exposed to various forms of potentially harmful noises. Acute acoustic trauma (AAT) results from an impact, unexpected intense noise ≥140 dB, which generates a high-energy sound wave that can damage the auditory system.

PURPOSE:

We sought to characterize AAT injuries among military personnel during operation "Protective Edge," to analyze the effectiveness of hearing protection devices (HPDs), and to evaluate the benefit of steroid treatment in early-diagnosed AAT injury.

RESEARCH DESIGN:

We retrospectively identified affected individuals who presented to military medical facilities with solitary or combined AAT injuries within 4 mo following an intense military operation, which was characterized with an abrupt, intensive noise exposure (July-December 2014).

STUDY SAMPLE:

A total of 186 participants who were referred during and shortly after a military operation with suspected AAT injury.

INTERVENTIONS:

HPDs, oral steroids.

DATA COLLECTION AND ANALYSIS:

Data extracted from charts and audiograms included demographics, AAT severity, worn HPDs, first and last audiograms and treatment (if given). The Student's independent samples t test was used to compare continuous variables. All tests were considered significant if p values were ≤0.05.

RESULTS:

A total of 186 participants presented with hearing complaints attributed to AAT: 122, 39, and 25 were in duty service, career personnel, and reservists, with a mean age of 21.1, 29.2, and 30.4 yr, respectively. Of them, 92 (49%) participants had confirmed hearing loss in at least one ear. Hearing impairment was significantly more common in unprotected participants, when compared with protected participants: 62% (74/119) versus 45% (30/67), p < 0.05. Tinnitus was more common in unprotected participants when compared with protected participants (75% versus 49%, p = 0.04), whereas vertigo was an uncommon symptom (5% versus 2.5%, respectively, p > 0.05). In the 21 participants who received steroid treatment for early-diagnosed AAT, bone-conduction hearing thresholds significantly improved in the posttreatment audiograms, when compared with untreated participants (p < 0.01, for 1-4 kHz).

CONCLUSIONS:

AAT is a common military injury, and should be diagnosed early to minimize associated morbidity. HPDs were proven to be effective in preventing and minimizing AAT hearing sequelae. Steroid treatment was effective in AAT injury, if initiated within 7 days after noise exposure.

Trauma oculaire de guerre

Combat Ocular Trauma Visual Outcomes during Operations Iraqi and Enduring Freedom

Weichel ED et Al. Ophthalmology. 2008 Dec;115(12):2235-45

---------------------------------------------------------------

Les trauma oculaires sont devenus extrêmement fréquents, qu'il s'agisse de blast primaire ou blast secondaire par lésions projectilaires. Alors qu'ils ne représentaient que moins d'1% des trauma au début du 19ème siècle, de l'ordre de 2% lors des deux guerres mondiales on considère qu'actuellement cette fréquence est de l'ordre de près de 10% essentiellement en rapport avec l'explosion d'IED.

Malgré le port d'effets de protection les lésions engendrées sont à l'origine de séquelles importantes dont la prévention nécessitent une démarche spécifique tant dans le cadre du sauvetage au combat que dans la prie en charge hospitalière. Ces données sont parfaitement exprimées dans les publications américaines et dans la procédure du TCCC (1,2). Outre la prévention par le port d'équipements adaptés, il faut certainement insister de manière plus appuyée sur l'identification précoce de ces lésions comme la détermination de l'acuité visuelle voire la mesure des pressions intraoculaires en role 1 (3) ou le recours à l'échographie du globe oculaire (recherche de décollement et de corps étranger, 4) ainsi que sur la réalisation de pansements non compressifs (5) et parfois de décompression en cas de syndrome orbitaire. 

 

Ce qu'il ne faut pas faire:

Ce qu'il faut faire: 

 

 

Cet article fait le point sur le devenir de telles lésions.

---------------------------------------------------------------

Objective: To report the visual and anatomic outcomes as well as to predict the visual prognosis of combat ocular trauma (COT) during Operations Iraqi and Enduring Freedom.

Design: Retrospective, noncomparative, interventional, consecutive case series. Participants: Five hundred twenty-three consecutive globe or adnexal combat injuries, or both, sustained by 387 United States soldiers treated at Walter Reed Army Medical Center between March 2003 and October 2006.

Methods: Two hundred one ocular trauma variables were collected on each injured soldier. Best-corrected visual acuity (BCVA) was categorized using the ocular trauma score (OTS) grading system and was analyzed by comparing initial and 6-month postinjury BCVA. Main Outcome Measures: Best-corrected visual acuity, OTS, and globe, oculoplastic, neuro-ophthalmic, and associated nonocular injuries.

Results: The median age was 25
7 years (range, 18–57 years), with the median baseline OTS of 70
25(range, 12–100). The types of COT included closed-globe (n  234; zone 12, n  103; zone 3, n  131), open-globe (n  198; intraocular foreign body, n  86; perforating, n  61; penetrating, n  32; and rupture, n  19), oculoplastic (n  324), and neuro-ophthalmic (n  135) injuries. Globe trauma was present in 432 eyes, with 253 eyes used for visual acuity analysis. Comparing initial versus 6-month BCVA, 42% of eyes achieved a BCVA of 20/40 or better, whereas 32% of eyes had a BCVA of no light perception. Closed-globe injuries accounted for 65% of BCVA of 20/40 or better, whereas 75% of open-globe injuries had a BCVA of 20/200 or worse. The ocular injuries with the worst visual outcomes included choroidal hemorrhage, globe perforation or rupture, retinal detachment, submacular hemorrhage, and traumatic optic neuropathy. Additionally, COT that combined globe injury with oculoplastic or neuro-ophthalmologic injury resulted in the highest risk of final BCVA worse than 20/200 (odds ratio, 11.8; 95% confidence interval, 4.0 –34.7; P0.0005). Nonocular injuries occurred in 85% of cases and included traumatic brain injury (66%) and facial injury (58%). Extremity injuries were 44% (170 of 387 soldiers). Amputation is a subset of extremity injury with 12% (46 of 387) having sustained a severe extremity injury causing amputation.

Conclusions: Combat ocular trauma has high rates of nonocular injuries with better visual outcomes in closed-globe compared with open-globe trauma. The OTS is a valid classification scheme for COT and correlates the severity of injury with the final visual acuity and prognosis. Globe combined with oculoplastic or neuroophthalmologic injuries have the worst visual prognosis.

Urgences opthalmologiques

http://home.smh.com/sections/services-procedures/medlib/e...

Syndrome compartimental du globe oculaire

Les syndromes compartimentaux peuvent tuer. On pense bien sûr au syndrome des loges, au syndrome compartimental abdominal. On peut en rapprocher la tamponnade cardiaque, le pneumothorax compressif et les hypertensions intracrâniennes. Il est moins naturel de penser au syndrome compartimental orbitaire. Pourtant un geste simple permet de réduire ce risque lors de trauma de la face, c'est la cantholyse externe.

 

Voici en quelques schémas comment la réaliser.

 

En réalisant ce geste simple, vous soulagez la pression intraorbitaire et améliorer  la perfusion rétinienne.