Reparable Eye Damage After Self-Inflicted Gunshot Wounds

NEW YORK (Reuters Health) - There's a good chance that eye damage from self-inflicted gunshot wounds can be repaired if a specialist is called in promptly, a new study suggests.

"As devastating as these injuries seem when first confronted by them, it is critical for these patients to be examined by an ophthalmologist. We found that the vast majority of these patients have salvageable vision in one or both eyes," Dr. Richard Allen, an associate professor of ophthalmic plastic and reconstructive surgery at the University of Iowa Hospitals and Clinics in Iowa City, who led the research, told Reuters Health by email.

Dr. Allen and his team published their findings March 27 online in JAMA Ophthalmology.

The study included 18 survivors of attempted suicide who shot themselves in the head and damaged their eyes.

The bullet's entry point affected the visual outcomes. Three patients shot themselves in the skull - one in the forehead, another in the left temple and the third through the right eye - and those three had the worst eye damage and visual outcomes.

Seven patients shot themselves in the mouth and the remaining eight shot themselves under the chin. When the entry point was intraoral, the patients were more likely to have lost light perception or one of their eyes compared to patients who inflicted submental entry points.

At the final follow up, seven patients had 20/40 vision or better in both eyes.

For the best results, "An ophthalmologist should evaluate these patients as soon as possible," Dr. Allen says. "Usually, we are consulted while the patient is still in the emergency department, and at times we will evaluate them for the first time in the operating room while they are being stabilized by the trauma team."

Treating eye injury is critical to recovery for these patients, says Dr. Bobby Desai, an assistant professor of emergency medicine at the University of Florida College of Medicine, who was not involved in the research but is familiar with it.

"These patients are already depressed or have another psychiatric disease. Blindness will only exacerbate this; thus prompt and effective treatment is mandatory in order to prevent a possible recurrence," Dr. Desai says.

The researchers also assessed the cost of treating these kinds of injuries. The mean cost was just above $117,000 and the mean reimbursement to the medical center was just higher than $124,000.

"Interestingly, although the personal and social cost of these events is inestimable, hospitals essentially break even when we look at the reimbursement and cost for care of these patients," Dr. Allen says.

Not many people survive after trying to end their lives with a gun, and those who do make up 1% of attempted suicide survivors, the researchers write.

Attempted suicides like these may call social and legal issues into question, including a lack of access to psychiatric care, Dr. Allen says. "These unfortunate events again bring attention to the lack of availability of and stigmata associated with psychiatric care in the US," he wrote in his email. "I would argue that, by definition, if you put a gun to your head, you are not thinking straight. In addition, this paper makes me wonder if our ready access to fire arms has an impact on these events."

SOURCE: http://bit.ly/1h9xUfu

JAMA Ophthalmol 2014.

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