Abstract
Background
The use of kinetic impact projectiles (KIPs) for crowd-control has increased worldwide. Despite having been created as non-lethal weapons, significant damage to several organs, including the eye, has been reported. In this study, we investigated cases of ocular trauma from KIPs during the civil unrest in Chile. To our knowledge, this is the largest case series recorded in international literature.
Methods
We included all patients who sought care or were referred to the Eye Trauma Unit, a national referral centre in Santiago, Chile, during the civil unrest from October 18 to November 30, 2019. We reviewed paper medical records and extracted data on suspected cause of trauma, type of trauma, visual acuity and sociodemographic data.
Results
We included 259 patients, out of which in 182 cases (70.5%) KIPs were the suspected cause. Cases by KIPs were predominantly male (86.6%), young (median age 26.3, interquartile range 22.0–31.4) and living in the Metropolitan Region. Eighty-nine patients (48.9%) had severe visual impairment or were blind at the first examination. The trauma was an open-globe injury in 20.3% of cases and 13 cases required evisceration of the ocular content. Compared to other causes of ocular trauma, KIPs were related to a more severe loss of visual acuity and a higher frequency of open-globe injuries.
Conclusions
The use of KIPs during a period of civil unrest in Chile resulted in severe ocular trauma, visual impairment and permanent disability. KIPs should be avoided as a method of crowd-control.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Millar R, Rutherford WH, Johnson S, Malhotra VJ. Injuries caused by rubber bullets: a report on 90 patients. Br J Surg. 1975;62:480–6. https://doi.org/10.1002/bjs.1800620613.
Haar RJ, Iacopino V, Ranadive N, Dandu M, Weiser SD. Death, injury and disability from kinetic impact projectiles in crowd-control settings: a systematic review. BMJ Open. 2017;7:e018154. https://doi.org/10.1136/bmjopen-2017-018154.
Amnesty International. France: calls for suspending the use of rubber bullets fired with the LBD40 and for banning grenades GLI-F4 in the context of policing protests. (2019). https://www.amnesty.org/en/documents/eur21/0304/2019/en/. Accessed 16 Dec 2019.
Jones S, Burgen S. Catalan referendu: “Police threw us aside... and more vanloads arrived”, The Guardian. Available at https://www.theguardian.com/world/2017/oct/01/police-started-throwing-us-aside-more-and-more-vanloads-arrived. Accessed 16 Dec 2019.
Reuters Investigates. Weapons of mass control, tactics of mass resistance, Reuters, October 31, 2019. Available at https://www.reuters.com/investigates/special-report/hong-kong-protests-violence/. Accessed 16 Dec 2019.
Associated Press. Lebanon protests roll into second day amid police crackdown, The Guardian, Dec, 2019. Available at https://www.theguardian.com/world/2019/dec/15/offices-of-two-major-parties-set-on-fire-lebanons-state-run-agency-reports. Accessed 16 Dec 2019.
Burin G, Health M. Argentine police fire rubber bullets at anti-austerity protesters, Reuters. Available at https://www.reuters.com/article/us-argentina-budget/argentine-police-fire-rubber-bullets-at-anti-austerity-protesters-idUSKCN1MY2KA. Accessed 16 Dec 2019.
Bauerlein, V, Calvert, S. Serious Eye Injuries at Protests Spur Calls to Ban Rubber Bullets, Wall Street Journal, June, 2020. Available at https://www.wsj.com/articles/serious-eye-injuries-spur-calls-to-ban-rubber-bullets-11592070374. Accessed 8 Jul 2020.
Instituto Nacional de Derechos Humanos. Informe Anual sobre la situación de los Derechos Humanos en Chile en el contexto de la crisis social Instituto Nacional de Derechos Humanos, 2019.
Jorquera, P, Palma, R. Estudio de perdigón. Informe final (UTO) 15/11/2019. Departamento de Ingeniería Mecánica, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile (2019). http://ingenieria.uchile.cl/noticias/159269/perdigones-usados-por-carabineros-contienen-80-de-metales. Accessed 21 Jan 2020.
Rocke L. Injuries caused by plastic bullets compared with those caused by rubber bullets. Lancet. 1983;1:919–20. https://doi.org/10.1016/s0140-6736(83)91340-5.
Jaouni ZM, O’Shea JG. Surgical management of ophthalmic trauma due to the Palestinian Intifada. Eye (Lond). 1997;11(Pt 3):392–7. https://doi.org/10.1038/eye.1997.83.
Hiss J, Hellman FN, Kahana T. Rubber and plastic ammunition lethal injuries: the Israeli experience. Med Sci Law. 1997;37:139–44. https://doi.org/10.1177/002580249703700209.
Lavy T, Asleh SA. Ocular rubber bullet injuries. Eye (Lond). 2003;17:821–4. https://doi.org/10.1038/sj.eye.6700447.
Lartizien R, Schouman T, Raux M, Debelmas A, Lanciaux-Lemoine S, Chauvin A, et al. Yellow vests protests: facial injuries from rubber bullets. Lancet. 2019;394:469–70. https://doi.org/10.1016/S0140-6736(19)31764-7.
Khan S, Maqbool A, Abdullah N, Keng MQ. Pattern of ocular injuries in stone pelters in Kashmir valley. Saudi J Ophthalmol. 2012;26:327–30. https://doi.org/10.1016/j.sjopt.2012.04.004.
Unuvar U, Yilmaz D, Ozyildirim I, Dokudan EY, Korkmaz C, Doganoglu S, et al. Usage of Riot Control Agents and other methods resulting in physical and psychological injuries sustained during civil unrest in Turkey in 2013. J Forensic Leg Med. 2017;45:47–52. https://doi.org/10.1016/j.jflm.2016.11.007.
Sharma AK, Shah DN, Shrestha JK, Thapa M, Shrestha GS. Ocular injuries in the people's uprising of April 2006 in Kathmandu, Nepal. Nepal J Ophthalmol. 2014;6:71–9. https://doi.org/10.3126/nepjoph.v6i1.10775.
Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ocular trauma. Ophthalmology. 1996;103:240–3. https://doi.org/10.1016/s0161-6420(96)30710-0.
Beck RW, Moke PS, Turpin AH, Ferris FL, SanGiovanni JP, Johnson CA, et al. A computerized method of visual acuity testing: adaptation of the early treatment of diabetic retinopathy study testing protocol. Am J Ophthalmol. 2003;135:194–205. https://doi.org/10.1016/S0002-9394(02)01825-1.
World Health Organization. International Classification of Diseases for Mortality and Morbidity Statistics (11th Revision, version: 04/2019). (2019). https://icd.who.int/browse11/l-m/en. Accessed 4 Jan 2019.
Ministerio de Salud. Guia Clínica Trauma Ocular Grave. Subsecretaría de Salud Pública, Ministerio de Salud, 2009.
Chauvin A, Bourges JL, Korobelnik JF, Paques M, Lebranchu P, Villeroy F, et al. Ocular injuries caused by less-lethal weapons in France. Lancet. 2019;394:1616–7. https://doi.org/10.1016/S0140-6736(19)31807-0.
Man CYW, Steel D. Visual outcome after open globe injury: a comparison of two prognostic models—the ocular trauma score and the classification and regression tree. Eye. 2010;24:84–9. https://doi.org/10.1038/eye.2009.16.
Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The Ocular Trauma Score (OTS). Ophthalmol Clin. 2002;15:163–5. https://doi.org/10.1016/S0896-1549(02)00007-X.
Maiden N. Ballistics reviews: mechanisms of bullet wound trauma. Forensic Sci Med Pathol. 2009;5:204–9. https://doi.org/10.1007/s12024-009-9096-6.
Carabineros de Chile. Disparos con escopeta antidisturbios, con empleo de cartuchería con perdigón de goma y sus efectos en la superficie del cuerpo humano. Departamento de Criminalística, Carabineros de Chile, 2012.
Acknowledgements
We are grateful to Mika Siuko and Paula Sierralta for their thoughtful comments on an earlier draft of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics
We obtained the approval from the Scientific Ethics Committee from the East Metropolitan Health Service in accordance with Law 20120 (2006).
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Rodríguez, Á., Peña, S., Cavieres, I. et al. Ocular trauma by kinetic impact projectiles during civil unrest in Chile. Eye 35, 1666–1672 (2021). https://doi.org/10.1038/s41433-020-01146-w
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/s41433-020-01146-w
This article is cited by
-
Risks and regulation of rubber scattershot in Switzerland: a narrative review
Eye (2024)
-
Visual-functional impact of people affected by severe ocular trauma during social protests in Chile in 2019
International Ophthalmology (2024)
