Combat injuries to the organ of vision in modern armed conflicts: epidemiological aspects, mechanisms of injury, diagnosis, stages of medical care and restorative treatment

Abstract

Contemporary military conflicts worldwide, including the war in Ukraine, pose extremely complex challenges for medicine while simultaneously stimulating the development of science, innovation, and interdisciplinary cooperation. The preservation of vision is not only a medical issue but also a matter of dignity, quality of life, and the future of those who defend the independence and freedom of their country. Vision is one of the most important human sensory systems, providing up to 80.0–90.0% of information about the surrounding environment, spatial orientation, professional activity, and social interaction. For military personnel, visual function is of particular importance, as the successful performance of combat tasks, personal safety, unit combat capability, and survival in modern warfare directly depend on its integrity. Therefore, combat ocular injuries represent one of the most serious and socially significant challenges in military medicine in the 21st century. Modern armed conflicts are characterized by high-intensity combat operations and the widespread use of artillery systems, explosive devices, high-precision weapons, unmanned aerial vehicles, and other destructive technologies. These factors contribute to an increase in both the frequency and severity of combat injuries, including ocular trauma. Consequently, the structure of combat injuries has changed significantly, particularly with regard to ophthalmic trauma. Ocular injuries are increasingly combined, multiple, or complex in nature and are frequently associated with traumatic brain injury, facial skeletal trauma, burns, acoustic injuries, and systemic damage to the body. According to international studies, combat-related ocular injuries account for approximately 5.0–15.0% of all combat injuries and represent one of the leading causes of disability among military casualties. The problem of combat eye injuries has become especially relevant in the context of the full-scale war in Ukraine. The new type of warfare that began in 2014 and escalated dramatically in 2022 has placed an unprecedented burden on the system of military medical care and rehabilitation. Thousands of servicemen of the Armed Forces of Ukraine and other defense forces have sustained ocular injuries of varying severity, ranging from mild concussive injuries and superficial wounds to severe penetrating trauma, loss of the eyeball, and complete blindness. These injuries result not only in serious medical consequences but also in profound psychological, social, professional, and economic effects that influence both the quality of life of the injured and their families and the overall defense capability of the state. In this context, a comprehensive interdisciplinary approach to the study of combat ocular injuries is of particular importance – from the analysis of epidemiology and pathophysiological mechanisms of injury to the development of modern strategies for diagnosis, treatment, rehabilitation, and prevention. The global experience of military conflicts in Vietnam, Afghanistan, Iraq, Syria, and other regional wars demonstrates that timely medical care, standardized medical evacuation systems, and the introduction of effective personal protective equipment can significantly reduce the incidence of severe ocular injuries and the rate of vision loss. At the same time, the specific characteristics of combat operations in Ukraine – including the widespread use of fragmentation munitions, explosive devices, kamikaze drones, high-precision weapons, and high-kinetic-energy projectiles – result in the formation of high-velocity fragments and lead to severe combined injuries, including ocular trauma. This creates a distinct profile of eye injuries that requires detailed and independent analysis. Existing international clinical guidelines and protocols cannot always be directly adapted to the conditions of the war in Ukraine, which necessitates the development of a national evidence base, clinical algorithms, and strategies for medical and social support for injured military personnel. This monograph represents an attempt to systematize contemporary scientific data, clinical experience, and practical developments in the field of combat ocular injuries within both global and national contexts. The work summarizes current knowledge regarding the mechanisms of ocular damage, the structure and severity of combat eye injuries, and presents an analysis of international and national experience in their treatment and rehabilitation. The first chapter examines the concept and classification of combat ocular injuries, analyzes their prevalence in modern military conflicts, and identifies their main medical and social consequences. The second chapter provides an in-depth analysis of the pathophysiological mechanisms underlying ocular trauma in modern armed conflicts. Based on a global meta-analysis, the structure of combat eye injuries in different regions of the world is examined, and key features characteristic of the full-scale war in Ukraine are identified. This approach allows not only for a better understanding of the nature of these injuries but also for predicting their clinical course and outcomes. The third chapter presents a comprehensive approach to the provision of medical care for combat ocular injuries at all stages of the treatment and evacuation process-from pri ary care on the battlefield to specialized ophthalmological treatment. It summarizes global experience in modern diagnostic methods and surgical and conservative treatment and provides a retrospective analysis of regional characteristics of ocular injuries and rehabilitation measures in Ukraine. The fourth chapter focuses on the rehabilitation and recovery of patients with combat eye injuries. It discusses modern approaches to the prevention, documentation, and rehabilitation of ocular trauma, possibilities for restoring visual function, ocular prosthetics, and the prospects of neuroprosthetic technologies. Particular attention is given to social adaptation, psychological support, and the quality of life of military personnel who have lost vision or suffer from significant visual impairment. The fifth chapter addresses the prevention of combat ocular injuries. It analyzes the effectiveness of modern personal protective equipment, medical and organizational prevention strategies, and the prospects for reducing the incidence of eye injuries in the Armed Forces of Ukraine. Prevention is considered a key component in maintaining the health of military personnel and improving the combat readiness of the armed forces. The monograph is intended for paramedics, general practitioners, ophthalmologists, surgeons, optometrists, disaster medicine specialists, rehabilitation physicians, healthcare administrators, researchers, cadets and students of higher medical education institutions, as well as professionals involved in the medical support system of the defense forces. The authors hope that the results presented in this monograph will contribute to improving the system of medical care, rehabilitation, and prevention of combat ocular injuries and to the development of scientifically grounded approaches to preserving health and improving the quality of life of military personnel.