#NoRubberBullets

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Amee Azad, MD, MSEpi student Stanford Med @ameeazad
& Ryan Brewster MD student Stanford Med @_ryanbrewster_

The term “rubber bullets” offers a false sense of security and especially when it comes to the eye. For rubber bullets, the risk for globe injury, orbital fractures, and permanent vision loss is increased. As Lavy and Asieh state, “The term ‘rubber bullet’ is misleading. ‘Rubber bullets’ cause a wide variety of ocular and periocular injuries. Orbital fractures are common. The tissues of the orbit are easily penetrated. If the globe is hit, it is rarely salvageable.” (Lavy, T., Asleh, S. Ocular rubber bullet injuries. Eye 17821–824 (2003). https://doi.org/10.1038/sj.eye.6700447 )

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Instagram: is.visualart 11/19/2019

There are numerous reports of the devastating effects which rubber bullets, pellet guns, and projectiles can have on the eyes. The NYTimes profiles Dr. Natarajan Sundaram and his heroic efforts to protect sight after the protests in Kashmir, India here. (“An Epidemic of ‘Dead Eyes’ in Kashmir as India Uses Pellet Guns on Protesters” 2016). More recently, see an article from Chile: “A Bullet to the Eye Is the Price of Protesting in Chile” November 19, 2019. (link). Eye injuries are becoming increasingly common worldwide.

As with potential tear gas exposure, eye protection is the best initial option to hopefully avoid injury from rubber bullets & projectiles but they do NOT give 100% protection. If exposed to a rubber bullet or projectile injury, an individual should protect the eye immediately. The eye may have an “open injury” (ruptured globe) and the intraocular contents are fragile and must be preserved. This is a medical emergency.

If injury occurs, remember the military phrase SHIELD AND SHIP. In transit to the emergency room:

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  1. Do not touch the eye.
  2. Do not rub the eye.
  3. Stay upright.
  4. SHIELD: Place a hard shield around eye. Even a temporary eyeshield, such as paper cup or styrofoam cup, may work in an emergency.
  5. SHIP: Seek emergency room and ophthalmology consultation immediately.

Tear gases and rubber bullets can cause permanent eye damage, eye injury, discomfort, pain, loss of vision, and blindness. In cases of chemical injury and eye trauma, protect the eyes and seek medical attention immediately.


Additional resources on #NoRubberBullets & Tear Gas Injury:

  1. Tear gases and rubber bullets can cause permanent eye damage, eye injury, loss of vision, and blindness. In cases of chemical injury and eye trauma, protect the eyes and seek medical attention immediately. (My original blog post, June 2, 2020)
  2. Interviewed by Reporter Evan Koslof (WUSA 9 in Washington DC) on the risks of ophthalmic injury with contact lens use and tear gas exposure (June 3, 2020)
  3. Nation’s Ophthalmologists Condemn Use of Tear Gas and Rubber Bullets. American Academy of Ophthalmology (June 3, 2020)
  4. Statement on Rubber Bullets for Crowd Dispersion. American Academy of Ophthalmology (June 4, 2020)
  5. “Rubber bullets are touted as a ‘safe alternative.’ My patient’s wound tells a different story” (Opinions). Dr. Lilun Li, Washington Post (June 4, 2020)
  6. “A guide to the less-lethal weapons that law enforcement uses against protesters.” By Alyssa Fowers ,Aaron Steckelberg andBonnie Berkowitz, Washington Post June 5
  7. Steve Gieser, MD, MPH, a Chicago ophthalmologist and glaucoma specialist, has posted poignant clinical vignettes of individuals affected by tear gas, rubber bullets, and other projectiles. Instagram
  8. The Department of Ophthalmology at the University of California San Francisco, in conjunction with the American Academy of Ophthalmology, is collecting information regarding ocular injuries surrounding civil protests. To add a case to this registry, please use the Google Form here.
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#NoRubberBullets vignettes by Steve Gieser, MD, MPH on Instagram

(Media: Journalists covering eye health news who are in need of information, expert and/or patient interviews should contact the American Academy of Ophthalmology’s public relations department at media@aao.org or call the media line at 415.561.8534.)

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#NoRubberBullets #NotOneMoreEye #SaveTheEye
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