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Study Shows Air Bags Can Cause Serious Eye Injuries

Mar 21, 1997 |

Activated air bags can inflict severe eye injuries, including blindness, even in minor car accidents, a small-scale study shows.

The research report, published in the March Journal of Ophthalmic Surgery and Lasers, describes the spectrum of air-bag-related eye injuries seen during a two-year period by an ophthalmology trauma team at UCLA.

The damage ranged in severity from bruises in the eye socket to a critically ruptured eyeball, resulting in blindness.

"The study highlights that air bags need some changes in design. They can be lifesaving, but they can also be hazardous to the eyes," said the report's lead author, Dr. Edward E. Manche, assistant professor of ophthalmology and director of cornea and refractive surgery at Stanford University Medical Center. "In one case we detailed, a pregnant woman was driving about 20 miles an hour when she crashed into another car. Her passengers had no air bags, and they were not injured. In this case, the air bag was not lifesaving, yet it certainly caused injury: the driver became legally blind in one eye."

In another low-speed accident described in the research paper, the driver's rigid gas-permeable contact lenses broke in her eyes. She needed surgery to repair a detached retina in her right eye and a torn retina in her left eye. Damage from the accident also led to the development of a cataract in the left eye and a hole in the macular region of the right retina, which created a blind spot.

The paper reviews the five cases of air bag injuries treated at the UCLA ophthalmology trauma service between 1993 and 1995. Manche, who was a visiting assistant professor at UCLA's Jules Stein Eye Institute before joining Stanford last July, co-authored the paper with two colleagues at the UCLA School of Medicine, Dr. Bartly J. Mondino and Dr. Robert A. Goldberg.

All patients suffered significant trauma to the soft tissues and bones of the eye socket and/or serious injury to the eyeball itself, the researchers found. The predominant injuries were bruising of the socket (orbital contusion) and bleeding in the eyeball (hyphema).

"Hyphema is usually caused by blunt trauma, which can damage the inner eye. It can cause immediate ocular problems and may also lead to problems many years later, such as the development of glaucoma," Manche said.

All five patients suffered hyphema, and three later developed angle-recession glaucoma, or pressure in the eye due to rips in the eye's drainage system. Glaucoma, which can slowly destroy vision, needs ongoing treatment. One patient with angle-recession glaucoma also developed a blind spot due to a macular hole.

Manche said he found it interesting that four of the five patients were Asian-American. While cautioning that the sample size makes it impossible to draw any conclusions, he speculates that Asian-Americans could be particularly prone to eye injuries for two reasons: They may tend to have a less protective eye anatomy, with a shallow eye socket and a less prominent orbital rim. In addition, since Asian-Americans tend to be of short stature, they might position their seats close to the steering wheel, where they would be hit earlier and more violently by the explosive power of a deploying air bag.

It's worth noting for further study," Manche said.

Unlike the drivers in the study, their passengers fared well. Some did not have air bags. Those who did, Manche speculates, might have escaped major injury because they sat farther from the air bag than the driver did.

In general, Manche thinks the number of eye injuries from air bags may be rising as more cars become equipped with air bags. "We're seeing more and more reports of ocular trauma from air bags in the medical literature," he said.

In their report, Manche and his co-authors call for manufacturers to continue studying the design and performance of air bags, perhaps with special attention to Asian populations.

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