Page 21 - Journal of Special Operations Medicine - Summer 2014

Ocular trauma is, of course, difficult to assess, and SOMA. Ideally, this would expand to the curriculum at
the best plan is often to transport the Servicemember JSOMTC and SOCMSSC. Advanced skills are readily
rearward when possible. The detection of globe lac- mastered when there is a low instructor-to-student ratio
eration is certainly facilitated by slit lamp examina- and the emphasis is on hands-on performance of the tech-
tion compared with a nonmagnified image. When the nique on a live patient. The 18Ds and other SOFMED
clinical scenario suggests risk of open globe (blast in- personnel therefore are able to demonstrate competency
jury, improvised explosive device, shrapnel, lack of eye in slit lamp examinations before deployment.
protection), a brief but accurate examination is also key
to proper management. A Fox or rigid shield should be Simple eye trauma such as embedded FBs involving
placed and the casualty evacuated for definitive diagno- less than 50% stromal thickness can safely be removed

sis and treatment as a vision-threatening injury. Terror- with use of the slit lamp. Our experience in Task Force
ist-orchestrated blast injuries often have glass fragments Reaper resulted in an aviator returning to duty with no
presenting as an intraocular foreign body (IOFB). Com- delay before next scheduled mission. We also assessed
4
pared with civilian IOFB cases, military personnel are and treated other conditions including conjunctivi-
at greater risk for IEDs as the cause. This is associated tis and possible iritis and flight physicals. The ability
with a delay of accurate diagnosis due to lack of spe- to diagnose accurately in the field prevents both the
cialty care and equipment. We believe our medics can expense and, more important, the risk of referral and
5
succeed in diagnosing eye trauma when given the proper transport to the next higher role facility. Timely de-
instrumentation. finitive care also lowers costs by preventing more ex-
pensive specialist care needed as a problem worsens in
In forward positions, if you did not bring it, you do theater. Given the expense invested in training our SOF
not have it (Figure 5). Every ounce of weight carried and aviation communities, a strong argument can be
into austere environments is critical for SOFMED per- made for a $495 purchase that will surely yield return
sonnel. However, the common incidence of eye injury on investment after the first successful use in Role 1
and disease argues for the supply of equipment that can aid stations.
match the skill set of our medics. While not reasonable
for every medic’s bag, we argue that the 18D, Seal Team
Corpsman, civil affairs medical officer, and flight medic Acknowledgments
should have the option to include a portable slit lamp We thank Mr. Victor Doherty, who provided a 510 LS
such as the device described here. The training needed on loan to MAJ Calvano for his recent deployment
to master such a device is 10 to 15 minutes, and we as flight surgeon for HHC 1-135th ARB, Task Force
(R.W.E. and C.J.C.) have successfully transferred skills Reaper to Afghanistan.
to physicians and medics at Special Operations Medical
Association (SOMA) 2013 on the Eilodon portable slit MAJ Calvano also wishes to thank LTC Schreffler and
lamp. MAJ Howerton, as well as Stephanie Birgel at the Of-
fice of the Chief Surgeon, National Guard Bureau, all of
To that end, two of us (R.W.E. and C.J.C.) offered oph- whom are responsible for allowing him to care for the
thalmology skills transfer lecture and laboratory exer- 1-135th ARB of the Missouri Army National Guard.
cises at the annual meeting of SOMA 2012. We intend
to provide this training biannually at a minimum at
Disclosures
The authors have nothing to disclose.
Figure 5 Afghanistan: a typical austere environment for
aviation and SOFMED.
References
1. Enzenauer RW, Vavra DE, Butler F. Combat ophthalmol-
ogy. When there isn’t an assigned ophthalmologist. Binocul
Vis Strabismus Q. 2007;22:153–168.
2. Heier JS, Enzenauer RW, Wintermeyer SF, et al. Ocular in-
juries and diseases at a combat support hospital in support
of Operations Desert Shield and Desert Storm. Arch Oph-
thalmol. 1993;111:795–798.
3. Calvano CJ, Enzenauer RW. Field diagnosis and treatment
of ophthalmic trauma. J Spec Oper Med. 2012;12:58–64.
4. Thach AB, Ward TP, Dick JS 2nd, et al. Intraocular foreign
body injuries during Operation Iraqi Freedom. Ophthal-
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