Ocular Trauma and Traumatic Brain Injury on the Battlefield: A Systematic Review After 20 Years of Fighting the Global War on Terror.

This article reviews combat ocular trauma (COT) sustained by U.S. service members during the Global War on Terror (GWoT), focusing on the epidemiology, injury mechanisms, treatment patterns, and the relationship between ocular injuries and traumatic brain injuries (TBIs). It highlights that improvised explosive devices (IEDs) were the predominant cause of COT, accounting for 51-69% of cases, with blast injuries responsible for 64-84% overall. Open-globe injuries comprised 38-64% of COT and were associated with worse visual outcomes and higher surgical intervention rates, while closed-globe injuries accounted for 42-45%. Approximately 40% of patients with ocular trauma also had concomitant TBI, which is intricately linked to visual dysfunction. Despite improvements in personal protective equipment and medical care reducing mortality, eye protection compliance remains variable, and enucleation rates range from 12-17%. The review underscores the need for enhanced eye protection, better documentation, and further research on TBI-related ocular trauma to improve care for future service members.