Eye injuries devastate troops in Iraq, but can be prevented

By Nancy Montgomery, Stars and Stripes
European edition, Tuesday, April 27, 2004

Cpl. Josh Carpenter was looking out his mouse hole on a Fallujah rooftop.

A sniper with the 1st Marine Expeditionary Force, he was lying prone behind a wall, looking through his rifle scope for trouble on the street below.

The trouble found him.

Now, late on Monday afternoon, he sits in an eye examination room in the 31st Combat Support Hospital in Baghdad. The smallest, faintest, crescent-shaped wound under his right, closed eye and the blood on his desert boots are the only clue that anything is wrong.

Right before noon, something landed on Carpenter’s rooftop. “I looked up,” Carpenter said. “It was a grenade.”

Carpenter, 20, is about to hear some terrible news.

“Josh, you have a very bad injury,” the surgeon, Col. Thomas Mader tells him. “There’s a very good chance you’ll never see out of that eye again. I promise you I’ll do my very best.”

Carpenter listens. He doesn’t make a sound or move a muscle. “OK,” he says softly.

Two minutes later, medics are wheeling him up to surgery, which Mader says it will take about two hours.

From the CAT scan, it appears that a chunk of metal shot through Carpenter’s upper right cheek, tore through his eye and is now lodged there, and it looks like a bad prognosis. But Mader won’t know for sure until he sees it up close during surgery.

“You have to see where the holes are and what you can sew up and what you can’t sew up,” Mader says.

Last year, hospital surgeons worked to repair 100 lacerated eyes, and removed 40 eyes. Since January, they’ve tried to repair about 20 eyes hit by shrapnel, bits of metal, rocks or debris, most frequently from roadside bombs. They’ve removed some 20 others.

“We’ve lost a lot of eyes here,” said Lt. Col. Clifton Slade, another of the hospital’s three ophthalmologists.

But such terrible losses could frequently be avoided, said Slade, who is on a mission to get troops to wear protective glasses.

“In our experience, even standard spectacles offer a measure of protection,” he said.

But regular glasses can shatter. What’s best, Slade said, are glasses with high-impact polycarbonate lenses, which don’t shatter.

Some units that have recently deployed to Iraq have been issued Wiley X sunglasses. One brand featuring the polycarbonate lens is especially useful because the glasses extend to the sides of the eyes. The glasses are also lightweight — and, Slade said — they don’t look too “dorky.”

“You have to have something soldiers will wear,” he said.

Slade wants commanders to provide the glasses, and sergeants to enforce their being worn.

“It’s trying to change group behavior,” he said. “If it’s not enforced, nothing is going to happen.”

The Army has been trying for decades to devise some sort of standard-issue, effective eye protection, Slade said.

“That’s the overriding goal,” he said. “You get a helmet, you get eye protection. But that hasn’t happened.”

In fact, the percentage of eye injuries may be going up, to about 10 percent of combat injuries — despite the fact that they make up a small percentage — 0.1 percent — of the total body surface.

One reason for the increase could be more lethal weapons that create more and smaller fragments.

Not every soldier could wear the sunglasses all the time, Slade conceded, because soldiers say they tend to fog up during intense physical exertion.

But, Slade said, “Any soldier in vehicle should wear eye protection.”

Carpenter was one of several Marines injured Monday when Fallujah insurgents fired mortars and rocket-propelled grenades.

Carpenter’s surgery, Slade said, was “uneventful.”

The rupture in his eye was located too deep for surgeons to attempt to fix at the hospital, and he’ll undergo further surgeries in Germany or in the States.

“His prognosis for useful vision in that eye is not good,” Slade wrote in an e-mail.

Now Carpenter’s war is over, but his future is uncertain.

“More or less, I’m mad,” he said before his surgery. “There’s nothing I can do about it now.”