Injury of the visual analyzer in blast trauma: mechanisms, diagnosis, treatment

Blast trauma is one of the most challenging problems in modern ophthalmology and neurology, as it is often accompanied by severe injuries of the visual system. According to various authors, ocular involvement accounts for up to 28% of all blast-related injuries. Traumatic brain injury (TBI), which frequently coexists with blast trauma, is complicated by ophthalmic disorders in 84% of cases. This highlights the exceptional vulnerability of the eye to blast-related factors — shock wave, thermal effects, and fragments. The most common injuries include open globe trauma, intraocular foreign bodies, globe rupture, retinal detachment, and traumatic optic neuropathy. Secondary factors (shrapnel, building debris, soil, metal) markedly increase the risk of severe complications such as endophthalmitis, post-traumatic glaucoma, and retinal neovascularization, which often lead to disability. Diagnosis requires a comprehensive approach involving ophthalmological methods (ophthalmoscopy, ultrasound, optical coherence tomography), neurophysiological techniques (visual evoked potentials, electroretinography), and neuroimaging (CT/MRI of the orbits and brain). Their combination enables detection of both local ocular damage and central visual pathway impairment. Treatment includes emergency surgery (globe repair, removal of foreign bodies, vitreoretinal interventions), infection prophylaxis (systemic and local antibiotic therapy), as well as anti-inflammatory and immunomodulatory therapy. Timely prevention of sympathetic ophthalmia is of particular importance. Further rehabilitation involves restorative and functional methods aimed at preserving residual vision and improving patient adaptation. Thus, blast-related injury of the visual analyzer is characterized by multifactorial mechanisms and a high risk of permanent vision loss. Optimal diagnosis and treatment are possible only through a comprehensive multidisciplinary approach with an emphasis on early intervention and long-term rehabilitation.