Foam Bullets Tied to Growing Number of Kids' Eye Injuries

Incidence of ocular trauma from Nerf guns and other "foam projectile blasters" appeared to increase over the past decade, especially among younger kids, a retrospective single-center study from France suggested.

Of more than 300 visits to the eye emergency department (ED) related to the use of nonpowder guns, half were associated with toy guns that shoot foam bullets or darts, while 36% involved a BB or airsoft gun, and 10% a paintball gun, according to Gilles Martin, MD, and colleagues from the Rothschild Foundation Hospital in Paris.

During the 2010-2022 study period at the center, two open-globe injuries were associated with foam projectile blasters, along with dozens of intraocular hemorrhages and corneal lesions, about 20 iris or retinal injuries each, and three cataracts, among others.

Following one globe rupture, a boy under age 10 subsequently had no light perception in one of his eyes, the group detailed in JAMA Ophthalmology.

"Recommendations might prevent many of these unintentional injuries," wrote Martin and co-authors, "such as consumer attention to age labeling and consideration of protective goggles, while manufacturers could promote use of safety glasses to protect children's eyes."

At the start of the study, no ED visits for ocular trauma were identified as being related to foam-shooting guns, but these cases grew to 10 in 2014 and doubled in subsequent years to peak at approximately 25 cases in 2019.

As these cases grew from 2014 to 2022, the average age of patients injured decreased by 6.1 years (95% CI 1.65-13.85, P=0.008), dropping from a mean 16 to 10 years. The median age ranged from 8 days to 74 years.

Martin and team said the increasing trend should be interpreted with caution, however, as the pandemic "may have interfered with epidemiological trends." Cases involving foam projectile blasters dipped to 15 a year in both 2020 and 2021 but then reached those totals in the first half of 2022 alone.

For their study, the researchers analyzed 304 ophthalmologic ED visits for eye trauma associated with nonpowder guns at Rothschild Foundation Hospital in Paris, from January 2010 to June 2022. To identify cases, the researchers searched medical records for all cases that included terms such as "foam bullets, foam darts, Nerf, paintball, airsoft, BB gun, and gun," with each case checked for relevance.

Overall, 77% of the cases involved males. The injuries associated with foam projectile blasters included 51 intraocular hemorrhages; 45 corneal lesions; 22 iris injuries; 19 retinal injuries, including two retinal tears and a retinal detachment; a dozen cases of ocular hypertension; three cataracts, and two open-globe injuries.

One limitation, according to the authors, is that Nerf was most commonly cited in medical records, but it was unclear whether patients may have said the brand was a substitute for other toy guns that similarly fire foam bullets or darts. "There has been no evidence that one brand would be less sight-threatening than others either in the peer-reviewed ophthalmic literature or in our experience," wrote Martin and colleagues.

They said the findings were in line with other studies examining pediatric eye injuries and recreational use of nonpowder guns, although those were mostly smaller series or case reports.

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