Case Reports Impaled Orbital TASER Probe Injury Requiring Primary Enucleation Leon Rafailov, M.D., Jenny Temnogorod, M.D., Frank F. Tsai, M.D., and Roman Shinder, M.D., F.A.C.S. Abstract: The Conducted Electrical Weapon is a weapon often used by law enforcement agencies as a method of less lethal means to subdue a suspect. Injuries to the eye with these devices are usually due to the projectile force of the metal probes that are released when these devices are engaged. The authors report what may be the first case of an impaled orbital TASER probe that required primary enucleation for globe perforation.
T
he TASER (Thomas A Swift’s Electric Rifle, TASER International, Scottsdale, AZ) was introduced in 1974 as a Conducted Electrical Weapon and utilized by law enforcement agencies as a means to subdue violent suspects. Currently, Conducted Electrical Weapons are also available to the public in the United States, being legal for consumer use in a large majority of states. It functions by shooting out 2 metal probes at over 160 feet/s when leaving the device using pressurized gas. These 2 probes remain connected to the weapon through conductive wiring that transmits an electrical impulse.1 When 2 darts make connection with skin or clothing, this completes an electrical circuit allowing the device to release short 50,000 V pulsations.1 This electrical current causes pain and muscular contraction meant to disorient and temporarily incapacitate the subject. Thomas A Swift’s Electric Rifle devices may also be used without the firing of probes by direct application of the device against the subject. The force of these probes when expelled from the TASER device can be significantly greater when fired at a close distance. Though meant to be nonlethal, in the history of its use it has been associated with significant and permanent damage and in some instances death.2,3. In a large study examining TASER device use in the field with 6 law enforcement agencies, it was found that 1.4% of subjects had device connection to the head and neck area when a TASER weapon was used.4 A case of a TASER device used by police to subdue a young man that perforated the globe and impaled in the orbit requiring primary enucleation is herein described. This study was reviewed and approved by the Institutional Review Board of SUNY Downstate Medical Center. The research adhered to the tenets of the Declaration of Helsinki, and the Health Insurance Portability and Accountability Act.
TASER weapon. The patient was in active psychosis on admission and was unable to describe further details regarding the circumstances of the event. On examination, the patient had a TASER electrode impaled into the medial aspect of left globe and orbit (Fig. 1A, B). Visual acuity was 20/20 in the right eye and no light perception in the left eye. The left pupil was dilated to 6 mm, peaked superiorly, and unresponsive to light. There was marked diffuse hemorrhagic chemosis of the left globe. Fundus examination was unable to be performed in the left eye due to intraocular hemorrhage. Orbit CT scan showed a cylindrical metallic foreign body penetrating through both the anterior and posterior globe in close proximity to the optic nerve, coursing intraconally in an inferior direction where its barb was impaled in the greater wing of the sphenoid bone (Fig. 2). Psychiatry consultation deemed the patient not to have capacity to properly make medical decisions, and the clinicians involved agreed that urgent surgical intervention was in the patient’s best interest. After receiving intravenous antibiotics, the patient was taken to the operating room for exploration and extraction of the TASER probe (Fig. 1C). During removal,
FIG. 1. A, Clinical photograph showing the impaled electrode with TASER wire. B, Intraoperative clinical photograph depicting the impaled body of the TASER probe through the medial globe with extensive chemosis. C, TASER probe following surgical extraction. TASER, Thomas A Swift’s Electric Rifle.
REPORT OF A CASE A 24-year-old schizophrenic male presented to the emergency department after being subdued by police with use of a Accepted for publication March 18, 2015. Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A. Supported in part by Research to Prevent Blindness, New York, NY, who had no role in the design or conduct of this research. Oral presentation American Society of Ophthalmic Plastic and Reconstructive Surgery 45th Annual Fall Scientific Symposium on October 17, 2014 in Chicago, IL. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Roman Shinder, m.d., f.a.c.s., Department of Ophthalmology, SUNY Downstate Medical Center, 541 Clarkson Ave, E bldg, 8th Fl, Suite C, Brooklyn, NY 11203. E-mail: [email protected] DOI: 10.1097/IOP.0000000000000486
Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2015
FIG. 2. CT scan of orbit revealing a metallic foreign body perforating the left globe and impaled into the greater wing of the sphenoid bone.
1
Copyright © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited.
Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2015
Case Reports
Ocular injuries associated with TASER use Author (year)
Age
Gender
Ng and Chehade (2005) Chen et al. (2006)
50
M
21
M
Seth et al. (2007) Han et al. (2009)
35 25
M M
Teymoorian et al. (2010) Sayegh et al. (2011)
26
M
39
M
Li et al. (2013)
47
F
Injury Lower eyelid with globe penetration Globe perforation from limbus through pars plana Electrical discharge across eye Upper eyelid with globe penetration Globe perforation from limbus to posterior sclera Lower eyelid perforation to anterior orbit Central corneal penetration
Vision on presentation
Final visual acuity
20/60
20/30
Mild anterior uveitis
Hand motions
20/60
20/100 Light perception
Unknown 20/40
Proliferative vitreoretinopathy, retinal detachment Cataract formation Retinal detachment, vitreous hemorrhage Blind painful eye, enucleation
No light perception 20/400 Bare light perception
Complications
No light perception 20/25 Exudative retinal detachment Light perception
Retinal detachment
TASER, Thomas A Swift’s Electric Rifle.
because a considerable amount of intraocular tissue was euthanized, a primary enucleation was undertaken. The patient was lost to follow up thereafter.
DISCUSSION To date, there have been few case reports focusing on penetrating ocular injury caused by TASER weapon use, with the first known reported case in 2005.5 Most of these reports suggest that injury with TASER probes is often mechanical.6,7 The consequences of globe injury led many of the subjects to develop significant vision loss with other complications (Table). Periocular injuries from a TASER device may include globe penetration or perforation, electrical injury, optic nerve damage, and orbital wall trauma.5–11. Out of the 5 reported ocular injuries associated with probe deployment that had surgical repair, 3 of the patients experienced retinal detachment in the postoperative period. One case had involvement of the bony orbit, with a probe tip terminating in the lacrimal fossa9. Another case described a male who sustained an ethmoid bone fracture and injury to the nasolacrimal duct, but was without globe injury or vision loss.12 The current case demonstrates the significant force associated with the probe as a projectile as it caused perforation of the globe with sufficient kinetic energy to reach the sphenoid bone posteriorly. In cases without globe penetration, 1 report described a patient who developed a cataract from direct electrical stimulation of a TASER device without probe deployment8. Another report characterized a patient who developed retinal damage despite lack of direct contact between the probe and the retina, leading the authors to propose that electrical stimulation and thermal injury were large contributors to the vision loss9. In this case, it is unclear if the probe was ever electrically discharged, though there was no evidence of electrical or thermal injury. Teymoorian et al.10 described a 26-year-old male who sustained perforating globe trauma from a TASER probe that was repaired, but eventually progressed to a blind painful eye that required enucleation. There have been no other cases of ocular injury by TASER probes described in the literature that have required enucleation. All cases demonstrated that care must be taken in the removal of these probes, as the barbed ends can cause iatrogenic injury during extraction.
2
The described case, to the authors knowledge, represents the first report of a TASER probe injury where the barbed end was impaled in the bony orbit and required primary enucleation. Law enforcement agencies are faced with a difficult task of avoiding these types of injuries in scenarios where targeting away from the face may be difficult to achieve due to rapidly evolving and dangerous circumstances. With Conducted Electrical Weapon usage rapidly expanding across the world, the importance of proper training and use must continue to be stressed to reduce the likelihood of such catastrophic periocular injuries.
REFERENCES 1. Taser International. Taser CEW Press Kit. Available at: h t t p : / / w w w. t a s e r. c o m / i m a g e s / p r e s s - r o o m / TA S E R C E W PressKitMASTER060514.pdf. Accessed January 8, 2015. 2. Zipes DP. TASER electronic control devices can cause cardiac arrest in humans. Circulation 2014;129:101–11. 3. Pasquier M, Carron PN, Vallotton L, et al. Electronic control device exposure: a review of morbidity and mortality. Ann Emerg Med 2011;58:178–88. 4. Bozeman WP, Hauda WE, 2nd, Heck JJ, et al. Safety and injury profile of conducted electrical weapons used by law enforcement officers against criminal suspects. Ann Emerg Med 2009;53:480–9. 5. Ng W, Chehade M. Taser penetrating ocular injury. Am J Ophthalmol 2005;139:713–5. 6. Chen SL, Richard CK, Murthy RC, et al. Perforating ocular injury by Taser. Clin Exp Ophthalmol 2006;34:378–80. 7. Li JY, Hamill MB. Catastrophic globe disruption as a result of a TASER injury. J Emerg Med 2013;44:65–7. 8. Seth RK, Abedi G, Daccache AJ, et al. Cataract secondary to electrical shock from a Taser gun. J Cataract Refract Surg 2007;33:1664–5. 9. Sayegh RR, Madsen KA, Adler JD, et al. Diffuse retinal injury from a non-penetrating TASER dart. Doc Ophthalmol 2011;123:135–9. 10. Teymoorian S, San Filippo AN, Poulose AK, et al. Perforating globe injury from Taser trauma. Ophthal Plast Reconstr Surg 2010;26:306–8. 11. Han JS, Chopra A, Carr D. Ophthalmic injuries from a TASER. CJEM 2009;11:90–3. 12. de Runz A, Minetti C, Brix M, et al. New TASER injuries: lacrimal canaliculus laceration and ethmoid bone fracture. Int J Oral Maxillofac Surg 2014;43:722–4.
© 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
Copyright © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited.
T
he TASER (Thomas A Swift’s Electric Rifle, TASER International, Scottsdale, AZ) was introduced in 1974 as a Conducted Electrical Weapon and utilized by law enforcement agencies as a means to subdue violent suspects. Currently, Conducted Electrical Weapons are also available to the public in the United States, being legal for consumer use in a large majority of states. It functions by shooting out 2 metal probes at over 160 feet/s when leaving the device using pressurized gas. These 2 probes remain connected to the weapon through conductive wiring that transmits an electrical impulse.1 When 2 darts make connection with skin or clothing, this completes an electrical circuit allowing the device to release short 50,000 V pulsations.1 This electrical current causes pain and muscular contraction meant to disorient and temporarily incapacitate the subject. Thomas A Swift’s Electric Rifle devices may also be used without the firing of probes by direct application of the device against the subject. The force of these probes when expelled from the TASER device can be significantly greater when fired at a close distance. Though meant to be nonlethal, in the history of its use it has been associated with significant and permanent damage and in some instances death.2,3. In a large study examining TASER device use in the field with 6 law enforcement agencies, it was found that 1.4% of subjects had device connection to the head and neck area when a TASER weapon was used.4 A case of a TASER device used by police to subdue a young man that perforated the globe and impaled in the orbit requiring primary enucleation is herein described. This study was reviewed and approved by the Institutional Review Board of SUNY Downstate Medical Center. The research adhered to the tenets of the Declaration of Helsinki, and the Health Insurance Portability and Accountability Act.
TASER weapon. The patient was in active psychosis on admission and was unable to describe further details regarding the circumstances of the event. On examination, the patient had a TASER electrode impaled into the medial aspect of left globe and orbit (Fig. 1A, B). Visual acuity was 20/20 in the right eye and no light perception in the left eye. The left pupil was dilated to 6 mm, peaked superiorly, and unresponsive to light. There was marked diffuse hemorrhagic chemosis of the left globe. Fundus examination was unable to be performed in the left eye due to intraocular hemorrhage. Orbit CT scan showed a cylindrical metallic foreign body penetrating through both the anterior and posterior globe in close proximity to the optic nerve, coursing intraconally in an inferior direction where its barb was impaled in the greater wing of the sphenoid bone (Fig. 2). Psychiatry consultation deemed the patient not to have capacity to properly make medical decisions, and the clinicians involved agreed that urgent surgical intervention was in the patient’s best interest. After receiving intravenous antibiotics, the patient was taken to the operating room for exploration and extraction of the TASER probe (Fig. 1C). During removal,
FIG. 1. A, Clinical photograph showing the impaled electrode with TASER wire. B, Intraoperative clinical photograph depicting the impaled body of the TASER probe through the medial globe with extensive chemosis. C, TASER probe following surgical extraction. TASER, Thomas A Swift’s Electric Rifle.
REPORT OF A CASE A 24-year-old schizophrenic male presented to the emergency department after being subdued by police with use of a Accepted for publication March 18, 2015. Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A. Supported in part by Research to Prevent Blindness, New York, NY, who had no role in the design or conduct of this research. Oral presentation American Society of Ophthalmic Plastic and Reconstructive Surgery 45th Annual Fall Scientific Symposium on October 17, 2014 in Chicago, IL. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Roman Shinder, m.d., f.a.c.s., Department of Ophthalmology, SUNY Downstate Medical Center, 541 Clarkson Ave, E bldg, 8th Fl, Suite C, Brooklyn, NY 11203. E-mail: [email protected] DOI: 10.1097/IOP.0000000000000486
Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2015
FIG. 2. CT scan of orbit revealing a metallic foreign body perforating the left globe and impaled into the greater wing of the sphenoid bone.
1
Copyright © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited.
Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2015
Case Reports
Ocular injuries associated with TASER use Author (year)
Age
Gender
Ng and Chehade (2005) Chen et al. (2006)
50
M
21
M
Seth et al. (2007) Han et al. (2009)
35 25
M M
Teymoorian et al. (2010) Sayegh et al. (2011)
26
M
39
M
Li et al. (2013)
47
F
Injury Lower eyelid with globe penetration Globe perforation from limbus through pars plana Electrical discharge across eye Upper eyelid with globe penetration Globe perforation from limbus to posterior sclera Lower eyelid perforation to anterior orbit Central corneal penetration
Vision on presentation
Final visual acuity
20/60
20/30
Mild anterior uveitis
Hand motions
20/60
20/100 Light perception
Unknown 20/40
Proliferative vitreoretinopathy, retinal detachment Cataract formation Retinal detachment, vitreous hemorrhage Blind painful eye, enucleation
No light perception 20/400 Bare light perception
Complications
No light perception 20/25 Exudative retinal detachment Light perception
Retinal detachment
TASER, Thomas A Swift’s Electric Rifle.
because a considerable amount of intraocular tissue was euthanized, a primary enucleation was undertaken. The patient was lost to follow up thereafter.
DISCUSSION To date, there have been few case reports focusing on penetrating ocular injury caused by TASER weapon use, with the first known reported case in 2005.5 Most of these reports suggest that injury with TASER probes is often mechanical.6,7 The consequences of globe injury led many of the subjects to develop significant vision loss with other complications (Table). Periocular injuries from a TASER device may include globe penetration or perforation, electrical injury, optic nerve damage, and orbital wall trauma.5–11. Out of the 5 reported ocular injuries associated with probe deployment that had surgical repair, 3 of the patients experienced retinal detachment in the postoperative period. One case had involvement of the bony orbit, with a probe tip terminating in the lacrimal fossa9. Another case described a male who sustained an ethmoid bone fracture and injury to the nasolacrimal duct, but was without globe injury or vision loss.12 The current case demonstrates the significant force associated with the probe as a projectile as it caused perforation of the globe with sufficient kinetic energy to reach the sphenoid bone posteriorly. In cases without globe penetration, 1 report described a patient who developed a cataract from direct electrical stimulation of a TASER device without probe deployment8. Another report characterized a patient who developed retinal damage despite lack of direct contact between the probe and the retina, leading the authors to propose that electrical stimulation and thermal injury were large contributors to the vision loss9. In this case, it is unclear if the probe was ever electrically discharged, though there was no evidence of electrical or thermal injury. Teymoorian et al.10 described a 26-year-old male who sustained perforating globe trauma from a TASER probe that was repaired, but eventually progressed to a blind painful eye that required enucleation. There have been no other cases of ocular injury by TASER probes described in the literature that have required enucleation. All cases demonstrated that care must be taken in the removal of these probes, as the barbed ends can cause iatrogenic injury during extraction.
2
The described case, to the authors knowledge, represents the first report of a TASER probe injury where the barbed end was impaled in the bony orbit and required primary enucleation. Law enforcement agencies are faced with a difficult task of avoiding these types of injuries in scenarios where targeting away from the face may be difficult to achieve due to rapidly evolving and dangerous circumstances. With Conducted Electrical Weapon usage rapidly expanding across the world, the importance of proper training and use must continue to be stressed to reduce the likelihood of such catastrophic periocular injuries.
REFERENCES 1. Taser International. Taser CEW Press Kit. Available at: h t t p : / / w w w. t a s e r. c o m / i m a g e s / p r e s s - r o o m / TA S E R C E W PressKitMASTER060514.pdf. Accessed January 8, 2015. 2. Zipes DP. TASER electronic control devices can cause cardiac arrest in humans. Circulation 2014;129:101–11. 3. Pasquier M, Carron PN, Vallotton L, et al. Electronic control device exposure: a review of morbidity and mortality. Ann Emerg Med 2011;58:178–88. 4. Bozeman WP, Hauda WE, 2nd, Heck JJ, et al. Safety and injury profile of conducted electrical weapons used by law enforcement officers against criminal suspects. Ann Emerg Med 2009;53:480–9. 5. Ng W, Chehade M. Taser penetrating ocular injury. Am J Ophthalmol 2005;139:713–5. 6. Chen SL, Richard CK, Murthy RC, et al. Perforating ocular injury by Taser. Clin Exp Ophthalmol 2006;34:378–80. 7. Li JY, Hamill MB. Catastrophic globe disruption as a result of a TASER injury. J Emerg Med 2013;44:65–7. 8. Seth RK, Abedi G, Daccache AJ, et al. Cataract secondary to electrical shock from a Taser gun. J Cataract Refract Surg 2007;33:1664–5. 9. Sayegh RR, Madsen KA, Adler JD, et al. Diffuse retinal injury from a non-penetrating TASER dart. Doc Ophthalmol 2011;123:135–9. 10. Teymoorian S, San Filippo AN, Poulose AK, et al. Perforating globe injury from Taser trauma. Ophthal Plast Reconstr Surg 2010;26:306–8. 11. Han JS, Chopra A, Carr D. Ophthalmic injuries from a TASER. CJEM 2009;11:90–3. 12. de Runz A, Minetti C, Brix M, et al. New TASER injuries: lacrimal canaliculus laceration and ethmoid bone fracture. Int J Oral Maxillofac Surg 2014;43:722–4.
© 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
Copyright © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited.
