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Purpose: To document the incidence and treatment of patients with severe ocular and ocular adnexal injuries during Operation Iraqi Freedom.

Design: Retrospective hospital-based observational analysis of injuries.

Participants: All coalition forces, enemy prisoners of war, and civilians with severe ocular and ocular adnexal injuries.

Methods: The authors retrospectively examined severe ocular and ocular adnexal injuries that were treated by United States Army ophthalmologists during the war in Iraq from March 2003 through December 2005.

Main Outcome Measures: Incidence, causes, and treatment of severe ocular and ocular adnexal injuries.

Results: During the time data were gathered, 797 severe eye injuries were treated. The most common cause of the eye injuries was explosions with fragmentation injury. Among those injured, there were 438 open globe injuries, of which 49 were bilateral. A total of 116 eyes were removed (enucleation, evisceration, or exenteration), of which 6 patients required bilateral enucleation. Injuries to other body systems were common.

Conclusions: Severe eye injuries represent a significant form of trauma encountered in Operation Iraqi Freedom. These injuries were most commonly caused by explosion trauma.