Ocular injuries following the pager explosion mass casualty event in Lebanon: a large single-centre case series

BACKGROUND/AIMS: On 17 September 2024, over 3000 pager devices containing explosives were remotely detonated across Lebanon in a coordinated mass-casualty event, causing unprecedented ocular trauma. This study aims to characterise the nature and extent of ophthalmic injuries treated at a tertiary care centre following this unique attack. METHODS: A retrospective chart review was conducted of patients presenting to the American University of Beirut Medical Centre on the day of the explosion. Only patients who underwent ophthalmic surgical exploration were included. Data were collected from clinical notes, imaging and operative reports. Injuries were categorised using the Birmingham Eye Trauma Terminology (BETT) classification, and descriptive statistics were applied. RESULTS: 79 patients (158 eyes) underwent surgical exploration. Severe globe trauma was identified in 111 eyes (70.3%), including 61 eyes (55%) with open globe injuries and 50 (45%) with traumatic eviscerations. Bilateral injuries were noted in 45.6% of patients. Intraocular foreign bodies were confirmed in all traumatic eviscerations and 81.9% of open globe injuries. Evisceration was performed in 49 eyes (31%). Adnexal injuries requiring reconstruction occurred in 27.3% of eyes. Among eyes that underwent globe-sparing repair, 71.7% had postoperative visual acuity of no light perception or light perception. CONCLUSION: This case series describes an unprecedented volume and severity of ocular injuries from a novel blast mechanism. The combination of thermal, chemical and penetrating trauma resulted in high rates of globe loss and poor visual outcomes. Preparedness for future unconventional mass-casualty scenarios must include rapid imaging, specialised ophthalmic teams and coordinated multidisciplinary care.