Nation’s Ophthalmologists Condemn Use of Tear Gas and Rubber Bullets

Newswise — SAN FRANCISCO, Calif. – Tear gas and rubber bullets may be non-lethal, but they can blind. This week, these tactics blinded at least two Americans and caused serious eye injuries in many others. Life-altering eye injuries are a common result of urban warfare and rioting, worldwide. The American Academy of Ophthalmology condemns this growing problem.¹

“Ophthalmologists, like many Americans, have mobilized to protect their communities from COVID-19 in recent weeks,” said Anne L. Coleman, MD, PhD, president of the American Academy of Ophthalmology.  “We are saddened that these same communities now need our professional skill to treat blinding eye injuries from senseless violence.”

We offer the following advice in the hope that it will mitigate some of the inevitable eye injuries from rubber bullets, tear gas, as well as paintball guns used to “mark” people.

Although, eye protection may help prevent injury from rubber bullets and projectiles, they do NOT give 100 percent protection. If your eye is injured, protect the eye immediately. This is a medical emergency!

1. Do not touch the eye
2. Do not rub the eye
3. Stay upright
4. Place a hard shield around eye. Even a temporary eye shield, such as paper cup or Styrofoam cup, may work in an emergency
5. If the eye ruptures, the contents inside must be preserved, seek emergency room and ophthalmology consultation immediately 

Tear gas typically doesn’t cause irreversible eye injuries, but tear gas has caused serious eye injuries, including hyphema, uveitis, necrotizing keratitis, coagulative necrosis, symblepharon, secondary glaucoma, cataracts and traumatic optic neuropathy and loss of sight.² 

Eye protection may help avoid exposure to tear gas, but they do NOT provide 100 percent protection. If exposed to tear gas, you should:

1. Remove yourself from the contaminated area as quickly and safely as possible.
2. Flush the eyes with lots of clean water.
3. Remove clothing near the face.
4. Seek fresh air.
5. Seek higher ground (aerosolized tear gases are heavier than air).
6. Blink frequently (to promote tearing).
7. Do not rub eyes (may spread crystals within ocular surfaces).
8. Remove contact lenses.
9. Seek emergency ophthalmic evaluation. 

If exposed to pepper spray:

1. Don’t touch the eye area. Pepper spray is oil-based. Touching the area will spread the oil.
2. Blink to help flush the eyes.
3. Flush the eyes with lots of clean water. A small, randomized, controlled trial compared these five treatments (Maalox, 2% lidocaine gel, baby shampoo, milk, water) and found no difference in pain relief. Milk is not recommended for flushing the eyes.
4. Wash the skin around the eyes with baby shampoo; it will breakdown the oil without irritating the eyes.

1.An Epidemic of ‘Dead Eyes’ in Kashmir as India Uses Pellet Guns on Protesters, The New York Times

A Bullet to the Eye Is the Price of Protesting in Chile, The New York Times

2.(Schep LJ, Slaughter RJ, McBride DI. “Riot control agents: the tear gases CN, CS and OC—a medical review.” BMJ Military Health 2015;161:94-99.)

About the American Academy of Ophthalmology

The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.