A Characterization of Gunshot Wounds to the Face in Pediatric Patients at an Urban Level I Trauma Center in the United States

Purpose: Literature regarding the effects of gunshot wounds (GSW) to the face in children is scarce. This study aimed to identify presenting features and clinical outcomes of pediatric patients with GSW to the face, with special attention to ophthalmic data. Methods: This is a retrospective cohort study of patients seen by oculoplastics at a Level I trauma center in the United States after a GSW injury to the face from May 2018 to September 2024. Relevant demographic and clinical data were collected through chart review. Categorical variables are described using percentages and numerical variables are described using median with interquartile range. Results: Nine patients were included with a median age of 16.6 (4.7) years; 67% were male. The most common bullet entry site was the orbit (44%) followed by cheek (33%). The bullet traversed the midline in 78% of cases. Common injuries included orbital wall fracture, open globe injury, optic nerve injury, and intra-ocular hemorrhages. 56% had concomitant intracranial hemorrhages. At least 2 patients presented with non-light perceiving (NLP) vision in at least 1 eye. At final ophthalmology follow-up, 2 patients were legally blind, and 4 were NLP or had undergone enucleation in at least 1 eye. The most common surgical intervention performed was fracture repair (56%) followed by enucleation (33%). Conclusion: This study highlights the devastating effect of GSW to the face in children, particularly with respect to the eyes and orbits. Further studies with larger sample sizes are warranted to identify optimal management patterns and risk factors for poor outcomes.