Eye Loss, Orbital Sequelae, and Prosthetic Rehabilitation Following Crowd-Control Kinetic Impact Projectile Injuries: The Largest Civilian Cohort

During the 2019–2020 Chilean social unrest, massive police use of kinetic impact projectiles (KIPs) caused unprecedented severe ocular traumas, initially affecting over 460 individuals. We examined the largest civilian cohort with complete globe loss to characterize orbital/peri-orbital sequelae, analyze projectile-specific injury patterns, and assess factors affecting rehabilitation. This retrospective cohort evaluated 57 individuals requiring ocular prostheses at Chile’s national referral center (2019–2022). Sociodemographic, clinical, and prosthetic variables were analyzed, encompassing immediate and delayed globe loss (secondary evisceration/phthisis bulbi). Sequelae count associations were assessed via the Kruskal–Wallis test. KIPs caused 94.7% of irreversible globe losses (pellets 73.7%, a tear-gas projectile 21.1%, blunt trauma 5.3%). A tear-gas projectile was significantly associated with a higher number of concurrent orbital/peri-orbital sequelae per individual (p = 0.002). Prevalent sequelae included palpebral scarring (43.9%), ptosis (26.3%), and orbital fractures (22.8%). Prior conformer shell installation correlated with significantly more sequelae (p = 0.002). This high sequelae burden also correlated with initial prosthetic complications, specifically rotation and intense mucoid discharge (p = 0.011). Overall prosthetic adherence reached 93.0%; notably, 17.5% of users selected non-mimetic (novelty) prostheses. During the repression of the 2019–2020 protests, “non-lethal” KIPs proved highly destructive. Beyond the globe loss itself, a tear-gas projectile was significantly associated with a high number of concurrent sequelae, uniquely causing widespread trauma, including maxillofacial fractures. Conversely, pellets—the most frequent KIP—frequently resulted in isolated globe loss but caused specific severe outcomes, including all cases of anophthalmic cavity syndrome and persistent conjunctivitis, alongside most ptosis. Complete globe loss occurred immediately or following a prolonged trajectory. High prosthetic adherence (93.0%) was achieved by offering non-mimetic designs when conventional prostheses were refused, preserving orbital integrity and addressing psychosocial needs. These findings reinforce the global need for multidisciplinary rehabilitation and provide medical evidence to demand the strict regulation of these weapons. During the 2019–2020 social protests in Chile, police crowd-control weapons—such as pellets and tear-gas canisters—caused an unprecedented number of severe eye injuries, affecting over 400 people. This study looked at 57 individuals who suffered complete eye loss from these weapons, entered low vision rehabilitation, and opted to receive a custom-made eye prosthesis. This is the largest and most representative sample studied to date, although it does not include a few individuals who were treated in remote regions or private centers, those who refused a prosthesis, or cases of eye loss occurring after this cohort analysis ended in 2022. We found that 94.7% of these irreversible eye losses were caused by these projectiles. Some eyes were destroyed immediately upon impact. Others were initially saved but naturally worsened over the following years despite medical treatments, eventually requiring surgical removal. Different weapons caused different damage. Tear-gas canisters aimed at the face caused widespread damage, including broken facial bones and deep scars. Pellets usually caused the loss of the eye itself along with severe problems inside the empty socket. Adapting to a custom-made eye prosthesis is difficult with massive damage. Yet, rehabilitation was highly successful (93.0% adherence). This was partly because doctors offered creative, non-traditional prosthesis designs to patients who initially rejected standard ones. These findings show that these weapons cause permanent physical mutilation and deeply impact other dimensions of human life, highlighting the urgent need for stricter global rules prohibiting their use to repress protests.