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Air
Bags Technologic advances designed to promote public safety can ironically cause devastating injuries. While most air bag deployments result in the saving of lives, thousands, in fact each year, operators of motor vehicles are faced with conflicting information regarding air bags and recognizing situations in which they might produce serious injury. The advantages and disadvantages of the device differ depending on whether the affected automobile occupants are children or adults. For example, a 1997 report in the Journal of the American Medical Association stated that children under 10 years have a 34% greater risk of dying in head-on accidents when air bags deploy. Air bag technology is relatively new. However, it rapidly became apparent that the rate at which air bags are deployed, i.e., in excess of 200 miles an hour, can cause crushing chest injury, severe neurologic injury, and ocular trauma. Because of the speed of impact, the National Highway Traffic Safety Administration (NHTSA) recommends that children under age 12 be secured in seats in the rear of the vehicle to provide an adequate distance protective of the child's head if the air bag does open; infants in rear-facing, child-safety seats should never ride in the front seats of a vehicle with a passenger-side air bag; little children and babies should ride in the back seat in child-safety seats that are approved for their age and size; adults and children should buckle shoulder and lap belts on every trip; driver and passenger seats should be moved as far back as possible from the dashboard, which is especially important for men and women of shorter height. Generally, ocular injuries do not occur as frequently as trunk injuries, but they do merit attention. In 1998, the American Academy of Ophthalmology recognized this and issued a statement advising that air bags not be disconnected, stating, "While air bags may cause eye injuries in low speed impacts, the number of lives saved by air bags during high-speed impacts outweighs the risk of eye injury." In 1998, in a study conducted at Harvard Medical School, the medical reports were examined by the NHTSA to determine the types and incidence of ocular injuries. They reported that while eye injuries seemed to be rare, a low percentage involve retinal detachment, which is sight-threatening. Most of the injuries sustained by 113 patients involved the superficial eyelid (81.8%) and the superficial cornea (11.8%), all of which resolved. A second report also issued in 1998 by Herbert Ingraham, MD, and colleagues from Penn State Geisinger Health System called attention to the possibility of bilateral ocular alkali burns caused by rupture of the air bag and release of a powdery aerosol into the area of the car in which a passenger was trapped following a high-speed head-on collision. After arrival in the emergency department, the patient complained of decreased vision bilaterally, counting fingers at 4 feet and 20/400 in the right and left eyes, respectively. Treatment was complicated by development of bilateral cataracts, persistent epithelial defects, corneal melting, perforations, and increases in intraocular pressure to 50 mm Hg in the left eye. The final visual outcome was 20/400 and hands motions in the right and left eyes, respectively. The investigators stressed that prompt recognition of the alkaline burn and ocular irrigation at the accident scene when victims complain of ocular irritation may result in a better visual outcome. In the latest report of ocular injuries, which was published in the August 2000 issue of the journal Ophthalmology published by the American Academy of Ophthalmology, an investigator from Washington University Medical Center, Gregg Lueder, MD, focused on the medical records of all children who had been involved in automobile accidents in which the air bags had deployed. Of the seven children injured in the accidents, all had periocular contusions. Serious injuries included corneal and a traumatic hyphema with secondary glaucoma and cataract; minor injures were corneal abrasions, superficial laceration, and traumatic iritis. Dr. Lueder stressed that the findings in the children included in the study support the transporting of children and infants in the rear vehicle seat. More sophisticated equipment advances are on the drawing board, and include systems that are individualized based on the height and weight of the driver.
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