Ocular foam round injury: A case report and literature review

PURPOSE: To report the case of a 25-year-old male who sustained significant ocular trauma from a confirmed foam round. To review the scientific literature on kinetic impact projectiles and legislation currently proposed to regulate their use. OBSERVATIONS: A 25-year-old male presented to the emergency department with acute pain and vision loss in his left eye after being struck by a foam round. Initial exam showed significant periorbital ecchymosis, multiple eyelid lacerations, microhyphema, and vitreous hemorrhage. Computed tomography revealed fractures of the inferior and medial orbital walls. Optical coherence tomography also demonstrated full-thickness macular hole. Microhyphema resolved after 15 days with steroid and mydriatic drops. Vision at 60 days after injury stabilized at 20/60. Repeat OCT at this time revealed closure of the macular hole. Care for the patient is ongoing. CONCLUSIONS AND IMPORTANCE: Foam rounds can cause a pattern of vision-threatening ocular trauma similar to that of rubber bullets with the additional risk of chemical injury. During the George Floyd protests, isolated reports of significant foam round-related ocular injuries have been reported in the press, but systematic epidemiologic and clinical data on the subject remains lacking. While accurate identification of the causative weapon is not required in the management of ocular trauma, it may impact advocacy efforts undertaken by physicians and the subsequent legislative efforts they inspire. Current state and federal law does not adequately protect individuals from these munitions. Multiple proposals in Congress aptly recognize the significant risk of blinding injury and mortality posed by all kinetic impact projectiles.