Joyce Nanjinga Mbekeani

Patterns of Pediatric Firearm-Related Ocular Trauma Interview with:

Joyce Nanjinga Mbekeani

Dr. Mbekeani

Joyce Nanjinga Mbekeani, M.B.B.S.
Associate Professor
Department of Ophthalmology and Visual Sciences
Montefiore Medical Center, Bronx, New York What is the background for this study?

Response: The United States has the highest incidence of gun violence, of all affluent, OECD countries. Thus, firearms are a major public health concern, ranking second among causes of pediatric trauma-related injuries that result in significant

morbidity and mortality. However, most scientific reports addressing pediatric firearm-related eye injuries have evaluated non-powder (recreational) firearm injuries. Our study used the large National Trauma Data Bank (NTDB) to study firearm-related eye injuries for all types of firearms from all intentions of injury. The NTDB collects de-identified submissions of trauma admissions from over 900 facilities in the US. What are the main findings? 

Response: We found that 1972 pediatric firearm-related ocular injuries occurred between 2008 and 2014 and affirmed the findings of previous trauma injuries that males, adolescents and black patients were disproportionately affected. Additionally, we found that 23% of all firearm-related eye injuries occurred in the pediatric population. Common injuries were ruptured globe (41.6%), orbital (30%) and open ocular adnexal (25.5%) injuries. Common locations were the home (38.6%) and street (24.8%).

Although almost 63% of injuries resulted from assault, black patients had four times greater likelihood of assault than white and Hispanic patients while white patients had seven times greater likelihood of self-inflicted injuries. Suicide patients had six times greater chance of traumatic brain injury and almost three times as likely to have optic nerve and visual pathway injuries than other intentions. Children up to 11 years of age were more likely to suffer unintentional or accidental injury, while the 19-21 years group had the greatest likelihood of assault and self-inflicted injury.

The majority (87.8%) survived, but their ocular injuries were mostly sight-threatening and associated with severe injury severity scores and traumatic brain injury. This has implications for complicated rehabilitation, considerable disability and compromised development. What should readers take away from your report?

Response: Pediatric firearm injuries are associated with significant morbidity and mortality. Beyond the initial surgical and medical intervention that contribute to the high survival rate, challenges of post-injury consequences need to be considered. Most eye injuries are sight-threatening and associated with severe injury severity score and traumatic brain injury with implications for long term-disability in this still developing and vulnerable population of patients. What recommendations do you have for future research as a result of this work?

Response: This study was retrospective, limited to the years 2008-2014 and used ICD 9 diagnostic codes. Further evaluation and confirmation of our findings using new 2015-2019 data and the new and more comprehensive ICD 10 codes may assist in providing a foundation for multifaceted and targeted prevention strategies using the associated factors that we identified. Is there anything else you would like to add?

Response: All authors participating in this study have no financial conflicts or other disclosures to report.

Corresponding Author (and PI): Joyce N Mbekeani, MD, FRCS, FRCOphth

Title: Associate Professor of Ophthalmology and Visual Sciences.


  1. Department of Surgery (Ophthalmology), Jacobi Medical Center, Bronx NY
  2. Department of Ophthalmology and Visual Sciences, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

Financial ties: None 


JAMA Ophthalmol. 2019 Oct 10. doi: 10.1001/jamaophthalmol.2019.3562. [Epub ahead of print]

Patterns of Pediatric Firearm-Related Ocular Trauma in the United States.
Weiss R He C Gise R Parsikia A, Mbekeani JN


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Last Updated on November 3, 2019 by Marie Benz MD FAAD