Eye Trauma Associated with Nonpowder Guns Increasing Among Children

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However, trends in the incidence of eye injuries associated with non-powder guns should be interpreted with caution as COVID-19 may have interfered with epidemiological trends.

An increasing trend in the incidence of eye trauma associated with non-powder guns among children was observed in new research, with the sight-threatening potential identified from foam projectile blasters supporting prior literature.1

However, the investigative team led by Gilles C. Martin, MD, from the ophthalmology department at Rothschild Foundation Hospital, urged caution when interpreting the results as the COVID-19 pandemic may have interfered with epidemiological trends

“Recommendations might prevent many of these unintentional injuries, such as consumer attention to age labeling and consideration of protective goggles, while manufacturers could promote the use of safety glasses to protect children’s eyes,” wrote the investigative team.

Ocular trauma is the reason for most pediatric visits to ophthalmic emergency departments. Prior literature has revealed pediatric eye injuries associated with the recreational use of non-powder guns, including paintball guns, air guns, BB or airsoft guns, and foam bullets and/or foam dart blasters.2 Martin and colleagues suggested that prior evidence on non-powder gun-associated ocular trauma has primarily consisted of case reports or small case series.

The current case series aimed to establish the annual incidence and severity of non-powder gun-related injuries within the study team’s eye emergency department. To do so, investigators retrospectively reviewed the medical records of all cases of non-powder gun-associated trauma managed since 2010. The team retrieved data and the cause of trauma, as well as demographics, initial and follow-up eye examinations, any surgical procedures, and visual outcomes.

Upon analysis, investigators found a total of 304 patients (mean age, 16 years; 234 [77%] male) consulted the eye emergency department after ocular trauma associated with a toy non-powder gun between January 2010 - June 2022. Data showed the most frequent toys involved in injury were foam projective from a non-powder gun in 151 cases (50%; mean age, 15 years), a BB or airsoft gun in 110 cases (36%; mean age, 16 years), a paintball gun in 31 cases (10%; mean age, 22 years), and unspecified in 12 cases (4%; mean age, 7 years).

Martin and colleagues noted the observed increase of foam-projectile blaster-associated injuries, data from the first half of 2022, and the estimated incidence for the end of 2022 suggested an increase in incidence between 2014 - 2022. Meanwhile, the mean age of patients with foam projectile blaster-associated injuries decreased from 16 years in 2014 to 10 years in 2022 (decrease, 6.1 years; 95% CI, 1.65 - 13.85 years; P = .008).

During the study period, investigators identified foam projectile blasters associated with 2 open-globe injuries, 51 intraocular hemorrhages, 3 cataracts, 19 retinal injuries, 22 iris injuries, 12 cases of ocular hypertension, and 45 corneal lesions. A single boy younger than 10 years experienced no light perception in 1 eye after a globe rupture associated with a foam projectile.

The study, however, may have been limited by the word “nerf” included in many of the medical records, as investigators could not determine whether patients mentioned this brand to reflect any non-powder gun involving foam bullets or darts or whether the term was associated with the brand itself.

“Nevertheless, there has been no evidence that one brand would be less sight-threatening than others either in the peer-reviewed ophthalmic literature or in our experience,” investigators wrote.


  1. Dentel A, Boulanger E, Vignal-Clermont C, Caputo G, Martin GC. Incidence of Eye Trauma in Children Associated With Foam Bullets or Foam Darts From Nonpowder Guns. JAMA Ophthalmol. Published online May 11, 2023. doi:10.1001/jamaophthalmol.2023.1464
  2. OydanichM,UppuluriA,ZarbinMA,BhagatN.Epidemiologyofocular injuries related to toy guns in pediatric patients from 2000 to 2019. J Pediatr Ophthalmol Strabismus. 2022;59(3):e29-e31. doi:10.3928/01913913- 20220314-01