Anyone with access to the news can tell you that gun violence in the United States is a substantial public health issue, but less well known are the significant impact firearms have on pediatric ocular trauma. Eye injuries from these weapons are predominantly sight-threatening and are frequently associated with traumatic brain injury, newly published research shows. “These findings may help develop strategies to prevent pediatric firearm-related ocular injuries,” conclude the New York–based investigators.

The investigators point out that the US far outranks other countries in gun deaths—and especially when the victim is a child. “Ninety-one percent of all children worldwide aged 0 to 14 years who died from firearm injuries were from the United States,” the data shows.

The team reviewed 1,972 pediatric patients’ firearm-related eye injuries between 2008 and 2014. Most, 85.1%, were male and 41.6% of the injuries involved an open wound of the globe. Ocular adnexa (25.5%), orbital injuries or fractures (30.0%) and contusion of the eye or adnexa (21.1%) were also common.

Many of these incidents occurred at the patients’ homes (38.6%) or in the street (24.8%). The youngest patients—those aged three or younger—were most likely to be accidently injured by a gun at home, while those between 19 and 21 were most likely to be injured in an assault outside the home. Black patients have a greater chance of injuries resulting from assault while Caucasian patients’ injuries were most likely to be self-inflicted. Traumatic brain and visual pathway injuries resulted mostly from self-inflicted injuries. Potentially impacting access to long-term care, the study pointed to research showing Black American families had longer periods of being uninsured than Caucasian counterparts.

Of the children in this study, 12.2% died as a result of their injuries. Most of the rest suffered lifelong disabilities and impeded physical, academic and social development.

Even air guns showed extremely high levels of serious injuries. Children who sustained air gun injuries had permanent vision loss 66% of the time and 39% of them went completely blind as a result of their injuries.