Student Submission: Ocular Trauma and Nonpowder Firearms

August 11, 2023 | Ayaka Fujihashi, Medical Student


Amidst the political climate on gun control and gun safety, there is another aspect of public safety that is often overlooked: nonpowder guns. Firearms such as BB guns, airsoft guns, and paintball guns. These guns differ from their powdered counterparts in their mechanisms. Nonpowder firearms use plastic or pellet bullets, and, instead of relying on the high pressures created from chemical reactions using powder, nonpowder guns utilize springs, compressed air, or CO2 to send their projectiles flying. Nonpowder firearms are often seen as toys, with marketing campaigns specifically targeting male children. Yet, these devices are deceptively dangerous.

Between 1990 and 2016, roughly 360,000 cases of nonpowder firearm related injuries were treated in emergency departments, which equates to about 13,500 cases annually.1 Most injuries occur in children between 6 and 12 years old, and 87% occur in boys. The majority of the injuries occur in the head and neck region, and many injuries specifically involve the eye. Of the total, 16% suffered an open injury to the eye. 3.5% were left with legal blindness—defined as visual acuity of 20/200 or less in the better eye with correction—and 11.1% were left with visual defects.2

While accidents do happen, 98% of these ocular injuries occur without eye protection and could have been prevented.1  Currently, there are no federal law regulations on the use, possession, or transfer of nonpowder firearms. Because these forms of firearms are considered a consumer product, the regulating body would be the Consumer Product Safety Commission (CPSC), but it has not adopted any specific regulations. Some states have laws limiting the possession, use, or sales to minors, but there are no laws at any government level mandating the use of eyewear protection.

The American Academy of Pediatrics and American Academy of Ophthalmology issued a joint statement recommending the use of protective eyewear for all participants in sports in which there is a risk of eye injury. Nonpowder firearms were categorized in the “high risk” category, meaning an increased risk of the eye being impacted with sufficient energy to cause injury.3

However, statements of recommendation with no actionable authority can only go so far. In order to help reduce needless injuries, legislation on the state/federal level is necessary. While these laws may be difficult to enforce, especially considering that many of these injuries occur in private homes, laws could provide a motivator for proper safety. The implementation of such a change can bring about awareness on the importance of eye protection, be the instigator of changes in social norms, and create a culture of social responsibility.

Ocular trauma is the leading cause of monocular blindness in the United States. But it doesn’t have to be. Well written legislation addressing this could be the difference between full, binocular vision or a life of permanent disability.



  1. Lee R, Fredrick D. Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012. J Am Assoc Pediatr Ophthalmol Strabismus. 2015;19(2):163-168.e1. doi:10.1016/j.jaapos.2015.01.010
  2. Jones M, Kistamgari S, Smith GA. Nonpowder Firearm Injuries to Children Treated in Emergency Departments. Pediatrics. 2019;144(6):e20192739. doi:10.1542/peds.2019-2739
  3. Protective eye wear for young athletes. A joint statement of the American Academy of Pediatrics and the American Academy of Ophthalmology. Ophthalmology. 1996;103(8):1325-1328.

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