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Airsoft Gun–Related Ocular Injuries: Novel Findings,Ballistics Investigation, and Histopathologic Study

ASSAF KRATZ, JAIME LEVY, DORINA CHELES, ZACH ASHKENAZY, EREZ TSUMI, AND TOVA LIFSHITZ

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PURPOSE: To describe the ocular injuries related toirsoft gun bullets, investigate the ballistics of airsoftullets, record real-time impact of the bullets on an eye,nd investigate the histopathologic changes within theornea after being hit by an airsoft gun bullet.DESIGN: Retrospective, interventional case series and

xperimental animal study.METHODS: All consecutive cases of patients with air-

oft gun–related ocular injuries during 2006 to 2008ere included in this study. Porcine eyes were used forigh-speed video photographs of bullet impacts. Rabbityes were used for the histopathologic investigation. Allatients were treated in the Department of Ophthalmol-gy at Soroka University Medical Center, Beer-Sheva,srael. Laboratory investigations were performed at Ben-urion University of the Negev, Beer-Sheva, Israel. Theain outcome measures were ocular injuries of theatients, ballistics of the airsoft bullets, nature of cornealeformation upon impact, and corneal histopathologichanges after the hit.RESULTS: Fifty-nine patients with a mean age of 9.8 �

.8 years (range, 2.8 to 26 years) were examined; 49 wereale (83.1%). The ocular injuries included hyphema,

orneal edema, corneal erosion, traumatic mydriasis, andosterior segment involvement. A novel, “donut” form oforneal erosion was seen and also demonstrated by theistopathologic investigation. Substantial anterior seg-ent deformation was recorded in real-time using theigh-speed video camera.CONCLUSIONS: Airsoft gun injuries affect mainly

oung men and can be visually threatening. Typicalcular injuries along with a unique form of cornealrosion can be seen. (Am J Ophthalmol 2010;149:7–44. © 2010 by Elsevier Inc. All rights reserved.)

IRSOFT GUNS (ALSO CALLED “SOFTGUN”) ARE 1:1

scale replicas of actual firearms and were firstdesigned and marketed in the United States about

5 years ago. Airsoft guns are plastic pistols that shoot hardound plastic bullets with a diameter of 6.0 mm (Figure 1).he bullets are available in 3 weights (0.12 g, 0.20 g, and

ccepted for publication Aug 12, 2009.From the Department of Ophthalmology, Soroka University Medical

enter, Faculty of Health Sciences, Ben-Gurion University of the Negev,eer-Sheva, Israel.Inquiries to Assaf Kratz, Department of Ophthalmology, Soroka

iniversity Medical Center, P. O. Box 151, Beer-Sheva 84101, Israel;

-mail: assaff@bgu.ac.il

© 2010 BY ELSEVIER INC. A002-9394/10/$36.00oi:10.1016/j.ajo.2009.08.013

.25 g), and can also be in the form of “mini-paintballs.”he airsoft bullets are much lighter than the lead bulletssed in BB guns (0.52 to 1.6 g).1 The guns use the directorce of a spring coil or compressed gas to fire the bullets.he airsoft bullets are made of a very hard and noncom-ressible plastic material and thus do not absorb energy.he muzzle velocity of a professional airsoft gun can reachver 120 m/s, but most commercially available airsoft gunseach a muzzle velocity of about 70 to 90 m/s.2 Theffective flight range of an airsoft bullet is 30 to 50 m. Inomparison, BB gun bullets reach speeds up to 200 m/s andave an effective flight range of about 150 m.1

Airsoft guns have gained popularity since they are rela-ively cheap, can be purchased without age restrictions, andook real. Many authorities have restricted the use and sales ofhese guns, but nevertheless they can still be easily purchased.lthough it is well recognized that conventional BB guns are

ision threatening, the potential ocular hazards of airsoft gunso not seem to be sufficiently recognized. A literature searchf English-language reports of airsoft ocular injuries finds aimited number of studies.1,3–6 In all reports, the typicalictim of the airsoft gun injury is a young male subject. Ocularnjuries can be found in both the anterior and posterioregments, with corneal erosion, corneal edema, hyphema,raumatic mydriasis, and retinal edema being the most com-on findings.1,3,4

While treating patients with airsoft gun injuries inoroka University Medical Center, we inspected a uniquedonut” form of corneal erosion that has not been previ-usly described. This led us to investigate the nature ofirsoft bullet impact.

There are 4 purposes for this study: to describe thecular injuries by airsoft gun bullets with emphasis on thenique corneal erosion; to investigate the ballistics ofirsoft bullets; to record the impact of the bullet in realime; and to study the histopathologic changes within theornea after a bullet hit. To our knowledge, no suchomprehensive report has previously been published onirsoft-related ocular injuries.

METHODS

CASE SERIES: Clinical records of all consecutive cases ofcular injuries from airsoft gun bullets treated in theepartment of Ophthalmology at Soroka University Med-

cal Center, Beer-Sheva, Israel, during 2006 to 2008 were

LL RIGHTS RESERVED. 37

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eviewed. This center is the only tertiary hospital in aegion of approximately 0.8 million people.

Complete ocular examination was performed in each case.e registered the patients’ age, gender, symptoms, and ocular

ndings. Initial and final follow-up examinations includedisual acuity, slit-lamp biomicroscopy, applanation in-raocular pressure (IOP), and indirect ophthalmoscopy.atients were scheduled, as needed, for further additionalye examination. Treatment profile and follow-up timeere also documented.

BALLISTIC INVESTIGATION: Ballistic investigation ofhe airsoft gun bullets was performed in the Department of

echanical Engineering at Ben-Gurion University of theegev, Beer-Sheva, Israel. Regular 0.12-g bullets were used

n this section of the study. The bullet flight was capturedy a high-speed camera system in which the illuminations double-frequency neodymium-doped yttrium aluminumarnet laser (Lee Laser Inc, Orlando, Florida, USA) pulsedt 10 kHz. The camera is loaded with standard 35-mm 400SA TMAX film (Eastman Kodak Co., Rochester, Nework, USA). At the time when the bullet leaves the barrel, a

rail of pulses illuminates the bullet. A prism positioned in theamera deflects each pulse to a different position on the filmnd produces an image. To trigger the illumination, a He-Neaser (Melles Girot, Rochester, New York, USA) and photo-etector were used. The photography sequence was con-rolled by a standard personal computer and timing cardT-IO-10; National Instruments, Austin, Texas, USA).bout 25 images can be captured on each run. The bullet

osition is plotted vs time, and the velocity is then calculated.

REAL-TIME RECORDING OF BULLET IMPACT: Real-ime recording of impact of the airsoft gun bullets waserformed in the Department of Mechanical Engineering at

IGURE 1. A common airsoft gun with 3 types of bullets:.2-g standard bullet (yellow), “mini-paintball” bullets (red),nd 0.12-g standard bullets (green).

en-Gurion University of the Negev, Beer-Sheva, Israel. s

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orcine eyes were fixated to a polyethylene surface. The eyesere pressurized to physiologic pressure. Tests were conductedy firing 0.2-g bullets from a distance of 0.2 m. A high-speedideo camera (Motion Scope PCI 8000sc; Redlake Imagingorp, Morgan Hill, California, USA, with a Pentax CosmicarV 25-mm lens) was pointed toward the porcine eye and

ecorded the impact event at 4000 frames per second.

HISTOPATHOLOGIC INVESTIGATION: Histopathologicnvestigation was performed in the Pathology Institute atoroka University Medical Center, Beer-Sheva, Israel. Fourabbits (weight range, 3200 to 3700 g) were anesthetized withn intravenous mixture of ketamine 35 mg/kg (Vetalar; Fortodge Laboratories Inc., Fort Dodge, Iowa, USA) plusylazine 5 mg/kg (XYL-M2 Veterinary; V.M.D. N.V., Aren-onk, Belgium). Drops of benoxinate hydrochloride were alsonstilled on the rabbit eyes to achieve both general and localnesthesia. A 0.12-g bullet was then shot into the center ofhe rabbit cornea in both eyes. The eyes were enucleated andent for histopathologic investigation by standard hematoxy-in-eosin stains. After enucleation of both eyes the rabbitsere overdosed with intravenous barbiturates.

RESULTS

CASE SERIES: Fifty-nine patients were included in this

TABLE 1. Demographics and Ocular Findings in PatientsSuffering From Airsoft Gun Injuries

Number of eyes 59

Number of patients 59

Age (years), range 9.8 � 3.8, range 2.8 to 26

Gender

Male (%) 49 (83.1%)

Female 10 (16.9%)

Affected eye

Right (%) 34 (57.6%)

Left (5) 25 (42.4%)

Mean initial BCVA 0.66 (20/30 Snellen)

Ocular findings (%)

Anterior segment

Hyphema 66.1%

Corneal edema 61.0%

Corneal erosions 59.3%

of those, with “donut” pattern 40.0%

Traumatic mydriasis 25.4%

Elevated IOP 1.7%

Traumatic cataract 1.7%

Posterior segment

Retinal edema 22.0%

Retinal & vitreous hemorrhage 2.1%

Mean final BCVA 0.8 (20/25 Snellen)

BCVA � best-corrected visual acuity; IOP � intraocular

pressure.

tudy (Table 1); all of them were accidentally hit directly in

OPHTHALMOLOGY JANUARY 2010

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IGURE 2. Three forms of corneal erosions caused by airsoft gun bullet. (Top left) “Regular” corneal erosion approximately theize of the airsoft gun bullet; marked stromal edema and hyphema are seen (Case 8). (Top right) Same eye with fluorescein stain.Middle left) “Donut erosion” pattern with marked stromal edema (Case 1). (Middle right) Same eye with fluorescein stain. Notehat the central island of the corneal epithelium does not stain. (Bottom left) “Donut erosion with a hinge” pattern (Case 7).Bottom right) Same eye with fluorescein stain. The “hinge” is demonstrated and the erosion has a temporal epithelial flap.

AIRSOFT GUN–RELATED OCULAR INJURIESOL. 149, NO. 1 39

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eye from airsoft gun bullets at distances of 0.5 to 3 meters.he patient admission took place 1 hour to 1 day after the

njury. Forty-nine patients were male (83.1%). The mean agef the patients was 9.8 � 3.8 years (range, 2.8 to 26 years).ean initial best-corrected visual acuity (BCVA) was 0.66

20/30 Snellen). Among anterior segment injuries, the mostommon ocular injury was hyphema (66.1%), followed byorneal edema (61.0%), corneal erosions (59.3%), and trau-atic mydriasis (25.4%). Elevated IOP and traumatic cata-

act were seen in 1 patient (1.7%). Hospitalization wasequired in 6 cases (10.2%).

As mentioned, the most common findings were cornealdema, hyphema, and corneal erosions. The corneal erosionsere usually slightly larger than 6 mm (the bullet diameter)ith substantial corneal stromal edema (Figure 2, Top leftnd right). Of the patients with corneal erosions, 40.0%howed a very unique shape of corneal erosion, which we hadot encountered before. In the center of the erosion was an

sland of corneal epithelium that did not stain with fluores-ein (Figure 2, Middle left and right). We described theserosions as “donut erosions” because of their appearance.ome of these donut erosions had a remaining “hinge” oforneal epithelium on one side that had not yet detachedrom the periphery (Figure 2, Bottom left and right), givinghem the shape of an epithelial flap. Later in follow-up,sually in the first hours after the hit, the epithelium islandell, leaving a “regular” corneal erosion. This unique andnusual form of corneal erosion led us to further search for thexact nature of this kind of injury.

Injuries of the posterior segment included retinal edema in

IGURE 3. Airsoft bullet position. (Top left and right) Bullosition vs time (plot), yielding a muzzle velocity of 73 � 1 m

2.0% of the patients and retinal hemorrhages and mild e

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itreous hemorrhage in 2.1%. One patient (1.7%) developedraumatic cataract but continued his follow-up at a differentnstitution. Mean follow-up time was 7.6 months. Mean finalCVA was 0.8 (20/25 Snellen), which is significantly better

han the initial BCVA (P � .0001). The final BCVA was fairven in cases with initial BCVA of light perception andresence of corneal erosion, corneal edema, hyphema, andetinal edema and retinal hemorrhages.

BALLISTIC INVESTIGATION: Using the method de-cribed previously, a series of bullet positions over time wasbtained (Figure 3, upper images, Top left and right) andhe bullet position was plotted vs time (Figure 3, Bottomight, plot). A linear velocity was observed with a calcu-ated value of 73 � 1 m/s. Over longer distances the bulletill gradually slow because of drag, but in the practical

ange of the airsoft gun (several meters), the velocityecrease would be insignificant.

REAL-TIME RECORDING OF BULLET IMPACT: Using theethod described previously, a video film of the bullet hitting

he porcine eye was obtained. A series of snapshots from thisideo film is shown in Figure 4. Substantial deformation ofhe cornea and anterior segment can be seen.

HISTOPATHOLOGIC INVESTIGATION: Histopathologicnvestigation of the rabbit eyes demonstrated the uniquetructure of the donut erosion. It can be seen that, dependingn where the cuts were made, a sequence of “erosion-pithelium-erosion” (Figure 5, Top left) or “epithelium-

sitions over time at 2 different times. (Bottom right) Bullet

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rosion-epithelium” (Figure 5, Top right) was obtained.

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ther interesting findings were identified in the transitionalones between areas with epithelium and areas withoutpithelium. At the margin of the erosion the epitheliumeems to be lifted from the stroma, leaving a space underneathFigure 5, Bottom). The epithelium also seems to be torn aftert was pulled away. On all slides, epithelial cells were swollennd marked stromal edema was seen.

DISCUSSION

LTHOUGH AIRSOFT GUN USE IS WIDESPREAD, THE LITER-

ture search of English-language reports of airsoft ocularnjuries produced limited results.1,3–6 There might beeports in the Japanese language7 because of confusionetween BB guns and airsoft guns, but these are notccessible and do not appear on PubMed.

The current series represents the first description of a

IGURE 4. Snapshots from a high-speed video of an airsoft buye. (Top right) Bullet impacts the eye. (Bottom left) Maximaullet rebounds from the eye.

nique corneal finding consequent to an airsoft corneal c

AIRSOFT GUN–RELATEDOL. 149, NO. 1

ontusion. We noticed that in 40.0% of the erosion thereas a remaining epithelium island in the center of therosion. In some cases, the epithelium had a “hinge” onne side, giving it the shape of an epithelial flap. We didot find a description of such a form of donut erosion inhe ophthalmologic literature; therefore it might be con-idered as a novel finding in airsoft injuries. The pattern ofhe donut erosion was also demonstrated and proven byhe histopathologic investigation that we performed.

In a search for the explanation of this finding, aeal-time high-speed video camera was used. It can be seenhat, as presumed, a substantial deformation is caused tohe cornea and globe. A deep indentation is caused by theullet in the cornea, which by itself can explain why thebserved erosions are slightly larger than the diameterf the bullet. We hypothesize that when the cornea isepressed by the bullet, the bullet compresses the epithe-ium and “sticks” it to the underlining stroma only in the

mpacting a porcine eye. (Top left) Bullet inbound towards theormation of the cornea and anterior segment. (Bottom right)

llet il def

enter of the impact. The epithelium in contact with the

OCULAR INJURIES 41

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AMERICAN JOURNAL OF42

ullet is also pushed posteriorly, pulled centrally, and tornrom the margin of the erosion (Figure 6). The torn edgesf epithelium were seen also in the histopathologic pic-ures. The result is the formation of an epithelium island inhe center of the erosion. The size of the epithelium islandepends on how much of remaining epithelium was stucko the bullet and went with it; the larger the amount ofpithelium that adhered to the bullet, the smaller thesland would be. In the cases where the epithelium was notushed equally posteriorly, some portion of it remains inontact with the margin, giving the shape of a “hinge” thats connected to the epithelial island. The epithelial islandsually remains attached to the stroma during the firstours after the injury, giving this erosion its unique form.o further demonstrate our theory, a much faster than000-frame-per-second video camera is needed, with much

airsoft bullet. (Top left) A sequence of “erosion-epithelium-erosion-epithelium” (hematoxylin-eosin, 2.5 � 1.5) is obtainedying illustrations. (Bottom) Lifted and torn epithelium at thehe large black circle represents the cornea, small black circleplain.

IGURE 6. The hypothesized mechanism of “donut erosion”ormation. The central epithelium is pushed posteriorly, pulledentrally, and torn from the margin.

IGURE 5. “Donut erosion” pattern in rabbit corneas, caused byrosion” (hematoxylin-eosin, 2.5 � 1.5) or (Top right) “epithelium-epending on the position of the cut, as indicated in the accompanransitional zone of the erosion (hematoxylin-eosin, 40 � 1.25). Tepresents the epithelium island, and vertical line indicates the cut

reater resolution and magnification.

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In general, ocular injuries caused by nongunpowderellets are widely reported in the literature, mainly inhe context of air guns (BB guns). BB gun bullets weigh.52 to 1.6 g, reach speeds up to 200 m/s, and have anffective flight range of about 150 m.1 BB bullets usuallyause severe ocular injuries; in one report about 50% ofhe cases presented with ruptured globe,6 and in othereports 27% of the injuries led to enucleation,8 or evenntracranial injuries and death.9 Another nongunpow-er weapon that was reported to cause ocular injuries ishe paintball gun. The paintball pellet is a 17-mmelatin projectile filled with paint, weighing approxi-ately 3 g, with a muzzle velocity up to 130 m/s.aintball pellets are known as a cause of severe ocular

njuries leading to enucleations.10

In a biomechanical study11 it was found that the mostignificant predictor of ocular injury is the normalizednergy (J/m2) of the pellet. The normalized energy is thenergy per projected area of the projectile. The projectedrea is the contact surface area for a flat impacting objectr the cross-sectional area of a sphere. It was found that a0% risk of corneal erosion occurs at about 1,500 J/m2,yphema and lens dislocation at about 20,000 J/m2, retinalamage at about 30,000 J/m2, and globe rupture at about4,000 J/m2 [ref 11]. The same calculation for an averageaintball pellet gives about 100,000 J/m2 and for anverage BB pellet more than 1,000,000 J/m2, explaininghe devastating effect of these pellets on the eye.

The airsoft bullet weighs 0.12 to 0.25 g. The muzzleelocity of a professional airsoft gun can reach over 120/s, but most commercially available airsoft guns reach auzzle velocity of about 70 to 90 m/s.2 The effective range

f the airsoft bullet is 30 to 50 m.In our study, the bullet velocity was 73 m/s for a 0.12-g

ullet, giving energy of 0.32 J. The calculated normalizednergy of this airsoft bullet, with 6-mm diameter, is therefore1,300 J/m2, and indeed corneal erosion and hyphema oc-

TABLE 2. Comparison of Reported

Author

Number

of

Cases

Study

Period

(years)

Mean Age

(years � SD)

P

Fleischhauer and associates1 9 3 13.9 � 2.3 1

Saunte and associates3 33 5 13.5 � 7.3

Ramsted and associates4 8 3 17.8 � 4.9 1

Our series 59 3 9.8 � 3.8

SD � standard deviation.

urred frequently, but no penetrating injuries were seen. m

nd preparation, review, and approval of the manuscript (A.K., J.L., T.L.).Thend Use of Animals in Experiments, Authorization No. IL-71-12-2006. The ret

AIRSOFT GUN–RELATEDOL. 149, NO. 1

Airsoft guns have gained popularity since they areelatively cheap, can be purchased without age restrictions,nd look real. In the Copenhagen area, for example, airsoftun accidents proved to be by far the most common ocularnjury mechanism, occurring more than twice as often ashe second most frequent trauma mechanism, fireworks.12

In our series the mean age of the patients was 9.8 � 3.8ears (range, 2.8 to 26 years), which is significantlyounger than other reported series (P � .007) (Table 2).s in other series, the patients were mostly male. The

ncidence of anterior segment findings is roughly equal inll studies. The incidence of retinal involvement rangesrom 12.5% to 55.6% among the different studies. Pene-rating injuries were seen in neither series. As in othereports, the airsoft injuries in our series ranged from lightontusions to potentially sight-threatening closed globenjuries. These are less severe than BB gun or paintball gunnjuries because airsoft bullets have much lower normalizednergy values. The mean BCVA in our study significantlymproved from 0.66 (20/30 Snellen) on admission to 0.820/25 Snellen) in the last examination (P � .0001). As inther reports, the final BCVA was good even in cases withoor initial BCVA. It should be noted that some patientsere lost to follow-up and not brought for further exami-ation by their parents, apparently because of satisfactoryisual acuity and absence of any other ocular complaints.In conclusion, our study demonstrated the airsoft gun–

elated ocular injuries, ranging from light contusions tootentially sight-threatening closed-globe injuries. Theeneral outcome is fair, but surgical intervention may beequired. A unique “donut” pattern of corneal erosion cane seen in many cases. The characteristic profile of anirsoft gun victim is a young male subject. Since airsoftnjuries are mostly confined to children, strict age restric-ion and law enforcement can reduce the incidence dra-atically. It is advised that safety goggles should be

ncluded with the guns and wearing them should be

s of Ocular-Related Airsoft Injuries

Hyphema

(%)

Corneal

Edema

(%)

Corneal

Erosions

(%)

Traumatic

Mydriasis

(%)

Traumtic

Cataract

(%)

Commotio

Retinae

(%)

77.8 44.4 66.7 44.4 33.3 55.6

84.9 60.1 66.7 51.5 3.0 33.3

100 50.0 37.5 75.0 12.5 12.5

66.1 61.0 59.3 25.4 1.69 22.0

andatory while playing.

HE AUTHORS INDICATE NO FINANCIAL SUPPORT OR FINANCIAL CONFLICT OF INTEREST. INVOLVED IN DESIGN ANDonduct of study (A.K., J.L., D.C., Z.A., E.T., T.L.); collection, management, analysis, and interpretation of data (A.K., J.L., D.C., Z.A., E.T., T.L.);

Serie

Male

atients

(%)

00

90.9

00

83.1

study was approved by the Institutional Committee for the Ethical Carerospective study of cases was approved by the Institutional Review Board.

OCULAR INJURIES 43

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The authors would like to thank Professor Gabi Ben Dor, Dr Oren Sadot, Mr Eli Leinov, and Mr Assaf Formoza, Department of Mechanicalngineering, Ben-Gurion University of Negev, Beer-Sheva, Israel, for their help in ballistics investigation; and Professor Eran Sher and Mr Boris Kirin,epartment of Mechanical Engineering, Ben-Gurion University of Negev, Beer-Sheva, Israel, for their help in real-time recording of bullet impact.

1

1

1

REFERENCES

1. Fleischhauer JC, Goldblum D, Frueh BE, Koerner F. Ocularinjuries caused by airsoft guns. Arch Ophthalmol 1999;117:1437–1439.

2. Kennedy EA, Ng TP, Duma SM. Evaluating eye injury risk ofAirsoft pellet guns by parametric risk functions. Biomed SciInstrum 2006;42:7–12.

3. Saunte JP, Saunte ME. 33 cases of airsoft gun pellet ocularinjuries in Copenhagen, Denmark, 1998–2002. Acta Oph-thalmol Scand 2006;84:755–758.

4. Ramstead C, Ng M, Rudnisky CJ. Ocular injuries associated withAirsoft guns: a case series. Can J Ophthalmol 2008;43:584–587.

5. Endo S, Ishida N, Yamaguchi T. Tear in the trabecularmeshwork caused by an airsoft gun. Am J Ophthalmol2001;131:656–657.

6. Shuttleworth GN, Galloway PH. Ocular air-gun injury: 19

cases. J R Soc Med 2001;94:396–399.

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7. Endo S, Ishida N, Yamaguchi T. The BB gun is equivalent tothe airsoft gun in the Japanese literature. Arch Ophthalmol2000;118:732.

8. Shanon A, Feldman W. Serious childhood injuries caused byair guns. CMAJ 1991;144:723–725.

9. Bratton SL, Dowd MD, Brogan TV, Hegenbarth MA.Serious and fatal air gun injuries: more than meets the eye.Pediatrics 1997;100:609–612.

0. Thach AB, Ward TP, Hollifield RD, et al. Ocular in-juries from paintball pellets. Ophthalmology 1999;106:533–537.

1. Duma SM, Ng TP, Kennedy EA, Stitzel JD, Herring IP,Kuhn F. Determination of significant parameters for eyeinjury risk from projectiles. J Trauma 2005;59:960–964.

2. Saunte JP, Saunte ME. Childhood ocular trauma in theCopenhagen area from 1998 to 2003: eye injuries caused byairsoft guns are twice as common as firework-related injuries.

Acta Ophthalmol 2008;86:345–347.

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Biosketch

r. Assaf Kratz is a senior Ophthalmologist and ocular surgeon in the Ophthalmology Department at the Sorokaniversity Medical Center in Bear- Sheva, Israel. His primary research interests include cataract surgery, glaucoma, and

cular infections. Dr. Kratz is a lecturer of ophthalmology at the Ben-Gurion University of the Negev, and combinesedical research with active teaching. Dr. Kratz has published more than 10 articles in the Ophthalmologic literature and

resented numerous papers in scientific meetings.

AIRSOFT GUN–RELATED OCULAR INJURIESOL. 149, NO. 1 44.e1

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Biosketch

aime Levy, MD, is a senior ophthalmologist and ophthalmic pathologist in the Department of Ophthalmology at Sorokaniversity Medical Center in Beer-Sheva, Israel. He completed a fellowship in Ophthalmic Pathology at the University

f Illinois at Chicago. His primary research interests include ophthalmic pathology, ocular tumors, retinal diseases, andongenital glaucoma. Dr. Levy has published more than 80 articles in the Ophthalmic literature, and presented numerousapers in scientific meetings.

AMERICAN JOURNAL OF OPHTHALMOLOGY4.e2 JANUARY 2010