REVIEW
Taser-Related Ocular Injuries: A Review of the Literature and Medico-Legal
Implications
Giovanni Aulinoa,b
*, Federico Giannuzzib,c
*, Matteo Mario Carlà d
*, Giorgia Guarnieria,b
, Domenico Spagnoloa,b
,
Domenico Leporeb,c
, Francesca Cittadinia,b‡
, and Stanislao Rizzob,c
a
Department of Health Surveillance and Bioethics, Section of Legal Medicine, Rome, Italy; b
Graduate School, Catholic University of the Sacred Heart,
Rome, Italy; c
Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, Italy; d
Ophthalmology, Universita Cattolica del
Sacro Cuore - Campus di Roma, Roma, Italy
ABSTRACT
Purpose: Electric weapons have dangers associated with their use, such as burns and trauma related with
the impacts of uncontrolled falls, even though they often minimize morbidity and mortality. The exact
visual outcome of the damage inflicted is unknown, even though numerous studies have been documented
in the literature about the ocular damage induced by the use of these tools.
Methods: We present a narrative review of types of eye damage associated with the use of the Taser. The
following search terms were used to identify eligible articles through the PubMed database: “TASER”,
“Conducted Electric Weapons”, “CEWs”.
Results: A total of 15 articles were included with information about 38 patients with eye damage
associated with the use of taser. The majority of patients were males. In most cases the mechanism of
injury was the penetration of the probe inside the eye. Clinical manifestations of ocular damage were
present in only 18 out of 38 cases and varied according to the type of damage mechanism. Indeed, the
cases in which the probe had penetrated the eye showed more severe clinical manifestations with a poor
visual outcome.
Conclusion: In conclusion, the introduction of taser use for law enforcement requires serious consideration
and adequate training for officers.
ARTICLE HISTORY
Received 6 January 2024
Revised 13 February 2024
Accepted 14 February 2024
KEYWORDS
Energy-conducting injury;
forensic medicine; ocular
injury; ophthalmic trauma;
taser
INTRODUCTION
The term “TASER” refers to a device currently produced by Axon
Enterprise Incorporated and is an acronym for Thomas A. Swift
Electric Rifle.1
TASERs are a type of Conductive Electrical
Weapon (CEW) that was primarily developed for use by law
enforcement organizations in situations where the use of lethal
weapons, such as guns, would put police or other people at risk.2
As the only such weapon capable of causing involuntary muscular
incapacitation, conducted electrical weapons (CEWs) are the law
enforcement officer’s chosen intermediate-force alternative.
The first taser conducted energy weapon was introduced in
1993 as a less-lethal alternative to firearms for subduing fleeing,
combative, or potentially dangerous individuals who
would have otherwise been subjected to more lethal force
options, such as firearms. According to Alpert et al., over
15,000 law enforcement and military agencies used tasers as
part of their continuum of use of force.3
It was authorized for
use in Italy in January 2020 although law enforcement agencies,
following training, began using it from March 2022.
TASERs are intended to deliver electrical energy to a subject
in two different ways (drive stun and probes), causing the
subject to feel discomfort from the contraction of their muscles
as well as maybe some pain.4
In drive stun mode, the person is hit with the TASER’s head
directly, sending an electrical charge through their skin and
flesh. A burn could develop from the arcing charge’s transfer of
heat and light to the impact’s surface. The electricity is contained
between two or more electrodes because the electrical
discharge is of the arcing kind.5,6
In probe mode, the patient is given electrical energy at
a distance using probes that are housed on the TASER’s cartridge
and connected to it by two wires.4
TASER International became a publicly traded company in
2001, and renamed itself Axon in 2017.
Axon introduced the TASER 10 model on January 24, 2023,
showing multiple new features and enhancements. The updated
de-escalation capabilities now incorporate several enhancements,
including a 1,000-lumen pulsating light, loud aural alarms, and
LASER painting. These additions serve to warn an individual to
comply with instructions before resorting to the deployment of
probes. The extended range now reaches up to 45 feet, as opposed
to the former limit of 25 feet. This allows for increased decisionmaking
time and space, thereby minimizing danger for all parties
involved. The current version has the capacity to deploy up to 10
probes, which is an improvement from the earlier models that
could only deploy two or four probes.
CONTACT Matteo Mario Carlà mm.carla94@gmail.com Ophthalmology Department, Catholic University of the Sacred Heart, “Fondazione Policlinico
Universitario A. Gemell, IRCCS”, Rome 001688, Italy
*These authors contributed equally to this study and share first authorship.
‡
These authors share senior authorship.
SEMINARS IN OPHTHALMOLOGY
2024, VOL. 39, NO. 5, 334–339
https://doi.org/10.1080/08820538.2024.2322452
© 2024 Taylor & Francis
The TASER’s trigger is pressed, pushing the probes toward
the target until they pierce the person’s skin and complete the
circuit needed to transfer electrical energy.7
Moreover, the
darts are capable of penetrating clothing and, upon making
contact with the target, delivering an electric charge that temporarily
incapacitates the target by disrupting the nervous
system. This ability can be used as often as needed to maintain
immobilization. Tasers have been demonstrated to effectively
immobilize offenders 82% of the time.8,9
In the US, the first report on the incidence of injuries
associated with Tasers showed an 11% rate associated with
the use of Conducted Electric Device or Taser.10
Contusions,
abrasions, and lacerations occur in approximately 38% of
patients, mild rhabdomyolysis in 1%,testicular torsion in .5%,
Sterility in men .5% are the most frequent complications and
the mortality rate associated with taser is 1.5%.11
However,
increasing numbers of cases of ocular injury resulting from
taser use are reported in the scientific literature.
A recent analysis using the Wilson score interval method
has estimated the chance of penetrating eye injury to be 1 in
123,000, with confidence limits ranging from 85,000 to
178,000.12
For these reasons, the purpose of this review is to determine
which are the most frequent causes of injury in cases of eye
involvement, their severity, outcomes and, finally, to provide
an analysis also from a forensic perspective.
MATERIALS AND METHODS
A narrative review of types of eye damage associated with the
use of the Taser was performed. The following search terms
were used to identify eligible articles through the PubMed
database: “TASER”, “Conducted Electric Weapons”,
“CEWs”and “ocular complications or ocular injuries or eye
trauma or cataract or glaucoma or retinal detachment or
intraocular hemorrhage of visual acuity or intraocular pressure
or ophthalmologic treatment.
The search was limited to articles written in English, published
from January 2004 up until the search was performed
(November 2023), and no other filters were applied.
Manuscripts that did not analyze ocular damage associated
with the use of a taser were excluded.
Two researchers (G.A and F.G) performed data extraction
from the included articles and reported the results in an Excel
worksheet. One author (G.A.) extracted data from the included
studies, and the second author (F.G.) checked the extracted
data. Disagreements were resolved by a consensus-based discussion
between the two review authors (G.A. and F.G.); if
agreement could not be reached, a third author (M.M.C.) was
scheduled to intervene.
RESULTS
Selection of the Studies
A total of 12 articles were included in the narrative review.12–23
Manual search among the cited references from the articles
retrieved in the first round of search provided additional three
references.24,25
The full text of the total of 15 articles was
examined in detail.
Description of the Selected Studies
According to the search terms and manual search through
references, 12 publications were retrieved. The results of our
review are reported in Table 1 in chronological sequence. All
the papers were published between 2005, and November 2021.
Most papers were case reports (12/15), followed by case
series (2/15) and a letter to the Editor (1/15). From the 15
papers, information about 38 patients with eye damage associated
with the use of taser, of these the majority of patients
were males (89.5%). In 13 papers the age of the patients was
reported, of these the average age was 30.6 years.
Mechanism of Injury
In most cases the mechanism of injury was the penetration of
the probe inside the eye (30/38). In four cases, however, the
probe had penetrated inside the eyelid. In a further three cases
the probe had penetrated the medial canthus (1/38), the zygomatic
bone (1/38) and the previously implanted ocular prosthesis
(1/38). Finally, in one case the damage to the eye had not
been caused by direct penetration but, indirectly, by the electroshock
caused by the taser discharge.
Ocular Findings
Clinical manifestations of ocular damage were present in only
18 out of 38 cases and varied according to the type of damage
mechanism. Indeed, the cases in which the probe had penetrated
the eye showed more severe clinical manifestations such
as vitreous hemorrhage,13,14,24
retinal penetration,13
retinal
hemorrhages,15,17,22
retinal detachment,14,17
uveal tissue
involvement,16,23
pupil distortion,25
hyphema20,25,26
and
globe rupture.24
Twelve taser-injured patients received enucleation surgery
because their condition prevented vision recovery. Surgery was
performed on 25 patients to try an anatomical and functional
recovery or to eliminate any remaining taser. Only one patient
needed both medical and parasurgical care. Functional
improvement was typically poor. Cases involving only the
median canthus and zygomatic bone had no impact on vision
and only needed oculoplastic surgery.
The overview of the individual cases is shown in Table 1.
DISCUSSION
To the best of our knowledge, this review includes all patients
who have experienced ocular involvement following the use of
tasers since their introduction in law enforcement. The introduction
of tasers for law enforcement is a highly debated and
controversial topic. On one hand, some argue that the use of
tasers could be a less lethal alternative to other weapons used
by police, such as guns.27
On the other hand, there are many
concerns regarding the safety of using tasers, especially
towards individuals who may be more vulnerable, such as
SEMINARS IN OPHTHALMOLOGY 335
children, the elderly, and those who suffer from mental
disorders.28–30
Although studies on the physiological dangers of CEWs have
been conducted for about 20 years, increasing attention has
recently been given to the physical concerns. In actuality, there
are dangers involved with the use of CEWs, just like there are with
the use of any force alternative. These dangers include those of
fall-related fatalities and severe head injuries, as well as those of
volatile fume igniting. In addition, the use of tasers by law
enforcement can cause ocular manifestations in different ways
that can range from transient symptoms such as pain and burning
sensation to severe injuries such as permanent blindness.
They are primarily due to the fact that the taser acts on the
central nervous system, creating an electrical wave that can
cause an involuntary contraction of the muscles in the body,
including those in the ocular region. This contraction can
cause a series of unwanted ocular effects, including temporary
loss of vision, corneal edema, rupture of blood vessels, and
Table 1. Full list of all articles highlighting taser-related ocular injuries.
Author, Year Type of article
Nr. of
patients Age Sex Mechanism of Injury Type of ocular damage
Visus postcorrection
Treatment
Ng W. et al.
(2004)
Case Report 1 50 M Probe penetration Retinal penetration,
subconjunctival and
vitreous haemorrhage, and
involvement of the inferior
rectus muscle
20/32 Surgical
removal
Chen S.
L. et al.
(2006)
Case Report 1 21 M Probe penetration Crystal rupture, vitral
haemorrhage, choroid
thickening, inferotemporal
retinal tear, and retinal
detachment
6/18 Vitrectomy,
lensectomy,
and
endolaser
Seth R.
K. et al.
(2007)
Case Report 1 35 M Electrical shock Decreased visual acuity
bilaterally.
Right eye: IOP: 48 mmHg;
angular recession; retinal
dialysis; retinal
haemorrhage.
Left eye: anterior subcapsular
opacity.
20/20 Medical
treatment.
Right eye:
Pneumatic
retinopexy
and
criotherapy
Han J.S.
(2009)
Case Report 1 25 M Penetration of right eyelid Anisocoria, Vitreous
Hemorrhage and globe
rupture
20/40 Surgical
oculoplastical
Teymororian
S. et al.
(2010)
Case Report 1 26 M Probe penetration Hemophthalmos and prolapse
of the uveal tissue.
0 Enucleation
Sayegh R.
R. et al.
(2011)
Case Report 1 39 M Penetration of right lower
eyelid
Laceration of the eyelid,
subconjunctival and retinal
haemorrhage, and
exudative retinal
detachment after 3 days.
20/25 Surgical
removal
Li J. et al.
(2011)
Case Report 1 47 F Probe penetration Penetration and laceration of
the cornea and iris, and the
posterior wall of the sclera.
Light perception Surgical
removal
De Runz
A. et al.
(2014)
Case report 1 35 M Penetration of left medial
canthus
None 20/20 Surgical
removal
Rafailov
L. et al.
(2015)
Case Report 1 24 M Probe penetration Hyphema and perforation of
the sphenoid bone.
0 Enucleation
Cahill C.
P. et al.
(2015)
Case Report 1 36 M Probe penetration Hyphema and distorsion of
pupil
Light perception Surgical
removal
Gapsis B.
C. et al.
(2015)
Case Report 1 N.R. M Probe penetration Hyphema, chemosis, and
periorbital edema,
hyperdense vitreous and
free air within the globe
0 Enucleation
Moysidid S.
N. et al.
(2018)
Case Series 5 24.8 5 M 2 Probe penetration, 1
penetration of zygomatic
bone, 1 penetration of orbital
implant, 1 penetration of
upper eyelid
1 subconjuntival, disc and mild
vitreous hemorrhage, 1
scleral laceration,
conjuntival injiection and
chemosis
1 20/20; 1 no
light perception,
1 20/400, 1 20/
100; 1 light
perception
5 surgical
removal
Kroll M.
W. et al.
(2018)
Case Series 20 30.3 ±
11.7
18 M,
2 F
Probe penetration Not reported 14 complete
blindness, 6
partial blindness,
12 Surgical
Repair; 8
Enucleation
Thiel M.
A. et al.
(2020)
Letter to the
Editor
1 N.R. M Penetration of left lower eyelid Peripheral subretinal
haemorrhage
80/100 Surgical
removal
Sharabaura
A.B. et al.
(2021)
Case Report 1 34 M Probe penetration Hemorrhagic chemosis,
proptosis, and prolapse of
charred, coagulated uveal
tissue
0 Enucleation
336 G.AULINO ET AL.
retinal injury.12
Only in one case the damage was indirect and
due to the electroshock that initially caused a bilateral reduction
of vision, an increase in intraocular pressure, retinal
hemorrhages and corneal opacity.15
Through timely treatment,
an excellent recovery of vision was observed, demonstrating
that despite being fired in close proximity to the eye,
but not hitting it directly, a better outcome was achieved.
However, when the taser probe penetrates the eye globe, it
can cause a variety of both mechanical and electrical injuries
both injuries to the ocular tissue, such as abrasions or lacerations
of the cornea, injuries to the retina and the optic nerve,
and electrical energy can cause vitreous and retinal hemorrhages,
retinal detachments and uveal involvement generally to
permanent loss of ocular function. Furthermore, the irritation
and inflammation caused by the probe penetration can
increase the risk of infections and further ocular damage.12–
14,16,18,20,21
In 93% of cases where the taser probe penetrated
inside the eyeball, there was a severe outcome both from
a surgical perspective, as 12 cases required enucleation, and
from the perspective of post-correction vision, as either total or
partial blindness could be observed.
Kroll et al. demonstrated that according to the globe rupture
model, there is a 50% probability of a globe rupture occurring
when the eye is within a distance of 6 meters from the muzzle.
The likelihood of a globe rupture falls significantly beyond this
distance. The critical distance for lens and retinal damage is 9
meters, which coincides with the typical range of the most frequently
used probe cartridges. At distances above 9 meters, it is
anticipated that there would be hyphema, as well as a hole caused
by the dart component of the probe. Our forecast of globe rupture
up to 6 meters (out of a usual range of 9 meters) aligns with the
documented probability of enucleation or unilateral blindness,
which is 69 ± 18%, along with eye penetration.31
Moreover, Kroll et al. hypothesized that in cases of intraocular
injury in the absence of probe penetration, ocular
damage could be caused by electroporation.12
Electroporation induced by the voltage surges of CEWs has
been proposed as a potential method of tissue injury.
Electroporation effects appear to be limited to a distance of 1
mm from probes, where they assist sterilize the probes.32,33
Ho
et al. found that the manufacturing process makes probes that
are not sterilized and have a 5% chance of being contaminated
with Staphylococcus aureus.34
In addition, eye trauma may also be indirect caused by
falls from being immobilized with a taser, with increased
risk of periocular oedema and orbital wall fractures.
Furthermore, frontal sinus injuries frequently occur by
TASER darts.35
As highlighted by Ordog et al., these are more common in
patients with a history of drug use, particularly PCP (phencyclidine
[phenyl-cyclohexylpiperidine]), due to the violent
behaviors associated with it.11
The use of the taser
in situations involving public or police control has been the
subject of increasing attention in the field of medical-legal
issues.2
Moreover, as Jauchem et al. showed the effectiveness
and safety of the electrical weapon have been the subject of
much controversy and debate, particularly regarding the risks
of serious injuries, including eye injuries, and the protocols for
appropriate use.36
In the specific case of the eye, the fact that the Taser probe
can cause permanent vision damage represents a significant
factor to consider in evaluating the risk-benefit of using the
device in law enforcement situations. From a medical-legal
standpoint, the use of the Taser for public or police control
should be based on criteria of proportionality, necessity, and
effectiveness. Thus, the use of the electrical weapon should be
justified only in emergency situations where the use of other
control techniques is inadequate or ineffective, and should be
proportionate to the threat posed by the subject involved. In
fact, officers must strictly adhere to established frameworks of
the law, policy, training, warnings, standards, and accountability
oversight while using force. Once a threat has passed, they
are not allowed to employ deadly force.37
Summarizing the available data, it is evident that the use of
CEDs as a weapon for law enforcement may be connected to
injuries, the great majority of which are deemed minor. Police
acknowledge that the inclusion of probing wounds or superficial
contact burns is quite likely with the usage of a CED.
Compared to the amount of times these weapons have been
used in all nations where they have been widely utilized for
a period of years, deaths or more severe injuries recorded in
the medical literature are uncommon. However, further
research is still required to fully understand the fatal potential
of such devices.
Indeed, it should be specified that the heightened physiological
stress experienced by a person after being exposed to
a CED should still be better explored, also by virtue of the
fact that there is a lack of a currently recognized prehospital
strategy for addressing this condition. In fact, this is also the
case in the Italian context: although training has been provided
in Italy for police officers who have been given access to this
tool up to this point, no training has been provided for hospital
staff regarding the treatment of injuries or the potential notification
of injuries of a serious enough nature to endanger the
life of the injured party, topic in which medical staff should
receive training in order to lower the danger of failing to alert
the judicial authority.38
Having said that, it must be made clear
that, in any event, using a CED shouldn’t be disallowed if the
risk-threat assessment turns out to be essential for situational
management.
Finally, taser use protocols should be designed to minimize
the risk of serious injuries, including eye injuries, and to ensure
that the electrical weapon is used only by adequately trained
and qualified personnel.39
CONCLUSION
In conclusion, the introduction of taser use for law enforcement
requires serious consideration and adequate training for
officers. If used responsibly, tasers could represent a less lethal
alternative to other weapons used by police, but with a high
potential for injuring different body organs, including the eye.
It is important that there is adequate regulation to ensure
individual safety and prevent abuse by law enforcement. The
use of the Taser in situations involving public or police control
represents a complex medical-legal challenge, which requires
careful evaluation of risks and benefits and the adoption of
rigorous and appropriate use protocols.
SEMINARS IN OPHTHALMOLOGY 337
FUTURE DIRECTIONS
Research on the harm the Taser did after being employed by
the police is still in its infancy and is constantly expanding.
This is particularly crucial when eye injury is involved because
the eyes are an organ that should be protected as much as
possible, even in situations where using them to avert potentially
fatal circumstances is necessary.
In fact, this document evaluates the body of literature now in
existence and emphasizes the areas in which further study is
needed to support its growth, particularly in the area of better
training for medical professionals who will have to deal with the
harm brought on by usage. This is essential given that the Italian
police have already been utilizing this instrument for a year and
that there may be a number of controversies around the topic. We
offer both broad and detailed advice for each of these most recent
topics.
Our review of the literature revealed two key factors to take
into account when evaluating eye damage1
: police officers
should receive more training in handling the stressful situations
in which they find themselves using it, and2
medical staff members
should receive training from emergency rooms as well as, in
this case, ophthalmologists who specialize in eye emergencies.
In order to address these two issues, we propose that Italy1
:
establish, as in other nations, such as Belgium,40
a public database
accessible to all citizens on all the instances this tool is used and on
all the instances check for damage following its use; and2
offer
training sessions to all healthcare professionals (doctors, nurses,
etc.), with the issuance of certificates, so they can be better
equipped to handle events on the front line adverse events that
may occur.
DISCLOSURE STATEMENT
No potential conflict of interest was reported by the author(s).
FUNDING
This research received no external funding.
ORCID
Matteo Mario Carlà http://orcid.org/0000-0003-2979-1638
AUTHOR CONTRIBUTIONS
Conceptualization, G.A. and F.G.; methodology, M.M.C.; validation, D.L.,
F.C. and S.R; writing—original draft preparation, G.A. and F.G.; writing—
review and editing, D.S. and G.G.; supervision, F.C. and S.R.; project
administration, S.R.; funding acquisition, S.R. All authors have read and
agreed to the published version of the manuscript.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the
corresponding author, MMC, upon reasonable request.
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