As eyecare professionals, we spend our entire professional lives fighting to preserve light. We train to master the delicate microscopic topography of the cornea, the retina and the optic nerve, all with the objective of saving our patients from the encroaching dark. What happens when the state itself wields darkness as a weapon and what is our clinical and moral response when blindness is not caused by disease or tragic accident, but is deliberately inflicted as a tool of political suppression?
Over the past few weeks, I have been chatting to colleagues in Iran in audio rooms on Clubhouse and X/Twitter Spaces. These conversations, often held late into the night through encrypted channels and VPNs to avoid state surveillance (sometimes with the participants using voice-altering technology), have been harrowing. Through the static and the fear, my fellow eye physicians and surgeons have described a waking nightmare – an ongoing, systematic campaign by Iranian security forces to intentionally blind protesters.
“We are not just treating collateral damage,” a Tehran-based vitreoretinal surgeon told me. “When you look at the trajectory of the pellets, the clustering around the orbital region, and the volume of ruptured globes, the clinical evidence points to only one conclusion: they are aiming for the eyes, they are shooting to blind.”
An oculoplastics colleague told me that security forces were “deliberately shooting at the head and the eyes […] so they can no longer see,” adding that many patients required eye removal and were left blind. The themes in the conversations surfaced on fear, shortages and a sort of survivors’ guilt – the moral injury of treating a preventable epidemic of ocular trauma.
Why the eye?
The eye is anatomically exposed and symbolically powerful. A destroyed eye sits on the face and is permanently visible. It alters identity, employability, independence and social participation in a way that is immediate and legible to everyone. In an IranWire ophthalmological review [1], the authors describe the use of pellet-type munitions as “an indiscriminate and brutal practice that does not just injure; it maims.” There is another logic behind this, too: if you take away sight, you take away witnessing.
"Through the static and the fear, my fellow eye physicians and surgeons have described a waking nightmare – an ongoing, systematic campaign by Iranian security forces to intentionally blind protesters"
For clinicians, these injuries are also hard to count. In environments where protesters fear arrest or reprisals, people delay or avoid hospital care. Doctors may treat quietly, incompletely document or be pressured to disclose information. The missing denominator becomes part of the weapon: undercounting blunts outrage, and silence protects perpetrators.
A grim clinical reality
This clinical reality aligns with a barrage of recent investigative reports. A disturbing investigation published by The Guardian on January 13, 2026 [2] revealed that hundreds of gunshot eye injuries had been documented in just one Iranian hospital alone. This is localised data which represents only a fraction of the national trauma. According to IranWire’s comprehensive tracking, over 500 severe eye injuries were reported across Tehran and other Iranian provinces in a terrifyingly short span of a couple of days [3].
The mechanics of this suppression are devastatingly simple and highly effective. Security forces are deploying birdshot, metallic pellets and high-velocity paintballs at close range, bypassing the torso and aiming directly for the heads and faces of demonstrators who are unarmed. Colleagues describe receiving patients, amongst them young women and university students, attending with presentations from severe corneal lacerations and hyphaema to traumatic optic neuropathy, massive retinal detachments and shattered globes that are entirely unsalvageable. This is alongside later complications such as infection, chronic pain syndromes and inflammatory sequelae including sympathetic ophthalmia. Often the radiological imaging shows multiple metallic pellets embedded deeply within the orbit. The IranWire review makes a service point that will feel familiar to any UK clinician who has lived through system strain (albeit at an entirely different scale): when severe trauma clusters in time, even well-organised specialist pathways can be overwhelmed.
“In a single night, our triage looked like a war zone,” a second-year resident physician shared on a Clubhouse room. “I performed four enucleations in one shift. We are removing the eyes of 20-year-olds. This is a punitive blinding and the regime wants them to survive so they can serve as walking warnings to the rest of the population when they see them in the street. A missing eye is a permanent mark of dissent.”
Forwarded messages, restricted access and internet shutdowns make independent verification of each event difficult. But we should listen to our colleagues and reflect their voices. What matters is that multiple sources describe a consistent injury distribution, a dense clustering of trauma to eyes and heads, which is hard to square with incidental, random harm.
Clinicians at risk
During and after the 2022 protests following the death of Mahsa Jina Amini, the medical community in Iran itself became a target. Doctors who treat these ophthalmic injuries risk arrest, torture and the revocation of their medical licenses. In some cases, they are facing execution [4]. Death certificates and medical records are routinely forged by the authorities to obscure the true cause of the injuries. Indeed, some colleagues are forced to establish clandestine, underground clinics, operating with smuggled surgical supplies and utilising makeshift slit lamps, purely to keep young protesters out of state-run hospitals where treatment is often followed by immediate arrest.
These assaults challenge the core professional principle of medical neutrality. The UN has long condemned attacks on medical personnel and facilities in conflict settings, and more recently, the BMA reiterated that health workers must be able to carry out their duties without fear of violence, intimidation or attack, and that medical facilities must remain safe places of care where, regardless of political context, doctors are free to treat the injured without coercion, reprisal or surveillance [7].
A global pattern
While the scale and deliberate malice in Iran are currently unprecedented, the weaponisation of blindness in crowd control is tragically not an isolated, regional phenomenon. As an international ophthalmic community, we must acknowledge that the misuse of ‘less-lethal’ crowd control weapons has caused an epidemic of visual impairment globally.
In Chile’s 2019–2020 protests, UN experts cited nearly 400 cases of eye injuries and loss of sight linked to anti-riot shotguns, calling for accountability. In Hong Kong, after a protester’s eye injury became a rallying point, demonstrators swarmed the airport chanting: “An eye for an eye!” In Gaza, ocular injuries have been compounded by the destruction of eyecare centres [5].
The US also documented a surge in severe ocular trauma during the 2020 Black Lives Matter protests and related demonstrations, often from less-lethal kinetic impact projectiles (KIPs) (including rubber bullets, foam batons and bean bag rounds). These munitions are designed to be fired at the ground to ricochet into the lower extremities, or aimed strictly at the larger muscle groups of the legs and abdomen. Instead, they were repeatedly fired at chest and head height. Protesters, photojournalists and casual bystanders suffered ruptured globes, orbital fractures and permanent vision loss after being struck by these KIPs. In a statement widely shared within ophthalmology, the American Academy of Ophthalmology warned: “While classified as non-lethal, they are not non-blinding” [6].
In the US, the blinding was largely attributed to poor training, panic or the reckless misuse of crowd-control protocols by militarised police forces. In Iran, the evidence strongly suggests a calculated, top-down directive to maim.
Regardless of politics or policing, the result for the patient in the examination chair is exactly the same: an irreversible plunge into darkness. The weaponisation of visual trauma is a direct assault on public health and human rights and we cannot remain confined to our clinics and operating theatres while the tools of our trade are rendered necessary by the brutality of the state. Especially whilst our colleagues are risking their lives to pull birdshot from the eyes of brave young men and women who simply asked for freedom. My colleagues in Iran are begging the international medical community not to look away and to use our platforms, our journals and our medical societies to amplify the voices of the Iranian doctors risking everything in the dark.
Sight is a fundamental human right. It is time the global medical and ophthalmic community stands firmly against those who would steal it to keep a population blind to their own power.
What eyecare professionals can do:
1: Support colleagues working under intimidation and scarcity
My conversations on Clubhouse and X/Twitter Spaces conversations have reminded me how isolating it can feel to practise ethically in a politicised clinical environment. Peer support, discreet mentorship networks and secure routes for sharing de-identified clinical patterns can help clinicians protect patients without increasing risk to themselves.
2: Advocate from evidence, not ideology
Advocacy doesn’t require partisan alignment, simply fidelity to what we see: preventable blindness. When our professional bodies state plainly that certain tactics are “not non-blinding,” bedside reality is translated into public-health language that policymakers cannot, and should not, ignore.
3: Document, safely and rigorously
Working or volunteering in such environments is already a challenge but documentation is key. Whether injuries are intentionally targeted or foreseeably caused by facial firing patterns, accurate clinical documentation supports patient care, enables epidemiology and (where appropriately anonymised and safeguarded) contributes to accountability.
4: Prepare for ‘mass ocular trauma’
Major-incident planning rarely specifies ocular injury, yet these episodes create exactly that: clusters of open globes, vitreoretinal emergencies, complex lid and orbital trauma. Under strain, rehearsed pathways delivered at scale can help (rigid shields, avoidance of pressure on suspected open globes, prompt CT imaging of orbit/face, appropriate infection prophylaxis and tetanus cover, and rapid access to VR and oculoplastics).
References
1. Highnett K. Blinding as a weapon: an ophthalmological review. IranWire [Online] 2023:
https://iranwire.com/en/features/114366-
blinding-as-a-weapon-an-ophthalmological-review/
2. Parent D, Christou W. Hundreds of gunshot eye injuries found in one Iranian hospital amid brutal crackdown on protests. The Guardian [Online] 2026:
https://www.theguardian.com/global-development/
2026/jan/13/hundreds-of-gunshot-eye
-injuries-found-in-one-iranian-hospital
-amid-brutal-crackdown-on-protests
3. Ghajar A. Exclusive: Live ammunition fired at protesters - over 500 eye injuries reported in Tehran and across Iran. IranWire [Online] 2026:
https://iranwire.com/en/features/147525
-live-ammunition-fired-at-protesters-over
-500-eye-injuries-reported-in-tehran-and-across-iran/
4. Howard S. Iran: Doctor faces execution for treating protestors as nine other physicians arrested, human right groups warn. BMJ [Online] 2026:
https://www.bmj.com/content/392/bmj.s228
5. Baker M, Yousef MGA, Alqtami HAY. Revealing the unspoken crisis of ocular health in the Gaza Strip: a call for action. JAPA Academy J 2025;3(1):75–6.
6. https://www.aao.org/about/governance/
academy-blog/post/fight-rubber-bullets
-blindness-protesters-eyes
7. https://www.bma.org.uk/bma-media-centre/
bma-alarmed-by-escalating-conflict-in-the-middle-east
[All links last accessed March 2026]
Declaration of competing interests: None declared.
