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Editor,—We would like to draw your attention to a successful injury prevention initiative in the Republic of Ireland. Eye perforations are a distinct form of trauma unrelated to severe general injuries and fatal accident1; perforations follow low speed crashes, usually with impact against stationary objects.2 They are due almost exclusively to fracturing of toughened glass windscreens, often with explosive effect.3 Collision at low speed allows time for a motorist's feet to press the floor and head to hit the windscreen; if it shatters, the head ploughs through the broken fragments of glass. Typical ocular injuries are corneoscleral perforation, uveal prolapse and lens opacification or dislocation. While safety belts reduce the risk of windscreen injury, many patients have still presented with ocular perforations, who claimed to be wearing seat belts and have demonstrated corresponding patterns of trunk ecchymosis. In February 1979 legislation was passed compelling motorists to wear safety belts. Compliance was poor, as it still is, and so the number of eye injuries continued to increase to a national rate of 90–100 per annum.
In 1983 therefore the first author published statistics on the incidence and severity of eye injuries on our roads over the preceding 20 years, and stressed the need for mandatory fitting of the safer laminated windscreens in all cars registered in this country. Submissions were made to government ministers directly and appropriate legislation was eventually passed; from 1 January 1986 all new cars had to be fitted with laminated windscreens. An immediate reduction in eye perforations was seen, with a fall to 70 in 1987, 30 by 1991, and 13 in 1997. From personal experience these few, but significant, persisting perforations arise in cars registered before 1986 and fitted with toughened glass windscreens, or from shattering of non-laminated side windows in lateral impacts.
While road traffic accidents continue to cause death and disability in Ireland it is encouraging to be able to demonstrate success in the prevention of one potentially devastating sequel.