This review was conducted as a scoping review following the framework of Arksey and O’Malley and reported in accordance with the PRISMA ScR (Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews) checklist. A protocol was not registered. We searched PubMed and Scopus for articles published between January 2004 and June 2025. An initial PubMed search identified relevant keywords. These were used in a systematic search strategy that combined free-text and Boolean terms applied to both databases. These search terms for ocular trauma and MENA countries included the following:

Two reviewers independently screened titles and abstracts, followed by full-text review. A third reviewer resolved disagreements. The inclusion criteria were original research, reviews, and case series in English reporting on the etiology, epidemiology, or management of ocular trauma in MENA countries. Exclusion criteria: non-English publications, studies not focused on trauma, editorials, preclinical studies, and studies conducted outside the MENA region.

Articles were systematically grouped by their primary country or region of focus, primary mechanism of injury (e.g., blast, road traffic accidents RTA, occupational), and key clinical themes (e.g., pediatric trauma, surgical outcomes, rehabilitation). Data relevant to Iraq were extracted and analyzed in parallel with data from other MENA nations, like Iran, Saudi Arabia, and Jordan, to enable a direct comparative analysis of epidemiological patterns, management protocols, and public health implications.

Microsoft Excel was used to manage extracted data. Authors, year, country, study design, population (civilian, military, or mixed), primary injury mechanism, and key clinical findings were collected. Data were grouped by country . Given heterogeneity in study designs and population, no meta-analysis was performed. Synthesis is descriptive and comparative. All included studies were summarized in a single table . Risk of bias assessment was not performed, consistent with scoping review methodology. Findings were presented as descriptive patterns rather than definitive comparative epidemiology.

The nature of trauma determines its severity. Iraqi data emphasize high energy, devastating injuries often presenting with extensive tissue loss, multiple intraocular foreign bodies, and associated maxillofacial trauma [¹⁴,²]. In Iraq, the capacity to manage this trauma burden is severely constrained. A study revealed that only 2% of Iraq’s primary health centers offer eye-related services, which contributes to tertiary hospitals being overwhelmed; more than half of specialist hospital consultations are for conditions that are manageable at the primary level [¹⁵]. This systemic gap takes place in the context of a high overall burden of eyesight loss in Iraq (7.4% of Iraqis, all causes combined, including cataract, glaucoma, and trauma [¹⁶,¹⁵]), which is provided here only as background on the general eye health challenge.

In other MENA settings, presentations, while serious, may more frequently involve isolated corneal abrasions, lid lacerations, or blunt trauma. shows the different kinds of trauma reported in many studies included in this review and reflects the variation in clinical courses and, consequently, the treatment needed.

The surgical burden differs accordingly. Evisceration and enucleation rates are significantly reported in the context of military trauma from Iraq [¹⁷,⁴] and in Palestinian territories [¹²], reflecting the severity of initial injuries and possibly delayed presentation. Surgical innovation is directed at complex reconstruction, such as managing orbital bullet injuries [²] and repairing corneal perforations using advanced techniques like the “sandwich” and amniotic membrane transplantation [¹⁸]. Managing sequelae like traumatic cataract and preventing sympathetic ophthalmia are critical concerns shared across the region [¹⁹] An important and recurrent theme is the high incidence of trauma among children, a vulnerable demographic across the MENA region. Ocular injury is a leading cause of preventable blindness in children all over the world. Studies from Iraq [²⁰], Iran [²¹], and Saudi Arabia [²²] consistently show that children represent a vulnerable demographic, suffering from domestic accidents and stray projectile injuries, often leading to lifelong visual disability and a need for prosthetic fitting.

The demand for pediatric prostheses following enucleation and evisceration was highlighted with this permanent need [¹³]. The challenges of delivering pediatric ophthalmic care in Gaza highlight how systemic collapse in conflict zones exacerbates trauma outcomes [¹³]. Furthermore, a study by Bahremani and colleagues confirmed that, while the prevalence of vision loss in MENA decreased by 11.1% from 1990 to 2019, the absolute number remains high at 32.5 million cases, with Iraq’s age-standardized prevalence rate at 7188.6 per 100,000 [¹⁶].

Furthermore, research on Iranian chemical warfare survivors provides clear evidence of the significant reduction in quality of life associated with ophthalmologic war injuries [²³], a finding with direct relevance to the Iraqi civilian population [²⁴,²⁵].

A distinguished variation exists between the advanced, well-resourced tertiary eye centers in the Gulf countries and the overwhelmed or fragmented systems in conflict zones. The Iraqi healthcare system bears a double burden: managing acute, complex war injuries requiring multi-specialty input and providing lifelong rehabilitation for survivors [²]. This includes not only prosthetic services but also low vision aid, psychological support for disfigurement and vision loss, and surgical management of late complications like glaucoma and retinal detachment. The strain on specialized ophthalmic surgical capacity is huge, Gaza, for example [¹²]. This disparity affects everything from timely primary repair to access to complex vitreoretinal surgery.

For Iraq, the primary preventive strategy is primarily political, focusing on conflict mitigation, mine clearance, and weapons control. Secondary prevention includes disseminating basic ocular first-aid knowledge to first responders and the public, and strengthening emergency trauma systems.

For other countries in the MENA region, effective strategies include enforcing occupational safety laws (e.g., mandatory eye protection in agriculture/industry), strict RTA prevention campaigns, public awareness on domestic hazards (fireworks, hazardous toys, chemicals), and community education on the dangers of traditional eye remedies.

The nature of its source data limits this review. The dataset consists of English-language, predominantly hospital-based studies, which introduces publication bias and underrepresents cases that do not reach tertiary centers. There is an obvious scarcity of population-based incidence and prevalence studies from Iraq.

Future research efforts must prioritize several key directions to address the identified gaps. First, establishing standardized ocular trauma registries in Iraq is essential for capturing accurate national epidemiological data. Building on this foundation, conducting cost-effectiveness analyses of prevention strategies tailored to the Iraqi context, compared with other MENA countries, would help guide efficient resource allocation. Additionally, research is needed to develop and evaluate integrated care models capable of delivering proper ophthalmic trauma and rehabilitation services within resource-constrained, post-conflict primary health systems.