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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 59  |  Issue : 4  |  Page : 400-403

The untouched globe: Penetrating eyelid injuries in a tertiary care center


Department of Cornea, RIO GOH, Chennai, Tamil Nadu, India

Date of Submission19-Aug-2021
Date of Decision27-Sep-2021
Date of Acceptance28-Sep-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Dr. B Meenakshi
Department of Cornea, RIO GOH, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_131_21

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  Abstract 


Ocular trauma is one of the leading causes of ocular morbidity all over the world. The most dreaded among this is penetrating trauma, one that can scare even the most experienced of eye surgeons. It requires immense skill on the part of the surgeon to restore the structure and function of the globe. Most penetrating traumas that affect the eyelid also penetrate the globe. It is very rare for an object to penetrate the lid and spare the globe. In this case series, we would like to present two cases of penetrating injury, wherein a fish hook in one case and glass shard in another, pierced the eyelid and missed the globe by a whisker. We would also want to discuss our line of management in tackling this case.

Keywords: Eyelid injury, fish hook injury, glass injury, ocular trauma, penetrating injury


How to cite this article:
Meenakshi B, Gandhi N, Jambagi A, Vadivelu SD, Sivakami M. The untouched globe: Penetrating eyelid injuries in a tertiary care center. TNOA J Ophthalmic Sci Res 2021;59:400-3

How to cite this URL:
Meenakshi B, Gandhi N, Jambagi A, Vadivelu SD, Sivakami M. The untouched globe: Penetrating eyelid injuries in a tertiary care center. TNOA J Ophthalmic Sci Res [serial online] 2021 [cited 2022 Aug 12];59:400-3. Available from: https://www.tnoajosr.com/text.asp?2021/59/4/400/333157




  Introduction Top


Ocular trauma with sharp objects usually Cause penetrating or perforating globe injury and may be associated with adjacent lid lacerations and injury to the lacrimal drainage system.

The injuries involving the globe are sight threatening as they may involve corneal or scleral lacerations, traumatic cataract, vitreous hemorrhage, retinal detachment, or endophthalmitis.[1] In our experience, injuries with sharp metal or glass objects hit with Great velocity that is Limited to just the eyelid and conjunctiva are quite rare. The technique of removal of the foreign body and the management of the injury plays a crucial role in preventing further complications. We report the incidence of two interesting cases of ocular injury with a fish hook and a broken glass shard that injured the lid and did not penetrate the globe.


  Case Reports Top


Case 1

A 29-year-old male, fisherman, presented to the casualty with a history of injury to his left eye with a fishing hook. The fishing hook flew and hit the Eye, penetrating the upper lid and got embedded in the lower conjunctiva rolling the eyeball upward [Figure 1]. Visual acuity in the left eye was perception of light. The right eye was normal with a Snellen's visual acuity of 6/6. Scleral and corneal involvement could not be made out. After obtaining a written consent, the patient was taken up for surgery. Under local anesthesia, the entry wound was explored. The fish hook barb embedded in the subconjunctival tissue was dissected and released. Scleral involvement and rectus muscle involvement were ruled out, and the fish hook was removed by retrograde fashion [Figure 2]. There was no injury to the cornea or lens. The conjunctival wound and lid laceration were sutured [Figure 3] and [Figure 4]. Postoperatively, visual acuity was 6/6. The posterior segment examination was normal.
Figure 1: Preoperative image showing fish hook penetrating upper lid and embedded in the conjunctiva

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Figure 2: Fish hook after removal

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Figure 3: Postoperative image showing sutured eyelid laceration

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Figure 4: Postoperative image showing a clear cornea and intact conjunctival wound

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Case 2

A 35-year-old male presented with a history of assault and injury to the right eye and right side of the face with a broken glass bottle. The patient had laceration extending from the lower cheek extending up to the lower lid with the broken glass shard penetrating the lid and Embedded in it [Figure 5]. Subconjunctival hemorrhage and corneal abrasion were seen inferiorly. The visual acuity was 6/9. After obtaining a written consent, the patient was taken up for surgery. Under local anesthesia, the entry wound was explored. The embedded glass piece was gently pulled out [Figure 6] and measured to be 3 cm × 5.5 cm [Figure 7]. There was no penetration into the globe [Figure 8]. The lid and facial lacerations were sutured [Figure 9] and [Figure 10]. Postoperatively, visual acuity was 6/6. The posterior segment examination was normal. There was no extraocular movement restriction. Computed tomography (CT) imaging revealed no orbital fractures or retrobulbar hematoma.
Figure 5: Preoperative image showing glass shard penetrating the lower lid with a facial laceration

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Figure 6: Intraoperative removal of foreign body

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Figure 7: Glass shard after removal

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Figure 8: Postremoval of foreign body

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Figure 9: Postoperative image showing clear cornea and sphincter tear at 5 o clock position

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Figure 10: Postoperative image showing sutured eyelid and face laceration

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  Discussion Top


Eyelid injury can be due to blunt trauma or penetrating trauma. Penetrating eyelid injury with various foreign bodies have been reported in the literature. Eyelid lacerations occur commonly in young males.[2] Although the penetration of foreign bodies is known to cause injury to eyelids or the conjunctiva, the removal of the object may potentially affect the vision or can cause further damage to the ocular and extraocular tissues. The technique of the removal of the foreign body has a main role in the management. A detailed examination is necessary to rule out injury to the sclera, cornea, or lens. Intraocular foreign body, vitreous hemorrhage, and retinal detachment should also be ruled out.

Ocular fish-hook injuries are common and can cause damage to both anterior and posterior segments usually associated with penetrating open globe injury. There are five methods mentioned for fish-hook removal from the paraocular or ocular tissues.[3] They are advance and cut technique, back-out technique, snatch technique, needle cover technique, and cut-it out technique. The method used in our case is the “Cut it out” technique where the entry wound is widened, the barb released from the conjunctival tissue, and the hook is pulled out by retrograde fashion without causing much damage to the ocular tissues.

Glass injuries are mainly due to glass bottles and most commonly caused by assaults where the victims are mostly young males.[4] The face was the commonly injured site in a glass bottle injury.[4] Glass injuries carry a risk of open globe injury with possible retained intraocular foreign body. As they are transparent, intraocular foreign body can go undiagnosed for a long time.[5] B scan and CT aids in localizing and assessing the size of the intraocular foreign body. The careful removal of the glass shard should be followed by meticulous wound exploration. Injury to the globe and extraocular muscles must be assessed intraoperatively and managed.

Postoperative wound care is essential in cases of ocular foreign-body injury to prevent orbital Infection and inflammation.[6] The patient's pupillary reaction, visual acuity, extraocular movements, and fundus must be examined postoperatively to rule out penetrating globe injury and intraocular foreign body. Intraocular pressure must be recorded to rule out secondary glaucoma.

Both reported foreign-body injuries had the velocity and potential to cause an open globe injury, but left the globe untouched. A severe eyelid penetrating injury can be uncomplicated with a full visual recovery when there is no intraocular penetration.[7]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ahmad SS, Seng CW, Ghani SA, Lee JF. Cut-it-out technique for ocular fish-hook injury. J Emerg Trauma Shock 2013;6:293-5.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Tabatabaei A, Kasaei A, Nikdel M, Shoar S, Esmaeili S, Mafi M, et al. Clinical characteristics and causality of eye lid laceration in Iran. Oman Med J 2013;28:97-101.  Back to cited text no. 2
    
3.
Elizabeth SJ, Krishan A, Thomas G. Fish hook injury. Kerala State Ophthalmic Soc J 2007;12:446-7.  Back to cited text no. 3
    
4.
Nzaumvila D, Govender I, Kramer EB. Glass injuries seen in the emergency department of a South African district hospital. Afr J Prim Health Care Fam Med 2015;7:e1-8.  Back to cited text no. 4
    
5.
Kuniyal L, Rishi E, Rishi P. Intraocular glass foreign body-retained amiss! Oman J Ophthalmol 2014;7:40-2.  Back to cited text no. 5
    
6.
Karcioglu ZA, Nasr AM. Diagnosis and management of orbital inflammation and infections secondary to foreign bodies: A clinical review. Orbit 1998;17:247-69.  Back to cited text no. 6
    
7.
Wasfi E, Kendrick B, Yasen T, Varma P, Abd-Elsayed AA. Penetrating eyelid injury: A case report and review of literature. Head Face Med 2009;5:2.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

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