|Year : 2021 | Volume
| Issue : 4 | Page : 413-414
Thorn strikes yet eye survives
Prateek Jain, Anshuman Pattnaik
Department of Community Ophthalmology, Global Hospital Institute of Ophthalmology, Abu Road, Rajasthan, India
|Date of Submission||25-Mar-2021|
|Date of Acceptance||17-Sep-2021|
|Date of Web Publication||21-Dec-2021|
Dr. Prateek Jain
Global Hospital Institute of Ophthalmology, Abu Road, Sirohi - 307 510, Rajasthan
Source of Support: None, Conflict of Interest: None
Ocular trauma is a disabling but preventable cause of blindness which can lead to disproportionate personal, social and economic handicaps. This snapshot deals with individuals belonging to different cohorts: a young child and an elderly lady who inadvertently injured their eyes by thorns. Peculiarity about the thorns' trajectory was such that the large-sized thorns pierced the outer coats of the eye without actually puncturing them. Rapid diagnosis and management ensured the quick anatomic restoration and visual recovery.
Keywords: Ocular trauma, thorn injury, wooden foreign body
|How to cite this article:|
Jain P, Pattnaik A. Thorn strikes yet eye survives. TNOA J Ophthalmic Sci Res 2021;59:413-4
| Ophthalmic Image Description|| |
Ocular thorn injury is a completely avoidable form of blindness. Early diagnosis and prompt management are must to prevent sight-threatening sequelae.
Case-1 describes a 5 year-old-male child presented with complaints of pain, watering, foreign-body (FB) sensation in the right eye (RE). His father revealed that the child injured his eye 1-day back while playing in a field. Torch-light examination showed wooden particles lodged in the cornea with conjunctival congestion and apparently formed anterior chamber (AC). Being uncooperative for visual acuity (VA) assessment and slit-lamp examination (SLE), an examination under general anesthesia was carried out. Under microscope [Figure 1], two thorns were noted, the larger one had created a partial-thickness corneo-limbo-scleral tract at 2 O'clock with surrounding infiltrates. The smaller one had penetrated into the AC creating a valvular wound. Fortunately, the lens was clear and limited view during fundoscopy showed unremarkable posterior segment. Both thorns were extracted out followed by the application of 10-0 Nylon sutures on the entry wound and side-port. Routine postoperative medications including topical Natamycin (5%) two-hourly were administered. Corneal infiltrates resolved in follow-ups and sutures were removed at 6-weeks, following which the child achieved the best-corrected VA of 20/20.
|Figure 1: (a) View under operating microscope showing injured RE and and presence of two thorn particles. (b)Larger particle being extracted out from partial thickness corneo-limbo-scleral tract. (c) Smaller particle that had penetrated into anterior chamber (AC) is being removed. (d) Image at the conclusion of surgery showing sutured ports and retained air bubbles in AC ensuring intact wound integrity|
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Case-2 shows a 60 year-old-female who injured her RE by a thorn while working in a farmland 2 days back. She presented with complaints of pain, FB sensation and redness. SLE revealed a wooden-particle having pierced conjunctiva and probably sclera temporally, roughly at 10 mm posterior to limbus without compromising globe integrity. There was diffuse conjunctival congestion and senile cataract, but otherwise normal anterior and posterior segments. Uncorrected-VA was 20/60 and IOP was 16 mmHg. B-scan showed no internal breach. The patient was taken to the operation theatre. Under peribulbar anaesthesia, the FB was grasped, gently manoeuvred and brought out of the wound in-toto [Figure 2]. It was a thorn, 8 mm in length and had partially lacerated the sclera. A (8-0) vicryl suture was applied at the partial-thickness scleral wound followed by conjunctival closure. Routine postoperative medications were administered. She had uncomplicated follow-ups and maintained the same vision and was advised to undergo cataract surgery later.
|Figure 2: (a) Image at presentation showing injury to the right eye by a thorn particle. “Tip of the iceberg” resemblance of thorn giving a false impression about the size. (b) Huge thorn measuring 8 mm in length is shown after extraction. Note the undisturbed ocular integrity. (c) Scleral tract is being examined with blunt spatula to assess if any collateral damage exists. (d) Image at the conclusion of surgery showing sutured conjuntiva|
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Both cases are interesting since the large-sized thorns had created lamellar tract in structures as thin as the ocular surface (sclera/cornea) without actually perforating it.
Ocular thorn injuries can result in conjunctival granuloma, fungal keratitis, AC perforation, traumatic cataract, vitritis, or even endophthalmitis.,
However, as the saying goes “Ounce of prevention is worth a pound of cure”, proper use of safety goggles at the workplace and restriction of unsupervised activities by children will drastically reduce the incidence of ocular trauma.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/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.
The authors acknowledge the guidance of Dr V C Bhatnagar, Head of Department and Medical Superintendent, Global Hospital Institute of Ophthalmology.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]