Journal of Case Reports in Practice (JCRP) 2016; 4(1): 12-13

BRIEF REPORT

Penetrating injury to eye

Aishwarya Venkataraman1, Kalaimaran Sadasivam1

1Royal London Hospital, Barts Health NHS Trust, London, United Kingdom

ABSTRACTPenetrating eye injuries are common and an important cause of visual disability in children and adults. Many

of these injuries are preventable and additional education of children, parents and carers on potential dangers is required. Prognosis is influenced by wound location, mechanism of injury, the extent of initial damage and prompt referral for management. Here we describe a case of 7-year-old girl who presented with a penetrating injury to the left eye and was successfully treated. This case also demonstrates that the need for serial neuro-imaging, especially computerised tomography (CT) scan may arise to deliver adequate and prompt care.

Key words: ocular injuries, penetrating eye injuries, safety measures

A seven-year-old girl presented to Accident and Emer-gency department with a penetrating injury to left ocular orbit after accidently falling onto a pen while playing. The pen penetrated the medial canthus of her eye. On examination she was conscious, clinically stable and remained neurologically intact throughout with a Glasgow coma score of 15. Urgent computed tomography (CT) of her head confirmed the pen had fractured the floor of her anterior cranial fossa and entered 3 cm into frontal lobe but had not injured any major vascular structures or her left eye or optic nerve (Fig. 1). She was transferred to the neurosurgical unit and the pen was removed under CT surveillance, with serial CT imaging to look for any evolving haemato-ma. After surgical removal there was no diplopia and she had full range of extra ocular movements. Due to the nature of her injury, she was given one week of prophylactic antibiotics. She made a complete recov-ery 8 weeks after initial presentation.Penetrating eye injuries are challenging to assess and are an important cause of visual disability in chil-dren.1-3 Blunt injuries and foreign bodies are most common type of injuries1-4 in children, with a pre-dominance in males.3,4 About 59% of these injuries occur during sport and recreational activities.3 Prog-nosis is influenced by wound location, mechanism of injury, the extent of initial damage and prompt referral for management.2 Neuroimaging, especially CT scan, may aid in determining the extent of dam-age and may provide useful prognostic information

regarding visual outcome. 5,6

Conclusion: This case report serves well to provide a broader general message that many of the eye inju-ries are preventable. Additional education of children, parents and carers on potential dangers is needed.1,7

CONFLICT OF INTERESTNone.

REFERENCES1. Thompson, C. G., et al. “The aetiology of perfo-rating ocular injuries in children.” British journal of ophthalmology 86.8 (2002): 920-922.2. Sternberg Jr, Paul, E. U. G. E. N. E. DE JUAN JR, and RONALD G. MICHELS. “Penetrating ocular injuries in young patients: initial injuries and visual results.” Retina 4.1 (1984): 5-8.3. Jandeck C, Kellner U, Bornfeld N, Foerster MH. Open globe injuries in children. Graefes Arch Clin Exp Ophthalmol.2000;238:420– 4264. MacEwen CJ, Baines PS, Desai P. Eye inju-ries in children: the current picture. Br J Ophthal-mol.1999;83:933– 9365. MAGUIRE, A. M., ENGER, C., ELIOTT, D., & ZINREICH, S. J. (1991). Computerized tomography in the evaluation of penetrating ocular injuries. Reti-na, 11(4), 405-411.6. Joseph, D. P., Pieramici, D. J., & Beauchamp, N. J. (2000). Computed tomography in the diagnosis and prognosis of open-globe injuries. Ophthalmology, 107(10), 1899-1906.7. Bhogal, G., P. J. Tomlins, and P. I. Murray. “Pene-trating ocular injuries in the home.” Journal of public health 29.1 (2007): 72-74.

Correspondence:Aishwarya Venkataraman, MDPaediatric Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London E1 1BBTel: +44 07877278031Fax: +44 2035940387E-mail: avenk9@gmail.com

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Aishwarya Venkataraman et al.

Journal of Case Reports in Practice (JCRP) 2016; 4(1): 12-13

Figure 1, Computed tomography; penetrating injury to the superomedial aspect of the left orbit. Tip of the pen is seen inside the frontal lobe. Preseptal orbital soft tissue swelling and orbital air is also noted.

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