About OJO | Search | Ahead of print | Current Issue | Archives | Author Instructions | Reviewer Guidelines | Online submissionLogin 
Oman Journal of Ophthalmology Oman Journal of Ophthalmology
  Editorial Board | Subscribe | Advertise | Contact
https://www.omanophthalmicsociety.org/ Users Online: 849  Wide layoutNarrow layoutFull screen layout Home Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents    
CLINICAL IMAGE
Year : 2018  |  Volume : 11  |  Issue : 1  |  Page : 92-93  

An unusual case of globe-sparing penetrating orbital injury by a nail


Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel

Date of Web Publication5-Mar-2018

Correspondence Address:
Yishay Weill
Department of Ophthalmology, Shaare Zedek Medical Center, Shmu'el Bait St. 12, Jerusalem 9103102
Israel
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_120_2016

Rights and Permissions
   Abstract 


We describe a case of a 28-month-old boy who presented to our emergency department with a right orbital penetration by an iron nail. At presentation, no pain or functional loss were noted. Plain head radiographs and computed tomography were performed and demonstrated a two centimeters long nail penetrating the right orbit. The foreign body was extracted carefully in the operating room. No complications were observed upon follow-up. Rarely, orbital penetration by an iron-nail can present without functional disturbances or pain and is not necessarily accompanied by sequelae.

Keywords: Eye trauma, nail injury, penetrating orbital trauma


How to cite this article:
Weill Y, Drabkin E, Hanhart J, Brosh K. An unusual case of globe-sparing penetrating orbital injury by a nail. Oman J Ophthalmol 2018;11:92-3

How to cite this URL:
Weill Y, Drabkin E, Hanhart J, Brosh K. An unusual case of globe-sparing penetrating orbital injury by a nail. Oman J Ophthalmol [serial online] 2018 [cited 2020 Sep 24];11:92-3. Available from: http://www.ojoonline.org/text.asp?2018/11/1/92/226330




   Introduction Top


A 28-month-old boy presented to our emergency department after his caregivers had noticed an iron nail head protruding from the nasal part of his right eye [Figure 1]a. The caregivers denied possessing a nail-gun and could not explain this unusual phenomenon. At admission, the patient was calm, and his behavior did not indicate any ocular or systemic injury. A thorough ophthalmic examination was normal, including eye movement, without any signs of a ruptured globe. Plain head radiographs followed by orbital computed tomography revealed a two centimeters long nail almost fully embedded in the inferior nasal aspect of the right orbit, between the medial wall of the orbit and the globe. No fractures were detected [Figure 1]b,[Figure 1]c,[Figure 1]d. The patient was taken to the operating room. Under general anesthesia, forced duction test was negative and lacrimal drainage irrigation revealed intact fluid passage. Following these procedures, we gently extracted the nail without any complications. We cleaned the wound with iodine and applied gentamicin into the wound with a 23 gauge cannula mounted on a syringe. We closed the laceration with a single 5-0 vicryl suture and administered a tetanus vaccine. After uneventful observation in our department overnight, we discharged the patient with systemic antibiotics for seven days. At one week follow-up, the ophthalmic examination was unremarkable.
Figure 1: (a) External photograph of the injured eye at presentation, (b) sagittal computed tomography image showing the location and depth of the nail's penetration in the right orbit, (c) coronal, and (d) sagittal head radiograph depicting the location of the nail

Click here to view



   Discussion Top


Ocular nail trauma is a fairly common cause of penetrating ocular injuries.[1],[2] The majority of such injuries are attributed to automatic nail guns and are associated with sharp pain and decrease in visual acuity. Other penetrating ocular nail trauma is otherwise rare. To the best of our knowledge, this is the first description of a nail-related orbital penetration that presented without pain or functional disturbance. As described above, promptly and methodically addressed, this impressive clinical picture is not necessarily accompanied by sequelae.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Burger BM, Kelty PJ, Bowie EM. Ocular nail gun injuries: Epidemiology and visual outcomes. J Trauma 2009;67:1320-2.  Back to cited text no. 1
[PUBMED]    
2.
Lee BL, SternbergPJr. Ocular nail gun injuries. Ophthalmology 1996;103:1453-7.  Back to cited text no. 2
    


    Figures

  [Figure 1]



 

Top
   
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1320    
    Printed29    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal