Removal of an Impaled Intraocular Hair Comb Following Self-inflicted Trauma

Abstract

Ocular trauma is one of the most common and vision-threatening ophthalmic presentations with a wide spectrum of complications, such as bleeding, infection, vision loss, and enucleation. A 64-year-old-male presented to the emergency department (ED) with a self-inflicted orbital penetrating injury with a hair comb. Computed tomography showed the comb traversed the medial orbit inferior to the medial rectus but did not damage the optic nerve; there were no globe or orbital wall fractures. His ocular exam was significant for a right eye afferent pupillary defect and decreased visual acuity 20/800, consistent with optic neuropathy. Primary concerns were stabilizing and removing the foreign body without causing further damage in the setting of an uncooperative patient. The comb was removed with the aid of local and systemic analgesia using gentle traction and normal saline irrigation. The patient was admitted for systemic and topical antibiotics and showed improvement in visual acuity and resolution of his optic neuropathy. This case illustrates the importance of rapid ED assessment and management of complex penetrating ocular trauma. Examination should specifically look for signs of globe rupture and optic nerve injury. Expedited foreign body removal should be managed together with an ophthalmologist with procedural sedation and broad-spectrum antibiotics to avoid further visual and infectious complications.

Prevention of self-induced re-injury to ruptured globe with a surgically fixated plastic eye shield

“…4 Psychologically or cognitively impaired individuals are often implicated in cases of self-inflicted ocular trauma such as OGI and self-enucleation. 5 , 6 , 7 , 8 , 9 Management of self-inflicted, intentional eye injury in a cognitively impaired patient poses a challenge, as these individuals may attempt re-injury if the cognitive deficits that led to the ocular trauma cannot be corrected. Following their initial presentation, these patients are often placed in restraints and/or on 1:1 monitoring.…”