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. 2020 Jan 2;4(1):8-11.
doi: 10.5811/cpcem.2019.10.44460. eCollection 2020 Feb.

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

Michele Markovitz  1 , Jordan Hamburger  2 , Brian S Fromm  3 , Brendan Carr  3 , Xiao Chi Zhang  3
Affiliations

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

Michele Markovitz et al. Clin Pract Cases Emerg Med. .

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.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
Hair comb impaled into the right inferomedial orbit (A) with higher magnification (B) of the foreign body with right conjunctival laceration at the nasal limbus extending inferonasally (arrow) with associated subconjunctival hemorrhage (arrowhead).
Image 2
Image 2
Computed tomography with sagittal view (A) and coronal view (B) showing the foreign body (arrow) entering the orbit, adjacent to the right medial rectus muscle (arrowhead) and abutting the optic nerve sheath (white asterisks in middle of figure) and terminating at the posterior superior orbital wall with no evidence of orbital wall fracture.
See this image and copyright information in PMC

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