Perforating Ocular Fishhook Injury healthy 15-year-old male was struck in the right eye by a fish¬ hook while casting. Results of an exam¬ ination disclosed that a rusty fishhook had penetrated the cornea, traversed the anterior chamber, and partially ex¬ ited from a second corneal site (Fig 1). The barb was located in the shallow an¬ terior chamber. A faint posterior subcapsular lens opacity was noted. Visual acuity was 20/200 OD. Results of the remainder of the ocular examination were unremarkable. A supersharp blade was used to ex¬ tend the corneal wound over the barb. The point and barb were then delivered through this wound (Fig 2). Sterile wire cutters were used to transect the hook at a location proximal to the barb (Fig 3). The now barbless hook (Fig 4) was backed out through both corneal wounds, which were subsequently closed with three 10-0 nylon sutures "
(Fig 5).
Visual acuity was 20/50 OD after sur¬ gery. Seventeen days later, a temporal wound leak was present, which per¬ sisted despite a bandage contact lens.
Cyanoacrylate tissue adhesive was suc¬ cessfully applied 28 days after initial repair and removed 13 months later. Subsequent corrected visual acuity of 20/20 OD (-0.25±0.75x005) had been maintained at last examination 6 years later (Fig 6). COMMENT
is
an international recre¬ Fishing ational pastime and commercial indus¬ try. With more than 30 million sport fishing licenses issued annually in the
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United States alone, some injuries are inevitable. The Eye Injury Registry of Alabama reports that 22% of fishingrelated eye injuries involve fishhooks.1
However, penetrating injuries
are a
and potentially devastating trauma. A recent review of all five pre¬ viously described reports2"4 and five ad¬ ditional cases indicates that visual prog¬ nosis after these injuries is excellent when prompt specialized repair is per¬ formed.5 All patients had final visual acuities of 20/40 or better. As with all rare
potentially sight-threatening activities, eye protection (eg, sunglasses) should be considered while fishing. Lloyd Paul Aiello, MD, PhD Mami
Iwamoto, MD Baltimore, Md Hugh R. Taylor, MD
East Melbourne, Australia
Reprint requests to Wilmer Ophthalmological Insti-
tute, Wilmer B-23, 600 N Wolfe St, Baltimore, MD Aiello).
21205 (Dr
References 1. White MF, Owens SD, Dooley CD, Kimble JA, Witherspoon CD. Fishing related eye injuries: a report of 27 cases. Invest Ophthalmol Vis Sci.
1990;31:21.
2. Mandelcorn MS, Crichton A. Fish hook removal from vitreous and retina. Arch Ophthalmol.
1989;107:493. 3. Grand MG, Lobes LH. Technique for removing a fishhook from the posterior segment of the eye. Arch Ophthalmol. 1980;98:152-153. 4. Bartholomew RS, MacDonald M. Fish hook injuries of the eye. Br J Ophthalmol. 1980;64:531\x=req-\
533. 5. Aiello LP, Iwamoto M, Guyer D, Smiddy WE. Surgical management and visual prognosis of penetrating ocular fishhook injuries. Ophthalmology.
1991;98:126.
Fig 1.—Ocular appearance on presentation. Visual acuity was 20/200 OD. Note barb buried in the anterior chamber.
Fig 2.—Point and barb have been delivered through a surgically en¬ larged exit site.
Fig 3.—Wire cutters barb.
removed
were
used to transect the hook
proximal to the
Fig 5.—Corneal appearance after repair. Note that 10-0 nylon corneal
sutures were used to close the entry and exit sites. Moderate corneal scarring and residual rust stains are present.
Fig 4.—Fishhook with the barb removed. The fishhook is then easily by backing it out of the wounds.
Fig 6.—Appearance 16 months after repair. Visual acuity of 20/20 OD was
maintained at last examination
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more
than 6 years later.
(Fig 5).
Visual acuity was 20/50 OD after sur¬ gery. Seventeen days later, a temporal wound leak was present, which per¬ sisted despite a bandage contact lens.
Cyanoacrylate tissue adhesive was suc¬ cessfully applied 28 days after initial repair and removed 13 months later. Subsequent corrected visual acuity of 20/20 OD (-0.25±0.75x005) had been maintained at last examination 6 years later (Fig 6). COMMENT
is
an international recre¬ Fishing ational pastime and commercial indus¬ try. With more than 30 million sport fishing licenses issued annually in the
Downloaded From: http://archopht.jamanetwork.com/ by a Michigan State University User on 06/18/2015
United States alone, some injuries are inevitable. The Eye Injury Registry of Alabama reports that 22% of fishingrelated eye injuries involve fishhooks.1
However, penetrating injuries
are a
and potentially devastating trauma. A recent review of all five pre¬ viously described reports2"4 and five ad¬ ditional cases indicates that visual prog¬ nosis after these injuries is excellent when prompt specialized repair is per¬ formed.5 All patients had final visual acuities of 20/40 or better. As with all rare
potentially sight-threatening activities, eye protection (eg, sunglasses) should be considered while fishing. Lloyd Paul Aiello, MD, PhD Mami
Iwamoto, MD Baltimore, Md Hugh R. Taylor, MD
East Melbourne, Australia
Reprint requests to Wilmer Ophthalmological Insti-
tute, Wilmer B-23, 600 N Wolfe St, Baltimore, MD Aiello).
21205 (Dr
References 1. White MF, Owens SD, Dooley CD, Kimble JA, Witherspoon CD. Fishing related eye injuries: a report of 27 cases. Invest Ophthalmol Vis Sci.
1990;31:21.
2. Mandelcorn MS, Crichton A. Fish hook removal from vitreous and retina. Arch Ophthalmol.
1989;107:493. 3. Grand MG, Lobes LH. Technique for removing a fishhook from the posterior segment of the eye. Arch Ophthalmol. 1980;98:152-153. 4. Bartholomew RS, MacDonald M. Fish hook injuries of the eye. Br J Ophthalmol. 1980;64:531\x=req-\
533. 5. Aiello LP, Iwamoto M, Guyer D, Smiddy WE. Surgical management and visual prognosis of penetrating ocular fishhook injuries. Ophthalmology.
1991;98:126.
Fig 1.—Ocular appearance on presentation. Visual acuity was 20/200 OD. Note barb buried in the anterior chamber.
Fig 2.—Point and barb have been delivered through a surgically en¬ larged exit site.
Fig 3.—Wire cutters barb.
removed
were
used to transect the hook
proximal to the
Fig 5.—Corneal appearance after repair. Note that 10-0 nylon corneal
sutures were used to close the entry and exit sites. Moderate corneal scarring and residual rust stains are present.
Fig 4.—Fishhook with the barb removed. The fishhook is then easily by backing it out of the wounds.
Fig 6.—Appearance 16 months after repair. Visual acuity of 20/20 OD was
maintained at last examination
Downloaded From: http://archopht.jamanetwork.com/ by a Michigan State University User on 06/18/2015
more
than 6 years later.
