|Year : 2001 | Volume
| Issue : 2 | Page : 115-116
Fish hook injury to the eyelid
Sathish Srinivasan, Shona Macleod
Department of Ophthalmology, Aberdeen Royal Infirmary, Grampian University Hospital, United Kingdom,
Department of Ophthalmology, Aberdeen Royal Infirmary, Grampian University Hospital, United Kingdom
|How to cite this article:|
Srinivasan S, Macleod S. Fish hook injury to the eyelid. Indian J Ophthalmol 2001;49:115-6
Fishing is recreational activity enjoyed by millions of people worldwide. Although uncommon in developing countries it is a popular pastime in the Western world, and, given this popularity, a number of associated personal injuries are probably inevitable. We report a case of fish hook injury to the eyelid and discuss the various techniques available for removal of fish hooks. The terminologies associated with various parts of the fish hook are also illustrated.
| Case Report|| |
In the course of casting his fishing time, a 50 year-old male sustained a fish hook injury in his left upper lid. He presented to the Ophthalmic casualty with a fishhook embedded in his left upper lid. He had cut off the line, but had made no attempt to remove the hook. On examination he had an aided visual acuity of 6/6, N5 in both eyes. The fish hook had pierced the lateral aspect of the upper eyelid through the skin, above the lateral canthus. The fish hook was covered with artificial feathers, which were brushing against the lateral bulbar conjunctiva [Figure - 1]. Slitlamp examination of the left eye was unremarkable.
Under local anesthesia (2% xylocaine with 1 in 200,00 adrenaline) the barb of the fish hook was pushed out through the undersurface of the eyelid and was cut off using wire cutters. This was essential to minimize movement of the fish hook and reduce trauma. We obtained wire cutters from a helpful hospital electrician, and disinfected them using 70% isopropyl alcohol wipes. The hook shank was then backed out (Back -Out technique) through its entrance wound. Since atraumatic removal was achieved the eyelid required no stitches.
| Discussion|| |
Fishing is a popular leisure activity in many parts of the world. Indeed, in 1653, Sir Isaac Walton described fishing as "the contemplative man's recreation". Ocular fishhook injuries though uncommon, can cause potentially devastating ocular trauma. Aiello et al reported five cases of penetrating ocular fishhook injuries and showed that with appropriated surgical techniques excellent visual outcome can be achieved in these cases. Although fishhook injuries to the eyelid are not sight threatening, appropriate techniques have to be employed to remove the fishhook and avoid major damage to the eyelid anatomy.
Fish hooks can be loaded with various baits. This patient had been fly-fishing and the fish hook was decorated with colored feathers (which resemble flies). Recently Kamath described a case of fishhook injury to the eyelid in which the fish hook was loaded with live maggots. It is vital to understand the various parts of the fishhook before any attempt is made to remove it [Figure - 2]. Although single barbs are common they may have multiple barbs, making removal quite complex.
Four techniques for the removal of fish hooks embedded in non-ocular tissues have been reported in the medical literature.[4-7] Their advantages, drawbacks and use in ophthalmic injuries are detailed below.
The Back-Out method refers to backing the hook out through its entrance wound. Although technically simple, it is primarily useful for barbless hooks. If a barb is present and engaged in ocular tissues, this method can cause excessive damage.
The Snatch technique is a modification of the back-out method, where downward pressure on the hook shank and rapid extraction are used to diminish pain during the removal procedure in nonocular tissues. This is a relatively traumatic technique and not advised for penetrating ocular injuries.
The Advance and Cut method is the most useful technique in anterior segment fishhook injuries. This procedure has been previously photographically documented. Briefly, the hook shank is grasped firmly, and a controlled surgical incision is placed to allow atraumatic delivery of the point and barb. Sterile wire cutters are used to transect the hook at a location between the barb and bend, after which the barbless hook is easily removed using the back-out technique described previously. Advantages of the advance and cut method include a surgically controlled second wound, no enlargement of the primary wound and minimal traumatic manipulation.
The usual method of choice for hook penetration of the retina is the needle-cover technique described by Grand and Lobes. This procedure entails passing a large bore needle into the eye through the hook entry wound. The fishhook barb is then engaged within the lumen of the needle and both are with drawn together.
An ophthalmologist may be considerably taken aback when confronted with the formidable task of removing large foreign body such as a fish hook from the eye. The hook can be successfully removed with minimal trauma to ocular structures by understanding the structure of the fish hook and by employing the correct technique.
| References|| |
|1.||Walton I. The Compleate Angler: or The Contemplative Man's Recreation. London: Printed by T.M for R.Marriot, 1653 |
|2.||Aiello LP, Iwamoto M, Guyer DR. Penetrating ocular fishhook injuries. Ophthalmology 1992;99:862-66. [PUBMED] [FULLTEXT]|
|3.||Kamath GG. Fish hook injury of the eyelid: An unusual case. Br J Ophthalmol 2000;84:441-42. |
|4.||Mandelcorn MS, Crichton A. Fish hook removal from vitreous and retina (Letter). Arch Ophthalmol 1989;107:493. |
|5.||Hung SO, Smerdon D. Eyeball injury due to fishhook, journal of Trauma 1984;24:997-98. [PUBMED] [FULLTEXT]|
|6.||Grand MG, Lobes LA Jr. Technique for removing a fish hook from the posterior segment of the eye. Arch Ophthalmol 1980;98:152-53. [PUBMED] [FULLTEXT]|
|7.||Bartholomew RS, MacDonald M. Fish hook injuries of the eye. Br J Ophthalmol 1980;64:531-33. [PUBMED] [FULLTEXT]|
|8.||Aiello LP, Iwamoto M, Taylor HR. Perforating ocular fishhook injury. Arch Ophthalmol 1992;110:1316-17. [PUBMED] [FULLTEXT]|
[Figure - 1], [Figure - 2]
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