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| ARTICLES |
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| Year : 1979 | Volume
: 27
| Issue : 1 | Page : 31-32 |
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Birth injury (A case report)
DK Sindal, RB Bhat, CJ Shaligram
Department of Ophthalmology, Wanless Hospital, Miraj, India
Correspondence Address:
D K Sindal
Department of Ophthalmology, Wanless Hospital, Miraj
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 500177 
How to cite this article:
Sindal D K, Bhat R B, Shaligram C J. Birth injury (A case report). Indian J Ophthalmol 1979;27:31-2 |
Birth injuries like lid-oedema, echymosis, subconjunctival haemorrhages, corneal abrasions, hyphaema, iridodialysis, lens-subluxation and luxations, retinal and vitreal haemorrages are known to occur commonly during mechanical stress and strain of birth. Traumatic injuries to lids, orbits, eyeballs, adnexae, and neural apparatus are also known to occur in prolonged labour or instrumental deliveries. Sub-luxation and luxation of the entire globe have been reported in the literature[1]. Occasionally the entire globe has been gouged out by injudicious exploratory fingers but with advances in ostetrics such eye injuries have become rare.
We report here an unusual birth injury to the globe following difficult prolonged labour managed in a village.
| Case Report | |  |
Thirty years old L.B.H. was referred to this hospital from moffusil area, for prolonged difficult labour. The attending doctor in the village had tried vaginal manipulation and forceps application. but did not succeed. On admission she showed gross vulval oedema, multiple lacerations of the vaginal introitus, cervix was fully dilated, membranes were ruptured, head was engaged in the pelvis with caput extending up to the perineum A female 8 lb. baby was delivered with low mid-cavity forceps application without any difficulty, after an episiotomy. The APGAR rating at birth and after five minutes were 2 and 8 respectively. The attending paediatrician while cleaning the baby's eyes noticed that the left eye socket was empty and was bleeding. The eyeball was later found along with the placenta.
On examining the baby's eyes, right eye was normal. There was minimal ecchymosis of the left eyelids [Figure - 1]. No abrasions over the eye lids were seen. The conjunctiva was in shreds and ocular muscles showed lacerated ragged ends [Figure - 1]. The gouged eyeball showed ragged tags of conjunctiva along the limbus. Cornea was clear, shoved no abrasions when examined under the slitlamp biomicroscope. Anterior segment was normal and clear. Ocular muscles at their insertions showed tags of lacerated muscles. The optic nerve was of 25 mm. in length with ragged ends [Figure - 2]. The scleral coat did not show any visible abrasions. X-rays skull showed no evidence of fracture of orbital walls.
| Discussion | | |
Gouging of the eyeball is a rare birth injury which mostly follows after injudicious manoeuvreing with fingers. With present advances in obstetrics, it has become very rare, almost nonexistant. In this case, surprisingly, neither were there external injuries to the cornea, the scleral coat, nor to the orbital wall. As the exact details of handling done by the attending doctor in the village is unknown, we only surmise that the attending doctor may have attempted to manipulate by his finger to deliver the baby. During manoeuvre one of the fingers may have pressed into the left orbit forced open the palpebral fissure, entered the orbital space through the conjunctiva, and the globe was gouged out due to the pressure. The globe was left behind in the uterine cavity and was prevented by the foetus from coming out, hence it was delivered along with the placenta.
| Summary | | |
An unusual case of birth injury to the eye been reported.
| Acknowledgement | | |
Authors are thankful to the Department of Obstetrics and Gynaecology; and Paediatrics and also to the Director, Wanless Hospital, Miraj, for allowing us to utilise the hospital records.
| References | | |
| 1. | Duke Elder S., 1972, System of Ophthalmology Volume XIV Part II, 15: Kimpton London.  |
[Figure - 1], [Figure - 2]
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