Young Sun, M.D.
Contributing Editor
Case History:
A 53 year-old male comes into the emergency room with sudden left eye pain and decreased vision after working on his lawn for one day. He states that he was using a weedwacker to trim his lawn when he developed sudden pain and decreased vision of the left eye. The patient arrives with profuse tearing and mild eyelid swelling. On examination, his visual acuity is 20/20 OD and HM OS. The examination is significant for a penetrating foreign body through the central cornea. On closer exam, the foreign body is a weedwacker spoke embedded into the cornea, causing shallowing of the anterior chamber with a positive Siedel sign and active aqueous leakage. The funduscopic examination shows normal retina but limited view. There are no other foreign bodies found in the left eye. The right eye examination is unremarkable.
CT scan of the orbit shows extension of the foreign body into the vitreous but no signs of vitreous hemorrhage or retinal detachment.
Figure 1: Penetrating wound OS with foreign body fragment still present.
Diagnosis: Ruptured globe injury OS
This is an unfortunate case of direct penetrating globe injury from a weedwacker spoke. The patient was taken immediately to the operating room for ruptured globe repair. The foreign body was found to have penetrated the cornea, the anterior capsule, and the posterior capsule of the lens. The vitreous came forward with the removal of the foreign body. After multiple sutures, the circular corneal laceration was closed after limited anterior vitrectomy. Intravenous moxifloxacin was given for prophylaxis against possible endophthalmitis. The patient subsequently developed a traumatic cataract that lead to phacolytic glaucoma requiring pars plana vitrectomy and an anterior chamber IOL. His final BCVA was 20/80 in the left eye.
The case above is a dramatic presentation of high projectile injury from a weedwacker. It emphasizes the importance of eye protection with usage of any power tools. Our patient was fortunate to have escaped permanent retinal damage from the injury and thus preserved much of his vision. Patient education is critical to prevent the development of these cases.
Figure 2: A typical weedwacker. High-speed rotation of the head can cause fragments of line to become potentially injurious projectiles. All patients should be advised to use protective eyewear when operating equipment like this.
Have a question or comment on this article? Use the "Comment" link above to leave your thoughts, and the author will respond.