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| PHOTO ESSAY |
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| Year : 2021 | Volume
: 1
| Issue : 2 | Page : 225-226 |
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Back-out method for removing a large lower eyelid foreign body
Deepsekhar Das1, Mohamed Ibrahime Asif2, Divya Challa Reddy3
1 Oculoplastic, Paediatric Ophthalmology and Oncology Services; Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
2 Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences; Department of Cornea and Refractive Surgery, New Delhi, India
3 Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| Date of Submission | 05-Jun-2020 |
| Date of Acceptance | 12-Sep-2020 |
| Date of Web Publication | 01-Apr-2021 |
Correspondence Address:
Dr. Deepsekhar Das
Oculoplastic, Pediatric Ophthalmology and Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1831_20
Keywords: Canalicular laceration, eyelid laceration, foreign body
How to cite this article:
Das D, Asif MI, Reddy DC. Back-out method for removing a large lower eyelid foreign body. Indian J Ophthalmol Case Rep 2021;1:225-6 |
| Case Report | |  |
A 13-year-old male presented to the ophthalmology emergency with an anchor-shaped keychain lodged in his right lower eyelid [Figure 1]a. He was playing with the keychain before it accidentally went in his eyelid. | Figure 1: (a). Clinical picture of the patient at presentation showing an anchor-shaped key chain lodged in the right lower eyelid with medial canthal laceration. (b). Clinical picture of the patient at 6-week follow-up
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On examination, the foreign body had entered from the conjunctival side near the lacus lacrimalis and came out from the skin. The medial canthus and the lower canaliculi were lacerated. However, the anterior and posterior segment examination was within normal limits.
The foreign body was removed using the “back-out method”,[1] wherein it was firmly held and by gently pulling it backwards the embedded edge was removed. The wound sites were examined, the proximal and distal edges of the lacerated lower canaliculi were identified, a mono canalicular stent was placed, and the medial canthus was repaired. At 6-week follow-up, the stent was removed, patient had visual acuity of 6/6 in both eyes and syringing revealed a patent lower canalicular system [Figure 1]b.
| Discussion | | |
On conducting a literature search, we found multiple reports of fishhooks getting impacted in the eyelids.[1],[2],[3],[4] Four different techniques have been described for their removal.[3],[4],[5],[6] The first technique is known as the “back-out” method, where the lodged hook is advanced back through its entry wound. The second is the ”snatch” technique, where a downward pressure is applied on the hook shank with rapid extraction of the foreign body. Third is the “advance and cut” technique, described for hooks impacted in the anterior segment. A new second wound is created by advancing the hook shark, the barb is cut, and the barbless part is then taken out by the “back-out” technique. The corneal wound is then repaired. The last technique is the “needle-cover” technique, used for removing hooks which had penetrated the retina.[5] The hook is engaged in the lumen of a wide bore needle and both are taken out simultaneously.
As our patient had an anchor-shaped keychain lodged in his right lower lid resembling a fishhook. It was easily removed using the 'back-out' technique.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Aiello LP, Iwamoto M, Guyer DR. Penetrating ocular fishhook injuries. Ophthalmology 1992;99:862-6.  |
| 2. | Kamath GG. Fish hook injury of the eyelid: An unusual case. Br J Ophthalmol 2000;84:441-2. |
| 3. | Mandelcorn MS, Crichton A. Fish hook removal from vitreous and retina. Arch Ophthalmol 1989;107:493. |
| 4. | Hung SO, Smerdon D. Eyeball injury due to fish hook. J Trauma 1984;24:997-8. |
| 5. | Grand MG, Lobes LA Jr. Technique for removing a fishhook from the posterior segment of the eye. Arch Ophthalmol 1980;98:152-3. |
| 6. | Bartholomew RS, MacDonald M. Fish hook injuries of the eye. Br J Ophthalmol 1980;64:531-3. |
[Figure 1]
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