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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 702-703

Massage gun-induced ocular injury – A case report


Department of Ophthalmology, Caritas Medical Centre, Hong Kong

Date of Submission31-Jan-2021
Date of Acceptance22-Mar-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Frank Hiu Ping Lai
Department of Ophthalmology, Caritas Medical Centre, 111 Wing Hong Street, Sham Shui Po
Hong Kong
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_253_21

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  Abstract 


A 30-year-old man presented to the ophthalmology clinic with a 1-week history of right eye blurred vision. He reported application of massage gun over bilateral periocular regions for 3 months. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Slit-lamp examination revealed bilateral iris atrophy at the inferonasal region. In the right eye, there was anterior subcapsular and cortical cataract at the visual axis, associated with mild phacodonesis. There were dot opacities in the left eye lens without lens subluxation. The patient received right phacoemulsification with a multifocal intraocular lens implanted. To the best of our knowledge, this is the first case of bilateral traumatic cataract with symmetrical iris atrophy after repetitive periocular massage with a massage gun reported in the literature.

Keywords: Iris injury, massage gun, traumatic cataract


How to cite this article:
Lai AC, Wong EW, Lai FH. Massage gun-induced ocular injury – A case report. Indian J Ophthalmol Case Rep 2021;1:702-3

How to cite this URL:
Lai AC, Wong EW, Lai FH. Massage gun-induced ocular injury – A case report. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:702-3. Available from: https://www.ijoreports.in/text.asp?2021/1/4/702/327729



Ocular injury is one of the frequent encounters in the ophthalmology clinic. It is estimated that there are 55 million activity-restricting eye injuries each year.[1] Traumatic cataract is one of the possible complications of ocular injury. It has been reported to occur in 1%–15% of all cases of ocular injury,[2] and even 43%–55% of open globe injuries.[3] Traumatic cataract typically occurs after an one-off injury to the eye. However, traumatic cataract secondary to relatively low-energy, repetitive vibration is rarely reported in the literature.

We report a case of bilateral traumatic cataract with symmetrical iris atrophy after repetitive periocular massage with a massage gun. We believe this is the first case reported in the literature.


  Case Report Top


A 30-year-old man presented to our ophthalmology unit with a 1-week history of right eye blurring of vision. There was no eye pain or redness. He volunteered the use of massage gun over bilateral periocular regions for 3 months. On the day of the first consultation, the best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. There was no relative afferent pupillary defect. Slit-lamp examination revealed bilateral symmetrical iris atrophy over the inferonasal region [Figure 1]. The anterior chamber was quiet with no keratic precipitates nor posterior synechiae. In the right eye, there was anterior subcapsular cataract and cortical cataract at the visual axis, associated with mild phacodonesis [Figure 2]. There was no lens subluxation nor vitreous prolapse in the anterior chamber. Dot opacities in the left eye lens without lens subluxation were found. The intraocular pressure was normal and no angle recession was identified. No abnormality was detected upon fundal examination.
Figure 1: Symmetrical iris atrophy over the inferonasal region was observed in both right eye (a) and left eye (b)

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Figure 2: Slit lamp photo of the right eye with pupil dilated, demonstrating the anterior subcapsular cataract and cortical cataract at the visual axis

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The patient received right phacoemulsification with the implantation of a multifocal lens. The best-corrected visual acuity was 20/25 in the right eye and 20/16 in the left eye at one month postoperatively. The multifocal intraocular lens over the right eye was stable. Mild right posterior capsular opacification was observed.


  Discussion Top


Massage gun is widely used to relieve muscle fatigue over the body. However, its use over the periocular region can incur significant danger to the eye. In this case, the patient suffered from bilateral cataract and iris atrophy. Several mechanisms have been proposed in the pathogenesis of the traumatic cataract, including coup, contrecoup, and equatorial expansion of the globe.[4] Coup injury refers to direct injury to the lens epithelium and capsule; contrecoup injury refers to indirect injury to the lens epithelium and capsule by shock waves propagated from a distal site; equatorial expansion of the globe occurs when the globe is shortened antero-posteriorly in a blunt trauma, leading to equatorial capsular rupture and zonular dehiscence.[4] It is postulated that the vibration generated by the massage gun can cause repetitive microtrauma to the lens epithelium and capsule by the three aforementioned mechanisms, leading to cataract formation and phacodonesis. Concussion of the lens without rupture of the capsule may result in a cataract that is initially sub-capsular and commonly has a star-shaped appearance,[5] which is compatible to that noted in our case [Figure 2]. The different types of cataract in the two eyes may reflect cataractous change in response to different degrees of trauma - the right lens was at a later stage of disease with development of anterior subcapsular cataract and cortical cataract, while the left lens may have suffered from less trauma with development of dot opacities only.

Iris and pupillary injuries are not uncommon in ocular trauma. Canavan et al.[6] reported that 37.3% of eyes had iris or pupillary abnormalities after ocular trauma. Nevertheless, sectoral iris atrophy or defects in pigmented layer of iris were only reported in 6.3% of all the eyes with iris or pupillary abnormalities. In this case, iris atrophy was noted at the inferonasal region of both eyes. Although pre-injury photo of iris status could not be obtained, this pattern of injury could potentially be explained by the anatomy of the orbit in relation to the surrounding structures. The inferonasal side of the orbit is bounded by the nose, which is an elevated structure not present adjacent to the other walls of the orbit. When the massage gun is used overlying the eye, naturally the direction of massage would be in an anterotemporal – posteronasal direction, since the head of the massage gun would be better fit to the orbit temporally than nasally due to the elevated nose. The temporal cornea may be more directly depressed by the waves from the massage gun, generating impulses in the aqueous humor towards the nasal side, creating iris atrophy preferentially at the nasal side.

In the literature, there has only been one case of traumatic anterior subcapsular cataract induced by vigorous ocular massage ever reported,[7] which was not associated with any iris atrophy.


  Conclusion Top


To our knowledge, this is the first reported case of bilateral traumatic cataract with symmetrical iris atrophy after repetitive periocular massage with a massage gun. Although massage guns seem harmless to the other parts of the body, they can induce significant permanent damage to the eye upon short-term usage. As the usage of household massage gun is getting popular, the potential risk of massage gun to the eye needs to be aware of. Ophthalmologists should keep vigilance to such disease mechanism. Other ways of relieving ocular discomfort could be considered, in view of the potential danger of periocular massage.

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 Top

1.
Negrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143-69.  Back to cited text no. 1
    
2.
Bhandari AJ, Jorvekar SA, Singh P, Bangal SV. Outcome after cataract surgery in patients with traumatic cataract. Delta J Ophthalmol 2016;17:56-8.  Back to cited text no. 2
  [Full text]  
3.
Thakker MM, Ray S. Vision-limiting complications in open-globe injuries. Can J Ophthalmol 2006;41:86-92.  Back to cited text no. 3
    
4.
Mian SI, Azar DT, Colby K. Management of traumatic cataracts. Int Ophthalmol Clin 2002;42:23-31.  Back to cited text no. 4
    
5.
Gupta VB, Rajagopala M, Ravishankar B. Etiopathogenesis of cataract: An appraisal. Indian J Ophthalmol 2014;62:103-10.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Canavan YM, Archer DB. Anterior segment consequences of blunt ocular injury. Br J Ophthalmol 1982;66:549-55.  Back to cited text no. 6
    
7.
Tang J, Salzman IJ, Sable MD. Traumatic cataract formation after vigorous ocular massage. J Cataract Refract Surg 2003;29:1641-2.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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