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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 126-127

Inadvertent ocular perforation with hypodermic needle during saline irrigation


1 Department of Retina and Vitreous Services, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
2 Department of Cornea and Refractive Services, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India

Date of Submission14-Jun-2021
Date of Acceptance06-Sep-2021
Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Arjun Velayudhan Nair
Department of Cornea and Refractive Services, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1641_21

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  Abstract 


We present a case of globe perforation with hypodermic needle during saline irrigation. A 24-year-old presented with sudden onset defective vision during saline wash in his left eye. Patient on examination had hypotony and mild lid edema. Scleral wound was only apparent after staining; rest of the anterior segment was within normal limits. Posterior segment showed vitreous hemorrhage with retinal tear nasal to disc and adjacent commotio retinae. Patient was given tapering topical antibiotic steroid eye drops and kept under close observation. On his final follow-up 6 weeks after the initial injury, vitreous hemorrhage was resolving; the retinal tear had scarred with a choroidal rupture. Hypodermic-needle injuries are often complicated by the development of endophthalmitis. Our patient did not develop endophthalmitis, possibly due to the needle being sterile. He regained good vision and was saved from devastating consequences as the needle had missed the disc by a few millimeters.

Keywords: Hypodermic needle, ocular injury, perforation


How to cite this article:
Kumarswamy K, Nair AV. Inadvertent ocular perforation with hypodermic needle during saline irrigation. Indian J Ophthalmol Case Rep 2022;2:126-7

How to cite this URL:
Kumarswamy K, Nair AV. Inadvertent ocular perforation with hypodermic needle during saline irrigation. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Jan 22];2:126-7. Available from: https://www.ijoreports.in/text.asp?2022/2/1/126/334897



Needlestick ocular injuries are rarely reported in the ophthalmic literature. Injuries with a hypodermic needle can occur in the iatrogenic and noniatrogenic scenarios. Noniatrogenic injuries are common in children who play with improperly disposed needles as squirt guns. Iatrogenic injuries are common during periocular anesthesia. The hypodermic needle being sterile during periocular injections, risk of infection and endophthalmitis is low. Iatrogenic needle stick injury occurs exceptionally during saline wash when the sharp needle is used for spraying a pressurized jet of saline. We report a case of a 24-year-old male who presented with globe perforation with a hypodermic needle during saline wash. These needles pose a higher risk of infection unlike other iatrogenic injuries often being performed in outpatient departments and semi-sterile environments.


  Case Report Top


A 24-year-old male presented with sudden defective vision (DV) in the left eye (LE) of 1-hour duration. His initial complaint was foreign body sensation after an insect hit. During saline wash done elsewhere, the hypodermic needle pierced LE when it loosened during irrigation. His vision was 6/6 in the right eye and 6/18 in LE. On examination, LE had lid edema, minimal congestion, and chemosis; the rest of the anterior segment was normal except for hypotony. Inferotemporal conjunctiva showed pinpoint staining with no leak on fluorescein staining [Figure 1]. Fundus showed vitreous hemorrhage (VH), retinal break nasal to the disc with commotio retinae [Figure 2]. The patient was started on antibiotic steroids and kept under close observation. Upon review, VH had settled and the perforation site showed good scaring. Patient's vision improved to 6/12 over 6 weeks, VH was resolving and scarred choroidal rupture was noted nasal to disc.
Figure 1: (a) Slit-lamp view of the anterior segment. (b) Inferotemporal conjunctiva pinpoint staining with fluorescence; no leak noted (arrowhead)

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Figure 2: (a) Fundus photograph taken on the same day as of injury showing retinal perforation nasal to disc with fresh vitreous hemorrhage. (b) Fundus photo taken on the third day of injury: vitreous hemorrhage is settling with retinal tear, commotio retinae, and choroidal rupture

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  Discussion Top


Ocular needle injuries are common, but only a few reports of needle injury during saline irrigation exist. Ocular injury during saline wash has poor visual outcome due to endophthalmitis.[1] Jalali et al.,[2] reported injury with a disposed hypodermic needle used by children to sprinkle water. Seventeen of the nineteen cases developed endophthalmitis and had poor outcomes.[2] According to Rabiah et al., endophthalmitis is more prevalent in hypodermic needle injuries than in solid sewing needle injuries.[3] Iatrogenic injuries have a lower rate of endophthalmitis, the needle being sterile.


  Conclusion Top


In conclusion, during saline wash, sharps should be avoided. Irrigation can be accomplished with a drip set. Luer locks can be used for pressure irrigation. A high index of suspicion is required to locate entry wounds, particularly in scleral punctures. Fluorescein staining aids in the localization. In our case, disaster was averted as the needle missed the disk by a few millimeters.

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.
Lu C-W, Hao J-L, Liu X-F, Liang L-L, Zhou D-D. Pseudomonas aeruginosa endophthalmitis caused by accidental iatrogenic ocular injury with a hypodermic needle. J Int Med Res 2017;45:882-5.  Back to cited text no. 1
    
2.
Jalali S, Das T, Majji AB. Hypodermic needles: A new source of penetrating ocular trauma in Indian children. Retina 1999;19:213-7.  Back to cited text no. 2
    
3.
Rabiah PK. Penetrating needle injury of the eye causing cataract in children. Ophthalmology 2003;110:173-6.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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