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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 786-788

An unusual foreign body from domestic ocular injury


1 EyeQ Superspecialty Hospitals & Max Healthcare, Delhi NCR, India
2 Bhagwan Mahavir Medica Superspecialty Hospital, Ranchi, Jharkhand, India
3 Department of Oral & Maxillofacial Surgery, RIMS, Ranchi, Jharkhand, India

Date of Submission20-Feb-2022
Date of Acceptance19-May-2022
Date of Web Publication16-Jul-2022

Correspondence Address:
Dr. Mainak Bhattacharyya
EyeQ Superspecialty Hospitals & Max Healthcare, Delhi NCR
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_499_22

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  Abstract 


Domestic ocular injuries are mostly caused by sharp objects such as needles or fists, balls, firecrackers, and bursting bottles; pressure cooker explosions constitute a relatively rare but largely under-reported cause of ocular trauma. We report here a domestic cooker blast injury in a 57-year-old lady who had an impacted nozzle and auto-eviscerated eyeball at the presentation that lead to permanent blindness. A careful evaluation and meticulous removal of the impacted foreign body (cooker whistle) prevented further damage to the surrounding structures. Pressure cookers are one of the most common kitchen appliances that need to be used with care and caution. We recommend stringent testing of the final product and complete adherence to the safety instructions on part of the users.

Keywords: Blast injury, evisceration, pressure cooker injury, ocular injury


How to cite this article:
Bhattacharyya M, Soren AJ, Anuradha A, Prakash O. An unusual foreign body from domestic ocular injury. Indian J Ophthalmol Case Rep 2022;2:786-8

How to cite this URL:
Bhattacharyya M, Soren AJ, Anuradha A, Prakash O. An unusual foreign body from domestic ocular injury. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 13];2:786-8. Available from: https://www.ijoreports.in/text.asp?2022/2/3/786/351197



Pressure cookers are common kitchen appliances that use high pressure and temperature to decrease cooking time and fuel while ensuring the preservation of food's nutrients.[1],[2] Rare failures may occur when pressure-release mechanisms become blocked either due to poor cleaning or overfilling. The excess accumulating steam can push the cooker's lid out with tremendous force.[3] Previous studies on ocular trauma have attributed pressure cooker explosion as the cause in 4.6% of cases although it has been reported sparsely as shown by PubMed/Medline search.[2]

Injuries from pressure cooker explosions should be evaluated such as blast injuries. Direct blast injuries are categorized into three types; primary blast wave injuries are from supersonic over-pressurization of air (e.g., tympanic membrane rupture, hollow viscus rupture, and pulmonary contusion), and secondary injuries are from flying debris (e.g., penetrating injury and contusions), and tertiary injuries are sustained being thrown from the blast.[2] The vast majority of the injuries from pressure cookers each year are minor burns.[2]


  Case Report Top


We report here the unfortunate case of a 57-year-old lady who presented to our emergency with a history of pressure cooker blast injury sustained one day ago while cooking on a traditional chulha, placed on the floor in her kitchen when she was trying to open the cooker lid and it burst open. She received initial treatment including tetanus toxoid at a nearby health center and was then referred to our tertiary care center. She was conscious, well-oriented, and hemodynamically stable, and local examination revealed sutured skin laceration over the forehead (repaired elsewhere) and a T-shaped extensive laceration extending from the left upper eyelid to the lower lid margin extending nasally. This was plugged by coagulated blood and had extensive crusting, which on clearing revealed the metallic nozzle impacted at the laceration site [Figure 1]. There was extensive periorbital swelling and globe contents appeared auto-eviscerated with eyeball chemosed and hypotonous. She had no perception of light in her left eye at presentation and her right eye had an uncorrected refractive error with best-corrected visual acuity (BCVA) 6/9. Non-contrast computed tomography (NCCT) orbit showed a large foreign body measuring 39 × 29 × 26 mm with metal artifact seen in left orbit perforating posterior and inferior wall with hemosinus of the left maxillary sinus [Figure 2].
Figure 1: At presentation, T-shaped laceration with impacted cooker nozzle (whistle)

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Figure 2: CT showing radiopaque foreign body (nozzle) with intact bony margins. Inset: Pressure cooker nozzle (after removal) recovered from the wound

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The nearest relatives of the patient were clearly explained the nil visual prognosis for her irreversibly damaged eye, needing complete evisceration. The patient was seen by a team of experts (ophthalmologist/ear nose throat [ENT] surgeon/maxillofacial surgeon); the impacted nozzle was removed in the emergency operation theater under general anesthesia, and evisceration of the left eye was completed with a conformer applied at the end of the procedure [[Figure 2] inset]. Multiple lacerations were repaired and packing was done with an absorbable gelatin sponge after debridement of traumatized frontal mucosa (the mucosa lining the normally air-filled frontal sinus). We also prescribed a course of oral steroids to the patient to minimize the risk of sympathetic ophthalmitis in her right eye. On subsequent follow-ups, the socket appeared healthy with scar tissue healing adequately and she is being planned for the secondary implant with a prosthetic eye for rehabilitation.


  Discussion Top


Domestic ocular injuries are usually caused by fist, stick, balls, firecrackers, bursting bottles, needles, and other sharp objects.[4] Because women and children are more likely to sustain a blinding ocular injury at home, there is a need to implement eye health awareness programs targeted at increasing awareness about safety measures at home.[4] In our patient, regular cleaning and timely replacing the safety valve, not leaning over the pressure cooker, and releasing the pressure on time while using the cooker might have saved the eyesight of the patient. Most domestic ocular injuries are mechanical in nature.[5] Therefore, the correct positioning of household equipment and adopting the right posture during work can also prove effective in reducing such injuries.

The mode of injury in our case was using pressure cooker on a traditional chulha, in a sitting position on the ground, common in Indian rural households. This poses an increased risk of injury as the patient moves closer to the pressure cooker and is in a more dependent position. In urban settings, usually, the stove is placed on a slightly higher level and cooking is done in a standing position. The severity of cooker injury will vary depending on the cooking position, and also depending on whether the affected person was him/herself using the cooker or was a mere bystander.

The onus of preventing pressure cooker-related accidents lies both with the manufacturers as well as the users.[3] The device should be manufactured and tested according to the published standards; the inside of the vessel should have volume marks, the bursting pressure of the vessel should not be less than six times the greatest nominal cooking pressure and the safety guidelines should be a part of the product advertisement and user manual.[3] Consumers need to adhere to these instructions for securing optimal safety.[3]

As our patient was conscious and cooperative at the time of presentation with no evidence of bony injury at the site of impact, documented on computed tomography (CT) scan, we proceeded with the examination of the globe and primary removal of the foreign body under general anesthesia to minimize any iatrogenic trauma to the ocular tissue. However, auto-evisceration of the ocular contents compelled us to complete the evisceration as a primary procedure and as there was a gross lack of support of the medial orbital wall to avoid migration/loss of implant later, primary implant insertion was avoided.


  Conclusion Top


A pressure cooker explosion is a known cause of severe ocular trauma but is largely under-reported. This lady sustained blast injury and presented with an auto-eviscerated eyeball resulting in permanent loss of sight. A careful evaluation and meticulous removal of the impacted foreign body (cooker whistle) prevented further damage to the surrounding structures.

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.
Atreya A, Kanchan T, Nepal S. Pressure cooker—a potential hazard in domestic setting. Kathmandu Univ Med J 2016;14:181-3.  Back to cited text no. 1
    
2.
Esposito M, Meyer M, Strote J. Polytrauma from unintentional pressure cooker explosion. JEmerg Med 2018;55;402-4.  Back to cited text no. 2
    
3.
Sandhir RK, Sandhir M. Accidental pressure cooker lid blow-out. Burns 1992;18:438.  Back to cited text no. 3
    
4.
Singh K, Mutreja A, Bhattacharyya M, Dangda S. Epidemiology & implications of ocular trauma admitted to a tertiary care hospital in north India. US Ophthalmic Rev 2017;10:64-8.  Back to cited text no. 4
    
5.
Mansouri MR, Mirshahi A, Hosseini M. Domestic ocular injuries: A case series. Eur J Ophthalmol2007;17:654-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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