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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 792-793

Henpecked: Penetrating orbito-cranial injury with orbital fat prolapse in a child


Regional Institute of Ophthalmology, Medical College and Hospital Kolkata, West Bengal, India

Date of Submission23-Jan-2022
Date of Acceptance12-Apr-2022
Date of Web Publication15-Jul-2022

Correspondence Address:
Dr. Bharati Jingar
D 112 Basant Vihar, Jhunjhunu - 333 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_213_22

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  Abstract 


Domestic henpecking can cause serious ocular injuries. Here, we report a case of penetrating orbito-cranial injury along with lid laceration and orbital fat prolapse in a two-year-old girl following henpeck injury. The eye ball was spared. Prolapsed fat was relocated and the wound was repaired successfully. Neurosurgery consultation was done and conservative management advised.

Keywords: Henpeck injury, lid laceration, orbital fat prolapse, orbito-cranial injury


How to cite this article:
Chakraborti C, Mandal RB, Francis D, Kumar M, Jingar B, Mathew JP. Henpecked: Penetrating orbito-cranial injury with orbital fat prolapse in a child. Indian J Ophthalmol Case Rep 2022;2:792-3

How to cite this URL:
Chakraborti C, Mandal RB, Francis D, Kumar M, Jingar B, Mathew JP. Henpecked: Penetrating orbito-cranial injury with orbital fat prolapse in a child. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 13];2:792-3. Available from: https://www.ijoreports.in/text.asp?2022/2/3/792/351136



Domestic henpecking ocular trauma is rare but can produce grievous injuries to the eye and the ocular adnexa, which vary from mild abrasions to severe penetrating trauma.[1] Domestic henpecking cases are more common in the village areas where the medical facilities for the proper treatment are comparatively low. Because of this time lag in getting proper treatment and negligence by the parents, the final visual outcome of severe henpeck injuries are usually not so good.[2] Here, for the first time, we report a case of henpecking which caused penetrating orbito-cranial injury with orbital fat prolapses, and which was managed successfully.


  Case Report Top


A two-year-old girl presented to the emergency ophthalmic outpatient department with a history of accidental henpeck injury to the left eye upper lid one day back. The injury was limited to the eyelid.

On examination, the child was active and alert with a normal general examination finding. On ocular examination of the left eye, the upper lid showed a horizontal laceration injury over the lateral one third area which measures about 4 cm in length and 2 mm in width with orbital fat prolapse through the lacerated wound [Figure 1]a. Visual acuity seemed to be within normal limit for age. The anterior segment of the left eye was found to be normal. Right eye findings were normal.
Figure 1: (a) Preoperative picture showing lid laceration with orbital fat prolapse. (b) Postoperative picture with repair of lid laceration and relocation of orbital fat. (c) Non contrast computed tomography (NCCT) of orbit showing discontinuity in bone of orbital roof along with inflammatory changes surrounding the superior rectus muscle. (d) NCCT of brain showing hypodense area in left frontal region suggestive of contusion injury

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The wound was repaired under general anesthesia. The necrotic tissue around and over the lacerated wound was debrided. Then the prolapsed orbital fat was relocated inside the wound and the orbital septum was closed with 6-0 vicryl sutures, followed by closure of orbicularis muscle and finally, the skin was sutured with 6-0 vicryl sutures [Figure 1]b. Posterior segment was examined and found to be normal in both eyes.

Postoperatively, the child was treated with broad spectrum intravenous antibiotic (amoxicillin and clavulanic acid combination 150 mg BD) for five days along with oral anti-inflammatory drugs and topical eye drop Tobramycin (0.3%) 6 hourly. Local dressing was done with povidone iodine (5%) lotion. After five days, the child was discharged with oral antibiotics and anti-inflammatory drugs and topical eye drop along with non-contrast computed tomography (NCCT) of brain and orbit. At two-week follow-up, wound margin was healing and there was no sign of inflammation. Patient was lost to follow-up and turned to us after two months with NCCT report which was suggestive of right orbital roof fracture [Figure 1]c with resolving right frontal lobe contusion [Figure 1]d. She was referred to neurosurgery where she managed conservatively.


  Discussion Top


Henpecking injuries are very rare and they are more common in children. Because the hens and roosters attack on the most exposed and accessible areas, their main target area is the face, more commonly the eyes. So far, four cases of henpecking have been reported, and none of these cases included an active orbital injury [Table 1].[1],[2],[3],[4]
Table 1: Shows details of all henpecking reported cases which caused serious ocular injuries

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A case of accidental henpeck that caused devastating eye injury with corneal tear and a total rhegmatogenous retinal detachment in a five-year-old boy was reported by Menezes et al.[1]

Ayanniyi et al.[2] described a uniocular blindness case in a six-year-old boy due to penetrating eye injury by a domestic henpeck.

A case of subretinal endophthalmitis in a 12-month-old boy due to an open globe injury following rooster attack was reported by Lekse Kovach et al.[3]

Chimdi M Chuka Okosa et al.[4] reported pecking injury of left eye by a hen in a three-year-old Gambian boy leading to dot sub conjunctival hemorrhage about 0.5 mm nasal to 8 o' clock and 10 o' clock positions of the limbus.

Fracture of orbital roof is a very rare entity in pediatric population. Children are more prone to fracture with less impact possibly due to greater elasticity of orbital bones.[5] Penetrating injury to orbital wall can be caused by trajectory with high velocity either vertical or horizontal force of direction. Orbital roof fracture with frontal lobe contusion may result by perpendicular force in vertical direction.[6] Orbital roof fracture can lead to cerebrospinal fluid leakage, infections such as meningitis and brain abscess.[7]

In our case, radio-imaging could not be arranged immediately so we had to repair the prolapsed orbital fat on an emergency basis. Due to the COVID-19 lockdown, the patient was lost to follow-up subsequently after discharge.


  Conclusion Top


Henpecking can cause devastating ocular injuries especially in children. Despite the serious nature of the injury, since the eye ball was not affected, final visual outcome was good in our case. Orbito-cranial injury demands multidisciplinary approach and treatment. The special attention of parents is needed to prevent children from playing with hens or in the vicinity. In cases of accidental injuries with henpecking, parents should be aware to seek medical help as soon as possible. Timely intervention in terms of radio-imaging prior to surgical management should be done in all cases of penetrating trauma to save the eye. We advocate for an awareness program involving rural areas where pet rearing is a common practice. School health education should include child safety measures and pet handling.

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.
Menezes V, Usgaonkar UPS. Accidental henpeck as a cause of devastating eye injury. Oman J Ophthalmol 2021;11:169-71.  Back to cited text no. 1
    
2.
Ayanniyi AA, Monsudi KF, Danfulani M, Jiya PY, Balarabe HA. Uniocular blindness in a 6 year old boy following penetrating eye injury from a domestic hen peck. J R Soc Med Sh Rep 2013;4:9:1-3.  Back to cited text no. 2
    
3.
Lekse Kovach J, Maguluri S, Recchia FM. Subclinical endophthalmitis following a rooster attack. Rep JAAPOS 2006;10:579-80.  Back to cited text no. 3
    
4.
Chuka Okosa CM. Pecking injury of the eye by a hen: A case report. J Coll Med 2002:7:33-4.  Back to cited text no. 4
    
5.
Bansagi ZC, Meyer DR. Internal orbital fractures in the pediatric age group: Characterization and management. Ophthalmology 2000;107:829-36.  Back to cited text no. 5
    
6.
Turbin RE, Maxwell DN, Langer PD, Frohman LP, Hubbi B, Wolansky L, et al. Patterns of transorbital intracranial: A review and comparison of occult and non-occult cases. Surv Ophthalmol 2006;51:449-60.  Back to cited text no. 6
    
7.
Kim JW, Bae TH, Kim WS, Kim HK. Early reconstruction of orbital roof fractures: Clinical features and treatment outcomes. Arch Plast Surg 2012;39:31-5.  Back to cited text no. 7
    


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