Dr Hurley is from the University of Ottawa Eye Institute and did fellowship training at Wills Eye Hospital. Dynamic speaker who runs Power Point for physicians course at the COS each year.
(Apologies, but there is no audio feed available for this talk.)
Most of the cases for this talk were from patients seen during his fellowship at Wills Hospital. Not always easy to get photos at time of injury but has great images from then.
Starts with case from Ottawa, 38 you healthy male, felt something fly up out of the water in the ocean in Haiti. Diagnosed with conjunctivitis but vision deteriorated over 4 days. Vision CF and full thickness laceration lower eyelid which in fact went right through sclera. Also had frozen globe with IOP of 0. Posteriorly saw vitreous haem and whitish material. CT scan show intravitreal FB penetrating out posterior of eye. This is now almost a week after initial injury.
Started IV Cipro, closure scleral entrance wound, removed foreign body. Later developed nasal RD. Most recently, 7/12 post-op, VA 6/6 with correction, and subretinal fibrosis present.
Foreign Body identified by Dr Seymour Brownstein and determined to be a piece of that fish…a needle fish.
Shows another case, this one from the literature, in which almost entire jaw of the needle fish was in the orbit despite a very small entry site.
How can we avoid missing something like this in the future? Certainly with a de-gloving injury or stab, you know there is damage. When less obvious, must always maintain high level of suspicion and know when to explore. Don’t just look at the wound; know the circumstances. Don’t forget detailed complete exam.
Ancillary studies: if non-metallic FB, an MRI can help but not always easy to obtain. Ultrasound good option and more accessible. UBM high resolution but does not penetrate too deeply (trade-off.)
Sums of reviewing signs of ruptured globe. When in doubt, explore.