W(EYE)RED

Abstract

Introduction
Penetrating and perforating eye injuries secondary to metal wires are a source of ocular morbidity.
Report
A 19-year-old female with unremarkable ocular history presented to the emergency room for severe left eye pain. Three days ago, the patient was fixing a wire kennel at a “doggie day care” when she felt a wire spring into her left eye. She initially disregarded the injury. Over the following three days, she reports increasing eye pain, photosensitivity, and decrease in vision. Upon presentation, the affected eye had hand motion acuity and intraocular pressure of 9 mm Hg. Pupils were equal, round and reactive to light. On slit lamp examination, the left eye was injected. A paracentral pinpoint corneal perforation was Seidel positive. There was 3+ anterior chamber cell. The anterior capsule was violated with a white, traumatic cataract obstructing the posterior view. A gentle B-scan was performed with no evidence of retinal detachment, vitritis, or intraocular foreign body. The patient was taken back to the operating room where the perforation was initially closed with liquid topical skin adhesive; the patient received intravitreal vancomycin and ceftazadime. At postoperative week 1, the patient continued to be uncomfortable secondary to phacolytic uveitis. She was taken back to surgery for a lensectomy and pars plana vitrectomy and left aphakic. The corneal glue was noted to be loose at postoperative week 1 status post lensectomy and again Seidel positive. The patient was placed on aqueous suppressants and taken back to the operating room for a compression suture which resolved the leak. The suture was eventually removed, and she received a sulcus lens with 20/25 visual acuity on postoperative day 1.
Conclusion
Oftentimes, perforating corneal injuries result in significant ocular morbidity. We report a perforating corneal injury due to a wire cage with an optimistic clinical outcome.