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Clinicopathologic Reports, Case Reports, and Small Case Series
May 2002

Here's Egg in Your Eye: An Unusual Penetrating Eye Injury

Arch Ophthalmol. 2002;120(5):666-667. doi:

Many unique, interesting, and even bizarre cases of penetrating eye injuries have previously been reported. Examples include injuries caused by a fishing hook1 and a golf tee,2 pecking injuries due to magpies3 and cormorants,4 and even a boa constrictor bite that perforated its owner's right eye.5 This report presents a case of a penetrating eye injury caused by an exploding emu egg, which to the best of our knowledge is the first such case reported in the ophthalmic literature. (Note: The emu is a large native bird of Australia, and adult birds may grow to more than 6 ft in standing height. Emu eggs are routinely about 5 times the size of a normal chicken egg.)

Report of a Case

A 10-year-old boy sustained a severe penetrating injury to his left eye from an exploding emu egg. He was expelling the egg's contents with an air compressor when yolk blocked the exit hole, causing the egg to explode. An examination revealed a full-thickness paracentral laceration of the cornea, extending from the superior to inferior limbus. The boy's visual acuity was light perception only OS. A computed tomographic scan revealed a large foreign body lodged in the nasal retina.

Later that day, the boy underwent surgery. The prolapsed vitreous was excised, and the corneal wound was sutured so that the intraocular pressure could be maintained. A 3-port pars plana vitrectomy and lensectomy were performed. The eggshell fragment embedded in the nasal retina was identified and removed from the eye with intraocular forceps via the corneal laceration, which was reopened (Figure 1 and Figure 2). The corneal wound was resutured, an inferonasal segmental scleral buckle was applied, and perfluoropropane gas was injected into the eye.

Figure 1.
Removal of the emu eggshell fragment
from the eye via the corneal laceration.

Removal of the emu eggshell fragment from the eye via the corneal laceration.

Figure 2.
The colorful, triangular, 11-mm
emu eggshell fragment adjacent to the corneal laceration.

The colorful, triangular, 11-mm emu eggshell fragment adjacent to the corneal laceration.

An intraoperative vitreous biopsy was obtained, and intravitreal injections of vancomycin hydrochloride (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL) were administered. Biopsy cultures revealed a mixed growth of viridans streptococci, Haemophilus parainfluenzae, Neisseria species, and Staphylococcus aureus (coagulase-positive). Oral and topical ciprofloxacin hydrochloride therapy was commenced postoperatively.

Six months later, further surgery was performed involving a sutured-in posterior chamber intraocular lens. At the most recent follow-up visit, the boy's pinhole visual acuity had improved to 20/30 OS.

Comment

For penetrating eye injuries involving organic matter, it is essential to collect vitreous and/or other appropriate intraocular specimens during the initial surgical procedure. Once intravitreal antibiotics are given, it may be very difficult to isolate the infecting organisms from subsequent aspirates.4 This is particularly important in penetrating injuries with a high risk of infection such as those including animal, soil, or water contamination. In addition, when gas or oil exchange is performed, injecting intravitreal antibiotics beforehand enables an appropriate concentration to be maintained after the exchange.

This case report presents a very unusual penetrating eye injury that, with appropriate and timely treatment, resulted in a good clinical outcome.

The authors thank Claire Cantwell and the Central Medical Illustration Unit, Royal Brisbane Hospital, Herston, Queensland, for their assistance with the preparation of the photographs.

Corresponding author and reprints: Lawrence R. Lee, FRANZCO, Department of Ophthalmology, Royal Brisbane Hospital, PO Box 41, Herston, Queensland 4029, Australia (e-mail: eye@cityeye.com.au).

References
1.
Krott  RBartz-Schmidt  KVHeimann  K Laceration of the eye with a fishing hook. Br J Ophthalmol. 1999;831194Article
2.
Mulvihill  AO'Sullivan  JLogan  P Penetrating eye injury caused by a golf tee. Br J Ophthalmol. 1997;81- 91
3.
Horsburgh  BJStark  DJHarrison  JD Ocular injuries caused by magpies. Med J Aust. 1992;157756- 759
4.
Lee  LRO'Hagan  SDal Pra  M Aeromonas sobria endophthalmitis. Aust N Z J Ophthalmol. 1997;25299- 300Article
5.
Kleinman  DMDunne  EFTaravella  MJ Boa constrictor bite to the eye. Arch Ophthalmol. 1998;116949- 950Article
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