Nail gun injury with intraocular foreign body

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Received: 22 June 2021 Accepted: 14 July 2021
DOI: 10.1002/emp2.12527
IMAGES IN EMERGENCY MEDICINE
Tra um a
Nail gun injury with intraocular foreign body
Matthew R. Starr MD Michael N. Cohen MD
Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
Correspondence
Michael N. Cohen, MD, Mid Atlantic Retina, Retina Service of Wills Eye Hospital, 840 WalnutSt. Suite 1020, Philadelphia, PA 19107 USA.
Email: mcohen@midatlanticretina.com
A 35-year-old phakic male presented to the emergency department
following a nail gun injury to his left eye. His visual acuity was 20/20 in
the right eye and 20/60 in the left eye. Slit lamp examination revealed
the nail penetrating the cornea at the nasal limbus in the left eye
(Figures 1and 2). The anterior chamber of the left eye was formed
and there were no signs of lens capsule violation. Surprisingly, the
nail curled immediately at the penetration site with minimal vitreous
FIGURE 1 Slit lamp photograph of a nail penetrating the
inferonasal limbus and into the iris and vitreous cavity of the left eye.
There was no obvious lens capsule violation or traumatic cataract
formation
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FIGURE 2 External photograph of the left eye highlighting the
course of the nail into the vitreous cavity
violation. This was confirmed on orbital radiographs and computed
tomography imaging (Figure 3).
The patient was admitted to the inpatient ophthalmology service,
received a tetanus vaccination booster, and initiated on intravenous
antibiotics before proceeding with removal 12 hours after the injury.
Given the limited vitreous penetration, the decision was made to sim-
ply remove the nail without performing pars plana vitrectomy, suture
the corneal laceration, perform laser indirect ophthalmoscopy around
a small retinal impact site, and inject intravitreal vancomycin and
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FIGURE 3 Computed tomography (CT) scan of head/orbits,
saggital scan, noting the location of the nail into the anterior vitreous
with no evidence of posterior globe penetration
ceftazidime. Two months following the injury, the patient is 20/20
uncorrected with well-healed laser scars (Figure 4).
Intraocular foreign bodies are significant ocular injuries. They typ-
ically require emergent removal and antibiotics to prevent endoph-
thalmitis and retinal detachments; however, newer evidence does
suggest delaying surgery does not increase the risk for endoph-
thalmitis or retinal detachments.1Intraocular foreign bodies with
minimal vitreous penetration may be able to be removed carefully
without concomitant vitrectomy and still achieve good anatomic
results.
FIGURE 4 Widefield false color image of the left eye with good
laser scarring around a small retinal impact site of the anterior
superonasal retina. The retina was attached with no evidence of
retinal tears or detachments
FUNDING
J. Arch McNamara, MD Fund for Retina Research and Education.
REFERENCE
1. Anguita R, Moya R, Saez V, et al. Clinical presentations and surgical out-
comes of intraocular foreign body presenting to an ocular trauma unit.
Graefes Arch Clin Exp Ophthalmol. 2021;259(1):263-268.
How to cite this article: Starr MR, Cohen MN. Nail gun injury
with intraocular foreign body. JACEP Open. 2021;2:e12527.
https://doi.org/10.1002/emp2.12527