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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 56  |  Issue : 1  |  Page : 29-31

An unusual cause of globe rupture in a child and its management


Department of Ophthalmology, Madurai Medical College, Madurai, Tamil Nadu, India

Date of Web Publication4-Jun-2018

Correspondence Address:
Dr. Gautham Kabilan
Department of Ophthalmology, Madurai Medical College, No: 9, 1st Floor Meenakshi Niwas, 1st Street, Namasivayam Nagar, Bypass Road, Madurai - 625 016, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_33_18

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  Abstract 


Globe rupture in children usually occurs from injury with sharp objects. Our patient had a pungai (Indian beech tree) seed thrown at his right eye and presented with ruptured globe. Globe repair was done, and the patient had a good visual outcome. Awareness about the outcome of open globe injury with unusual things should be created.

Keywords: Blunt pungai seeds, children, globe rupture, Indian beech tree, unusual cause


How to cite this article:
Kumar AR, Kabilan G, Kavitha K. An unusual cause of globe rupture in a child and its management. TNOA J Ophthalmic Sci Res 2018;56:29-31

How to cite this URL:
Kumar AR, Kabilan G, Kavitha K. An unusual cause of globe rupture in a child and its management. TNOA J Ophthalmic Sci Res [serial online] 2018 [cited 2019 Nov 20];56:29-31. Available from: http://www.tnoajosr.com/text.asp?2018/56/1/29/233724




  Introduction Top


Ocular trauma in children is a very sensitive topic due to its effect on lifelong visual prognosis and socioeconomic outcome. Some previous studies[1-3] have identified wooden stick, metal piece, glass piece, firecrackers, pencils, and pen as the objects commonly leading to eye injury in children. Sufficient awareness also exists in the community regarding the dangers posed by these with regard to ocular trauma.

Pungai tree (Pongamia pinnata), aka Indian beech tree, is abundantly found in Southeast Asia. Each seed weighs about 1.1–1.8 g and is flat, oval shaped with rounded edges. It is very common in rural areas where children tend to play with these seeds. We selected this case as it was a rare encounter for us, and there was no preexisting report identifying this as a cause of globe rupture in children. Even in the community, there seems to be less awareness about serious injuries caused by such common objects.


  Case Report Top


Our patient, a 10-year-old male child, was referred as a case of right eye (RE) globe rupture with an alleged history of accidental injury by pungai seed thrown at him while playing at school with his friends. The informant was his mother with good reliability.

The patient had a full-thickness scleral tear on the nasal side of his RE with uveal tissue prolapsing through it [Figure 1] and vitreous disturbance in the anterior chamber (AC). He was in severe agony. He had perception of light in his RE. RE was hypotonic with severe congestion, but his cornea was clear. AC was deep and there was phacodonesis. There was inferior iridolenticular contact. Computerized tomography scan ruled out any foreign body in the RE [ [Figure 2]. His left eye was normal. His vitals were stable and blood routine was within normal limits. After obtaining fitness, he was shifted to emergency operation theater. Guarded visual outcome was explained to his parents, and with their consent, RE globe repair was done under general anesthesia within 24 h of the injury. Uveal tissue was abscised and closed with 8-0 prolene; conjunctiva was sutured with 10-0 vicryl. Intracameral moxifloxacin was given. AC was reformed and pad and bandage were applied.
Figure 1: Right eye at presentation (uveal tissue prolapse)

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Figure 2: Computerized tomography orbit – no evidence of foreign body or bony orbital injuries

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He was started on intravenous cefotaxime, topical moxifloxacin, moxifloxacin/dexamethasone, atropine eye ointment, and oral prednisolone, with daily monitoring of vision and intraocular pressure (IOP). On his first postoperative day (POD), vision improved to 6/9 in the RE and IOP was normal. On his 3rd POD, fundus examination revealed preretinal hemorrhages and vitreous opacities [Figure 3]. The patient was discharged on his 8th POD with the advice to continue topical moxifloxacin eye drops (e/d) 6 times per day (t/d), moxifloxacin-dexamethasone e/d 6 t/d, nepafenac e/d thrice daily, homatropine e/d BD (twice daily), oral prednisolone, and regular follow-up. His vision was 6/12 and IOP was 15 mmHg at the time of discharge.
Figure 3: Right eye fundus photograph showing 3rd postoperative day (vitreous opacities and preretinal hemorrhages)

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During the first follow-up visit after 1½ months, his vision in RE was 6/12, wound site was healthy, and subconjunctival hemorrhage was resolving. Pupil remained pharmacologically dilated, IOP was normal, and preretinal hemorrhage was resolving. The frequency of the topical drugs and dosage of prednisolone were tapered and stopped. He was given fitness to attend school thereafter.

During subsequent follow-up after 3 months, his vision in RE was 6/9, wound site was healthy [Figure 4], IOP was normal, pupil was reacting to light, and the fundus showed resolved preretinal hemorrhage. All medications were stopped except for topical nonsteroidal anti-inflammatory drugs.
Figure 4: Right eye at second follow-up visit

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  Discussion Top


In school premises, we have lots of pungai trees and children tend to play with the shed seeds. It should be cautioned and awareness should be created regarding eye injuries. We would like:

  1. To have routine awareness programs in schools regarding eye care along with other screening programs
  2. To create awareness among students, teachers, and public regarding the sequelae of eye injuries
  3. To educate that whenever eyes are injured, immediately wash the eyes with clean water and should be referred to a nearby ophthalmologist as early as possible.


Previous studies on open globe injury in children[4-8] have recorded the causes as sharp objects commonly. We selected this case as globe rupture caused by seeds presented for its rarity. We report this case to create awareness because small pungai seeds can also cause devastating injuries.

Hence, always prevention is better than cure.

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.
Saxena R, Sinha R, Purohit A, Dada T, Vajpayee RB, Azad RV, et al. Pattern of pediatric ocular trauma in India. Indian J Pediatr 2002;69:863-7.  Back to cited text no. 1
    
2.
Narang S, Gupta V, Simalandhi P, Gupta A, Raj S, Dogra MR, et al. Paediatric open globe injuries. Visual outcome and risk factors for endophthalmitis. Indian J Ophthalmol 2004;52:29-34.  Back to cited text no. 2
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3.
Lee CH, Lee L, Kao LY, Lin KK, Yang ML. Prognostic indicators of open globe injuries in children. Am J Emerg Med 2009;27:530-5.  Back to cited text no. 3
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4.
Salvin JH. Systematic approach to pediatric ocular trauma. Curr Opin Ophthalmol 2007;18:366-72.  Back to cited text no. 4
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5.
Brophy M, Sinclair SA, Hostetler SG, Xiang H. Pediatric eye injury-related hospitalizations in the United States. Pediatrics 2006;117:e1263-71.  Back to cited text no. 5
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6.
Gogate P, Sahasrabudhe M, Shah M, Patil S, Kulkarni A. Causes, epidemiology, and long-term outcome of traumatic cataracts in children in rural India. Indian J Ophthalmol 2012;60:481-6.  Back to cited text no. 6
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7.
Tok O, Tok L, Ozkaya D, Eraslan E, Ornek F, Bardak Y, et al. Epidemiological characteristics and visual outcome after open globe injuries in children. J AAPOS 2011;15:556-61.  Back to cited text no. 7
    
8.
Li X, Zarbin MA, Bhagat N. Pediatric open globe injury: A review of the literature. J Emerg Trauma Shock 2015;8:216-23.  Back to cited text no. 8
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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