Penetrating Ocular Fishhook Injury

A patient with a history of stroke, hypertension, and pseudophakia of both eyes, presented with eye trauma while fishing without protective eyewear. While reeling in, his fishhook flew out of the water and hit him in the right eye. On presentation, his right eye visual acuity was light perception, intraocular pressure was unable to be evaluated, the pupil was fixed with no afferent pupillary defect, and extraocular movements were full. On exam, there was a large, curved, barbed fishhook penetrating his inferonasal cornea and iris. He had a hyphema and fibrin in the anterior chamber and no view to the fundus. On B-scan ultrasound, there were vitreous opacities and membranes. He underwent surgery with removal of the fishhook by the cut-out technique, repair of the corneal laceration with nylon sutures and cyanoacrylate glue, and pars plana vitrectomy with intravitreal injection of antibiotics and antifungals. Intraoperatively, he was found to have a suprachoroidal hemorrhage and overlying retinal detachment, and he developed adjacent subretinal hemorrhage during fluid-air exchange. He underwent tamponade with 12% C3F8 gas. At postop month 1, his visual acuity was 20/60, the glue was slowly dissolving over intact sutures, the central cornea and the anterior chamber were clear, and the retina was attached with resolution of the suprachoroidal hemorrhage and retinal detachment.

Presentation Date: 05/26/2022

Issue Date: 06/17/2022