Penetrating ocular fish-hook injuries. Surgical management and long-term visual outcome.

Abstract

Ocular penetrating fish-hook injuries represent a rare yet potentially devastating ocular trauma. To date, only five cases have been reported in the medical literature. The authors present five new cases with long-term follow-up. All individuals who presented to the Wilmer Ophthalmological Institute emergency room with ocular fish-hook injuries between 1974 and 1990 were identified, and ophthalmic follow-up evaluations were performed. Individuals were male, between the ages of 10 and 27, with follow-up evaluation of 2.0 to 15.5 years (mean, 6.7 years). The left eye was involved in 80% and in no instance had a single hook penetrated the lid and globe simultaneously. Initial visual acuity was uniformly poor (20/200 or worse). Using specialized surgical techniques, ultimate visual outcome was excellent in 80% of cases (4 of 5 with visual acuity of 20/30 or better). One eye was enucleated because of panendophthalmitis after delayed wound closure. Similar overall results are achieved when previous reports are included in the analysis (90% with visual acuity of 20/40 or better). These results suggest that penetrating ocular fish-hook injuries may have an excellent long-term prognosis if prompt, appropriate surgical intervention is accomplished.