Uniocular blindness in a six-year-old boy following penetrating eye injury from a domestic hen peck
The boy squatted near a domestic hen and her two-week-old brood of chicks (Figure left) and the ‘mother’ hen suddenly pecked the boy's left eye. There was associated pain, eye fluid loss and sudden loss of vision. The boy was rushed to the accident and emergency unit of a tertiary hospital nearby, and a casualty officer placed him on ciprofloxacin eye drops (guttae) and syrup amoxicillin. In addition, the patient was instructed to present in the eye clinic of the same hospital two days later. At the eye clinic, both general clinical condition and salient laboratory tests were essentially normal. The visual acuities were 6/9, right eye and light perception, left eye. The right eye was essentially normal. The left eye had mild lid swelling, conjunctiva hyperaemia and cornea laceration with uveal prolapse about the upper medial quadrant. The anterior chamber appeared formed, but pupillary and posterior segment details could not be ascertained.\nThe boy eventually had two stage surgeries within a month interval. Examination under general anaesthesia (EUA) revealed further details including healing fibrinous exudates on prolapsed uveal tissue, which had formed a plug along a cornea laceration (Figure , top left) (almost letter ‘L’ or ‘V’ shaped) extending from 9 o'clock to pupillary margin (about 0.4 cm) then directed upward towards 11 o'clock (about 0.5 cm) (Figure , top and lower right). The anterior chamber had iris pigments and hyphaema. There was associated traumatic cataract. After copious irrigation with normal saline the uveal prolapse was excised and wound edges freshened. The obvious lens matter in the anterior chamber was irrigated with minimal disruption. Anterior chamber was formed with viscoelastic and cornea sutured using 9/0 Nylon. Subconjunctival 4 mg dexamethasone and 20 mg gentamycin as well as initial guttae were given. The guttae were recommenced the following day following removal of eye pad and continued till the next surgery. The guttae include Ofloxalab (Ofloxacin 0.3%) 4 hourly, Flucamed® (Drugfield Pharmaceutical Limited, Sango-Ota, Nigeria) (Fluconazole 0.3%) 6 hourly, Mydriacyl (tropicamide 1%) 8 hourly and Ivyflur (Flurbiprofen Sodium USP 0.03%) 8 hourly. Furthermore, the patient was placed on syrup Cefunat® (Okasa Pharma Pvt Ltd, Satara, India) (Cefuroxime axetil USP) 250 mg 12 hourly for seven days, Brustan-N (Ibuprofen oral suspension USP 20 mL/kg/day, 10 ml 12 hourly (5 ml contain 100 mg) for five days, intramuscular tetanus toxoid, 0.5 mL and antitetanus serum, 750 IU.\nAbout a month after the first surgery, ocular ultrasound confirmed cataract and revealed intact retina (Figure ). During the second surgery, EUA revealed cornea scar, 0.4 cm by 0.5 cm (Figure , lower left) anterior synechiae, cataract, zonular dehiscence and fibrous capsular bands. Through a superior limbal incision, viscoelatic was introduced to form the anterior chamber/separate the synechiae. Irrigation and aspiration of lens matter was carried out and fibrous bands excised. The available 23.5 Dioptre posterior chamber intraocular lens was implanted. The incision was closed using 9/0 Nylon and the routine drugs were administered as in the first surgery. Postoperatively, guttae were continued as in the first surgery. Also given were oral prednisolone 5 mg daily for 10 days, syrup brustan-N and ascorbic acid 5 mL eight hourly for seven days. Nine months after the surgery, the visual acuity was 2/60.