A barbed fish hook embedded in the eye is an injury unlikely to be forgotten by any ophthalmic surgeon.
This young man presented with a corneal perforation of the left eye caused by a fish-hook injury while fishing. The fish-hook penetrated the cornea, passed the anterior chamber and iris, and exited into the lens through the pupil. He underwent surgery under local anesthesia to remove the intraocular foreign body and to repair the wound. The hook was removed backing through the entrance wound, enlarge the primary scleral laceration.
Fish-hook injury is a really uncommon event and frequently occurs in the skin involving hands and fingers mostly. There are only a few cases of ocular penetrating fish-hook trauma published in the medical literature. All eye structures can be involved.
There are four primary surgical techniques for the removal of fish-hooks embedded in nonocular tissue and their advantages and drawbacks in ophthalmic injuries. (a) The “back-out” or “retrograde” method, useful for barbless hooks, refers to backing the hook out through its entrance laceration. In globe trauma its use can bring excessive damage. (b) On the “snatch” or “string-yank” technique, not recommended for penetrating ocular injuries, downward pressure on the hook shank is used during a rapid extraction. (c) The “advance and cut” technique, the most useful method in anterior segment fish-hook laceration, consists of performing a controlled surgical incision to allow a traumatic release of the point and barb. The fish-hook is advanced through the tissue causing a second wound, the barb is then cut, and the remaining hook is backed out through the entry wound. (d) The “needle-cover” technique, the common choice for hook penetration of the retina, consists of passing a large bore needle into the eye through the hook entry laceration and then to engage the fish-hook barb within the lumen of the needle and both are removed at the same time.
Although the fish-hook injury represents generally a serious occurrence, in some cases, a prompt and appropriate method of extraction can lead to a good final outcome.