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The cotton bud as a missile causing penetrating eye injury
  1. GREGOR L CAMPBELL-HEWSON,
  2. CONOR V EGLESTON,
  3. SUSAN M ROBINSON
  1. Accident and Emergency Department
  2. Addenbrooke’s Hospital, Cambridge CB2 2QQ
  1. Gregor L Campbell-Hewson.

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Editor,—Airguns have been responsible for a substantial number of eye injuries over the past 70–80 years. In published series airguns have accounted for up to 7% of severe eye injuries.1 Sevel and Atkins reported a final visual acuity of 6/60 or less in 77% of patients following an airgun pellet injury to the eye.2 A recent study demonstrated that injuries caused by the discharge of airguns were the commonest cause of enucleation secondary to trauma in the paediatric and adolescent population.3 We report an unusual case of severe eye injury resulting from an apparently harmless household item used inappropriately as air weapon ammunition.

CASE REPORT

A 15-year-old boy broke a plastic cotton bud and fired it from a 0.22 air rifle. The cotton bud hit his older brother from a range of 5–7 metres. The cotton bud penetrated the eyelid, sclera, and pars plana in the superonasal quadrant of the right eye. As an impulsive action the patient removed the cotton bud from his eye immediately. On examination in the accident and emergency department he had a scleral wound with ciliary body exposed and no perception of light in the affected eye (Fig 1). The cornea was oedematous and no view of the fundus was possible. At primary repair apposition of the scleral wound was not possible and therefore closure was achieved using an autologous half thickness scleral flap.

Figure 1

Clinical photograph of right eye on presentation with penetrating injury in superior sclera.

The patient had no perception of light at 1 day, 1 week, and 1 month following the operation. The eye became hypotonous and phthisical and remained uncomfortable. Five months after the injury the eye was enucleated. Histological examination of the eye (Fig 2) demonstrated a superonasal penetrating wound resulting in massive subretinal haemorrhage and subsequent organisation causing a total fibrotic funnel retinal detachment. There were occasional areas of chronic inflammation within the eye but no evidence of sympathetic ophthalmitis.

Figure 2

Enucleated eye with total fibrotic funnel retinal detachment (asterisk), massive subretinal haemorrhage (arrowheads), and site of penetrating injury (arrow) (haematoxylin and eosin, × 1.5).

COMMENT

Eye injuries from the discharge of airguns tend to be accidental rather than malicious.4 The injury described in this report can be regarded as the result of poor gun safety rather than a deliberate attempt to injure.

In a series of 105 eye injuries caused by discharge of airguns5 only one penetrating injury avoided enucleation and in this case final vision was reduced to hand movements only. More recently in a series of 60 ocular airgun injuries 11 out of 16 penetrating injuries required enucleation and none of the eyes retained visual acuity better than counting fingers.6 In all of these cases the injury resulted from lead pellets, or ball bearings, or darts. We know of only one other case of eye injury resulting from unconventional airgun ammunition, a contusional injury caused by a piece of pear fired from an air weapon.6

Most air rifles available in the UK have muzzle velocities of between 600 and 800 feet per second (185 m/s to 250 m/s). It has been demonstrated that an airgun pellet only requires a velocity of 236 feet per second (72 m/s) to penetrate the globe.7 In our case a missile weighing less than 0.13 g was responsible for a devastating injury. We contend that air weapons belong on the shooting range rather than in the back garden.

Acknowledgments

We wish to thank Mr T Rimmer for allowing us to report the details of his patient and Dr Ian Cree for carrying out the pathological examination.

References

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