Ocular nail gun injuries: epidemiology and visual outcomes

Nail-gun accidents have become a common reason for penetrating ocular injuries in patients presenting to the emergency room with globe trauma. To date, there are only five patients (one case report and one small case series) in the medical literature of penetrating ocular injury due to nail-guns. The aim of this study is to describe the epidemiology and visual outcomes of patients presenting to a tertiary medical center with ocular injuries resulting from nail-gun injuries.

This is an institutional review board-approved retrospective chart review of 24 patients presenting to the Medical University of South Carolina after sustaining eye injuries secondary to the use of nail-guns. The records of 178 patients with penetrating eye injuries treated between July 1996 and June 2006 were reviewed. Twenty-four patients (14%) had open globe injuries related to nail-guns. Demographic data, ocular examination findings, and visual outcomes were recorded.

Of the 24 cases identified, 17 were work-related; this represented approximately 71% of patients. All were men with an average age of 29.4 years. Fifty-eight percent of the patients were non-English speaking. There was no record of any patient wearing safety glasses at the time of injury. The visual acuity at presentation ranged from 20/20 to hand motion or worse. Half (50%) of these patients had a presenting visual acuity of hand motion or worse. At last examination, 38% (nine patients) had visual acuity of 20/40 or better, 34% (eight patients) had visual acuity of counting fingers to hand motion, 13% (three patients) 20/60, 4% (one patient) 20/200, and three were lost to follow-up. The correlation coefficient between visual acuity at presentation and most recent was significant at 0.679 (p = 0.001).

The majority of nail-gun injuries presented in this series were work-related. These injuries could be prevented with adherence to established safety measures including proper training and education of nail-gun operators, the use of sequential-trip triggers, and required safety glasses. Visual acuity outcomes of these 24 patients are better than what might be expected due to the nature of the injury.