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Corneal laceration caused by river crab
Naidu Vinuthinee1, Anuar Azreen-Redzal2, Jaafar Juanarita2
1Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia ; Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Insights
A child sustained a corneal ulcer and laceration from a river crab injury. Prompt surgical repair and antibiotic treatment led to significant vision recovery.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Corneal trauma can lead to microbial keratitis.
- Ocular injuries from aquatic animals pose diagnostic and therapeutic challenges.
Observation:
- A 5-year-old boy presented with acute eye pain, tearing, and photophobia after a river crab injury.
- Initial examination revealed a corneal ulcer with hypopyon; later, a full-thickness corneal laceration was discovered.
- Cultures identified Citrobacter diversus and Proteus vulgaris.
Findings:
- The patient received topical antibiotics (gentamicin, ceftazidime) and underwent emergency corneal repair (toileting and suturing).
- Postoperative treatment included oral ciprofloxacin, topical antibiotics, and corticosteroids.
- Vision improved to 6/6 with pinhole correction by the 2-week follow-up.
Implications:
- This case highlights the importance of thorough examination in diagnosing traumatic corneal injuries, even when initial tests are negative.
- Early surgical intervention and appropriate antimicrobial therapy are crucial for managing complex microbial keratitis secondary to ocular trauma.
- River crab-related eye injuries require prompt management to prevent vision loss.
Abstract:
A 5-year-old boy presented with right eye pain associated with tearing and photophobia of 1-day duration. He gave a history of playing with a river crab when suddenly the crab clamped his fingers. He attempted to fling the crab off, but the crab flew and hit his right eye. Ocular examination revealed a right eye corneal ulcer with clumps of fibrin located beneath the corneal ulcer and 1.6 mm level of hypopyon. At presentation, the Seidel test was negative, with a deep anterior chamber. Culture from the corneal scrapping specimen grew Citrobacter diversus and Proteus vulgaris, and the boy was treated with topical gentamicin and ceftazidime eyedrops. Fibrin clumps beneath the corneal ulcer subsequently dislodged, and revealed a full-thickness corneal laceration wound with a positive Seidel test and shallow anterior chamber. The patient underwent emergency corneal toileting and suturing. Postoperatively, he was treated with oral ciprofloxacin 250 mg 12-hourly for 1 week, topical gentamicin, ceftazidime, and dexamethasone eyedrops for 4 weeks. Right eye vision improved to 6/9 and 6/6 with pinhole at the 2-week follow-up following corneal suture removal.
