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Corneal lacerations following crab claw injuries
Abdelhalim A Awidi1, Fasika A Woreta1
1Cornea Cataract and Anterior Segment Division, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA.
Insights
Crab claw injuries can cause severe eye damage, including full-thickness corneal lacerations and traumatic cataracts. Handling crabs requires safety precautions to prevent serious ocular trauma.
Area of Science:
- Ophthalmology
- Trauma Surgery
Background:
- Corneal lacerations are serious eye injuries.
- Crab claw injuries are uncommon but can cause significant ocular trauma.
Observation:
- Two cases of full-thickness corneal lacerations from crab claw injuries are presented.
- One patient sustained a 9.5 mm laceration and developed a traumatic cataract, requiring multiple surgical interventions.
- The second patient developed endophthalmitis and a traumatic cataract, necessitating emergent treatment and subsequent cataract surgery.
Findings:
- Both patients experienced vision loss and required complex surgical management.
- Long-term visual acuity was affected by corneal scarring, cataract formation, and intraocular lens complications.
- Infection (endophthalmitis) was a complication in one case.
Implications:
- Crabs should be handled with caution due to their potential to cause severe eye injuries.
- Ophthalmologists should be aware of crab claw injuries as a cause of corneal lacerations and traumatic cataracts.
- Public awareness campaigns may be necessary to promote safety when handling crabs.
Purpose:
To present two cases of full-thickness corneal lacerations following crab claw injuries.
Observations:
The first case is a 61-year-old male who presented to the emergency department (ED) with right-eye discharge, pain, and vision loss. Prior to presentation, the patient was with his friends on a fishing trip when one of them caught a crab and threw it to the patient, striking him in the right eye. The crab claw caused a penetrating injury to the cornea, with the patient presenting with a 9.5 mm full-thickness corneal laceration. He underwent emergent corneal laceration repair.Six months post-trauma, because of the sustained injury, the patient developed a traumatic cataract. Cataract removal with an iris-sutured intraocular lens (IOL) was subsequently performed. In subsequent follow-up visits, due to the corneal scarring that developed and IOL decentration, the patient's visual acuity continued to deteriorate. This required a combined penetrating keratoplasty with IOL scleral fixation that was performed approximately three years following his initial injury date. The patient's uncorrected visual acuity (UCVA) was 20/50 and 20/80 at his one-year and two-year post-operative follow-up visits.The second case is a 6-year-old girl who arrived at the ED with left eye conjunctival injection. Two days prior to presentation, the patient was accidently struck by a steamed crab claw while dining with her parents. She sustained a full-thickness corneal laceration injury and was diagnosed with endophthalmitis. She was taken for emergent open globe repair, anterior chamber washout, and injection of intravitreal antibiotics. Fluid taken from the anterior chamber grew Streptococcus viridans on culture.A month later, following the development of a traumatic cataract and posterior synechiae, with the patient's vision decreasing to hand motions in her injured eye, she underwent cataract extraction and IOL implantation with posterior capsulectomy and PPV. Her UCVA was 20/80 and 20/60 at her two-month and four-month visits, respectively, and 20/50 at the four-year post-operative follow-up visit.
Conclusions And Importance:
Given the settings in which both injuries occurred, awareness should be raised to handle crabs with safety precautions as they are not inherently viewed as objects that can potentially cause corneal lacerations and subsequent traumatic cataract.
