Minor trauma, disastrous results

An 81-year-old-woman developed a right facial palsy and orbital cellulitis following an apparently innocuous puncture injury of the right lower eyelid. Generalized tetanus ensued which proved fatal despite aggressive treatment including use of tetanus immune globulin, wound debridement, and neuromuscular blockade with ventilatory assistance. Tetanus immunization status should be ascertained in all patients with potentially contaminated wounds in and around the eye. Cephalic tetanus, may be misleading initially because of the presence of cranial nerve palsies and the absence of classic signs such as trismus and risus sardonicus.