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 Table of Contents  
Year : 2017  |  Volume : 110  |  Issue : 4  |  Page : 138-140

Fish-hook removal in a child from eyelid by modified retrograde technique: a case report

Department of Ophthalmology, Goa Medical College, Bambolim, India

Date of Submission05-Feb-2015
Date of Acceptance09-Sep-2017
Date of Web Publication8-Mar-2018

Correspondence Address:
Pradnya Kamat
168, 8/2, Kamat Nursing Home, Upper Bazaar, Ponda Town, Ponda 403401, Goa
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejos.ejos_2_15

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Fishing is one of the most common activities in coastal areas. Improperly disposed fishing hooks are often used by children to play with and are potential sources of ocular injuries, ranging from simple to grievous damage. Here we report a case of a 6-year-old boy who presented with a rusted fish-hook embedded in his left upper eyelid. It was removed under local anaesthesia by modified retrograde technique. We concluded that in an otherwise unharmed eye, modified retrograde technique is a safe method of removing a small barbed fish-hook from the eyelid.

Keywords: eyelid injury, fish-hook injury, hook removal, modified retrograde

How to cite this article:
Kamat P, Mailankody S, Doshi P. Fish-hook removal in a child from eyelid by modified retrograde technique: a case report. J Egypt Ophthalmol Soc 2017;110:138-40

How to cite this URL:
Kamat P, Mailankody S, Doshi P. Fish-hook removal in a child from eyelid by modified retrograde technique: a case report. J Egypt Ophthalmol Soc [serial online] 2017 [cited 2018 Mar 20];110:138-40. Available from: http://www.jeos.eg.net/text.asp?2017/110/4/138/226937

  Introduction Top

All around the world, fishing is widely practiced as an occupation or past-time and is responsible for a relatively common form of accidental injuries [1]. However, most minor injuries to the eyes from fish-hooks are rarely reported as the hook removal is generally accomplished at the injury site. More often than not safety precautions are not undertaken by adults while disposing off the fishing hooks. These hooks become potential sources of accidental ocular injuries for children, especially of fisher folks. Literature search provided very few reported cases of fish-hook injuries amongst children [2]. Hence, we report this case.

  Case report Top

A 6-year-old boy presented with a fish-hook embedded in his left upper eyelid since 4 h which occurred while playing with the hook as his friend threw it at him after getting into an argument. On examination, a rusted metallic barbed fish-hook was found embedded ∼14 mm superior to left lateral cantus. Globe was intact and no other adnexal damage was noted. Visual acuity was 6/5 in both eyes by Snellen’s chart and intraocular pressure was normal.

Fish-hook removal was undertaken in the out-patient department under local anaesthesias after taking necessary aseptic precautions by a modified retrograde technique. Child moved during injection of 2% xylocaine anaesthetic resulting in a small eyelid hematoma. After sterile preparation, we first gave a controlled push forward by about one millimetre distance to release any tissue engaged in the barb and then hook was removed very slowly by moving in the direction of the curve of the hook. This push in and then pull out technique was repeated every time resistance was encountered until it completely came out of the entry wound. A single suture was taken to appose the wound edges. Topical antibiotic ointment was prescribed for 1 week. There were no postoperative complications and the wound healed with an unnoticeable scar ([Figure 1],[Figure 2],[Figure 3]).
Figure 1 Photograph showing fish-hook embedded in the left upper eyelid.

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Figure 2 (a) Photograph showing a barbed fish-hook embedded in left upper-lid. Globe is intact. (b) Photograph posthook removal. Wound is seen apposed by a single suture.

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Figure 3 Photograph of the rusted barbed metal fish-hook.

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  Discussion Top

Accidental fish-hook injuries are common amongst adults either during occupational or recreational fishing. They are however, rare source of eye injury amongst children. The severity of ocular damage caused will vary depending upon several factors such as: type of the hook, velocity of the hook, direction and orientation from which it is thrown, position of the globe and lids at that time and reflex reaction of the patient [2]. Damage may vary from a superficial eyelid injury to a more severe, penetrating injury to the globe [1],[3]. Even the superficially embedded fish-hooks are at a risk of causing further ocular damage especially amongst uncooperative children during the process of evaluation and hence need removal by a skilled ophthalmologist in the emergency setting.

Several techniques have been described in the past for hook removal from the lids. They include retrograde, needle cover, string yank, advance and cut and vertical eyelid-splitting [3],[4],[5],[6]. Retrograde method is used mainly for superficially embedded hooks wherein a downward pressure is applied to the slank and it is pulled out the entry path. In needle cover technique, a needle is used to cover the barb in the depth of the wound and the hook is pulled out along the entry path. String yank technique involves giving traction along the string that is tied to the bend of the hook while giving pressure to the skin. Advance-and-cut technique, the hook is advanced further into the eyelid until the tip and barb are outside the eye from the other end and subsequently, wire is cut. Cut-it-out technique involves enlarging the entry wound by a clean surgical cut to remove the hook. A thorough evaluation of the type of hook and approximate depth of wound is essential in order to decide about the most appropriate and least traumatising technique of removal. Retrograde technique is generally applied for superficial non barbed hooks. In case of barbed hooks, it carries a small risk of traumatising surrounding structure during the back tracking as tissues get engaged in the barb. Hence, we used a modified push and then pull retrograde technique to slowly and steadily remove the hook without causing additional adnexal damage.

In summary, this case illustrates the risk of fish-hook injuries even amongst children and highlight the need for improving public education on safety precautions on use and disposal of old rusted hooks. It also highlights how we can successfully remove the hook in out-patient department even in a paediatric preschool patient if the child is cooperative avoiding the need for general anaesthesia. Lastly, decision on the technique for removal should be made after careful evaluation and the technique may then be then modified to minimise tissue damage.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Levy J, Lifshitz T. Eyelid fish-hook injury. Int Ophthalmol 2001; 24:297–298.  Back to cited text no. 1
Omar N, Salleh R. Eyelid hook injury − a preventable domestic injury. Saudi J Ophthalmol 2009; 23:219–220.  Back to cited text no. 2
Doser C, Cooper WL, Ediger WM, Magen NA, Mildbrand CS, Schulte CD. Fishhook injuries: a prospective evaluation. Am J Emerg Med 1991; 9:413–415.  Back to cited text no. 3
Kreis AJ. Fishing down under:case report and review of management of fishhook injury of the eyelid. Clin Exp Optom 2008; 91:473–475.  Back to cited text no. 4
Gammons MG, Jackson E. Fishhook removal. Am Fam Physician 2001; 63:2231–2236.  Back to cited text no. 5
Cannava PE. Fishhook removals. Arch Ophthalmol 1999; 117:1668–1669.  Back to cited text no. 6


  [Figure 1], [Figure 2], [Figure 3]


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