Prevention of self-induced re-injury to ruptured globe with a surgically fixated plastic eye shield

Abstract

Purpose: Open globe injury is an emergent, vision threatening condition. To ensure the best possible visual outcome after an open globe, it is essential to protect the eye from further trauma during the critical period of healing. In cases where the open globe is caused by repeated self-mutilation, long term prevention of re-injury must also be considered and can pose a significant challenge. Observations: Here we describe a 68-year-old male with a history of severe intellectual disability. The patient presented after an episode of eye self-mutilation, resulting in an open globe injury. After being taken to the operating room for emergent repair of the eye, the primary concern was how to prevent re-injury. Ultimately, as an alternative to the long-term use of restraints, the decision was made to fixate a plastic eye shield over the affected eye using sutures. The eye shield prevented any unwanted manipulation of the eye while implanted, despite several attempts. After 18 days, the eye shield was forcibly removed by the patient. However, this allowed adequate healing time, and there has not been any repeated damage to the eye since. Conclusions and Importance: Our proposal to suture a plastic eye shield to the orbital rims of a patient is an attempt to allow the eye to heal while avoiding prolonged use of restraints and minimizing long-term hospital stays. This intervention may prove to be beneficial for the population of psychologically or cognitively impaired individuals, as they are often implicated in cases of self-inflicted ocular trauma. To our knowledge, this is the first description of the use of this method.

Keywords

• Trauma
• Open globe
• Wound care
• Cognitive impairment