Thursday 18 January 2018

Op saves sight of nail in eye man

A CT scan with a nail in the eye of a patient - after it was removed vision returned to normal (AP/New England Journal of Medicine)
A CT scan with a nail in the eye of a patient - after it was removed vision returned to normal (AP/New England Journal of Medicine)

A man escaped with barely a scratch after a 3in nail hurtled into his eye when he accidentally hit it with a strimmer.

Doctors removed the nail, and eight weeks later the 27-year-old landscaper's vision had returned to normal.

But medics said had the nail struck just a millimetre away he would probably have suffered major damage.

Doctors who removed the nail at Boston's Massachusetts General Hospital describe the case in the New England Journal of Medicine.

Dr Wael Asaad, a neurosurgeon now at Rhode Island Hospital and Brown University, said: " When you looked at him, all you saw was the back end of the nail."

It happened about two years ago, and the man was not identified.

Doctors could not tell how long the nail was or its path, so radiologist Dr Rajiv Gupta used a new type of CT scanner to get detailed images.

"It reached almost to the tip of the other eye and the brain. It was a very long nail," he said.

The good news was that the nail had not penetrated the globe of the eye, but was to one side.

The bad news was that it was lodged against one of the main arteries supplying blood to the head, and another artery serving the other eye.

Dr Asaad said: "The tip of the nail was like the finger in the dam. We were worried that if we pulled it out, there would be bleeding."

There could have been a jet of blood that could damage the other eye or the brain, or even prove fatal.

So they made an elaborate plan in case an artery ruptured and had to be repaired. One surgeon was ready to operate through the head.

A second surgeon was ready to operate through the neck. As these two stood by, a third surgeon carefully pulled out the nail.

They waited several minutes. No major bleeding occurred. They stopped sedating him and the patient was allowed to wake. After a tetanus shot and a prescription for five days of preventive antibiotics, he was on his way.

Dr Asaad said as dramatic as the incident was, nails penetrating the skull are not as uncommon as might be thought, usually from nail gun accidents.

Dr Gupta said the lesson was clear - wear eye protection whenever operating heavy machinery or power tools, even simple ones used in gardening.

Press Association

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