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EMERGENCY DEPARTMENT:
The nail was left in place, and care was taken during the examination
to avoid manipulating the foreign body. The nail’s size and
the fear of causing further injury by accidentally displacing
the nail precluded the use of an eye shield. Because the upper
lid was stabilizing the nail (see photograph below), a large cup
was not placed over it. Intravenous vancomycin
and ceftazidime were administered immediately in the emergency
department. A CT scan of the orbit was ordered that revealed the
presence of a nail in a formed globe with a normal-appearing optic
nerve. No posterior penetration of the globe was observed, nor
were there any other foreign bodies or fractures. The medical
team prepared the patient for surgery in the operating room.
OPERATING ROOM: In
the operating room, a conjunctival peritomy
was performed from the 10-o’clock to the 2-o’clock limbal
position by carefully dissecting the conjunctiva from the nail.
The nail was removed, and protruding vitreous was cut flush to the
wound. The nail was submitted for culture. Three sutures were used
to close the scleral laceration and subconjunctival antibiotics
were injected. Indirect ophthalmoscopy was
performed under anesthesia that showed no retinal breaks or detachment.
A small amount of blood was noted near the wound site. |
