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Metallic Foreign Body Removed from Tear Duct
N O T E S , CASES, I N S T R U M E N T S METALLIC FOREIGN BODY REMOVED FROM TEAR DUCT MOHAMMAD H. LASHKARI,
M.D.
Tehran, Iran
A thorough survey of all available litera ture failed to reveal the report of a single case similar to that of my patient in whose right tear duct roentgenographic examina tion detected a metallic foreign body. CASE REPORT
A 22-year-old white woman complained of tear ing from both eyes and of pain in the area of the tear duct of the right eye. Her history showed that epiphora had developed after she had had smallpox at the age of four years. In 1967, at the age of 20 years, she under went a dacryocystectomy on the left eye. The tear duct of the right eye was unsuccessfully probed in January, 1969. The pain worsened and a third oph thalmologist treated her for two or three weeks without discovering the cause of the pain. When I first saw the patient in November, 1969, the right eye showed a scar in the region of the tear duct, caused by pericystitis, and the left eye showed the dacryocystectomy scar. Laboratory examinations detected no abnormali ties. X-ray studies, however, revealed a needleshaped metallic foreign body (Fig. 1) that appeared to be about 1.0 cm in length. Its somewhat horizon tal placement in the medial aspect of the right orbit suggested that it was located in the lacrimal canal. The patient was admitted to the hospital. A dacryocystorhinostomy under local anesthesia made possible the removal of a slender piece of metal 10 mm in length (Fig. 2) which was identified as the broken-off tip of a probe. The postoperative course was uneventful. The patient left the hospital in three days (Fig. 3) and, three days later, the suture was removed and the tear duct was irrigated. Recovery continued to be satisfactory. The most recent follow-up examina tion (Fig. 4) showed the patient to be in good con dition. The epiphora had disappeared completely and she had no complaints.
Fig. 1 (Lashkari). X-ray view of the slender metallic foreign body in the lacrimal canal.
SUMMARY
Acting on x-ray evidence, the broken-off tip of a metal probe was removed in a dacryFrom the Department of Ophthalmology, Uni versity of Tehran, Farabi Hospital, Tehran, Iran. Reprint requests to Mohammad H. Lashkari, M. D., Kakh Square, 60 Takht Jamshid Avenue, Teh ran, Iran.
Fig. 3 (Lashkari). Appearance of the patient upon discharge from the hospital.
484
AMERICAN JOURNAL OF OPHTHALMOLOGY
Fig. 4 (Lashkari). The patient shows a satisfactory result.
ocystorhinostomy from the tear duct of the right eye of a 22-year-old woman who had
AUGUST. 1971
suffered from epiphora since childhood and who had had severe pain in the area of the tear duct following numerous probings of the lacrimal canal. Removal of the metallic foreign body relieved the pain and cured the epiphora. ACKNOWLEDGMENT
I thank A. Fatemi, M.D., radiologist, and B. Parsa, M.D., for the x-ray studies and the use of laboratory facilities. I also thank Mr. Jahanfar for taking the photographs.
OPHTHALMIC MINIATURE
A child is taken, tied up in a small net, and placed towards the front part of the stage. A Sengalese comes in, bows, and slowly walks toward the place where the child is lying on the floor tied up in the net. He stoops over, looks intently at the child, and as he straightens up, the child's body is actually lifted from the floor and follows him as he walks several steps backward. He again stoops forward and allows the child to sink to the floor. To all appearances he has lifted the child from the floor with power from his eyes. The child and the net are unprepared, but the Sengalese is prepared with a set of false eyes which he wears over his natural eyes. These are made of silver and are painted to resemble the human eye. These artificial eyes have aperatures which permit a perfect range of vision and are held in place by being inserted underneath the eyelids. A very strong piece of silk twine (reaching below the knees) is fastened to each artificial eye, and a small strong hook is secured to the lower end of each piece of twine. As the Sengalese bends over and gazes intently at the child, he bends his knees and secretly inserts the hooks into the net en twining the child. After the hooks are made fast, he slowly straightens up and bends backwards, and so causes the twine to rest upon his chest, thereby taking the actual strain from his eyes, and thus raises the child from the floor. Houdini on Magic Dover Publications, 1953
M.D.
Tehran, Iran
A thorough survey of all available litera ture failed to reveal the report of a single case similar to that of my patient in whose right tear duct roentgenographic examina tion detected a metallic foreign body. CASE REPORT
A 22-year-old white woman complained of tear ing from both eyes and of pain in the area of the tear duct of the right eye. Her history showed that epiphora had developed after she had had smallpox at the age of four years. In 1967, at the age of 20 years, she under went a dacryocystectomy on the left eye. The tear duct of the right eye was unsuccessfully probed in January, 1969. The pain worsened and a third oph thalmologist treated her for two or three weeks without discovering the cause of the pain. When I first saw the patient in November, 1969, the right eye showed a scar in the region of the tear duct, caused by pericystitis, and the left eye showed the dacryocystectomy scar. Laboratory examinations detected no abnormali ties. X-ray studies, however, revealed a needleshaped metallic foreign body (Fig. 1) that appeared to be about 1.0 cm in length. Its somewhat horizon tal placement in the medial aspect of the right orbit suggested that it was located in the lacrimal canal. The patient was admitted to the hospital. A dacryocystorhinostomy under local anesthesia made possible the removal of a slender piece of metal 10 mm in length (Fig. 2) which was identified as the broken-off tip of a probe. The postoperative course was uneventful. The patient left the hospital in three days (Fig. 3) and, three days later, the suture was removed and the tear duct was irrigated. Recovery continued to be satisfactory. The most recent follow-up examina tion (Fig. 4) showed the patient to be in good con dition. The epiphora had disappeared completely and she had no complaints.
Fig. 1 (Lashkari). X-ray view of the slender metallic foreign body in the lacrimal canal.
SUMMARY
Acting on x-ray evidence, the broken-off tip of a metal probe was removed in a dacryFrom the Department of Ophthalmology, Uni versity of Tehran, Farabi Hospital, Tehran, Iran. Reprint requests to Mohammad H. Lashkari, M. D., Kakh Square, 60 Takht Jamshid Avenue, Teh ran, Iran.
Fig. 3 (Lashkari). Appearance of the patient upon discharge from the hospital.
484
AMERICAN JOURNAL OF OPHTHALMOLOGY
Fig. 4 (Lashkari). The patient shows a satisfactory result.
ocystorhinostomy from the tear duct of the right eye of a 22-year-old woman who had
AUGUST. 1971
suffered from epiphora since childhood and who had had severe pain in the area of the tear duct following numerous probings of the lacrimal canal. Removal of the metallic foreign body relieved the pain and cured the epiphora. ACKNOWLEDGMENT
I thank A. Fatemi, M.D., radiologist, and B. Parsa, M.D., for the x-ray studies and the use of laboratory facilities. I also thank Mr. Jahanfar for taking the photographs.
OPHTHALMIC MINIATURE
A child is taken, tied up in a small net, and placed towards the front part of the stage. A Sengalese comes in, bows, and slowly walks toward the place where the child is lying on the floor tied up in the net. He stoops over, looks intently at the child, and as he straightens up, the child's body is actually lifted from the floor and follows him as he walks several steps backward. He again stoops forward and allows the child to sink to the floor. To all appearances he has lifted the child from the floor with power from his eyes. The child and the net are unprepared, but the Sengalese is prepared with a set of false eyes which he wears over his natural eyes. These are made of silver and are painted to resemble the human eye. These artificial eyes have aperatures which permit a perfect range of vision and are held in place by being inserted underneath the eyelids. A very strong piece of silk twine (reaching below the knees) is fastened to each artificial eye, and a small strong hook is secured to the lower end of each piece of twine. As the Sengalese bends over and gazes intently at the child, he bends his knees and secretly inserts the hooks into the net en twining the child. After the hooks are made fast, he slowly straightens up and bends backwards, and so causes the twine to rest upon his chest, thereby taking the actual strain from his eyes, and thus raises the child from the floor. Houdini on Magic Dover Publications, 1953