Management of Metal Nail Penetrating the Eye
A person who sustains a penetrating eye injury from a metal nail should seek immediate medical attention and should not attempt to remove the nail, as this requires specialized surgical intervention to prevent further damage to ocular structures. 1
Immediate First Aid
- Do not attempt to remove the penetrating object as this could cause additional damage 1
- Do not rub the eye as this can worsen the injury 1
- Tape a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent unintentional touching 1
- Seek immediate emergency medical attention 1
Medical Management
The treatment approach for a penetrating eye injury from a metal nail involves a multi-step surgical procedure:
Surgical Intervention
- Primary surgical repair of the entry wound 2, 3
- Careful removal of the metal nail under controlled surgical conditions 2, 3
- Repair of any scleral or corneal lacerations 2, 4
- Assessment and management of associated injuries to intraocular structures 2, 3
Additional Surgical Procedures Based on Extent of Injury
- Pars plana vitrectomy if there is vitreous involvement 2
- Lensectomy if the lens is damaged 2
- Laser photocoagulation to seal any retinal damage 2
- Possible intraocular lens implantation at a later date 2
Post-Surgical Management
- Broad-spectrum topical antibiotics to prevent infection 5
- Pain management with topical NSAIDs and/or oral analgesics 5
- Regular ophthalmological follow-up to monitor healing 6
Prognosis
- Visual outcomes depend on the extent of injury and structures involved 2, 4
- Despite the severity of penetrating nail injuries, good visual outcomes are possible with prompt and appropriate surgical management 2, 4
- In cases with minimal damage to critical structures like the retina and optic nerve, visual acuity can be restored to near-normal levels 2, 3, 7
Prevention
- Proper training for nail gun operators 2
- Mandatory use of safety equipment, particularly safety glasses 4
- Most eye injuries from nails are preventable with appropriate safety measures 2, 4
Potential Complications
- Infection
- Retinal detachment
- Traumatic cataract
- Glaucoma
- Sympathetic ophthalmia
- Permanent vision loss 2, 4
Important Considerations
- The high velocity of nail penetration may result in less contusive force and potentially better outcomes than expected 4
- Double penetrating injuries (entry and exit wounds) require specialized management techniques 7
- Intraocular foreign bodies require immediate removal to prevent complications such as endophthalmitis and metallosis 2, 3