gms | German Medical Science

Orbital lesions by foreign bodies are a common disorder in ophthamology. They are frequent in handcraft, accidents and acts of violence. According to the variety of causes various kinds of foreign bodies could be found while exploring the orbit. This case report is the first description of an orbital lesion by fish offence in the Baltic Sea.

A 38-year-old man introduced himself to our eye clinic one week after he had encountered a resting fish under the sea surface while he was swimming in the Baltic Sea at 11 pm. At the encounter he felt a shooting pain in a massively bleeding wound of the right eye. Except for a tiny superficial lesion of the upper lid skin the primary ophthalmological examination did not reveal any pathology. Computer tomography (CT) was inconspicuous. One week later we found slight diplopia due to moderate deficiency of eye elevation on the right side maybe caused by lid swelling. Visual acuity was 20/20 on both sides. Anterior and posterior segments were without disorders. We treated with systemic antibiotics. A further CT revealed a 2cm long foreign body in the nasal upper compartment of the orbit. It lay near to medial rectus muscle. Subsequently, surgical exploration was performed in general anethesia. Multiple fragments of chalk-like substance with little teeth could be extracted via transconjunctival and transpalpebral access. The following analysis showed that these parts were fragments of a garfish's jaw. Control CT could demonstrate no remaining foreign bodies. After wound suture and antibiotic therapy symptoms improved rapidly.

Trauma of the orbit by garfish's jaw fragments is a rare disorder. Due to the jaw's structure it can be easily overseen in CT. Minimal objective findings were contradictory to the extent of the patient's grievances. This and the exceptional history bring about the risk of diagnostic inattention the more so as fish attacks in the Baltic Sea are not to be assumed. The trauma, however, is according to the way garfish attack and hunt. So keeping garfish in an aquarium is impossible as the fish attack their reflection and often shatter their jaws. As garfish hunt during nighttime under the sea surface, late hour swimming in the Baltic Sea may not be recommended.