Wir überwinden Grenzen

(09.09.2016) Martin K.* went snorkeling and diving in the Red Sea in Egypt. But when he took off his diving goggles as usual while snorkeling and swimming underwater, something hit his left eye. He couldn't see exactly what it was. His eye bled and hurt a little for a short time. The acute pain soon passed, but something was wrong with his eye.

Drooping eyelid and double vision

When the situation did not improve even after four weeks, he turned to the Department of Ophthalmology at the Freiburg University Medical Center. "The patient could only open his right eyelid about halfway. He also saw double vision, as if he were squinting, when he looked upwards," says Professor Dr. Wolf Lagrèze, Head of the Section of Neuroophthalmology, Pediatric Ophthalmology, Strabismus Treatment at the Freiburg University Medical Center and Head of the Freiburg Orbita Center. At the Orbita Center, experts from a total of eleven departments at the University Medical Center Freiburg work together to provide optimal treatment for diseases and injuries of the eye socket.

During the first examination, Professor Lagrèze felt an unusual, roundish, scarred area on the left upper eyelid. The ophthalmologist initially suspected that it was a benign nodule or a small scar. This is also known as a granuloma. Magnetic resonance imaging, which can be used to visualize the soft tissue of the eye in great detail, should reveal something about the cause of the nodule. "Nothing unusual was seen on the MRI images, just a lump in the eyelid tissue," says Professor Lagrèze.

Two objects that looked like straws at first glance

Under local anaesthetic, Professor Lagrèze's team therefore set about surgically removing the granuloma. "When we cut open the scar, we discovered a dark blue-greenish foreign body," says Professor Lagrèze. It was then discussed with the patient to switch the operation to a general anesthetic. "During further dissection of the scar, two objects appeared that initially looked like straws and reached deep into the eye socket. Fortunately, they could be pulled out relatively easily," says the eye expert. The wound on the eyelid was then sutured and closed with a bandage.

Fish experts clarify the origin

The exact nature of the approximately three-centimetre-long, transparent and pointed objects was only revealed by the analysis of the Hamburg Thünen Institute of Sea Fisheries. The doctors had already suspected that the foreign bodies could be parts of a fish. The scientists there identified them as the lower jaw of the halfbeak, which is native to tropical waters and searches for prey in shallow water just below the surface.

"Obviously the patient collided with the fish and the lower jaw bones above the eyeball penetrated the eye socket and broke off. Like two pins, they have fixed the lifting muscle of the eyelid and the muscle for upward movements of the eye," says Professor Lagrèze. As this meant that only the right eye could move when looking upwards, the double vision occurred. After three months, the injury was completely healed. "There is no reason why the patient should not go snorkeling in the future," says Professor Lagrèze.

* Name changed by the editors