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Year : 2021  |  Volume : 33  |  Issue : 2  |  Page : 209-210

Complete eyelid loss due to dog bite: A rare presentation

Department of Ophthalmology, Goa Medical College, Bambolim, Goa, India

Date of Submission25-Jun-2020
Date of Acceptance04-Jul-2020
Date of Web Publication21-Aug-2021

Correspondence Address:
Dr. Akshaya Nagvenker
Pin Code: 403716, Near Dandi Ground Adsulim, Benaulim, Salcete, Goa
Dr. Ugam P.S. Usgaonkar
Professor and Head of Department of Ophthalmology, Goa Medical College, Bambolim, Pin code: 403202, North-Goa, Goa.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_88_20

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A 46-year-old male presented with a history of dog bite to the left eye. Examination revealed complete loss of the left upper eyelid with loss of the upper punctum and the surrounding tissue with extensive tissue damage. Anterior segment examination revealed an irregular epithelial defect, and the rest of the findings were unremarkable. After a thorough assessment and cleaning, anti-rabies immunoglobulin injection was given around the wound and anti-rabies vaccination schedule was started. Locally the eye was covered with plastic shield to prevent exposure after instillation of homatropine eye drop as a cycloplegic and chloramphenicol eye ointment as a broad-spectrum antibiotic. Systemically amoxicillin-clavulanic acid and metronidazole was started. Daily dressing was done for about a week. Once signs of healing were seen, the patient was posted for multi-step lid transplantation.

Keywords: Dog bite, eyelid loss, rare presentation

How to cite this article:
Naik VD, Usgaonkar UP, Nagvenker A. Complete eyelid loss due to dog bite: A rare presentation. Kerala J Ophthalmol 2021;33:209-10

How to cite this URL:
Naik VD, Usgaonkar UP, Nagvenker A. Complete eyelid loss due to dog bite: A rare presentation. Kerala J Ophthalmol [serial online] 2021 [cited 2021 Nov 30];33:209-10. Available from: http://www.kjophthal.com/text.asp?2021/33/2/209/324205

  Introduction Top

Dog bites are not uncommon. However, most of these dog bites involve the upper and lower limbs. Dog bite to the head and face is more common in children. Ocular injuries due to dog bite are uncommon. Literature search did not reveal any case of dog bite causing complete upper lid loss and hence, we report this interesting case.

  Case Report Top

A 46-year-old-male presented to the emergency department with 2-h history of dog bite to the left eye as the patient was found over the floor under the influence of alcohol.

Examination revealed complete loss of the left upper eyelid starting from the medial canthus involving the upper lacrimal punctum up to the lateral canthus and superiorly involving the brow area [Figure 1]. Anterior segment examination revealed central, corneal, 4 mm × 3 mm, irregular epithelial defect, and rest of the findings were unremarkable. Visual acuity in the left eye was 6/60 and in right eye was 6/6 by Snellen's chart.
Figure 1: Coloured photograph showing complete loss of upper eyelid with soft tissue loss

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The wound was thoroughly washed with saline and irrigated with 5% betadine solution. Anti-rabies immunoglobulin 20 IU/kg was injected around the wound. Intramuscular anti-rabies vaccination schedule was initiated. Because the wound was secondary to dog bite with extensive tissue loss, the wound was unrepairable with simple suturing. The eye was covered with a plastic shield with homatropine eye drop and chloramphenicol ointment. Tetanus toxoid intramuscular injection was given. Systemic antibiotics such as amoxicillin-clavulanic acid and metronidazole were given. Daily dressing with 5% betadine was done BD, with frequent lubricant eye drop instillation. Slough noted on days 3 and 4 was debrided with the blunt end of a blade and thoroughly irrigated with 5% betadine. Once signs of healing were noted, the patient was posted for multi-step lid transplantation, which included lower lid rotational flap [Figure 2].
Figure 2: Coloured photograph showing lower lid rotational flap for upper lid transplantation

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  Discussion Top

Ocular injuries secondary to dog bite are uncommon.[1],[2] Injuries sustained in the area of ocular adnexa and lids due to blink reflex bear the brunt of dog bite injury.

Since ocular injuries secondary to dog bite are rare, they are more commonly seen in children than adults.[3]

Complete eyelid loss secondary to dog bite injury is extremely rare. Dog bite injury to the ocular area is considered Category 3 injury. Dog bite injuries are almost always contaminated by various microorganisms and cause high risk of local infection[1],[4] as well as rabies. To prevent infection of the wound, it should be cleaned meticulously to remove any foreign body with copious saline and antiseptic solution such as 5% povidone iodine solution[1],[5] (as it is safe for contact with ocular surfaces). Patients should be treated with systemic and local broad-spectrum antibiotics, anti-rabies vaccination, local anti-rabies immunoglobulin, and tetanus toxoid injection.

Function of the upper eyelid is blink reflex, which helps in spreading the tear film, prevents evaporation of tears, and protects the eye from dust/foreign body from entering.[1],[6] When there is complete eye lid loss, all the above-mentioned functions are hampered, which can lead to exposure keratopathy, corneal ulceration, corneal melt, and dry eye disease.[7] Hence, early lid transplantation is important to avoid the above complications.[8] Complete upper eyelid loss carries high risk of complications and poor prognosis.[9]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Kamat P, Doshi P. Eyelid avulsion due to bull horn injury: A rare presentation. Sudan J Ophthalmol. 2015.  Back to cited text no. 1
Aguiar M, S. Usgaonkar U. Open globe injury secondary to a dog bite presenting to a tertiary care hospital. J Clin Ophthalmol Res. 2018.  Back to cited text no. 2
Gent G. Ocular emergencies in the dog and cat: part 2. Companion Anim. 2013;   Back to cited text no. 3
Erickson BP, Feng PW, Liao SD, Modi YS, Ko AC, Lee WW. Dog bite injuries of the eye and ocular adnexa. Orbit (London). 2019.   Back to cited text no. 4
Gra JM, Allen R. Canalicular Laceration - Dog Bite 5-year-old white female presenting with dog bite to le side of face. 2005.   Back to cited text no. 5
E.M. B, L. G, L.A. W, B.W. D, V.D. D. Ophthalmic manifestations of facial dog bites in children. Ophthal Plast Reconstr Surg. 2018.  Back to cited text no. 6
Gent G. Ocular emergencies in the dog and cat: Part 1. Companion Animal. 2013.   Back to cited text no. 7
Shuler CM, DeBess EE, Lapidus JA, Hedberg K. Canine and human factors related to dog bite injuries. J Am Vet Med Assoc. 2008.  Back to cited text no. 8
Bengoa-González Á, Laslâu BM, Martín-Clavijo A, Mencía-Gutiérrez E, Lago-Llinás MD. Reconstruction of Upper Eyelid Defects Secondary to Malignant Tumors with a Newly Modified Cutler-Beard Technique with Tarsoconjunctival Graft. J Ophthalmol. 2019.  Back to cited text no. 9


  [Figure 1], [Figure 2]


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