• Users Online: 230
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2022  |  Volume : 34  |  Issue : 3  |  Page : 265-267

A case of eyelid avulsion injury caused by bull horn

Department of Ophthalmology, Goa Medical College, Goa, India

Date of Submission19-Jan-2021
Date of Decision23-Jan-2021
Date of Acceptance29-Jan-2021
Date of Web Publication22-Dec-2022

Correspondence Address:
Dr. Ravina Satish Nachnolkar
Sandeep Apartments, G3 Dr. Dada Vaidya Road, Panaji - 403 001, Goa
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_21_21

Rights and Permissions

An 18-year-old male presented with a history of injury to the right eye with a bull horn. Examination revealed an avulsed flap of the right upper eyelid from medial canthus up to 1 cm above lateral canthus without any other ocular damage. After a thorough examination, the lid flap was sutured in layers. Postoperative antibiotic prophylaxis was given. The postoperative complication was in the form of mechanical ptosis.

Keywords: Avulsion injury, bull horn, eyelid

How to cite this article:
Nachnolkar RS, Naik VD, Usgaonkar UP. A case of eyelid avulsion injury caused by bull horn. Kerala J Ophthalmol 2022;34:265-7

How to cite this URL:
Nachnolkar RS, Naik VD, Usgaonkar UP. A case of eyelid avulsion injury caused by bull horn. Kerala J Ophthalmol [serial online] 2022 [cited 2023 Feb 8];34:265-7. Available from: http://www.kjophthal.com/text.asp?2022/34/3/265/364700

  Introduction Top

Bull or cow horn injuries are common among people dealing with animals and can cause serious injuries by their various appendages, especially horns. Bull horn injuries to the head or face can be in the form of lacerations, fractures, palate injuries, blow out fracture of orbit, and eyeball injuries.[1] The majority of the cow horn injuries studied caused severe permanent impairment of vision. Owing to the blunt nature of the horns, a significant amount of energy is imparted into the eye.[2] The literature search did not reveal many cases of bull horn injury causing only avulsion of the eyelid without affection of any other ocular structures, and hence, we report this interesting case.

  Case Report Top

An 18-year-old patient presented to the casualty of tertiary care center with a 2-h history of being hit by a bull horn in the right eye. There was no history of sudden diminution of vision following trauma.

Examination revealed an avulsed flap of the right upper eyelid extending from medial canthus up to 1 cm above lateral canthus [Figure 1]. The levator palpebrae superioris muscle was unaffected; however, its action could not be demonstrated due to mechanical ptosis as a result of eyelid edema. The rest of the anterior segment appeared normal with best-corrected visual acuity of 6/6 by Snellen's chart. The posterior segment appeared normal by indirect ophthalmoscopy.
Figure 1: Right upper eyelid flap avulsed from medial canthus up to 1 cm above lateral canthus without any other ocular damage

Click here to view

Avulsed eyelid flap was sutured under local anesthesia after thorough wound cleaning with normal saline and 5% povidone-iodine solution. The lid flap was sutured in layers using 6-0 Vicryl suture [Figure 2]. The patient was vaccinated with 0.5 ml tetanus toxoid and was prescribed topical moxifloxacin eye drops 4 times per day and systemic antibiotics-amoxicillin-clavulanic acid 625 mg and T. Metronidazole 400 mg for 1 week. Mechanical ptosis of the right upper eyelid was noticed at the first follow-up visit.
Figure 2: Postoperative image of the right upper eyelid sutured with 6-0 Vicryl suture

Click here to view

  Discussion Top

Bull horn injuries are common accidents in rural India, where people make their living rearing the livestock for domestic and farming purposes. The patterns of injuries sustained by the victim depend on the height of the victim, height of the bull, position of the animal, and victim at the time of the attack.[3]

Most of these injuries due to bull involve the lower extremities, whereas those involving the face and neck are very less.

The injuries produced by bull goring can be classified into blunt wounds, or contusions, and penetrating or open wounds.

To these injuries must be added the fractures that generally result from the charge of the bull. Burns may occur when the bull has flares or torches attached to its horns.[4]

Eyelid avulsion due to bull horn injury as a sole finding is extremely rare. It is usually the result of the blunt tangential impact on the side of the horn that leads to horizontal traction on the eyelid which causes avulsion at a weak point, usually at the medial or lateral canthal tendon. However, sometimes, avulsions starting from other areas can occur.[5]

For full-thickness upper eyelid injuries, never forget to check for globe perforations. Globe injuries should be attended before lid injuries. Eyelid trauma can be associated with hyphema, angle recession, or retinal detachment. Clear watery discharge from one nostril indicates cerebrospinal fluid rhinorrhea and is a red alert sign to look for anterior skull base fractures.

All eyelid tissues should be saved, as high vascularity often allows for viable re-approximation of partially avulsed ocular adnexal tissue.[6] If the canalicular damage is found, repair by stenting should be undertaken before the repair of the avulsed lid flap.[7]

The general management of these patients must include:

  • Preoperative and postoperative antibiotic therapy and tetanus vaccination
  • Wounds must be cleaned exhaustively with saline solution and an antiseptic solution (hydrogen peroxide and/or povidone-iodine) and all foreign bodies (horn splinters, stones, dirt, and remains of clothing, glass, and others) must be removed.[8]

  Conclusion Top

Reconstruction of the eyelid should be done in layers as per correct anatomical orientation. Full-thickness lid margin lacerations, canalicular tears, canthal injuries, and lacerations with tissue loss are entities which should be meticulously tackled using specialized techniques.[6]

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 initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ugboko VI, Olasoji HO, Ajike SO, Amole AO, Ogundipe OT. Facial injuries caused by animals in northern Nigeria. Br J Oral Maxillofac Surg 2002;40:433-7.  Back to cited text no. 1
Goldblum D, Frueh BE, Koerner F. Eye injuries caused by cow horns. Retina 1999;19:314-7.  Back to cited text no. 2
Kulkarni SR, Biradar SB, Nagur BK, Reddy M, Savsaviya JK. Bull horn injuries in rural area: A case series. Int J Sci Stud 2016;3:201-3.  Back to cited text no. 3
Crespo Escudero JL, ArenazBúa J, Luaces Rey R, García-Rozado Á, Rey Biel J, López-Cedrún JL, et al. Maxillofacial injury by bull goring: literature review and case report. Rev Eesp Cir Oral Maxilofac 2008;30:353-62.  Back to cited text no. 4
Kamat P, Doshi P. Eyelid avulsion due to bull horn injury: A rare presentation. Sudanese J Ophthalmol 2015;7:61-3.  Back to cited text no. 5
  [Full text]  
Tomy RM. Management of eyelid lacerations. Kerala J Ophthalmol 2018;30:222-7.  Back to cited text no. 6
  [Full text]  
Smith B, English FP. Techniques available in reconstructive surgery of the eyelid. Br J Ophthalmol 1970;54:450-5.  Back to cited text no. 7
Martínez-Ramos D, Miralles-Tena JM, Escrig-Sos J, Traver-Martínez G, Cisneros-Reig I, Salvador-Sanchís JL. Bull horn wounds in Castellon General Hospital. A study of 387 patients. Cir Esp 2006;80:16-22.  Back to cited text no. 8


  [Figure 1], [Figure 2]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Case Report
Article Figures

 Article Access Statistics
    PDF Downloaded17    
    Comments [Add]    

Recommend this journal