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Dr.Deepak Choudhury, Dr.NIKITA DASH,Dr. SUBHABRATA PARIDA

ABSTRACT:-

 Aim: To study ocular injuries due to blouse hook in babies during breast feeding. Material & methods: Prospective interventional case series done from Nov 2016 to Oct 2017 included 22 eyes of 22 babies with ocular injuries due to blouse hook. Full thickness eyelid injuries were repaired in 3 layers. Canalicular injury repair was done. Follow up at 1, 4 and 6 weeks was done. Results: Corneal abrasion found in 12 cases (54.6%), subconjuctivalhaemorrhage in 4 (18.2%), full thickness eyelid injury in 9 (40.9%). Out of 9 cases 7 (77.8%)had lowerlid laceration with canalicular injury and 2 (22.2%) had laceration in lateral canthal area. 2 cases repaired with Auro lacrimal canula& 3 were repaired with 24 no. venfloncanula due to unavailability of Mini Monoka stent. In other 2 cases only lid repaired due to late presentation & gross edema. Conclusion: Proper precautions to be taken while breast feeding must be taught to every mother by paediatricians and health workers to avoid injury.

Keyword: Blouse hook injury, canalicular repair, eyelid repair.

INTRODUCTION:-

Injury by the “blouse-hook fastener” is unique to infants in the Indian context.[1]Canalicular laceration is one of the common injury seen in the pediatric age group. Majority of them are caused by maternal blouse hook in breast fed infants. The injury requires prompt surgical correction by an ophthalmologist. Poorly repaired wound or unrepaired wound run the risk of persistent epiphora in these patients. This injury can be prevented to some extent if we can incorporate ocular safety counseling to the mothers along with breast feeding counseling during postpartum period.[2] Aim of this study was to study ocular injuries due to blouse hook in babies during breast feeding and their management.

MATERIAL AND METHODS:-

This study included22 eyes of 22 babies with ocular injuries due to blouse hook. It was a prospective interventional case series study of 1 year duration done from November 2016 to October 2017.

INCLUSION CRITERIA:

All babies suffering from ocular trauma due to blouse hook during breast feeding were considered for this study.

EXCLUSION CRITERIA:

  1. Eyelid injury of babies due to other causes.
  2. Eyelid injury associated with facial injury.

In these patients detailed Ophthalmological investigations carried out. Patients with full thickness eyelid injury were admitted. Rest patients were treated conservatively. All patientswith full thickness lid injury were subjected to routine investigations like blood analysis. Full thickness eyelid injuries were repaired in 3 layers under general anaesthesia using 6-0 vicryl and 5-0 silk sutures. Canalicular injury repair was done whenever possible.Auro lacrimal canula or 24 no. venfloncanula was used for canalicular repair due to unavailability of mini Monoka stent. Follow up examination was done at 1, 4 and 6 weeks.Canula was removed at 6 week following repair.

RESULTS:-

 22 eyes of 22 babies with ocular injuries due to blouse hook were studied. Male patients were 15 in number (68.2%) while females were 7 (31.8%). Youngest was 10 months old and oldest was 3 years. Corneal abrasion found in 12 cases (54.6%), subconjuctivalhaemorrhage in 4 (18.2%), full thickness eyelid injury in 9 (40.9%). Out of 9 cases 7 (77.8%)had lowerlid laceration with canalicular injury and 2 (22.2%) had laceration in lateral canthal area. 2 cases repaired with Auro lacrimal canula& 3 were repaired with 24 no. venfloncanula due to unavailability of Mini Monoka stent. In other 2 cases only lid repaired due to late presentation & gross edema. Out of 5 cases 2 cases (40%) had patent canaliculi at the end of 6 months.

Table no-1:- Ocular injuries due to blouse hook trauma

No. of patients Percentage
Corneal abrasion 12 54.6%
Subconjunctivalhemorrhage 4 18.2%
Lower canalicular injury 7 31.8%
Lateral canthal injury 2 9.1%

DISCUSSION:-

Naik et al in 66 patients with eyelid laceration found 36% cases had involvement of canalicular system. Mode of injury included the blouse-hook fastener in five (20.8%) breast-feeding infants. Lower canaliculus was involved in 13 (54.1%), upper in eight (33.3%), and both in three (12.5%) patients. Twenty-seven canalicular lacerations (24 patients) underwent stenting with the Mini-Monokamonocanalicular stent.[1]In our study 31.8% cases had lowerlid with canalicular injuries.2 cases (28.6%) repaired with Auro lacrimal canula& 3 (42.9%) were repaired with 24 no. venfloncanula due to unavailability of Mini Monoka stent. Gupta et al in a study of 13 children with canalicular tear found injury by mother’s blouse-hooks in breast feeding infants (10 out of 13) a unique cause of canalicular lacerations peculiar to the Indian scenario.[2]

CONCLUSION:-

To avoid injury, proper precautions to be taken while breast feeding must be taught to every mother by paediatricians and health workers. Proper treatment of injuries should be done in babies with ocular injuries.

REFERENCES:- 

  1. Naik M, Kelapure A, Rath S, Honavar S. Management of canalicular lacerations: Epidemiological aspects and experience with mini Monokamonocanalicular stent. American Journal of Ophthalmology. 2008 February; 145(2): 375-380.
  2. Gupta P, Kujur R. Canalicular laceration in Indian children. International Journal of Scientific Research. 2018 August; 7(8):37-38

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