Landscaper Survives After Nail Impaled In His Eye

BOSTON (CBS/AP) – A landscaper survived a horrific accident after a nearly 3-inch nail was impaled in his eye when he accidentally hit it with a weed-whacker.

The incident happened about two years ago, but was just reported this week in the New England Journal of Medicine.

The unidentified 27-year-old landscaper was cutting weeds using a power string trimmer when it hit a nail and it became lodged in his right eye.

'EXCRUCIATING' PAIN

"He had immediate and persistent severe pain in the eye, which became excruciating with attempts to open the eye or move it," doctors at Massachusetts General Hospital wrote in their presentation of the case.

The man did not lose consciousness and there was slight bleeding.

He was rushed to the emergency department at MGH.

"When you looked at him, all you saw was the back end of the nail" in his right eye, said Dr. Wael Asaad, a neurosurgeon now at Rhode Island Hospital and Brown University.

Doctors couldn't tell how long the nail was or its path, so radiologist Dr. Rajiv Gupta used a new type of CT scanner to get detailed images.

"It reached almost to the tip of the other eye and the brain. It was a very long nail," he said.

The good news: It had not penetrated the globe of the eye, but was to one side.

The bad news: It was lodged against one of the main arteries supplying blood to the head, and another artery serving the other eye.

'LIKE THE FINGER IN A DAM'

"The tip of the nail was like the finger in the dam. We were worried that if we pulled it out, there would be bleeding" — a jet of blood that could damage the other eye or the brain, or even prove fatal, Asaad said.

So they made an elaborate plan in case an artery ruptured and had to be repaired: One surgeon was ready to operate through the head. A second surgeon was ready to operate through the neck. As these two stood by, a third surgeon carefully pulled out the nail.

They waited several minutes. No major bleeding occurred. They stopped sedating him and the patient was allowed to wake. After a tetanus shot and a prescription for five days of preventive antibiotics, he was on his way.

1 MM FROM MAJOR DAMAGE

A checkup eight weeks later showed his vision had returned to normal. Had the nail struck 1 millimeter away, he likely would have had major damage, doctors said.

As dramatic as it was, "nails penetrating the skull are not as uncommon as you would think," usually from nail gun accidents, Asaad said.

Gupta said the lesson is clear: "Wear eye protection whenever operating heavy machinery" or power tools, even simple ones used in gardening.

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In:
• New England Journal of Medicine